Hypnosis for Anticipatory CINV

Hypnosis for Anticipatory CINV

PEP Topic 
Chemotherapy-Induced Nausea and Vomiting
Description 

Hypnosis is a state between wakefulness and sleep, a state of heightened focal concentration and receptivity, an altered state of consciousness of a state of focused attention that results in suspension of peripheral cues. The effect of a hypnotic state results in alteration in perception and attention. Hypnosis has been tested for effect in pain, anxiety, depression, chemotherapy-induced nausea and vomiting (CINV), hot flashes, and fatigue in patients with cancer. Hypnosis has been delivered in various formats, including individual inperson sessions and use of a CD program for induction and training in self-hypnosis. Hypnosis has differing effectiveness according to the synthesis of evidence for CINV when used for anticipatory CINV versus for treatment of actual CINV.

Likely to Be Effective

Systematic Review/Meta-Analysis

Luebbert, K., Dahme, B., & Hasenbring, M. (2001). The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: A meta-analytical review. Psycho-Oncology, 10, 490-502.

doi: 10.1002/pon.537
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Search Strategy:

Databases searched were MEDLINE, PsycINFO, PSYNDEX, and CANCERLIT (1980-Dec., 1995).

Search keywords were relaxation techniques, progressive muscle relaxation (PMR), autogenic training, hypnosis, imagination, and guided imagery in combination with neoplasms, cancer treatment, chemotherapy, radiotherapy, drug therapy, and bone marrow transplantation.

Literature Evaluated:

A total of 280 abstracts were found, 58 studies were relevant, and 15 met the inclusion criteria for meta-analysis. Moderator variables included intensity, schedule, and focus of intervention.

Sample Characteristics:

A total of 742 primarily female subjects with variable malignancies receiving highly emetogenic chemotherapy and trained in progressive muscle relaxation (PMR) were part of this review.

Results:

Consistent positive results in meta-analysis studies showed clinically significant reductions in nausea and other symptoms. Relaxation during the courses of treatment made the experience less stressful, reducing side effects. Studies supported the implementation of relaxation training into clinical routines as standard adjunctive treatment.

Redd, W.H., Montgomery, G.H., & DuHamel, K.N. (2001). Behavioral intervention for cancer treatment side effects. Journal of the National Cancer Institute, 93, 810-823.

doi: 10.1093/jnci/93.11.810
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Search Strategy:

  • Databases searched were National Library of Medicine PubMed database, which includes MEDLINE, PreMedline, and other related databases (1979-January, 2000).
  • Search keywords were cancer and behavior, intervention, nausea, vomit, depression, anxiety, fatigue, neuro, cognitive, menopause, sex, and post-traumatic stress disorder.
  • Studies were included if they were randomized controlled studies, within-subject studies, or case reports.

Literature Evaluated:

  • The review consisted of 54 studies that met the criteria.
  • Three symptom clusters were evaluated. The review included published reports for nausea and vomiting, anxiety/stress, and pain.
  • For the nausea and vomiting review, studies must have addressed
    • Cancer-related treatment side effect with behavioral intervention
    • Cancer-treatment intervention effects.

Results:

  • The following treatments were evaluated: relaxation, hypnosis, cognitive/attentional distraction, desensitization, and rehearsal modeling.
  • Four studies for relaxation and hypnosis showed effectiveness of behavioral intervention for control of anticipatory nausea and vomiting (no anticipatory vomiting occurred).
  • Results from the individual analyses were confirmed in 12 of 13 randomized-controlled trials that compared behavioral interventions with no treatment/attention control conditions.
  • The impact of behavioral intervention on postchemotherapy side effects was less established, with four studies reporting that the behavioral intervention reduced the intensity of the postchemotherapy side effects but did not prevent their occurrence.

Silva, D.R.F., dos Reis, P.E.D., Gomes, I.P., Funghetto, S.S., & Ponce de Leon, C.G.R.M. (2009). Non pharmacological interventions for chemotherapy induced nausea and vomits: Integrative review. Online Brazilian Journal of Nursing, 8(1).

doi: 10.5935/1676-4285.20092098
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Purpose:

 To identify the evidence in scientific literature related to nonpharmacologic interventions for the treatment of chemotherapy-induced nausea and vomiting (CINV)

Search Strategy:

Databases searched were Cochrane, PubMed, Latin American and Caribbean Health Sciences Literature (LILACSO), and Brazilian Nursing Database (BDENF).

