Berliere, M.; Piette, N.; Gerday, A.; Roelants, F.; Docquier, M.-A.; et al
Cancer Research, suppl. Supplement 179.4 American Association for Cancer Research Inc. (Feb 2019)
Abstract
Background: Our team has previously highlighted the benefits of hypnosis analgesia on different modalities of breast cancer treatment. In order to confirm these benefits and -in order to try to explain the mechanisms implicated in hypnosis sedation we have initiated this new study. Material and methods: This study is a prospective non -randomized multicentric study approved by our local ethics committee which has planned to include 450 consecutive non -metastatic breast cancer patients treated in our breast clinic. The study is divided in 3 arms. In the first arm, patients undergo oncologic breast surgery while on general anesthesia. In the second arm , general anesthesia is preceded by a session of hypnosis relaxation mediated by virtual reality (Aqua program, Oncomfort ). In the third arm , the patients undergo breast surgery while on hypnosis analgesia and local anesthesia. To decrease the impact of local anesthesia, on the measured outcomes , this procedure is added to general anesthesia in the first two arms. Different parameters are measured for every patient : anxiety scales (- evaluated by the NCCN DT-National Comprehensive Cancer Network Distress Thermometer- on days 0, 1 and 8), pain scores (measured by NRS (- numerical rating scale-) and VAS (-visual analogue scale-) on days 0, 1 and 8 and biological parameters : NLR( – Neutrophils to lymphocytes ratio- and CRP – C reactive protein-measured on days 0, 1 and 8.) Results: We here present the results of the first 150 patients included in the study between October 2016 and April 2018, i.e 50 patients in each arm. The groups are well balanced for age (mean age of 60 years in the 3 arms), surgical procedures (lumpectomies, mastectomies and sentinel biopsies), tumor and patients’ characteristics. Anxiety scales are high and do not differ statistically between the 3 groups on day 0. On the contrary , on days 1 and 8, anxiety scales are lower in the groups of hypnosis analgesia and hynorelaxation – compared with the group of general anesthesia alone – (p value= 2. 2 e-16). No – statistically significant differences- are observed between the hypnosis and hypnorelaxation groups . Pain scores and analgesics consumption are lower in the groups – using hypnosis analgesia and hypnorelaxation at each time point -. The group using hypnosis analgesia is the most efficient in pain reduction. The variations are statistically significant : p- value -0.009 -on day 0, 0.002 on day 1 and 0.0009 on day 8. The NLR and CRP values do not differ between the 3 groups on day 0. They are statistically lower on day 1 in the arm of hypnosis analgesia compared with the two groups with general anesthesia (p-values 0.00037 for NLR and 0.024 for CRP). On day 8, the variations are not statistically different between the 3 groups. Discussion: Inflammatory reactions associated with breast cancer surgery could exert a negative impact on quality of life (pain, anxiety) and perhaps on breast cancer survival. On the contrary, interventions associated with a decreased inflammatory reaction could be beneficial for breast cancer patients. Conclusion: This preliminary report suggests that hypnosis analgesia can modulate the immune system and exert benefits in this way.