Mind-body interactions include the techniques of relaxation, meditation, music therapy, hypnotherapy and other complementary therapies. Many of us have used some of these techniques to help with a single symptom such as anxiety, stress, or to quit smoking. In chronic illness such as cancer, patients often present with a complex pattern of symptoms, including anxiety, pain and sleep disturbance.
Hypnotherapy in particular, has proven benefits in smoking cessation, weight control and treating phobias. But it is also useful in maintaining a positive outlook on life, mainly by changing perceptions. Shortly after my mother died from lung cancer, her hypnotherapist and I wrote a short article on the benefits of hypnotherapy in chronic and terminal illness. This was first published in the newsletter of the Spirit Fitness Club, Guildford. I reproduce part of the article below (Hypnotherapy with Stephen Rigby), by kind permission of Stephen Rigby. We felt that there was more to write, however, and I have been looking into recent research papers* to further substantiate our (largely) anecdotal evidence, and to show that there is good evidence for the use of complementary therapies in patients with chronic illness.
The Marie Curie Cancer Centre, Newcastle upon Tyne, published a small pilot study, looking at the role of hypnotherapy in the palliative care setting, by relieving stress and helping patients to cope with their illness and the prospect of dying. The audit established the demand for a hypnotherapy service, and the practicalities of providing such a service in a busy centre. It also identified the benefits of hypnotherapy, as perceived by patients and therapist. The study was conducted over 5 months, involving just eleven clients (seven staff and four patients), using questionnaires. The main findings were a unanimous positive coping and relaxation benefit, with 82% of clients reporting it had assisted in improving the presenting problem, and 91% felt it had been of benefit in general. Similar findings were published in 2008, where mind-body therapies, not just hypnotherapy, were found to improve cancer survivorship. Two studies carried out more recently further suggest strategies and methods for the use of hypnosis in complex oncology.
Other studies have looked at the role of integrative complementary therapies, including mind-body techniques, on specific cancer-related neuropathic pain, a complex physical and psychosocial pain; indeed in all types of chronic pain, hypnotherapy is shown to be effective on a variety of pain outcomes.
Another aspect of cancer treatment is the sleep disturbance many patients experience. Hypnotherapy can effectively help manage the pain-sleep disturbance cycle in people with cancer, by helping with relaxation. A good night’s sleep is fundamental to well-being, for both patients and families. A report in 2010 found that further studies on mind-body interactions in the treatment of complex sleep disturbance could help patients with all aspects of the pain-fatigue-sleep disturbance cluster.
In a specific case of the management of leukaemia, researchers found that patients were looking for complementary therapies to be used in conjunction with traditional cancer treatments to reduce side-effects of the drugs, or as a coping mechanism during treatments. In this study mind-body interactions such as self-hypnosis, meditation and breath awareness such as is practised in yoga, massage and reflexology, acupuncture, and a healthy diet and exercise were analysed and found to be useful for these patients. Just a word of caution here, botanical extracts and vitamin supplements may interfere with cancer treatment, so ask before using these.
And finally, in a randomized trial of mind-body interactions on a positive/negative effect during breast cancer radiotherapy, forty women were randomized to receive either cognitive-behavioural therapy and hypnosis or standard care, and their analysis showed a reduction in the negative effect and an increased positive effect, which was significantly more intense. Patients receiving this therapy also had significantly more positive days during their treatment, and the authors conclude that mind-body interaction therapies have the potential to significantly improve the experience of women breast cancer patients receiving radiotherapy.
It seems obvious to me that these complementary approaches together with traditional cancer treatment should be more widely offered to patients during treatment, both as outpatient chemotherapy and radiotherapy patients, but also as inpatients in hospital. Sometimes, as a cancer patient, despite all your best efforts, a hospital stay is necessary. That in itself is traumatic, but it shouldn’t have to be without complementary therapy too. By writing this blog, I am hoping to raise awareness of the possibilities, and to encourage patients and their families to ask for more help along the cancer journey. It can make life so much easier.
*You can search the Pubmed database for these and many more science and medicine topics.
Hypnotherapy with Stephen Rigby
Ask somebody how they feel about being hypnotised and you will get a wide range of responses – fear being one of them. Yet, without knowing it, everyone reading this article is likely to utilise the hypnotic state every time they visit the gym – that music you hear may be just music but it helps you to get into “the zone” of heightened performance. I am a hypnotherapist and I use hypnosis in conjunction with other therapeutic techniques to teach my clients how to utilise that high performance state to overcome habits, fears, weight issues, anxieties; it even helps with some medical problems (like Irritable Bowel Syndrome). Not surprisingly hypnotherapy can also be useful for improving sports performance and over the years, I have been asked by professional and Olympic standard athletes to help them improve their game.
How does hypnosis work?
Maybe because of the misrepresentation of hypnosis on stage, screen and literature the most frequent question I am asked is “How does it work?” The goal of all therapy is to create a new perspective; hypnotherapy achieves this by helping us build new mental pathways. Hypnotherapy is far more effective than other forms of therapy because it is extremely efficient at achieving perspective changes. Where people may attend other forms of therapy for months on end, I expect most people to get the change they want within four sessions using hypnotherapy.
