Surgery is an essential part of all current treatments to cure breast cancer. The vast majority of women will experience highly aversive side effects following breast conserving surgery, including pain, nausea, and fatigue. The negative consequences of these side effects of surgical treatment are reflected in multiple public health domains including the suffering these women endure, as well as the financial costs borne by medical institutions and thereby society at large. To address this important clinical and public health problem, we developed and established the effectiveness of a brief, presurgery, psychologist-administered hypnosis intervention for breast cancer patients. This intervention significantly reduced pain, nausea and fatigue in a sample of 200 breast cancer surgical patients, and additionally resulted in a cost savings to the institution of $727 per patient. This indicates that If presurgery hypnosis were routinely used with all breast cancer surgical patients on a national basis, over $140 million health care dollars would be saved each year. Unfortunately, the track record of empirically-supported behavioral medicine interventions making the jump from research protocol to standard clinical care is abysmal. Common reasons given for the failure of the translation of new interventions are the unavailability of trained personnel and cost. To promote the routine use of presurgery hypnosis to improve patient care, we plan to implement and evaluate a new training program. Specifically, consistent with the R25E program announcement, we plan to train nurse anesthetists in our evidence-based approach to symptom and side effect control, namely in our hypnosis intervention. Collecting cost-effectiveness data is an important part of the design, as such data are key to promoting the continuation of the training program beyond conclusion of the funding period, and as such data will provide empirical evidence to decision makers. Furthermore we will train nurses in both academic and public hospitals, as too often advances at academic settings do not translate to the community. Program evaluation will focus on three levels: nurses'learning of the training material, their performance of the hypnosis intervention, and the effectiveness of the nurse anesthetist-administered hypnosis intervention in reducing institutional costs and patients'postsurgery side effects (assessed using a randomized clinical trial design).
Aim 1 : To develop and implement a training program in presurgery hypnosis for nurse anesthetists.
Aim 2 : To examine the effectiveness of the presurgery hypnosis training program from the perspective of end-users (patients).
Aim 3 : To investigate the relative effectiveness of the hypnosis training program from the perspective of the institution (hospitals).

National Institute of Health (NIH)
National Cancer Institute (NCI)
Education Projects (R25)
Project #
Application #
Study Section
Subcommittee G - Education (NCI)
Program Officer
Korczak, Jeannette F
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Icahn School of Medicine at Mount Sinai
Internal Medicine/Medicine
Schools of Medicine
New York
United States
Zip Code
Miller, Sarah J; Sohl, Stephanie J; Schnur, Julie B et al. (2014) Pre-biopsy psychological factors predict patient biopsy experience. Int J Behav Med 21:144-8
Montgomery, Guy H; David, Daniel; Kangas, Maria et al. (2014) Randomized controlled trial of a cognitive-behavioral therapy plus hypnosis intervention to control fatigue in patients undergoing radiotherapy for breast cancer. J Clin Oncol 32:557-63
Miller, Sarah J; Schnur, Julie B; Weinberger-Litman, Sarah L et al. (2014) The relationship between body image, age, and distress in women facing breast cancer surgery. Palliat Support Care 12:363-7
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Sucala, Madalina; Schnur, Julie B; Brackman, Emily H et al. (2013) Clinicians' attitudes toward therapeutic alliance in E-therapy. J Gen Psychol 140:282-93
Schnur, Julie B; Graff Zivin, Joshua; Mattson Jr, David M K et al. (2012) Acute skin toxicity-related, out-of-pocket expenses in patients with breast cancer treated with external beam radiotherapy: a descriptive, exploratory study. Support Care Cancer 20:3105-13
Sucala, Madalina; Schnur, Julie B; Constantino, Michael J et al. (2012) The therapeutic relationship in e-therapy for mental health: a systematic review. J Med Internet Res 14:e110
Schnur, Julie B; Montgomery, Guy H (2012) E-counseling in psychosocial cancer care: a survey of practice, attitudes, and training among providers. Telemed J E Health 18:305-8
Mohamed, Nihal E; Bovbjerg, Dana H; Montgomery, Guy H et al. (2012) Pretreatment depressive symptoms and treatment modality predict post-treatment disease-specific quality of life among patients with localized prostate cancer. Urol Oncol 30:804-12

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