July, 2006

Scope of the Problem of Chemotherapy Side Effects
Approximately 1,399,790 Americans are expected to be diagnosed with cancer in 2006 (American Cancer Society, 2006), and about half will receive chemotherapy as part of their treatment regimen. As many as 25% of chemotherapy patients experience anticipatory nausea (Redd, Rosenberg, and Hendler, 1982-83).

Vomiting, nausea, fatigue, and depression are common after having chemotherapy. Painful side effects (e.g., mouth sores) can also occur. Severe side effects like fatigue and anemia can lead to loss of time at work for the patient and/or the caregiver, additional office visits, and failure to complete chemotherapy treatment -- all of which contribute to morbidity and mortality, and to the total in 2005 of $209.9 billion direct and indirect costs of cancer (American Cancer Society).

Research in Mind/Body Interventions for Chemotherapy
Cognitive behavioral intervention successfully lessened the symptoms of chemotherapy, especially among those with severe symptoms (Given C, Given B, et al, 2004). Some people undergoing chemotherapy become nauseated prior to a chemotherapy treatment. This is called “anticipatory nausea.”

Hypnosis has been successful in reducing or eliminating anticipatory and post-treatment nausea in both adults and children (Jacknow, Tschann, et al, 1994; Marchioro, Azzaarello et al, 2000; Morrow and Morrell,1982; Mundy, DuHamel & Montgomery, 1993). Relaxation training is also effective in reducing anticipatory nausea (Vasterling, Jenkins et al, 1993).

The authors of one meta-analysis concluded that relaxation training was so effective at helping emotional adjustment, tension, mood, and anxiety that “relaxation training should be implemented into clinical routine for cancer patients in acute medical treatment” (Leubbert, Dahme & Hasenbring, 2001).

Imagery’s effectiveness as a complementary treatment extends to pain as well. One study demonstrated that imagery, relaxation, and cognitive behavioral training can reduce the pain of certain chemotherapy side effects (Syrjala, Donaldson, et al, 1995).

Guided imagery can also help people tolerate chemotherapy treatments and have a better sense of well-being. Several studies have shown that guided imagery and relaxation techniques have been able to lessen the nausea caused by some chemotherapy drugs (Lehrman, Rimer, et al, 1990; Molassiotis, Yung, et al, 2002; Mundy, DuHamel & Montgomery, 2003). In one study patients using chemotherapy-specific guided imagery reported a “significantly more positive experience” (Troesch, Rodehaver, et al, 1993).

Having a better chemotherapy experience is important because as many as 31% of chemotherapy patients prematurely stop treatment because of anxiety or depression (Newell, Sanson-Fisher, et al, 1998). Relaxation and imagery can directly relieve anxiety and depression. They can also indirectly help these conditions by improving quality of life and reducing side effects. This may allow patients to successfully complete treatment.

A study of 96 breast cancer patients who used guided imagery and relaxation were more relaxed during chemotherapy, and had a better quality of life. This led the study’s authors to conclude that relaxation and guided imagery were “simple, inexpensive and beneficial” for patients undergoing chemotherapy (Walker LG, Walker MB, et al, 1999).

Other researchers concluded that chemotherapy patients who use self-help programs to manage their stress do even better than people who receive professional stress-reduction help. They have more energy, can function better, and feel better mentally. The economic consequences are equally impressive. The self-help program studied cost 66% to 68% less than a typical professional psychosocial chemotherapy preparation (Jacobson, Meade et al, 2002).

Relaxation with guided imagery is a safe, inexpensive technique that can improve chemotherapy patients’ quality of life, reduce side effects, and improve their chances of completing therapy.

American Cancer Society, Cancer Facts and Figures 2006. Atlanta: American Cancer Society: 2006. Pgs. 1, 3.
Accessed July, 2006.

