Clinical Hypnosis and Music In Breast Biopsy:A Randomized Clinical Trial

Effect of music therapy on anxiety and depression in breast cancer patients: systematic review and meta-analysis

To systematically evaluate the intervention effect of music therapy on anxiety and depression in breast cancer patients. Randomised controlled trial (RCT) on music therapy for anxiety and depression in breast cancer patients was searched from 7 major databases, PubMed, Embase, the Cochrane Library, WOS, CNIC, Wanfang, and Wipro, spanning the period of library construction to 23 October 2023, and the literature screening of music therapy for anxiety or depression in breast cancer patients was carried out by 2 experimentalists, each of whom conducted a literature screening RCT independently of the other anxiety or depression in a RCT. Methodological quality was evaluated using the PEDro scale; GRADE profiler software for quality of evidence; and RevMan 5.4 was used for effect size merging and forest plots; publication bias tests and sensitivity analyses were performed using Stata 17.0; and standardized mean difference (SMD) and 95% CI were used as the effect statistics. A total of 13 RCTs with 1326 subjects (aged 18-70 years) were included in the literature, with a mean PEDro score of 6.8, and the literature was overall of good methodological quality. Meta-analysis showed that music therapy improved anxiety in breast cancer patients (841 cases), with a combined effect size (SMD = - 0.82, 95% CI [- 1.03, - 0.61] and P < 0.001); and improved depression in breast cancer patients (387 cases) with a combined effect size (SMD = - 0.76, 95% CI [- 1.15, - 0.38], P < 0.001). Subgroup analyses showed that music intervention with off-site music (757 cases) and music choice of non-self-selected music (537 cases) had the best effect on anxiety improvement, with corresponding combined effect sizes (SMD = - 0.88, P < 0.001; SMD = - 0.83, P < 0.001), respectively; followed by an intervention length of < 30 min (589 cases), a frequency of 2 times/day (382 cases), and intervention period of 2-3 weeks (101 cases) had the best effect on anxiety improvement, and the corresponding combined effect sizes were (SMD = - 0.80, P < 0.001; SMD = - 0.91, P < 0.001; SMD = - 1.02, P < 0.001), respectively; and the music selection was the choice of one's own favourite music among the expert recommendations (219 cases) (270 cases) had the best effect on the improvement of depressed mood, with combined effect sizes of (SMD = - 1.15, P < 0.001; SMD = - 0.71, P < 0.001) and music with an intervention duration of 30 min (287 cases), an intervention frequency of 1 time/day (348 cases), and an intervention period of 2-4 weeks (120 cases), respectively, with corresponding combined effect sizes of (SMD = - 0.75, P < 0.001; SMD = - 0.86, P < 0.001; SMD = - 1.06, P < 0.001), respectively. Music therapy can improve anxiety and depression in breast cancer patients, and the level of evidence is moderate. Although the heterogeneity between studies is high, which may lead to bias in the results, we explored the source of heterogeneity through subgroup and sensitivity analyses, providing a good evidence-based basis for clinical practice. The heterogeneity of anxiety and depression was explored by subgroup analysis, with anxiety due to music duration and music cycle; and depression due to intervention cycles and music duration. Sensitivity analyses also identified music duration and music cycle as contributing to the heterogeneity. Also, this study has some limitations since the included literature did not take into account the duration of the disease, education, and family economic status and did not categorize the age stages. This study found that music therapy improves anxiety and depression in breast cancer patients and the results can be used as a basis for clinical practice and researcher enquiry. This research has been registered on the INPLASY platform ( https://inplasy.com/contact/ ) under the number: INPLASY2023100057.

Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology-ASCO Guideline

PURPOSE

To provide evidence-based recommendations to health care providers on integrative approaches to managing anxiety and depression symptoms in adults living with cancer.

