The Role of Hypnosis in Cancer Care
Purpose of Review
This paper reviews the current evidence-base for the use of hypnosis as an adjunct treatment for common cancer-related symptoms and side effects, including those experienced during treatment, as well as long-term and late effects. First, a general description and history of medical hypnosis in cancer care is provided, followed by a review of the latest evidence across a range of common symptoms.
The evidence suggests that hypnosis may help treat symptoms of nausea and vomiting in breast cancer patients, manage pain in a variety of contexts, and also reduce levels of anxiety and overall distress around surgical and medical procedures, both in children and adults. Emerging research shows promise for treating hot flashes in women with breast cancer.
The research in this area would benefit from assessing populations beyond women with breast cancer, including late-stage disease, using more rigorous study designs, following published reporting guidelines and better describing and standardizing interventions.
KeywordsHypnosis Cancer Breast cancer Nausea Vomiting Pain Anxiety Depression Quality of life Hot flashes Mind-body therapies Integrative oncology
Dr. Carlson holds the Enbridge Research Chair in Psychosocial Oncology, co-funded by the Canadian Cancer Society Alberta/NWT Division and the Alberta Cancer Foundation, and a Canadian Institutes of Health Research (CIHR) Strategy for Patient-Oriented Research (SPOR) Innovative Clinical Trials Mentorship Chair which funds the TRACTION (Training in Research and Clinical Trials in Integrative Oncology) program. Dr. Subnis is supported by the Enbridge Research Chair in Psychosocial Oncology. Dr. Subnis, Kirsti Toivonen, Michelle Flynn, and Julie Deelmans are supported in part by the CIHR SPOR TRACTION program. Kirsti Toivonen receives funding from a Canadian Institutes of Health Research Doctoral Award and an Izaak Walton Killam Pre-Doctoral Scholarship. Michelle Flynn receives funding from a Canadian Institutes of Health Research Masters Award.
Compliance with Ethical Standards
Conflict of Interest
Linda E. Carlson, Kirsti Toivonen, Michelle Flynn, Julie Deleemans, Katherine-Anne Piedalue, Emma Tolsdorf, and Utkarsh Subnis declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.• Hammond DC. A review of the history of hypnosis through the late 19th century. Am J Clin Hypn. 2013;56:174–91. https://doi.org/10.1080/00029157.2013.826172 Provides a thorough chronological overview of the history of hypnosis, from earliest recorded uses worldwide, to applications in medicine and psychiatry in Europe and America. Includes detailed contributions of several prominent figures in the history of hypnosis.CrossRefPubMedGoogle Scholar
- 3.APA Div. 30: Society of Psychological Hypnosis. About the Society of Psychological Hypnosis. At: http://www.apadivisions.org/division-30/about/index.aspx. 2018. Accessed July 28, 2108.
- 5.• Montgomery GH, Schnur JB, Kravits K. Hypnosis for cancer care: over 200 years young. CA Cancer J Clin. 2012;63:31–44. https://doi.org/10.3322/caac.21165 Provides a detailed overview of the applications of hypnosis to various aspects of cancer care, including cancer-prevention behaviours, diagnostic procedures, cancer treatment, and cancer survivorship. CrossRefPubMedPubMedCentralGoogle Scholar
- 6.• Jensen MP, Adachi T, Tomé-Pires C, Lee J, Osman ZJ, Miró J. Mechanisms of hypnosis: toward the development of a biopsychosocial model. Int J Clin Exp Hypn. 2015;63:34–75. https://doi.org/10.1080/00207144.2014.961875 Provides a thorough review of the evidence of all biological, psychological, and social factors studied in relation to hypnosis; provides rationale for a preliminary biopsychosocial conceptualization of hypnosis.CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Sliwinski J, Fisher W, Johnson A, Elkins G. Medical hypnosis for pain and psychological distress during burn wound debridement: a critical review. OA Altern Med. 2013;1:5.Google Scholar
- 15.Canadian Cancer Society. Hypnosis (in Cancer Care). At: http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/complementary-therapies/hypnosis/?region=on. 2018. Accessed July 28, 2018.