Search keywords were nausea, vomiting, chemotherapy, nursing care, cursing care protocols for cancer chemotherapy, and chemotherapy induced nausea and vomiting.

Studies were included in the review if they

  • Addressed nonpharmacological interventions for nausea and vomiting.
  • Were completed within the past 10 years (1998–2008).
  • Were conducted in English or Spanish.

Literature Evaluated:

  • An initial set of 111 articles were identified. Of these, 102 were related to pharmacological management and were eliminated. A final sample of nine studies was included in the review.
  • The authors developed an instrument to analyze the literature related to method, journal type, and author.
  • The articles were published in English (78%), Portuguese (11%), and Spanish (11%).
  • The majority of the articles (67%) were written by physicians in collaboration with psychologists and pharmacists.

Sample Characteristics:

  • Across the nine studies, a total sample of 1,635 patients were studied.
  • The majority of studies involved the use acupuncture, acupressure, or electroacupuncture (5 trials and 1 meta-analysis).
  • Studies involved patients receiving highly emetogenic chemotherapy or those with refractory CINV.

Results:

  • One of the studies involved patient dietary education and adherence to antiemetic therapy in which patients reported a better sense of security with the provision of written information.
  • One study, which had 16 participants, found hypnosis to be effective in reducing anticipatory CINV.
  • One randomized, controlled trial of 62 patients using a yoga program showed no decrease in frequency or intensity of CINV with the intervention.
  • Findings among studies of acupuncture and acupressure had mixed results, with most showing no significant difference in symptoms with the intervention.
  • The meta-analysis showed a reduction in the proportion of patients with acute vomiting but not in the severity of nausea.
  • Electrical stimulation did not improve results.

Conclusions:

This review demonstrated no substantial effects among the interventions included. Findings regarding the use of acupuncture, acupressure, and electroacupuncture were mixed. Most studies using acupuncture and acupressure involved use of the p6 point on the wrist.

Limitations:

This review included a limited number of studies.

Nursing Implications:

The evidence does not demonstrate significant effect of these interventions for CINV. However, these interventions may be useful as adjuncts to pharmacologic treatment. Nonpharmacologic interventions appear to be most effective in the prevention of acute vomiting rather than symptoms of nausea.

Research Evidence Summaries

Marchioro, G., Azzarello, G., Viviani, F., Barbato, F., Pavanetto, M., Rosetti, F., … Vinante, O. (2000). Hypnosis in the treatment of anticipatory nausea and vomiting in patients receiving cancer chemotherapy. Oncology, 59, 100–104.

doi: 10.1159%2F000012144
Print

Study Purpose:

To evaluate the use of hypnosis in the management of anticipatory nausea and vomiting

Intervention Characteristics/Basic Study Process:

Patients received two hours of training in progressive relaxation, followed by a one-hour hypnosis program. No drugs were given in association with the hypnotherapy. After the intervention, patients immediately went to their scheduled chemotherapy.

Sample Characteristics:

  • The study consisted of 16 adults with anticipatory nausea and vomiting from at least four previous courses of chemotherapy.
  • The majority of the sample was female (n = 14).
  • Median age was 44 years.
  • Patients did not have metastatic disease to the brain or gastrointestinal (GI) tract.
  • Cancer types included were ovarian, Hodgkin, testicular, lung, and breast.
  • Chemotherapy received included cisplatin, carboplatin, cyclophosphamide, dacarbazine, doxorubicin, and epirubicin.
  • All patients had to have previously undergone four cycles of 5-HT3 and developed nausea and vomiting.
  • The sample was a convenience sample.

Setting:

All patients were from an outpatient setting.

Measurement Instruments/Methods:

A Visual Analog Scale (VAS) was used to measure complete response (CR) (mild nausea with no vomiting), major response (moderate to severe nausea and one vomiting episode), or no response (none of the above).

Results:

In all of the 16 patients in the study, anticipatory nausea and vomiting disappeared. Major responses (moderate to severe nausea, with one vomiting episode) to chemotherapy-induced emesis control occurred in 14 of the 16 patients.

Limitations:

  • The study included a very small population.
  • No interrater reliability was reported.
  • No control group was used.
  • Patients with brain metastasis or cognitive disabilities were excluded.

Nursing Implications:

Caution should be used regarding patient selection; some patients should not be hypnotized.


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