METHODS

The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, methodology, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2023. Outcomes of interest included anxiety or depression symptoms as measured by validated psychometric tools, and adverse events. Expert panel members used this evidence and informal consensus with the Guidelines into Decision Support methodology to develop evidence-based guideline recommendations.

RESULTS

The literature search identified 110 relevant studies (30 systematic reviews and 80 randomized controlled trials) to inform the evidence base for this guideline.

RECOMMENDATIONS

Recommendations were made for mindfulness-based interventions (MBIs), yoga, relaxation, music therapy, reflexology, and aromatherapy (using inhalation) for treating symptoms of anxiety during active treatment; and MBIs, yoga, acupuncture, tai chi and/or qigong, and reflexology for treating anxiety symptoms after cancer treatment. For depression symptoms, MBIs, yoga, music therapy, relaxation, and reflexology were recommended during treatment, and MBIs, yoga, and tai chi and/or qigong were recommended post-treatment.

DISCUSSION

Issues of patient-health care provider communication, health disparities, comorbid medical conditions, cost implications, guideline implementation, provider training and credentialing, and quality assurance of natural health products are discussed. While several approaches such as MBIs and yoga appear effective, limitations of the evidence base including assessment of risk of bias, nonstandardization of therapies, lack of diversity in study samples, and lack of active control conditions as well as future research directions are discussed.Additional information is available at www.asco.org/survivorship-guidelines.

Applications of Hypnosis as an Adjuvant in Oncological Settings: A Systematic Review

Previous research has shown promising results in using hypnosis to treat various symptoms and side effects of medical treatments. The objective was to identify studies that use hypnosis as an adjuvant to evidence-based treatments to evaluate its benefits in patients with cancer. The search identified 873 articles published between 2000 and February 2021, of which 22 were selected using the principles of the PRISMA. Apart from 1 study, all studies showed that interventions improved the measured variables compared to a control group. Most studies showed that hypnosis has positive effects on reducing anxiety, pain, nausea, fatigue, drug use, and length of hospital stays. Hypnosis also improves depressive symptoms, insomnia, hot flashes, well-being, and quality of life, and helps increase adherence to treatment. When used by qualified professionals as an adjuvant to well-established treatments, hypnosis improves symptoms caused by oncological interventions and the disease itself. In addition, hypnosis has no side effects.

Effect of hypnosis before general anesthesia on postoperative outcomes in patients undergoing minor surgery for breast cancer: a systematic review and meta-analysis

BACKGROUND

Preoperative anxiety is a common phenomenon in breast cancer, causing pain and tension, which is not conducive to the effective surgical treatment and postoperative recovery. It is believed that hypnosis can change the patient's perception of pain, thereby improving the patient's ability to control pain. However, the results of studies for this topic were controversy. In order to explore the effect of hypnosis in breast cancer surgery we included randomized controlled trials (RCTs) and conducted a meta analysis.

METHODS

PubMed, Web of Science, Wiley online library, Elsevier, and Clinicaltrials.gov databases were searched by computer with the keywords "hypnosis/hypnotherapy" and "breast cancer" and "oncologic surgery/surgery/biopsy". After screening, the meta-analysis was performed using RevMan 5.4 software, and the evidence was rated using GRADE profiler 3.6 software.

RESULTS

A total of 1,242 patients were included in 8 studies, including 630 patients who received preoperative hypnosis and 612 patients who did not receive hypnosis. Meta-analysis showed that hypnosis before general anesthesia reduced the degree of preoperative anxiety (MD =-2.79, 95% CI: -3.93, -1.65, P<0.00001) and postoperative pain (MD =-1.25, 95% CI: -1.64, -0.86, P<0.00001) in patients undergoing breast cancer surgery, but had no effect on the operation time (MD =-6.30, 95% CI: -15.38, 2.78, P=0.17) and the incidence of postoperative nausea and vomiting (OR =0.68, 95% CI: 0.22, 2.07, P=0.49).

