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RESEARCH FINDINGS USING GUIDED IMAGERY FOR
Biopsy

July, 2006


Value, Prevalence and Costs of Biopsy
A biopsy is the removal of a small piece of tissue for microscopic examination or testing. Biopsies can be done on almost any part of the body. Biopsies are among the most commonly performed medical procedures in the America.

For example, in 1995, about 600,000 prostate biopsies were performed in the U.S.A.; 700,000 breast biopsies were performed, at an average cost of $1,500 each; and a half million biopsies of the GI tract were done in that year (Agency for Health Care Policy and Research, 1995). Other areas frequently biopsied include the liver, lungs, and lymph structures.

Biopsies are an extremely valuable diagnostic tool, not only for confirming or ruling out cancer, but for assessing other conditions in the lungs, liver, and GI tract. According to the National Institutes of Health, the two major methods of biopsy are needle biopsy and open biopsy, which is a surgical procedure. Needle biopsies generally cost one third to one half as much as surgical biopsy, and have a quicker recovery time (CNN, 1999). Endoscopic biopsies are also frequently performed.


Problems with Biopsy
The complication rate in all types of biopsies is quite low. One to two percent of patients may develop significant low blood pressure, which is often stress-related (Al Amair, Al Bark & Al Trafi, 1997). However, biopsies sometimes cause significant pain. For example, the American Journal of Gastroenterology Editors (2001) wrote that patient facing liver biopsy “frequently have anticipatory anxiety, which would be expected of a procedure that is associated with pain in 30% of patients, severe complications in 0.3%, and death in 0.03%.”

A far greater problem for many patients is fear of the results of biopsy. For example, women who are called back after screening mammography “may interpret need for further examination as meaning a definite diagnosis of cancer, referral to an operation, or even death,” according to Arja Aro, Senior Researcher at the National Public Health Institute of Finland (Aro, 2001). This fear of bad news keeps some patients from getting timely biopsies.

This delay, however, endangers their lives and adds an unknown, but significant amount to medical costs. Even when patients do come for their biopsies, they may suffer from tremendous anxiety, which can increase their need for sedation and worsen their quality of life (Aro). Therefore, interventions that reduce patients’ anxiety and increase their level of confidence are needed.


Pharmacologic and Non-pharmacologic Anxiety Treatment in Biopsy
Most patients undergoing biopsy receive pain medication and sedation, either orally or intravenously. Because sedation requires increased monitoring by medical staff, it increases the costs, the recovery time, and the risk of low blood pressure.

Hypnosis, self-hypnosis, relaxation and guided imagery can reduce anxiety and pain in adults undergoing liver (Adams & Stenn, 1992) and breast (Montgomery, Weltz, et al, 2002) biopsies, and in children undergoing bone marrow aspiration (Zeltzer & LeBaron, 1982).

Similar techniques have resulted in reduced anxiety, fewer complications, less need for medication and, in some cases, shorter procedures in angiography (Lang & Mailton, 1994), upper intestinal endoscopy (Zimmerman, 1998), abdominal surgery (Tusek, Church & Fazio, 1997), and Magnetic Resonance Imaging (Friday & Dubal, 1990).


Conclusion
Guided imagery can reduce patients’ anxiety and improve their ability to cope with biopsy-related stress. This anxiety reduction could potentially result in improved patient cooperation with ordered biopsies, reduced medication use, and lower cost savings in some cases.


References
Adams PC, Stenn PG. Liver biopsy under hypnosis. J Clin Gastroenterol 1992 Sep;15(2):122-4.

Agency for Health Care Policy and Research 1995 Nationwide Inpatient Sample. http://www.ahcpr.gov/data/hcup/his95/table2b.htm Accessed July, 2006.

Al Omair A, Al Bakr F, Al Traif I. Outpatient Percutaneous Blind Needle Biopsy: Safety and Cost Analysis. Ann Saudi Med 1997;17(5):503-505.
American Journal of Gastroenterology Editorial November 2001; 96 (11):3053-3055.

Aro A, Psycho-social Impact of Breast Cancer: Second Update for Health Professionals. Publication of Union Internationale Contre Le Cancer (International Union Against Cancer)(2001).

Cable News Network report. May, 1999 . http://www.cnn.com/HEALTH/9905/04/breast.biopsy/
Accessed July, 2006.

Friday PJ, Kubal WS. Magnetic resonance imaging: improved patient tolerance utilizing medical hypnosis. Am J Clin Hypn 1990 Oct;33(2):80-84.

Lang EV, Hamilton D. Anodyne imagery: an alternative to i.v. sedation in interventional radiology. AJR Am J Roentgenol 1994 May; 162(5): 1221-6.

Montgomery GH, Weltz CR, Seltz M, Bovbjer DH. Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients. Int J Clin Exp Hypn. 2002 Jan;50(1):17-32.

National Institutes of Health Report. http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm Accessed July, 2006.

Tusek D, Church J, Fazio V. Guided imagery as a coping strategy for perioperative patients. AORN Journal 66 (4) 644-649 (1997).

Zeltzer L, LeBaron S. Hypnosis and nonhypnotic techniques for reduction of pain and anxiety during painful procedures in children and adolescents with cancer. J Pediatr 1982 Dec;101(6):1032-5.

Zimmerman J. Hypnotic technique for sedation of patients during upper gastrointestinal endoscopy. Ám J Clin Hyp 1998 40(4): 284-7.