March 2007: Complementary Medicine Techniques

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Reducing side effects from Femara?

Question from Vikki: I'm 6 months post last chemo treatment and still feel down. I think it's due to the side effects from Femara. How can I reduce these side effects using adjuvant treatments? I used music during my treatments, but these side effects (fatigue, hot flashes, severe joint and muscle pain, headaches) are different.

Answer —Beth DuPree, M.D., F.A.C.S.: The side effects from Femara and chemotherapy treatment can feel daunting initially. There are many complementary modalities that can be used in order to combat these symptoms. If music therapy during your chemotherapy was successful in helping you alleviate the side effects from chemotherapy, you may want to revisit this as a modality. If the fatigue, hot flashes, joint, and muscle pain cannot be improved, you may want to try another modality such as Reiki or massage in order to help alleviate the symptoms.

This is certainly something you should discuss with your medical oncologist, as some of the side effects may be coming initially from having started on the Femara and may dissipate themselves. When chemotherapy is completed, there is often a period of time that is very difficult to transition when you are returning to living your daily life after the treatment of breast cancer. So some of your symptoms may also be coming from getting back to a new starting point in your life overall since the diagnosis of cancer. After discussing this with your oncologist, if the side effects that you're having are not improving, I would suggest trying a complementary therapy such as Reiki, massage, or acupuncture to help alleviate the symptoms.

Speed up recovery of damaged nerves?

Question from Cathy: My daughter has very painful tingling in all fingers and toes. Her last chemo was September 2006. Lately she's fallen down a few times as her feet were "dead." Anything you can suggest to speed up recovery of the nerves and/or relieve the pain? Does massage help the nerve endings?

Answers —Lorenzo Cohen, Ph.D: The sensation of tingling and numbness in both the feet and hands as a result of chemotherapy is very common. Unfortunately, there are very few conventional treatments to help combat this problem. It is important, however, to make sure that your medical oncologist knows of this problem, and to make sure he/she knows the severity of this problem if it's actually interfering with balance and mobility. There are some complementary therapies that should be explored to help with peripheral neuropathy, as it's called—the sensation of tingling in the hands and feet. One that's being explored extensively is the use of acupuncture to help with this problem. You should be able to tell after a relatively short period of time whether it's going to relieve some of the sensations.

Reiki as well as light touch massage may also be useful, but there isn't a lot of evidence to suggest that these modalities will be useful, simply because there hasn't been the research conducted. We do know that over time the sensations should dissipate. On average, it can take up to a year or a year and a half before the tingling fully disappears. However, as mentioned at the beginning, it is very important that all conditions are discussed with your daughter's medical oncologist.

Beth DuPree, M.D., F.A.C.S.: Acupuncture has been very successful in my practice with these symptoms, and for those patients who have an aversion to needles after their extensive treatment, acupuncture treatments can be performed with sound and vibrational energy. So don't let a fear of needles prevent you from seeking acupuncture as a complementary modality.

Importance of prayer?

Question from Ellen: What is your feeling about the importance of prayer?

Answers —Beth DuPree, M.D., F.A.C.S.: Prayer is an incredibly important aspect of nearly every religious practice in the world. There have been clinical trials such as the STEP study in which patients undergoing cardiac surgery were randomized to receive prayer remotely versus no prayer at all. There were several potential flaws in that study that did show a significant difference in the patients who received the prayer. As Reiki is a form of focused concentrated energy, it has also been likened to a form of prayer as well. As for my practice and many other physicians that I work with, we feel that the energy that is focused through prayer on our patients' highest healing intention is of the utmost importance. It is very difficult to perform a clinical trial on something as vast and potentially powerful as prayer. Clearly no harm will come from prayer, and potentially only good will come from this process. Therefore, I encourage my patients to give and receive prayer and I personally participate in this practice as well, as I work as a surgeon for the highest healing intention for each individual patient.

Lorenzo Cohen, Ph.D: It's important to distinguish between self-prayer and other prayer: prayer as a form of meditation that one would do by oneself, and then prayer as Dr. DuPree has mentioned that can also come from another individual for the receiver's benefit. Now, the distant prayer, the latter one that was mentioned, is probably one of the most controversial areas of research in complementary medicine combined with conventional medicine. Less controversial is the concept of self-prayer, and we know from a lot of research that one's involvement in one's faith and spirituality, whether it's organized religion or just a self spiritual practice, can be extremely useful in coping with life-threatening illnesses such as cancer.

Herbs, oils to avoid for ER-positives?

Question from CrystalCat: I was diagnosed with strongly hormone-receptor-positive breast cancer. What herbs and/or essential oils should I avoid? I do lots of aromatherapy and hear that certain oils like clary sage contain or mimic estrogens, which obviously I want to avoid as much as I can.

Answers —Beth DuPree, M.D., F.A.C.S.: As I am not aware of the estrogenic effects of clary sage, I do not feel comfortable making a comment about its use in ER-positive breast cancer.

Lorenzo Cohen, Ph.D: There's a good reason to be concerned about the use of different herbs and essential oils in general, but in particular when one has a hormone-sensitive breast cancer. This area is probably one of the most complicated areas in working with patients in the field of complementary medicine, and it is very important to get information on this topic from dietitians and nutritionists, as well as physicians who have solid expertise in this area.

