HYPNOSIS FOR THE PATIENT WITH CANCER

It has always been difficult for Physicians to handle the psychological problems that arise in patients with malignant disease, especially when cure is unlikely or impossible. We rely on the use of tranquilizers, sedatives and narcotics to solve their problems and too often they are inadequate. Also, some aspects of the Cancer patient’s care require a great deal of time and the results are frequently disappointing. For these reasons and because of the obvious hopelessness of many situations, psychiatric treatment is impractical, and not often used. Medical Hypnosis, however, offers an alternative approach to the problem and may well serve to be the most practical approach toward solving problems encountered in the total care of patients with Cancer.

That Hypnosis is useful should not be difficult to understand. It has been shown that this modality produces anesthesia, elevates pain thresholds, and improves mental attitudes. These effects specifically lend themselves to the total care of cancer patients.

Comparatively little is to be found in the literature concerning the use of hypnotic suggestion in the treatment of the patient with cancer by Physicians and other health care providers. Often, In articles that are available the number of cases is small and the conclusions of the author’s discouraging despite hours spent trying to achieve some benefit for a patient

The purpose of this report will be to present the author’s experiences in using Medical Hypnosis to deal with symptomatic, psychological and somatic aspects of the care of eighty-one patients with malignant disease. The results of this study are presented as objectively as possible. The time involved, length of time of beneficial effects, and some of the practical aspects of this technique will be discussed in order to make this study as useful as possible.

This report consists of a series of eighty-one patients with the pathological diagnosis as shown in the able below

Diagnosis         No. of Patients

Carcinoma of the Cervix 32

Ovarian malignancy 9

Carcinoma of the Endometrium 7

Carcinoma of Breast 18

Carcinoma of Urinary Bladder 2

Carcinoma of Larynx 3

Carcinoma of Testicle 2

Carcinoma of Prostate 1

Carcinoma of Lung 1

Hodgkin ’s disease 1

 Leukemia 1

Multiple Myeloma 2

Malignant Melanoma 1

Abdominal carcinomatosis 1

Total 81

The patients were initially interviewed for approximately thirty minutes to determine their mental ability, suggestibility and willingness to cooperate. The hypnotic induction, with appropriate post-hypnotic suggestions, was often completed within this length of time. Reinforcement or re-induction sessions were given as necessary during daily ward rounds or during special "hypnosis rounds". The author had as many as ten patients in this group hospitalized at one time.

Seventy-three patients or 90% of this group were induced into a hypnotic state. The verification of the results of this research will require an evaluation of several factors [not necessary for this brief presentation] measured during the study concerning the type of medical hypnotic approach, the attaining of a trance state, the depth of trance, anesthesia, pain relief and its duration, mood elevation, the time expended per patient, and the reinforcements sessions necessary for each patient will be found in the complete text.[ See below ]

Post-hypnotic suggestions fell into four main categories: those dealing with anesthesia, those for the relief of intractable [unrelenting] pain, those for the relief of pain not classified as intractable, and those for attitude or mood elevation.

37 patients were induced within 15 minutes, 27 in 30 minutes and 9 patients required one hour for the initial induction.

This group consists of a total of 24 patients confirmed to be suffering from the pain of their disease.

This group varied in age from 17 to 60 years .The diagnoses in these patients were Carcinomas of the Cervix (9), Breast (6), and one each of Ovary, Uterus, Urinary Bladder, Testicle, Prostate, Larynx and Lung. There was also one case of Leukemia and one of Multiple Myeloma

% Relief of Pain --- % of Group

75% - 100% --- 29%

50% - 75% ---   25%

25% - 50% ---     4%

No change ---    2%

This table shows that more than 50% of these patients experienced some degree of pain relief. It also noted that the number of reinforcement sessions varied in this group from none to as many as 5 sessions, with an average of 2.3 reinforcements per patient. Time spent with these patients varied from 15 minutes to 3 hours, The majority of patients were treated within 60 minutes.

The next table shows the time of effectiveness for the 14 patients in this group during their hospital stay.