- 16.van Overbruggen R. Hypnosis—American Cancer Society. At: https://helpforhealth.com/hypnose-coaching-2/hypnosis-american-cancer-society/. 2013. Accessed July 25, 2018.
- 19.Enqvist B, Björklund C, Engman M, Jakobsson J. Preoperative hypnosis reduces postoperative vomiting after surgery of the breasts. Acta Anaesthesiol Scand. 1997;41:1028–32. https://doi.org/10.1111/j.1399-6576.1997.tb04831.x.CrossRefPubMedGoogle Scholar
- 22.• Cramer H, Lauche R, Paul A, Langhorst J, Kümmel S, Dobos GJ. Hypnosis in breast cancer care: a systematic review of randomized controlled trials. Integr Cancer Ther. 2015;14:5–15. https://doi.org/10.1177/1534735414550035 This review is important as it systematically evaluated all published studies in the area up to the year 2014 across a range of outcomes, using standardized methods of comparison. CrossRefPubMedGoogle Scholar
- 24.Montgomery GH, Hallquist MN, Schnur JB, David D, Silverstein JH, Bovbjerg DH. Mediators of a brief hypnosis intervention to control side effects in breast surgery patients: response expectancies and emotional distress. J Consult Clin Psychol. 2010;78:80–8. https://doi.org/10.1037/a0017392.CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Roila F, Molassiotis A, Herrstedt J, Aapro M, Gralla RJ, Bruera E, Clark-Snow RA, Dupuis LL, Einhorn LH, Feyer P, Hesketh PJ, Jordan K, Olver I, Rapoport BL, Roscoe J, Ruhlmann JH, Walsh D, Warr D, van der Wetering M. MASCC and ESMO Consensus Guidelines for the Prevention of Chemotherapy and Radiotherapy-Induced Nausea and Vomiting: ESMO Clinical Practice Guidelines. Ann Oncol. 2016; 27 Suppl 5:v119–v133.Google Scholar
- 31.van den Beuken-van Everdingen MH, Marieke HJ, Hochstenbach LMJ, Joosten EAJ, Tjan-Heijnen VCG, Janssen DJA. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manag. 2016;51:1090.e9. https://doi.org/10.1016/j.jpainsymman.2015.12.340.CrossRefGoogle Scholar
- 33.Jibb LA, Nathan PC, Stevens BJ, Seto E, Cafazzo JA, Stephens N, et al. Psychological and physical interventions for the management of cancer-related pain in pediatric and young adult patients: an integrative review. Oncol Nurs Forum. 2015;42:339–E357. https://doi.org/10.1188/15.onf.e339-e357.CrossRefGoogle Scholar
- 40.•• Wortzel J, Spiegel D. Hypnosis in cancer care. Am J Clin Hypn. 2017;60:4–17. https://doi.org/10.1080/00029157.2017.1290577 In this recent review article by leading researchers in the field of psycho-oncology, the current neurobiology of hypnotizability and hypnosis is reviewed, along with the methods and results of hypnosis interventions for pain control in acute and chronic settings. Furthermore, the areas of the brain affected by hypnosis-based interventions for pain-management are described, which provides the neuroanatomy and physiology of hypnotic analgesia. CrossRefPubMedGoogle Scholar
- 41.• Mendoza ME, Capafons A, Gralow JR, Syrjala KL, Suárez-Rodríguez JM, Fann JR, et al. Randomized controlled trial of the valencia model of waking hypnosis plus CBT for pain, fatigue, and sleep management in patients with cancer and cancer survivors. Psycho-Oncology. 2017;26:1832–8. https://doi.org/10.1002/pon.4232 This study used rigorous methodology, i.e. blinded randomized controlled trial, to determine the effects of a hypnosis technique combined with CBT for managing the symptoms of pain, fatigue, and sleep problems in a mixed sample of cancer patients taking treatments and cancer survivors post-treatment. The results showed the beneficial effects of hypnosis relative to an educational intervention controlling for the effects of time, therapist attention, and participation in a clinical trial, with benefits that were maintained for at least 3 months’ post-intervention, and without any adverse effects. CrossRefPubMedGoogle Scholar