In this first article, I am going to talk about how hypnotherapy helped one lovely lady change her perspective on life. Vivienne, the lady in question, is the late mother of Lesley Beeton, one of the members at the Spirit. Here is what Lesley says about how hypnotherapy helped Vivienne.
Lesley talks about how hypnotherapy helped
“Mom was extremely ill and there was no cure for her cancer. She was very afraid of her diagnosis, devastated by the prognosis, and felt unable to see any positives in her life. We knew that Mom needed to come to terms with her disease, to decide how to live the rest of her life, and to tell the clinical teams how she wanted to be treated. I asked Stephen to work with Mom when conventional anti-depressant therapy was withdrawn and she was not offered any counselling. Stephen adopted a personalised approach to Mom’s needs. She was very fragile and cried a lot during the initial sessions, but she seemed much calmer to us almost from the beginning. Mom learnt to trust Stephen and enjoyed the one-to-one time, working hard to change her perspective as her disease progressed. Although she never understood how hypnotherapy worked, she acknowledged that without it she would never have achieved the insight and focus to make informed choices about dying at home or plan her funeral. She was calm and at peace, happy to be alive each day, right up until the end. On the day she died, Mom declined all drug interventions and passed away quietly at home, pain-free and in her own time.”
Peace and quiet
Most chronic illnesses, including cancer and heart disease, are complex – having more than one cause and often more than one treatment. The medical teams work very hard to treat the disease but often the patient gets trapped on a medical ‘treadmill’ without the peace and quiet they need to consider their own needs. Patients suffering with these serious conditions also have all the small niggles that rest of us do – headache, stomach upset, coughs and colds, dental pain, period pain etc, and it’s often these small things which can really bring a person down. So there is a real benefit in investing early on in diagnosis in a plan for managing ongoing symptoms, medical interventions and the emotional side effects of chronic illness – hypnotherapy can help with this.
Lost: Sense of Perspective. Last seen somewhere between problems and issues. If found, please return to MmeLindor, c/o CamelsHump
Have you ever lost perspective and suddenly found it again?
I did this week. I was having one of those days, when everything seemed to go wrong. I was cross and irritated, and settled down to see what my friends were up to on Facebook. Distracted, I scrolled through the posts, stopping suddenly when I saw this drawing by an eight year old girl. It’s the kind of drawing that any eight year old would draw. Except this girl was not asking for a Nintendo DS or a fun day out.
All she wants is to be better. To be well. To be healthy.
Aillidh is eight years old and seriously ill. As ill as a little girl can get. She has Acute Myeloid Leukaemia and is going through her third chemotherapy session. She desperately needs a bone marrow transplant. Her parents are appealing, through their Facebook page and elsewhere, to find a donor.
Aillidh is a blend of white Scottish and Mestizo – the mix of European and indigenous N. American peoples (Native American/Indian). Her type is very hard to match so for this reason it is important that her story is shared throughout Europe and America. It is particularly difficult to find matches for mixed race patients. So, the more people who sign up to the Anthony Nolan stem cell register (or in the US Be The Match website), the better chance Aillidh has of finding a match.
Some worry, like I did, about signing up to the register, as the procedure is rumoured to be very painful. I was reassured by this quote from the Anthony Nolan Trust website:
Myth: Donating blood stem cells is painful.
Reality: People who have donated via the bone marrow method compared the after-effects to a hard game of football. Many donors find the experience fulfilling and for some, it’s life-changing.
Donation can be done via surgery or a simple blood transfusion – the doctor of the recipient advises on this, but the final decision is made by the donor.
So this week, I found my sense of perspective. Nothing in my life is close to the horror that Aillidh’s parents are going through. This sense of perspective does not lessen my problems, they still exist after all, but they are manageable.
I ask you to do the same. Sit down and count your blessings.
If you are on Facebook, please *like* Aillidh’s page and pass it on to your friends. If you are on Twitter, pass it on. Email your friends and family, particularly those in the US and ask them to pass the FB page on. The more people sign up as a potential donor, the higher the chance is of finding a match for Aillidh or for one of the other Leukaemia sufferers around the world.
In addition to this appeal, Charlie Brooker, of all people, has urged YouTubers to sign up to the Anthony Nolan Register. Click here to watch it.
If you search for ‘statin and cancer’ on the public science and medicine database you will find 1,774 articles dating back to 1976. So, why was there a dramatic headline splashed across the newspaper last week? It’s not like we don’t already know about statins. They’re taken by millions of people around the world to reduce cholesterol by blocking something called the mevalonate pathway. This is a metabolic pathway involved in cholesterol production. Blocking this pathway reduces the production of cholesterol. This effect is simplified in the figure below. It’s like re-directing a stream of water.
Much of our understanding of of statins has come from work in animal models, looking at the reduction in cholesterol levels in the blood. In the lab I worked in we investigated the effect of two commonly prescribed statins on a protein made in white blood cells, which is a sign of inflammation. We showed that this sign of inflammation was decreased in response to these statins when the cells were treated with a substance known to mimic the effects of infection. As a result of these experiments, we considered another use of statins in blood vessels. They could be used to reduce inflammation inside the arteries of people with cardiovascular disease. The only current accepted, clinical use of statins is to lower the circulating fat (lipids) in the blood, which can be deposited in arteries causing heart attacks and stroke.