% of Pain Relief ---Time of Effectiveness

75% - 100%---2 to 12 weeks

50% - 75% --- 2 days to 6 weeks

25% - 50% --- 3 days

During the course of this study two interesting findings were noted. The first, none of these patients, whether considered success of failure, required a surgical procedures for pain relief during a nine month period that the author was able to follow the course of their disease. Secondly, all patients in the failure group continued to use the same dosage, of the narcotic drug, being administered when the hypnotic suggestions were first given. [They did not require higher doses of the narcotic as would normally be expected, with time]

It is worthy of note that observations by nurses and colleagues were considered more important than that of the author’s in these evaluations.

The next table lists the four categories of hypnotic suggestion previously mentioned and shows the distribution within the group of 73 patients according to the extent of their response. [The hypnotic suggestions concerned the mood of the patients, their activities, appetite and overall attitudes.]

Excellent ------ 30 (41%)

Good ------------20 (27.5%)

Fair --------------14(19%)

Poor ---------------9(12.5%)

68% of this total series appeared to have a good or excellent response to post-hypnotic suggestions.These suggestions proved to be invaluable as an aid to Nurses and members of the house staff caring for these patients.

The anxieties of "not knowing" often cause the variety of reactions seen in the patient with malignant disease. Fortunately, the vast majority handle their problems well, possibly as a result of family support and/or religious conviction.

Hypnotic suggestion gave these patients a measure of control over the "frightening unknown", of how and what I would feel/suffer" if I must die from my disease". It also appeared to support the hope that a cure will be found before too long.

In any event, the student of Medical Hypnosis will witness in most of these patients an unqualified cooperation and the utmost in motivation combined with a satisfactory imaginative ability that allows their induction into a hypnotic trance to be relatively easy. Of course, one is also confronted with the patient who says, "Let’s face it, words just can’t help me".

At first, it was confusing to find that an individual who entered deep trance state might be unable to obtain relief of pain while another, who was at best in a light state, experienced complete pain relief.

When it is realized, however, that an individual may believe that this disease is a form of punishment from God; that this suffering may reward him or her with "eternal life" after death then one can realize that such patients cannot and will not accept pain-relieving suggestions.

When one understands that relief of pain could mean being sent home, for a young woman with the offensive odor urine and fecal leakage, one can understand why hypnosis might fail.

If relief of pain means that a young father has to face his family in a wheel chair, needs to have someone clean him after each bowel movement, or help him wash his scarred/deteriorating body then relief of pain may be undesirable and the hospital serves as a refuge.

If one learns that a completely bedridden patient cannot financially afford or arrange for someone to render the necessary care at home, failure is easier to understand.

All patients classified as failures were notified, if at anytime in the future they felt they could derive help through Hypnosis; it would be available. Interestingly, only two patients requested help at a later date.

Self hypnosis was taught without hesitation to terminal cases. The author could see no contraindication. It was also firmly suggested, to all patients,  they would be able to help themselves, at any time, and  would not always need the presence of the Therapist.

This study demonstrated that a place exists for the use of hypnotic suggestion in the care of patients with malignant disease. Its use for the relief of pain and mood elevation proved sufficiently successful, not unduly time consuming, and free of complications or morbidity. It is especially indicated for pain relief in the patient whose life expectancy is short or for whom chemical and surgical approaches are not suitable.

The time required is not impractical for the trained  Physician and other properly licensed health care providers to administer/support the use of this treatment modality. The success of this effort requires  a "team like"  participation of all those involved in the care of these patients.  Most initial inductions are completed in less than one hour and reinforcement sessions in five to fifteen minutes.

In the author's opinion, "The benefits of Medical Hypnosis for the patient suffering with a malignant disease is not in doubt. Rather, it is the patient's willingness to receive its benefits that raises the questions. Either way the choice is theirs and must be respected." 

The full report of this research study is available:

Vincent W Cangello, MD,

"Hypnosis for the Patient with Cancer",

April, 1962; Volume IV, Number 4, Pages 215-228

[The number of patients in this study is now more than twice the number of the initial manuscript]