- 47.Michael N, Dominic M, Tamsin F, Morwenna R, Christine C, Stuart L, et al. Effectiveness of nonpharmacological interventions to reduce procedural anxiety in children and adolescents undergoing treatment for cancer: a systematic review and meta-analysis. Psycho-Oncology. 2018;Prepublished Online:1–11;27:1889–99. https://doi.org/10.1002/pon.4749.CrossRefGoogle Scholar
- 48.•• Pei-Ying C, Ying-Mei L, Mei-Ling C. The effect of hypnosis on anxiety in patients with cancer: a meta-analysis. Worldviews Evid-Based Nurs. 2017;14:223–36. https://doi.org/10.1111/wvn.12215 This is a comprehensive meta-analysis evaluating studies that have used hypnosis to treat anxiety among both pediatric and adult cancer patients. They have thoroughly synthesized and evaluated recent literature regarding the topic. CrossRefGoogle Scholar
- 51.Landier W, Tse AM. Use of complementary and alternative medical interventions for the management of procedure-related pain, anxiety, and distress in pediatric oncology: an integrative review. J Pediatr Nurs. 2010;25:566–79. https://doi.org/10.1016/j.pedn.2010.01.009.CrossRefPubMedPubMedCentralGoogle Scholar
- 52.• Bragard I, Etienne A, Faymonville M, Coucke P, Lifrange E, Schroeder H, et al. A nonrandomized comparison study of self-hypnosis, yoga, and cognitive-behavioral therapy to reduce emotional distress in breast cancer patients. Int J Clin Exp Hypn. 2017;65:189–209. https://doi.org/10.1080/00207144.2017.1276363 This study conducted a comparison study of self-hypnosis to yoga and CBT, examining effects on distress and patient well-being. It is noteworthy for comparing three active interventions in a pragmatic design, but suffers from lack of randomization and unequal group sizes. CrossRefPubMedGoogle Scholar
- 54.Grégoire C, Bragard I, Jerusalem G, Etienne A, Coucke P, Dupuis G, et al. Group interventions to reduce emotional distress and fatigue in breast cancer patients: a 9-month follow-up pragmatic trial. Br J Cancer. 2017;117:1442–9. https://doi.org/10.1038/bjc.2017.326.CrossRefPubMedPubMedCentralGoogle Scholar
- 55.•• Grégoire C, Nicolas H, Bragard I, Delevallez F, Merckaert I, Razavi D, et al. Efficacy of a hypnosis-based intervention to improve well-being during cancer: a comparison between prostate and breast cancer patients. BMC Cancer. 2018;18:677. https://doi.org/10.1186/s12885-018-4607-z This study demonstrates the importance of 1) standardizing interventions so comparisons can be made across groups (and, beyond this publication, across studies) and 2) testing interventions in multiple groups of patients as there may be heterogeneity in patients’ responses. CrossRefPubMedPubMedCentralGoogle Scholar
- 59.MacLaughlan David S, Salzillo S, Bowe P, Scuncio S, Malit B, Raker C, et al. Randomised controlled trial comparing hypnotherapy versus gabapentin for the treatment of hot flashes in breast cancer survivors: a pilot study. BMJ Open. 2013;3:e003138. https://doi.org/10.1136/bmjopen-2013-003138.CrossRefPubMedPubMedCentralGoogle Scholar
- 65.Montgomery GH, David D, Kangas M, Green S, Sucala M, Bovbjerg DH, et al. Randomized controlled trial of a cognitive-behavioral therapy plus hypnosis intervention to control fatigue in patients undergoing radiotherapy for breast cancer. J Clin Oncol. 2014;32:557–63. https://doi.org/10.1200/JCO.2013.49.3437.CrossRefPubMedPubMedCentralGoogle Scholar