Given C, Given B, Rahbar M, Jeon S, McCorkle R, Cimprich B, Galecki A, Kozachik S, Brady A, Fisher-Malloy M, Courtney K, Bowie E. Effect of a cognitive behavioral intervention on reducing symptom severity during chemotherapy. J Clin Oncol. 2004 Feb 1;22(3):507-16.

Jacknow DS, Tschann JM, Link MP, Boyce WT. Hypnosis in the prevention of chemotherapy-related nausea and vomiting in children: a prospective study. J Dev Behav Pediatr. 1994 Aug; 15 (4): 258-64.

Jacobsen PB, Meade CD, Stein KD, Chirikos TN, Small BJ, Ruckdeschel JC. Efficacy and costs of two forms of stress management training for cancer patients undergoing chemotherapy. J Clin Oncol. 2002 Jun 15;20(12):2851-62.

Lerman C, Rimer B, Blumberg B, Cristinzio S, Engstrom PF, MacElwee N, O'Connor K, Seay J. Effects of coping style and relaxation on cancer chemotherapy side effects and emotional responses. Cancer Nurs. 1990 Oct;13(5):308-15.

Luebbert K, Dahme B, Hasenbring M. The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: a meta-analytical review. Psychooncology. 2001 Nov-Dec;10(6):490-502.

Marchioro G, Azzarello G, Viviani F, Barbato F, Pavanetto M, Rosetti F, Pappagallo GL, Vinante O. Hypnosis in the treatment of anticipatory nausea and vomiting in patients receiving cancer chemotherapy. Oncology. 2000 Aug; 59 (2): 100-4.

Molassiotis A, Yung HP, Yam BM, Chan FY, Mok TS. The effectiveness of progressive muscle relaxation training in managing chemotherapy-induced nausea and vomiting in Chinese breast cancer patients: a randomised controlled trial. Support Care Cancer. 2002 Apr;10(3):237-46. Epub 2001 Dec 18.

Morrow GR, Morrell C. Behavioral treatment for the anticipatory nausea and vomiting induced by cancer chemotherapy. NEJM. 1982 307; 1476-80.

Mundy EA, DuHamel KN, Montgomery GH. The efficacy of behavioral interventions for cancer treatment-related side effects. Semin Clin Neuropsychiatry. 2003 Oct;8(4):253-75.

Newell S, Sanson-Fisher RW, Giris A, Bonaventura A. How well do medical oncologists' perceptions reflect their patients' reported physical and psychosocial problems? Data from a survey of five oncologists. Cancer. 1998 83(8):1640-51.

Redd WH, Rosenberger PH, Hendler CS. Controlling chemotherapy side effects. American Journal of Clinical Hypnosis. 1982-1983 25 (2-3); 161-72.

Syrjala KL, Donaldson GW, Davis MW, Kippes ME, Carr JE. Relaxation and imagery and cognitive-behavioral training reduce pain during cancer treatment: a controlled clinical trial. Pain. 1995 Nov; 63 (2):189-98.

Troesch LM, Rodehaver CB, Delaney EA, Yanes B. The influence of guided imagery on chemotherapy-related nausea and vomiting. Oncol Nurs Forum. 1993 Sep; 20 (8): 1179-85.

Vasterling J, Jenkins RA, Tope DM, Burish TG. Cognitive distraction and relaxation training for the control of side effects due to cancer chemotherapy. J Behav Med. 1993 Feb; 16 (1): 65-80.

Walker LG, Walker MB, Ogston K, Heys SD, Ah-See AK, Miller ID, Hutcheon AW, Sarkar TK, Eremin O. Psychological, clinical and pathological effects of relaxation training and guided imagery during primary chemotherapy. Br J Cancer. 1999 Apr; 80 (1-2): 262-8.

Yoo HJ, Ahn SH, Kim SB, Kim WK, Han OS. Efficacy of progressive muscle relaxation training and guided imagery in reducing chemotherapy side effects in patients with breast cancer and in
improving their quality of life. Support Care Cancer. 2005 Oct;13(10):826-33. Epub 2005 Apr 23.