Can Hypnosis Reduce Hot Flashes in Breast Cancer Survivors? A Literature Review

American Journal of Clinical Hypnosis,  Jul 2004  by Elkins, Gary,  Marcus, Joel,  Palamara, Lynne,  Stearns, Vered

• E-mail
• Print
• Link

Hot flashes are a significant problem for many breast cancer survivors and can cause discomfort, insomnia, anxiety, and decreased quality of life. In the past, the standard treatment for hot flashes has been hormone replacement therapy. However, recent research has found an increased risk of breast cancer in women receiving hormone replacement therapy. As a result, many menopausal women and breast cancer survivors reject hormone replacement therapy and many women want non-pharmacological treatment. In this critical review we assess the potential use of hypnosis in reducing the frequency and intensity of hot flashes. We conclude that hypnosis is a mind-body intervention that may be of significant benefit in treatment of hot flashes and other benefits may include reduced anxiety and improved sleep. Further, hypnosis may be a preferred treatment because of the few side-effects and the preference of many women for a non-hormonal therapy. Two case studies are included to illustrate hypnosis for hot flashes. However this intervention has not been adequately studied. We discuss an NIH-funded randomized clinical trial of hypnosis for hot flashes in breast cancer survivors that is presently being conducted.

Hot flashes are experienced by most perimenopausal and menopausal women and can cause considerable distress. Further, hot flashes are an especially significant problem for many breast cancer survivors (Carpenter, et al., 1998). In breast cancer survivors, adjuvant cytotoxic chemotherapy results in diminished ovarian function and causes hot flashes. Also, anti-hormonal agents such as tamoxifen and raloxifene that are given to prevent breast cancer are associated with hot flashes. It is recognized that chemotherapy-induced hot flashes are particularly difficult because of the sudden onset and intensity. We review the definition, impact, findings from the Women's Health Initiative, alternative interventions, and the potential use of hypnosis in treatment of hot flashes in breast cancer survivors. Two case illustrations of hypnosis for hot flashes are presented, and an NIH-supported clinical research trial currently underway is discussed.

Definitions

As described by Kronenberg ( 1994) a hot flash may be identified as "a transient episode of flushing, sweating, and a sensation of heat, often accompanied by palpitations and a feeling of anxiety, and sometimes followed by chills." hot flashes occur as a consequence of estrogen depletion (Ganong, 1993) which results in decreased tonic inhibitory stimuli and induction of noradrenergic hyperactivity, an activation of heat-loss responses (Bider, Masiach, Serr, & Ben-Rafael, 1989; Casper & Yen, 1985).

Many women experience an aura, which signals an impending hot flash immediately prior to its onset. The hot flash typically begins with a sudden increased heart rate and peripheral blood flow (Ginsberg, Swinhoe, & O'Reilly, 1981 ; Kronenberg, Cote, Linkie, Dyrenfurth, & Downey, 1984). Skin temperature rises and there is often a sudden outpouring of sweat. The sensation of a wave of heat spreads over the person's body, especially the upper body (Kronenberg & Downey, 1987; Tataryn et al., 1980). Although there is a sensation of heat, evaporation of sweat from the forehead and chest results in a drop in temperature in these areas (Kronenberg et al., 1984). As a result the hot flash is sometimes followed by a chilled feeling.

Impact of Hot Flashes on Breast Cancer Survivors

The impact of hot flashes can be significant in breast cancer survivors. Finck, Barton, Loprinzi, Quella, and Sloan (1998) reported on 102 breast cancer survivors with hot flashes. Severe hot flashes were described by 89 of the women. Of these, 54% reported experiencing hot flashes that were like "a raging furnace" or "burning up" with heat sensations. Physical symptoms included weakness, feeling faint, rapid heartbeat, and itching sensations. Twenty-six percent of the women reported total body sensations involving their face, neck, chest back, legs, and feet. Thirty-seven percent of the women indicated that these hot flashes interrupted their daily activities and disrupted sleep. For example, one woman stated that she could no longer work in her garden because she could not tolerate being outside in the heat. The disruptions in sleep included awakenings and insomnia. Half of the women reported being awakened from sleep with severe sweating. Many reported taking cold showers, putting cold towels on their pillows, or use of ice around their necks. Emotional aspects that were reported included anxiety, "panic attacks," and being "embarrassed in public." Responses to moderate hot flashes included fanning, uncovering, drinking water, and opening windows. Some of the women reported feeling faint or dizzy, having heart palpitations, or having feelings of nausea.

Pansini et al. (1994) also described the many physical symptoms associated with hot flashes. The most common symptoms included headaches, irritability, palpitations, paresthesias, and dizziness. Also, Hunter and Liao (1995) found that one-third of women with hot flashes described embarrassment, and 20% described a general sense of a loss of control.