As the number of breast cancer (BCa) survivors increases, medication adherence has been identified as a key challenge in their long-term treatment. Current guidelines recommend that postmenopausal women with hormone receptor-positive BCa take aromatase inhibitors (AI) to improve survival. However, a large subgroup of BCa survivors discontinue AIs prematurely (24%), and up to 50% of survivors poorly adhere to AIs, potentially putting their lives at risk. A primary reason for AI non-adherence is musculoskeletal pain (MSP). Up to 61% of BCa survivors taking AIs develop MSP. MSP can be grueling, including severe joint, bone, and muscle pain and stiffness particularly in the wrists, hands and knees. MSP can lead to an inability to perform daily activities and can reduce quality of life in BCa survivors. Hypnosis, a mind-body intervention, has been widely demonstrated to reduce pain. In fact, analgesia is perhaps the best known effect of hypnosis. Meta-analyses have consistently supported the efficacy of hypnosis for pain control, including chronic pain. The results of our group?s randomized controlled trial (RCT) using hypnosis for pain control in BCa surgical patients were consistent with published effects. The cost-effectiveness of hypnosis in BCa settings has also been supported (e.g., average cost savings of $772.71/patient). What is known is that hypnosis has been shown to be efficacious in managing pain, and that pain (MSP) is associated with AI non-adherence. What is unknown is whether hypnosis, by controlling MSP, can improve AI adherence (proposed mediational model). The proposed study will determine whether hypnosis can reduce MSP and improve AI adherence. In addition, the cost-effectiveness of hypnosis will be investigated. Both clinical efficacy and cost-effectiveness data are necessary to promote dissemination of complementary interventions to patients in need.
The Specific Aims of this RCT are:
Aim 1) To investigate the clinical efficacy and cost-effectiveness of a ?live? hypnosis intervention to reduce MSP in breast cancer survivors taking AIs. Patients (N=200) from the Mount Sinai Medical Center will be randomly assigned to 1 of 2 groups: a) H-L, a live clinician-led hypnosis intervention; and, b) AC, a live attention control group (empathic listening).
Aim 2) To investigate the clinical efficacy and cost-effectiveness of a ?live? hypnosis intervention to increase AI adherence in breast cancer survivors.
Aim 3) To test the hypothesized mediational model: Hypnosis exerts its effects on AI adherence through MSP reduction. This mediational model will be tested using a latent growth curve modelling (LGCM) approach and will help us understand the underlying mechanisms responsible for hypnosis effects.

Public Health Relevance

Among breast cancer survivors, musculoskeletal pain (MSP) has been identified as a primary reason for non-adherence to potentially life-saving aromatase inhibitors (AIs). Hypnosis has been demonstrated to control pain in the breast cancer setting. The purpose of the proposed randomized controlled trial is to test the clinical efficacy and cost-effectiveness of hypnosis to reduce MSP and improve adherence in breast cancer survivors taking AIs. This project is a critical step towards reducing the serious public health problems of MSP and non-adherence in BCa survivors taking AIs. By reducing MSP and improving AI adherence, the intervention tested here has the potential to improve patient quality of life and to potentially save lives.

National Institute of Health (NIH)
National Center for Complementary & Alternative Medicine (NCCAM)
Research Project (R01)
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Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
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Mudd, Lanay Marie
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Icahn School of Medicine at Mount Sinai
Internal Medicine/Medicine
Schools of Medicine
New York
United States
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Montgomery, Guy H; Sucala, Madalina; Dillon, Matthew J et al. (2018) Interest and Attitudes about Hypnosis in a Large Community Sample. Psychol Conscious (Wash D C) 5:212-220
Montgomery, Guy H; Sucala, Madalina; Dillon, Matthew J et al. (2017) Cognitive-Behavioral Therapy Plus Hypnosis for Distress During Breast Radiotherapy: A Randomized Trial. Am J Clin Hypn 60:109-122