What’s the connection between inflammation and disease?
We have known for about twenty years that the underlying pathology in cardiovascular disease is rampant inflammation in the arteries. This is often due to fatty deposits, which cause red blood cells to clot in the arteries. A number of cells migrate to the region and release chemicals, which contribute to the inflammatory reaction, much like you might see if a wound becomes infected. Other causes of inflammation are viral infections, like influenza.Inflammation in the arteries happens over a long time and there are multiple signs in the blood. Testing for it is complex, which is why a doctor will often consider a full medical history when making a diagnosis.
I mention this because it is also known that markers of inflammation, like C-reactive protein in some cancer patients are only slightly increased. Two clinical trials looking at the use of statins, the PROVE-IT Study and REVERSAL Trial (reviewed by Salam, 2004) showed a reduction in C-reactive protein in people taking statins. For scientists, inflammation presents a wonderful environment for experimentation.
What about statins and cancer?
The author of the report in the newspaper, Dr Carol Prives and her team work with p53 a well known tumour suppressor gene found in many but not all cancers. The research referred to last week is in its very early stages. Dr Prives reports that the mevalonate pathway is significantly upregulated in tumours containing the p53 mutation. They do not say that statins have an effect on these tumours, merely that the same pathway of action of statins is implicated in p53-containing tumours (Freed-Pastor et al, 2012). This is interesting because it represents another line of research – to look at the effect of statins in these tumours. But it should be remembered that cancer cells outside of the human body, such as those used in laboratory experiments, are often derived from people who had cancer and died a long time ago. Their cells have been immortalized and are continually cultured for use in experiments. The disadvantage of this is that sometimes it does not represent the true tumour response. The advantage, however, is that the cells are always the same and experimental data can be compared over time and between laboratories, unlike if we use different people (or animals) each time.
So, there is a long way to go before we can say that millions of lives will be saved by taking statins. But, according to one cardiologist, the real importance of statins is longer life, and that’s a good thing, whichever way you look at it.
“That which can be asserted without evidence, can be dismissed without evidence.”
It saddened me to learn of the death of writer, journalist, atheist and professional agitator Christopher Hitchens, aged 62, after a long battle against cancer. ‘The Hitch’ was an inspirational character, being an astounding intellect, a devastating debater, a possessor of a wit sharper than a sword lined with piranha teeth, and, just to prove he was human, a roaring drunk.
His speeches resonate with me, and I can’t help but think of a legendary address from history. At Gettysburg, 1863, at the dedication of a cemetery to the fallen of the American Civil War battle, politician Edward Everett was giving a keynote speech. It lasted over two hours. After he had finished, Abraham Lincoln arose and spoke for a little under three minutes, beginning by intoning the immortal words “four score and seven years ago…” Which speech does history recall? That was the power of The Hitch: He had impact. You could argue intelligently for hours, with facts and figures in your support, but unleashing the Hitch on an opponent was like fighting cavemen with a tactical nuke.
His put-downs have become colloquially known as ‘Hitch slaps,’ for their sharpness and ferocity, and for leaving those on the receiving end feeling like they’ve been smacked in the face.
He argued from a position on the political left, pro the preeminence of science, not just as an atheist, but as an anti-theist. Where Professor Richard Dawkins – who lead the tributes to his friend – would avoid direct debate with Creationists, Hitchens would actively pursue confrontation with religious extremists, and had been very vocal on religious issues and figures, such as Mother Teresa.
His thoughts on alcohol are almost as well known, citing many writers that created their best works while drunk. Perhaps as a society we’re more willing to forgive a drinker over any other form of personal abuse, and accept characters like Oliver Reed and George Best in spite of their flaws. But he never saw his drinking as a flaw. When former MP George Galloway once described him as a “drink-sodden ex-Trotskyist popinjay,” Hitchens let it pass bar protesting at the suggestion he couldn’t hold a drink.
Later in life some of his opinions seemed at odds with his liberal leanings, including being actively outspoken in support for the Iraq war. At the time I too shared his opinion, but have come to think differently in the light of subsequent information about the misleading and demonstrably false intelligence given in justification. This isn’t flip-flopping, but a change of mind of which Hitch would have approved. He was a believer in the primacy of persuasion and a sucker for a well-constructed argument, supported by proofs. He would never stubbornly maintain a view when all the evidence was against him.
If how he lived his life was the model I aspire to, then how he faced death can be an inspiration to us all. He refused to be cowed by his illness, and continued to fight for his cause until he was no longer able to. He recently engaged in a high profile debate against former Prime Minister Tony Blair, arguing against the proposal that religion is a force for good, in Canada in 2010. The assembled audience voted at its conclusion in favour of Hitchens.
Towards the end some religious opponents, upon hearing of his illness, offered to pray for his salvation. He told them not to bother, as heaven is deaf.
I hope, when I go, that I can face my death with as much dignity and humour, and with his lack of fear.
Christopher Hitchens 1949-2011