Treating Chemotherapy related Nausea and Vomiting with Hypnosis

Chemotherapy induced nausea and vomiting or CINV is said to be a significant problem reported by cancer patients receiving the treatment (Koeller et al. 2002). Seventy to eighty percent of cancer patients who receive chemotherapy show levels of nausea and vomiting. Treatment in recent years via pharmacological management means has improved with significant decreases in those that show signs of CINV. However still, many do not respond positively to pharmacological treatment that involves anti-emetic therapies with many reporting severe side effects. Furthermore, many patients report nausea and vomiting even prior to chemotherapy treatment and this is said to be due in part to perceived outcomes and the societal known side effects of chemotherapy treatment. Many studies have looked at alternative means to help alleviate CINV in cancer patients. One such means that has been looked at extensively is hypnosis.

Hypnosis being an approach where a therapist suggests to a patient changes in perception, sensation, behaviour and thought (Kirsch et al. 1995). Initially the therapist will ‘induct’ the patient into hypnosis, a technique that relaxes the patient and induces a state of suggestibility. One variable that is seen to influence hypnosis related outcomes is the level of suggestibility in the patient.

Furthermore a number of literature reviews and meta analyses have looked at the effectiveness overall of hypnosis. Kirsch et al. (1995) found that in 18 studies that reviewed the effectiveness of hypnosis as an adjunct to CBT or cognitive behavioral therapy in treatment of obesity, smoking, and anxiety found that hypnosis significantly improved successful treatment outcome levels.

Many studies have shown that hypnosis can be significantly effective in alleviating some of the problems involved with cancer treatment. A good example of this is Stalpers et al. (2005) which showed that with hypnosis, cancer patients on the receiving end of radiotherapy showed a significant improvement in overall well being and mental states post treatment.

The aim of the study being reviewed was to research the systematic effectiveness of hypnosis treatment for the alleviation of vomiting and nausea in cancer chemotherapy treatment (Richardson et al., 2007). The study found six randomly controlled trials met the inclusion criteria. (Zeltzer et al., 1984, 1991; Cotanch et al., 1985; Syrjala 1992; Jacknow et al., 1994; Hawkins et al., 1995). Five of these studies involved children.

The meta-anaylsis of the six studies found that hypnosis was a valuable intervention and significantly reduced anticipatory nausea and vomiting as well as CINV in the studies. More studies have to be done to further show the efficacy of hypnosis in this regard. Furthermore, the studies reviewed had small sample sizes. Future studies show include great participatory numbers.

References

Cotanch P., Hockenberry M. & Herman S. (1985) Self-hypnosis as antiemetic therapy in children receiving chemotherapy. Oncology Nursing Forum 12, 41–46.

Jacknow J.S., Tschann J.M., Link M.P. & Boyce W.T. (1994) Hypnosis in the prevention of chemotherapy-related nausea and RICHARDSON et al.vomiting in children: a prospective Study. Developmental and Behavioural Pediatrics 15, 258–264.

Koeller J., Aapro M., Gralla R., Grunberg S., Hesketh P., Kris M. & Clark-Snow R. (2002) Antiemetic guidelines: creating a more practical treatment approach. Supportive Care in Cancer 10, 519–522.

Kirsch I., Montgomery G. & Sapirstein G. (1995) Hypnosis as an adjunct to cognitive-behavioural psychotherapy: a meta analysis. Journal of Consulting and Clinical Psychology 63, 214– 220.

Richardson J., Smith J.E., McCall G., Richardson A., Pilkington K. & Kirsch I. (2007) Hypnosis for nausea and vomiting in cancer chemotherapy: a systematic review of the research evidence. European Journal of Cancer Care 16, 402–412

Stalpers L.J.A., da Costa H.C., Merbis M.A.E., Fotuin A.A., Muller M.J. & Van Dam F.S.A.M. (2005) Hypnotherapy in radiotherapy patients: a randomized trial. International Journal of Radiation Oncology 61, 499–506.

Syrjala K. (1992) Hypnosis or cognitive behavioural training for the reduction of pain and nausea and vomiting during cancer treatment: a controlled clinical trial. Pain 48, 137–146. Syrjala L.K., Donaldson G.W., Davis M.W., Kippes M.E. &

Zeltzer L.K., LeBaron S. & Zeltzer M. (1984) The effectiveness of behavioural intervention for reduction of nausea and vomiting in children and adolescents receiving chemotherapy. Journal of Clinical Oncology 2, 683–690.

Zeltzer L.K., Dolgin M.J., LeBaron S. & LeBaron C. (1991) A randomised controlled study of behavioural intervention for chemotherapy distress in children with cancer. Pediatrics 88, 34–42.

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