DISCUSSION

The application of hypnosis before general anesthesia for breast cancer surgery can reduce the degree of anxiety of patients, also reducing postoperative pain.

Music interventions for improving psychological and physical outcomes in people with cancer

BACKGROUND

This is an update of the review published on the Cochrane Library in 2016, Issue 8. Having cancer may result in extensive emotional, physical and social suffering. Music interventions have been used to alleviate symptoms and treatment side effects in people with cancer. This review includes music interventions defined as music therapy offered by trained music therapists, as well as music medicine, which was defined as listening to pre-recorded music offered by medical staff.

OBJECTIVES

To assess and compare the effects of music therapy and music medicine interventions for psychological and physical outcomes in people with cancer.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 3) in the Cochrane Library, MEDLINE via Ovid, Embase via Ovid, CINAHL, PsycINFO, LILACS, Science Citation Index, CancerLit, CAIRSS, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, the RILM Abstracts of Music Literature, http://www.wfmt.info/Musictherapyworld/ and the National Research Register. We searched all databases, except for the last two, from their inception to April 2020; the other two are no longer functional, so we searched them until their termination date. We handsearched music therapy journals, reviewed reference lists and contacted experts. There was no language restriction.

SELECTION CRITERIA

We included all randomized and quasi-randomized controlled trials of music interventions for improving psychological and physical outcomes in adults and pediatric patients with cancer. We excluded patients undergoing biopsy and aspiration for diagnostic purposes.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted the data and assessed the risk of bias. Where possible, we presented results in meta-analyses using mean differences and standardized mean differences. We used post-test scores. In cases of significant baseline difference, we used change scores. We conducted separate meta-analyses for studies with adult participants and those with pediatric participants. Primary outcomes of interest included psychological outcomes and physical symptoms and secondary outcomes included physiological responses, physical functioning, anesthetic and analgesic intake, length of hospitalization, social and spiritual support, communication, and quality of life (QoL) . We used GRADE to assess the certainty of the evidence.

MAIN RESULTS

We identified 29 new trials for inclusion in this update. In total, the evidence of this review rests on 81 trials with a total of 5576 participants. Of the 81 trials, 74 trials included adult (N = 5306) and seven trials included pediatric (N = 270) oncology patients. We categorized 38 trials as music therapy trials and 43 as music medicine trials. The interventions were compared to standard care. Psychological outcomes The results suggest that music interventions may have a large anxiety-reducing effect in adults with cancer, with a reported average anxiety reduction of 7.73 units (17 studies, 1381 participants; 95% confidence interval (CI) -10.02 to -5.44; very low-certainty evidence) on the Spielberger State Anxiety Inventory scale (range 20 to 80; lower values reflect lower anxiety). Results also suggested a moderately strong, positive impact of music interventions on depression in adults (12 studies, 1021 participants; standardized mean difference (SMD): -0.41, 95% CI -0.67 to -0.15; very low-certainty evidence). We found no support for an effect of music interventions on mood (SMD 0.47, 95% CI -0.02 to 0.97; 5 studies, 236 participants; very low-certainty evidence). Music interventions may increase hope in adults with cancer, with a reported average increase of 3.19 units (95% CI 0.12 to 6.25) on the Herth Hope Index (range 12 to 48; higher scores reflect greater hope), but this finding was based on only two studies (N = 53 participants; very low-certainty evidence). Physical outcomes We found a moderate pain-reducing effect of music interventions (SMD -0.67, 95% CI -1.07 to -0.26; 12 studies, 632 adult participants; very low-certainty evidence). In addition, music interventions had a small treatment effect on fatigue (SMD -0.28, 95% CI -0.46 to -0.10; 10 studies, 498 adult participants; low-certainty evidence). The results suggest a large effect of music interventions on adult participants' QoL, but the results were highly inconsistent across studies, and the pooled effect size was accompanied by a large confidence interval (SMD 0.88, 95% CI -0.31 to 2.08; 7 studies, 573 participants; evidence is very uncertain). Removal of studies that used improper randomization methods resulted in a moderate effect size that was less heterogeneous (SMD 0.47, 95% CI 0.06 to 0.88, P = 0.02, I² = 56%). A small number of trials included pediatric oncology participants. The findings suggest that music interventions may reduce anxiety but this finding was based on only two studies (SMD -0.94, 95% CI -1.9 to 0.03; very low-certainty evidence). Due to the small number of studies, we could not draw conclusions regarding the effects of music interventions on mood, depression, QoL, fatigue or pain in pediatric participants with cancer. The majority of studies included in this review update presented a high risk of bias, and therefore the overall certainty of the evidence is low. For several outcomes (i.e. anxiety, depression, pain, fatigue, and QoL) the beneficial treatment effects were consistent across studies for music therapy interventions delivered by music therapists. In contrast, music medicine interventions resulted in inconsistent treatment effects across studies for these outcomes.

