Mastectomy with Sentinel Lymph Node Biopsy and Prosthetic Breast Reconstruction under Hypnosis Analgesia: A Multistep Approach (original) (raw)
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The advantages of hypnosis intervention on breast cancer surgery and adjuvant therapy
The Breast, 2018
Background: In oncology, hypnosis has been used for pain relief in metastatic patients but rarely for induction of anesthesia. Material and method: Between January 2010 and October 2015, 300 patients from our Breast Clinic (Cliniques universitaires Saint-Luc, Universit e catholique de Louvain) were included in an observational, non-randomized study approved by our local ethics committee (ClinicalTrials.gov e NCT03003611). The hypothesis of our study was that hypnosis intervention could decrease side effects of breast surgery. 150 consecutive patients underwent breast surgery while on general anesthesia (group I), and 150 consecutive patients underwent the same surgical procedures while on hypnosis sedation (group II). After surgery, in each group, 32 patients received chemotherapy, radiotherapy was administered to 123 patients, and 115 patients received endocrine therapy. Results: Duration of hospitalization was statistically significantly reduced in group II versus group I: 3 versus 4.1 days (p ¼ 0.0000057) for all surgical procedures. The number of post-mastectomy lymph punctures was reduced in group II (1e3, median value n ¼ 1.5) versus group I (2e5, median value n ¼ 3.1) (p ¼ 0.01), as was the quantity of lymph removed (103 ml versus 462.7 ml) (p ¼ 0.0297) in the group of mastectomies. Anxiety scale was also statistically reduced in the postoperative period among the group of patients undergoing surgery while on hypnosis sedation (p ¼ 0.0000000000000002). The incidence of asthenia during chemotherapy was statistically decreased (p ¼ 0.01) in group II. In this group, there was a statistically non-significant trend towards a decrease in the incidence of nausea/ vomiting (p ¼ 0.1), and the frequency of radiodermitis (p ¼ 0.002) and post-radiotherapy asthenia (p ¼ 0.000000881) was also reduced. Finally, the incidence of hot flashes (p ¼ 0.0000000000021), joint and muscle pain (p ¼ 0.0000000000021) and asthenia while on endocrine therapy (p ¼ 0.000000022) were statistically significantly decreased in group II. Discussion: Hypnosis sedation exerts beneficial effects on nearly all modalities of breast cancer treatment. Conclusion: Benefits of hypnosis sedation on breast cancer treatment are very encouraging and further promote the concept of integrative oncology.
Anesthesiology Research and Practice, 2016
The aim of this review is to summarize data published on the use of perioperative hypnosis in patients undergoing breast cancer surgery (BCS). Indeed, the majority of BCS patients experience stress, anxiety, nausea, vomiting, and pain. Correct management of the perioperative period and surgical removal of the primary tumor are clearly essential but can affect patients on different levels and hence have a negative impact on oncological outcomes. This review examines the effect of clinical hypnosis performed during the perioperative period. Thanks to its specific properties and techniques allowing it to be used as complementary treatment preoperatively, hypnosis has an impact most notably on distress and postoperative pain. During surgery, hypnosis may be applied to limit immunosuppression, while, in the postoperative period, it can reduce pain, anxiety, and fatigue and improve wound healing. Moreover, hypnosis is inexpensive, an important consideration given current financial concern...
Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients
International Journal of Clinical and Experimental Hypnosis, 2002
Each year, hundreds of thousands of women undergo excisional breast biopsies for definitive diagnosis. Not only do these patients experience pain associated with the procedure, but they also endure distress associated with the threat of cancer. Hypnosis has been demonstrated as effective for controlling patients' pain in other surgical settings, but breast surgery patients have received little attention. To determine the impact of brief presurgical hypnosis on these patients' postsurgery pain and distress and to explore possible mediating mechanisms of these effects, 20 excisional breast biopsy patients were randomly assigned to a hypnosis or control group (standard care). Hypnosis reduced postsurgery pain and distress. Initial evidence suggested that the effects of hypnosis were mediated by presurgery expectations. The adverse consequences of breast surgery (e.g., pain, distress) are experienced not only by the more than 150,000 women who undergo lumpectomy and mastectomy for breast cancer each year but also by the hundreds of thousands more women who undergo excisional breast biopsies for definitive diagnosis (Landis, Murray, Bolden, & Wingo, 1999; National Cancer Institute, 1999). From the surgical perspective, there is little difference between excisional biopsy and lumpectomy outside the need to take a greater surgical margin with the latter (DeVita, Hellman, & Rosenberg, 1997). Thus, finding interventions to reduce aversive sequella of surgery for these patients is of considerable interest. Chief among the acute aversive side effects of breast surgery are patients' pain and distress. Pain is a nearly ubiquitous side effect of all surgery (Loeser & Melzack, 1999), and women undergoing breast surgery are certainly no exception (Carpenter et al., 1998). In addition to the Manuscript submitted November 14,2000; final revision received March 19,2001 'TIUS research was supported in part by a research grant from the National Cancer Institute (R03CA86562-01). 'We would like to thank the Post Anesthesia Care Unit staff and the ambulatory care staff for their strong support in conducting the study.
