EVIDENCE OF EFFICACY FOR GUIDED
IMAGERY FOR
CHILDREN
AND ADOLESCENTS
UNDERGOING CHEMOTHERAPY
September, 2006
Scope
of the Problem
According to the National Cancer Institute, approximately
9,510 American children were expected to be diagnosed with
cancer in 2005; approximately 1,585 children are expected
to die, one-third from leukemia, a condition for which
chemotherapy is the most effective treatment (American
Cancer Society, 2005).
Unfortunately, chemotherapy is associated with numerous
side effects. Vomiting, nausea, fatigue, and depression are
common after treatments. Other side effects are nerve pain,
mouth sores, and pain upon touching or being touched
(Hockenberry-Eaton, Barrera, et al, 1999). There are also
significant behavioral effects.
Younger children’s behavioral distress usually decreases as
treatment goes on, while adolescents’ tends to increase
(Dolgin, Katz, et al, 1989).. Adolescents also tend to have
more nausea and vomiting than their younger children
(Dolgin, Katz, et al.). Failure to cooperate with medical
recommendations is frequently a problem, with adolescents
tending to be less compliant than young children (Spinetta,
Masera, et al, 2002).
Severe side effects, and non-compliance because of those
side effects, can lead to loss of time at school for the
child, loss of time at work for the caregiver, and
additional office visits to the doctor -- all of which
contribute both to death and disability, and to the annual
costs of cancer (U.S. Dept. Health & Human Services,
2000).
Research
in Mind/Body Interventions for
Chemotherapy
Nausea
can occur both after treatment, and before treatments
("anticipatory nausea"). Children respond well to various
mind-body techniques, including distraction, including
breathing exercises and relaxation techniques (Williams,
Schmideskamp, et al, 2006).
Hypnosis has been successful in reducing or eliminating
both types of nausea in adults and children (Jacknow,
Tschann, et al, 1994; Machioro, Azzarello, et al, 2000;
Morrow and Morrell, 1982). Relaxation training has also
proven effective in reducing anticipatory nausea adults and
children (Jacknow, Tschann, et al; Vasterling, Jankins, et
al, 1993).
As
early as 1982, a study reported that relaxation
significantly reduced anticipatory nausea (Morrow and
Morrell). In one pediatric study, the hypnosis group had
less anticipatory nausea and lower need for anti-nausea
medication during both the first and second courses of
chemotherapy (Jacknow, Tschann, et al). Hypnosis, as well
as distraction and relaxation, reduced both distress and
nausea (Zeltzer, Dolgin, et al, 1991).
Patients’ well-being and ability to tolerate treatment are
also enhanced by the use of guided imagery. Adult patients
using guided imagery specifically geared toward
chemotherapy reported a “significantly more positive
experience” (Troesch, Rodhaver, et al, 1993).
Imagery is
effective in pain relief, too.
Imagery, relaxation and a psychological approach called
cognitive behavioral training can reduce the pain of
certain chemotherapy side effects (Syrjala, Donaldson, et
al, 1995). Relaxation and imagery can also relieve anxiety
and depression by improving quality of life, and reducing
side effects.
Breast cancer patients who used guided imagery and
relaxation were more relaxed during chemotherapy, and had a
better quality of life. This lead 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). The
National Cancer Institute (2001) has also recommended
“relaxation therapy, guided imagery, hypnosis, music, and
other techniques…to ease your child's discomfort and fear”
before and during cancer procedures.
A
pediatric guided imagery program can increase relaxation,
coping skills, and compliance, and reduce anxiety,
discomfort, and side effects of chemotherapy. A caregivers’
guided imagery program can enable parents and others
involved in the care of the child to reduce their stress,
and increase their relaxation and coping skills.
Conclusion
Relaxation
with guided imagery is a safe, inexpensive intervention
that can improve pediatric chemotherapy patients’ quality
of life, reduce side effects, and help with anxiety and
depression. This can help to improve compliance and lower
incidents of stopping treatment before it is finished.
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