AUTHORS' CONCLUSIONS

This systematic review indicates that music interventions compared to standard care may have beneficial effects on anxiety, depression, hope, pain, and fatigue in adults with cancer. The results of two trials suggest that music interventions may have a beneficial effect on anxiety in children with cancer. Too few trials with pediatric participants were included to draw conclusions about the treatment benefits of music for other outcomes. For several outcomes, music therapy interventions delivered by a trained music therapist led to consistent results across studies and this was not the case for music medicine interventions. Moreover, evidence of effect was found for music therapy interventions for QoL and fatigue but not for music medicine interventions. Most trials were at high risk of bias and low or very low certainty of evidence; therefore, these results need to be interpreted with caution.

How to Minimize Patient Anxiety From Screening Mammography

Anxiety has been portrayed by the media and some organizations and societies as one of the harms of mammography. However, one experiences anxiety in multiple different medical tests that are undertaken, including screening examinations; it is not unique to mammography. Some may argue that because this anxiety is transient, the so-called harm is potentially overstated, but for some women the anxiety is significant. Anxiety can increase or decrease the likelihood of obtaining a screening mammogram. There are multiple ways that anxiety associated with screening mammography can be diminished, including before, during, and after the examination. These include simple measures such as patient education, improved communication, being aware of the patient's potential discomfort and addressing it, validating the patient's anxiety as well as providing the patient with positive factual data that can easily be implemented in every breast center. More complex interventions include altering the breast center environment with multisensory stimulation, reorganization of patient flow to minimize wait times, and relaxation techniques including complementary and alternative medicine. In this article we will review the literature on measures that can be taken to minimize anxiety that would maximize the likelihood of a woman obtaining an annual screening mammogram.

Hypnosis and the Alleviation of Clinical Pain: A Comprehensive Meta-Analysis

This is the first comprehensive meta-analysis in approximately 20 years of all controlled studies of the use of hypnosis for relieving clinical pain. To be included, studies were required to utilize a between-subjects or mixed model design in which a hypnosis intervention was compared with a control condition in alleviating any form of clinical pain. Of 523 records screened, 42 studies incorporating 45 trials of hypnosis met the inclusion criteria. Our most conservative estimates of the impact of hypnosis on pain yielded mean weighted effect sizes of 0.60 (p ≤ .001) for 40 post trials and 0.61 (p ≤ .001) for 9 follow-up trials. These effect sizes fall in the medium range according to Cohen's guideline and suggest the average participant receiving hypnosis reduced pain more than about 73% of control participants. Hypnosis was moderated by the overall methodological quality of trials-the mean weighted effect size of the 19 post trials without high risk ratings on any of the Cochrane Risk of Bias dimensions was 0.77 (p ≤ .001). Hypnosis was also moderated by hypnotic suggestibility, with 6 post trials producing a mean weighted effect size of r = 0.53 (p ≤ .001). Our findings strengthen the assertion that hypnosis is a very efficacious intervention for alleviating clinical pain.

