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KRISTIN D. HUDACEK
breast cancer. However, what the experiments fail to answer is
whether or not such elevations in white blood cells are clinically rele-
vant, especially in the setting of cancer. It is known that lymphocytes
can destroy cancer cells, but what is not discussed is the magnitude of
the increase in white blood cells needed to improve the clinical course
of breast cancer. Until this issue is addressed, no firm recommendation
about the use of hypnosis as adjuvant therapy in the treatment of
breast cancer can be given.
However, because hypnosis causes no harm and on the contrary
improves psychological well-being and immune cell counts, hypnosis
can be suggested to breast cancer patients who have the motivation
and resources to use it. The two studies evaluated indicate that hypno-
sis will have optimal results in patients who are high hypnotizables,
and thus a test for hypnotic susceptibility should be used to screen
interested patients for their hypnotizability. Benefits should improve
the more hypnosis is practiced, and thus self-hypnosis performed out-
side of guided sessions should be encouraged. Finally, patients should
employ a hypnotic technique that appeals to them, whether it is imagery-
guided hypnosis, autogenic training, or an alternative therapy. Clini-
cians serve a critical role in this respect by educating patients about
different hypnotic interventions.
R
ECOMMENDATIONS
FOR
F
UTURE
S
TUDIES
The experimental designs of the Bakke et al. (2002) and Hidderley
and Holt (2004) experiments give indications for the optimal design of
future studies investigating the role of hypnosis on the immune sys-
tem of breast cancer patients. The ideal study should consist of a large,
randomized-control trial. The hypnotizability of subjects should be
measured, since the effects of hypnosis are influenced by an individ-
ual’s ability to focus attention. Moreover, the scores from the test can
help stratify results based on participant hypnotizability and deter-
mine if experimental outcomes will apply to other patients with simi-
lar hypnotizability scores.
Immune-related outcomes should be assessed at the end of treat-
ment and at follow-up intervals to determine the long-term effects of
hypnosis. In order to evaluate the clinical significance of immunologi-
cal results in the setting of cancer, hypnosis should be related to other
outcomes of clinical importance. For example, it would be useful to
examine the effect of hypnosis on the incidence of metastases, 5-year
survival rates, and recurrence rates. Such associations would require
longer follow-up times and would be more difficult to control for other
factors. However, only by studying the effects of hypnosis on the clini-
cal course of cancer can a recommendation about its use as adjuvant
therapy be made.
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