Contemporary Hypnosis, 2006
Despite conclusive evidence for the efficacy of clinical hypnosis in the management of many cancer related symptoms and particularly acute and chronic pain, hypnosis is currently under-utilized in these applications. This paper gives a brief overview of the contemporary uses of hypnosis in paediatric and adult oncology and shows how hypnosis can be integrated into a total therapeutic process based on the needs and goals of the patient and the health care team treating them. The first section describes studies that have evaluated hypnosis in adult oncology. The second half consists of a review of the hypnosis literature in paediatric oncology. The paper concludes with suggestions for future research, and implications for clinical practice, which at the moment lags behind.
Journal of Pain Research, 2023
Clinical hypnosis is an effective strategy for managing acute pain in the surgical setting. However, the opioid sparing effects of clinical hypnosis are not as well understood. This pre-registered (NCT03730350) randomized, controlled trial (RCT) examined the impact of clinical hypnosis, pre-and post-surgery, on opioid consumption during hospitalization as well as on measures of pain intensity, pain interference, depressed mood, anxiety, sleep, and pain catastrophizing. Participants (M = 57.6 years; SD = 10.9) awaiting oncologic surgery were randomized to treatment-as-usual (n = 47) or hypnosis (n = 45). Intent-to-treat analyses were conducted using linear mixed effects modeling. A significant Group × Time interaction, F(6, 323.34) = 3.32, p = 0.003, indicated an opioid sparing effect of clinical hypnosis during the acute postoperative period. Hypnosis also protected against increases in pain catastrophizing at one-week after surgery, F (1, 75.26) = 4.04, p = 0.048. A perioperative clinical hypnosis intervention had a sparing effect on opioid consumption in-hospital after major oncologic surgery. These findings extend the efficacy of clinical hypnosis as an adjunct tool for perioperative pain management.
Journal of Consulting and Clinical Psychology, 2010
Hypnosis is widely recognized as an empirically supported intervention to improve postsurgical outcomes. However, to date, no research has examined mediators of hypnotic benefit among surgery patients. The present study was designed to test the hypotheses that response expectancies and emotional distress would mediate the effects of an empirically validated presurgical hypnosis intervention on postsurgical side effects (i.e., pain, nausea, and fatigue). In a sample of 200 women undergoing breast conserving surgery (mean age = 48.50 years), structural equation modeling revealed the following: 1) hypnotic effects on postsurgical pain were partially mediated by pain expectancy (p< .0001), but not by distress (p=.12); 2) hypnotic effects on postsurgical nausea were partially mediated by presurgical distress (p=.02), but not by nausea expectancy (p=.10); 3) hypnotic effects on postsurgical fatigue were partially mediated by both fatigue expectancy (p=.0001) and presurgical distress (p=.02). These results improve understanding of the underlying mechanisms responsible for hypnotic phenomena in the surgical setting, and suggest that future hypnotic interventions target patient expectancies and distress to improve postsurgical recovery.
Clinical Hypnosis in Medical Care: A Mixed-Method Feasibility Study
Integrative Cancer Therapies, 2021
Background Preoperative hypnosis has shown promising effects in controlling side effects from breast cancer surgery, but the feasibility and effects are largely unknown outside the US. Methods A mixed-methods approach was applied involving a large-scale population survey and a small-scale pilot study. The survey assessed attitudes toward hypnosis in a representative sample from the general population (n = 1049), while the pilot study involved interviews with 5 women who received hypnosis prior to mastectomy/lumpectomy. Results In the survey, 8% reported to have previous experience with hypnosis, and 67% reported willingness to accept hypnosis in a medical setting. Increasing age was associated with more skepticism, while previous experience was associated with less skepticism. In the pilot study, 4 themes were identified: (1) caretaking, (2) experiences related to hypnosis, (3) thoughts and feelings related to diagnosis, and (4) surgery. All participants reported positive experience...