Impact of a Music Intervention on Quality of Life in Breast Cancer Patients Undergoing Chemotherapy: A Randomized Clinical Trial

Background: Music can influence human behavior and may be used as a complementary therapy in health care. Objectives: To assess the effect of music interventions on symptoms, adverse events, and quality of life (QoL) of breast cancer patients undergoing chemotherapy (CT). Design: Nonblinded, randomized clinical trial. Women with breast cancer undergoing adjuvant CT were randomized into 2 groups—Group Music (GM) or Group Control (GC)—and followed during the first 3 cycles of treatment. Measurements: Sociodemographic data, WHOQOL-BREF, BDI-II, BAI, and Chemotherapy Toxicity Scale were assessed. Patients were evaluated after each session of the first 3 CT cycles. GM underwent a 30-minute musical intervention before CT. There was no intervention in the GC. Continuous data were analyzed by Student’s t test, and χ² test was used to compare qualitative variables. Results: Higher QoL scores on functional scales were observed for the GM in comparison to the GC after the first and third sessions of CT. Depression (P < .001) and anxiety scores (P < .001) and vomiting (P < .01) incidence were lower for the GM in the third session of CT. All the participants in the GM reported positive changes in life in the Subjective Impression of the Subject questionnaire, as well as improvement in fatigue and reduced stress levels. Conclusions: Improvements in QoL, anxiety, depression, and incidence of vomiting were associated with the music intervention, suggesting a positive effect of the music intervention on adverse events of cancer CT.

Hypnotic intervention in people with fibromyalgia: A randomized controlled trial

Fibromyalgia affects the quality of life of the patients, as well as their family. It also affects their social, labor, physical, and psychological dynamics. We aimed to evaluate the effectiveness of audio-recorded hypnosis in ameliorating fibromyalgia symptoms. We enrolled 97 individuals with fibromyalgia (mean age: 45 years) and randomly distributed them to two groups (48 in the experimental group and 47 in the control group). Individuals in both groups maintained their standard pharmacological treatment and continued their usual physical or psychological activities. The experimental group received an audio-recorded hypnosis intervention in the first session; subsequently, they received another audio hypnosis session to use for daily practice for a month. We evaluated the pre- and post-intervention pain intensity, pain interference, fatigue intensity, fatigue interference, depressive symptomatology, and satisfaction with life. We found that the self-administered audio-recorded hypnotic intervention significantly decreased the intensity and interference of pain and fatigue, as well as the depressive symptomatology. Audio-recorded clinical hypnosis techniques could provide an effective, practical, and economical alternative for reducing fibromyalgia-related symptoms.

Relaxation with heat and procedural information to diminish anxiety in presurgical patients of hernia surgery

Presurgical anxiety has been associated with postsurgical pain and complications, therefore we decided to compare two psychological interventions in order to reduce presurgical anxiety-state and pain in patients undergoing hernia surgery. Patients undergoing the presurgical consultation for hernia repair (umbilical or inguinal), were invited. The group of procedural information consisted in administering an informative brochure after the presurgical consultation, while the relaxation with heat group (RWH) consisted in giving a heat pack to the patients while asking them to think in the benefits of the surgery and instructions of relaxation were given, this was performed at the operating theater before surgery. Anxiety-state and pain levels were measured after presurgical consultation and a day after just before surgery. Ninety-five patients were included in 3 groups of study (control = 36, procedural information = 31 and RWH = 28); when we included only those individuals with moderate or high anxiety at the presurgical consultation, we found that procedural information (-4.72 ± 6.10) and RWH diminished anxiety (-9.29 ± 6.91) but only RWH group reached statistical significance when compared with control group (-9.29 ± 6.91 vs -0.56 ± 9.82, p = 0.007). In conclusion, RWH produced a significantly higher reduction of anxiety-state before hernia surgery.