RESEARCH FINDINGS USING GUIDED IMAGERY FOR
People Undergoing Radiation

September, 2006

Scope of the Problem of Radiation Side Effects
The American Cancer Society estimates that more than 1.2 million Americans were diagnosed with cancer in 2001 (2001). More than half of these people received radiation therapy, either alone or in combination with surgery or chemotherapy (Radiation Oncology, 2006). Possible radiation side effects depend on the area of the body treated.

Some of the more common side effects are: loss of appetite; anemia; shortness of breath; fatigue; hair loss; insomnia; nausea and vomiting; skin rash/redness; and diarrhea. In some treatments, there can be painful and unpleasant oral side effects such as cavities, thickening saliva, and taste loss.

Side effects such as hair loss and fatigue can add additional stress to an already stressful disease. The occurrence of side effects, or the fear of having side effects, often leads to patients missing or stopping treatments (Compliance and Compromise, undated).

About 50% of patients don’t follow through with their full treatments, according to the American Cancer Society, and cancer patients often feel a loss of control and feel powerless (Compliance and Compromise, undated). The frequent presence of depression “significantly influence[s]” the severity of fatigue and anxiety in cancer patients (Badger, Braden, and Mishel, 2001).

The majority of patients report significant lifestyle changes. Some have insomnia. Some stop working or work shorter schedules. For others, cancer and its treatment badly affect their household duties and leisure activities (Malone, Harris, et al, 1994). Quality of life is often significantly lessened.

The physical and psychological issues of cancer and radiation can lead to loss of time at work for the patient and/or the caregiver, additional doctor’s office visits, and failure to complete treatment -- all of which contribute to death and disability, and to the $107 billion direct and indirect annual costs of cancer (Healthy People 2010, 2000).


Research in Mind/Body Interventions for Radiation
Patients using guided imagery for coping with radiation therapy reported lower stress levels, more energy, and a better quality of life (Richardson, Post-White, et al, 1997). Patients using audio relaxation and imagery programs reported that they took better care of themselves (Bridge, Benson, et al, 1988). Patients in one study who used radiation-specific guided imagery had “enhanced comfort levels” during treatment, especially in the first three weeks of treatment (Kolcaba and Fox, 1999).

The ability to stay perfectly still is vital during external beam radiation. People using hypnosis have been successful in eliminating unwanted movement (Bertoni, Conardi, et al, 1990), and in coping with claustrophobia during radiation treatments.

Giving patients access to good information (including taped programs for self-help), relaxation training, and Cognitive Behavioral Therapy (CBT) have helped them overcome helplessness and gain a better sense of control (Braden, Mishel, and Longman, 1998; Christman and Cain, 2004; Greer, Moorey, et al, 1992; Johnson, Fieler, et al, 1997). Cognitive Behavioral Stress Management was also effective at lowering cancer patients’ serum cortisol (a stress-related chemical) (Cruess, Antoni, et al, 2000).

The effectiveness of guided imagery, and other mind/body approaches in coping with chronic pain, depression, anxiety, and insomnia have been well documented.


Conclusion
Guided imagery can help patient tolerate radiation therapy, and increase their likelihood of finishing all treatments. It gives patients the tools to improve coping skills, stay relaxed during treatments, and minimize the number and severity of radiation side effects by lowering stress, depression, and anxiety, and promoting a sense of being more in control.


References
Badger TA, Braden CJ Mishel MH. Depression burden, self-help interventions, and side effect experience in women receiving treatment for breast cancer. Oncol Nurs Forum. 2001 Apr;28(3):567-74.

Bertoni F, Bonardi A, Magno L, Mandracchia S, Martinelli L, Terraneo F, Tonoli S. Hypnosis instead of general anaesthesia in paediatric radiotherapy: report of three cases. Radiother Oncol. 1999 Aug;52(2):185-90.

Braden CJ, Mishel MH, Longman AJ. Self-Help Intervention Project. Women receiving breast cancer treatment. Cancer Pract. 1998 Mar-Apr;6(2):87-98.

Bridge LR, Benson P, Pietroni PC, Priest RG. Relaxation and imagery in the treatment of breast cancer. BMJ. 1988 Nov 5;297(6657):1169-72.

[no authors listed] Cancer Facts and Figures 2001. American Cancer Society.
www.cancer.org/downloads/STT/F&F2001.pdf
Accessed September, 2006.

Christman NJ, Cain LB. The effects of concrete objective information and relaxation on maintaining usual activity during radiation therapy. Oncol Nurs Forum. 2004 Mar-Apr;31(2):E39-45.

[no authors listed] Compliance and Compromise Using the Internet to Improve Treatment Adherence (undated). Oncology Net Guide.
www.mdnetguide.com/oncology/v2n5/feature.html
Accessed September, 2006.

Cruess DG, Antoni MH, McGregor BA, Kilbourn KM, Boyers AE, Alferi SM, Carver CS, Kumar M. Cognitive-behavioral stress management reduces serum cortisol by enhancing benefit finding among women being treated for early stage breast cancer. Psychosom Med. 2000 May-Jun;62(3):304-8.

Greer S, Moorey S, Baruch JD, Watson M, Robertson BM, Mason A, Rowden L, Law MG, Bliss JM. Adjuvant psychological therapy for patients with cancer: a prospective randomised trial. BMJ. 1992 Mar 14;304(6828):675-80.

Hagopian GA. The effects of informational audiotapes on knowledge and self-care behaviors of patients undergoing radiation therapy. Oncol Nurs Forum.1996 May;23(4):697-700.

Johnson JE, Fieler VK, Wlasowicz GS, Mitchell ML, Jones LS. The effects of nursing care guided by self-regulation theory on coping with radiation therapy. Oncol Nurs Forum. 1997 Jul;24(6):1041-50.

Kolcaba K, Fox C. The effects of guided imagery on comfort of women with early stage breast cancer undergoing radiation therapy. Oncol Nurs Forum. 1999 Jan-Feb;26(1):67-72.

Malone M, Harris AL, Luscombe DK. Assessment of the impact of cancer on work, recreation, home management and sleep using a general health status measure. J R Soc Med. 1994 Jul;87(7):386-9.

[no authors listed] Radiation Oncology: Treating Cancer with Radiation Therapy. (Reviewed August 7, 2006). University of Iowa Hospitals and Clinics. http://www.uihealthcare.com/topics/medicaldepartments/cancercenter/radiation/radtherapy.html
Accessed September, 2006.

Richardson MA, Post-White J, Grimm EA, Moye LA, Singletary SE, Justice B. Coping, life attitudes, and immune responses to imagery and group support after breast cancer treatment. Altern Ther Health Med. 1997 Sep;3(5):62-70.

Steggles S. The use of cognitive-behavioral treatment including hypnosis for claustrophobia in cancer patients. Am J Clin Hypn. 1999 Apr;41(4):319-26.

U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office, November 2000. www.health.gov/healthypeople/Document/pdf/Volume1/03Cancer.pdf Accessed September, 2006.