Complementary therapies prescribed?

Question from Liz: Typically, are complementary therapies prescribed by the physician or self-prescribed?

Answers —Lorenzo Cohen, Ph.D: The majority of the U.S. population is engaging in complementary practices, whether they are mind/body, dietary supplements, or special diets, not under the guidance of a physician. However, the field of complementary medicine is growing dramatically year by year and there are more physicians who are getting continuing education in this area. In addition, the majority of the more prestigious medical schools in the country now offer education in complementary and integrative medicine, so the newer generation of physicians will graduate with much more knowledge in this area. It is important to always share the practices that you engage in with your physician, to help start an open dialogue.

Beth DuPree, M.D., F.A.C.S.: We are clearly in a time of change, and the integration of complementary therapies is becoming more widely seen in standard medical practices. It is very important to be a partner with your health care provider so there are no secrets about what therapy, supplements, herbal remedies, or other therapies you are seeking or participating in. Many physicians are beginning to be much more open-minded about the role the complementary therapies play in the healing processes of patients and by physicians and patients partnering in this way. Take for example our new facility which will open in a few weeks, where our holistic spa is the same square-footage as our operating rooms. As a surgeon trained in Western medicine, I have learned to embrace the importance of healing modalities and have become a Reiki master practitioner myself in order to help my patients before, during, and after their surgical treatments. This is certainly not the norm, but more and more physicians are becoming open and inquiring about how they too can incorporate these aspects into their practices.

Complementary therapies at treatment centers?

Question from Jean Van Etten: What is the future of some of these complementary services at treatment centers? What will it take for more to offer them to patients?

Answer —Lorenzo Cohen, Ph.D: One of the challenges in the field of conventional medicine is that everything tends to be based on what is called "evidence-based" medicine. Typically, that means preparing. It also means intervention, whether that be something you take as a pill from a pharmaceutical company compared to an herbal remedy, or whether it's acupuncture compared to a placebo needle. But in reality, when conventional physicians practice medicine, it's surprising to many but true that they don't always practice evidence-based medicine. It's interesting when it comes to prescribing a pharmaceutical drug that if it is done off-label (they are using the drug for an indication of which there isn't strong evidence in terms of randomized placebo trials), that is often accepted. However, if that same physician were to use an herb for that same condition, that is somehow viewed very differently.

I think that the major medical centers in this country have now accepted this field of integrative medicine in some form or another. I work at M.D. Anderson, one of the largest and most respected cancer centers in the country. We have had an incorporation of these complementary modalities since 1998. At that time we were the first comprehensive cancer center to have such an on-site facility. Very shortly after that, many of our competitors across the country opened similar centers. I think within the next decade, there will be a minority of medical centers that don't offer some form of treatment modalities that are covered under the umbrella of complementary and integrative medicine. I feel that it's not going to move forward just because of the evidence. The evidence is important, and more research showing what works and what doesn't work will be useful. But it's also having the medical establishment learn the difference between curing and healing.

Therapies covered by Medicare/HMO?

Question from EH: Are complementary medicine techniques covered under Medicare/HMO coverage? My mother-in-law just had a mastectomy and would be interested, but what is the cost? Can my wife and I defer the costs with our coverage plans?

Answers —Lorenzo Cohen, Ph.D: Some complementary and integrative modalities are covered by different insurance plans and HMOs. The first thing, of course, is to check with the one you are covered by to see. In general, the majority of complementary medicine modalities are not covered yet by the major carriers in the US. However, there are many HMOs that have some of these services bundled as part of the package. For example, Kaiser on the west coast covers many of these modalities. At M.D. Anderson, our integrative medicine program offers all these services free of charge except for a nominal fee for acupuncture and massage.

Beth DuPree, M.D., F.A.C.S.: My belief in the importance of these complementary therapies was my reason for starting the Healing Consciousness Foundation, which provides funding for these services that are so essential to the healing process of women and men when facing the diagnosis of breast cancer. The therapies are so needed that at the time of the diagnosis of cancer, it is very difficult for patients who could even afford the therapies to go forward with them. Therefore, our facility providing these services allows them to understand the importance of learning to nurture themselves and to find a safe place where they can begin their healing process.

Acupuncture for radiation to lung?

Question from Eastman: I am currently undergoing radiation for a metastatic tumor in my lung. How can acupuncture help during this treatment?

Answer —Lorenzo Cohen, Ph.D: Acupuncture can be useful for helping to combat many of the side effects that are experienced due to conventional treatments. Unfortunately there isn't a lot of evidence from the typical randomized trials that we like to see before we suggest the use of acupuncture to help manage certain symptoms. With that said, we know that acupuncture is very safe when performed by a well-qualified acupuncturist. So the risk and the downside to trying acupuncture is minimal. The main cost is in terms of financial and time commitments. In terms of side effects from radiation treatments, some people find acupuncture can help to improve your overall sense of well-being, to increase your energy, to decrease fatigue, to improve sleep quality, and perhaps to improve difficulty with breathing, depending on the origin of that difficulty. Acupuncture is something that is worth trying.

Lymphedema risk from acupuncture?

Question from Piks: Can you please address the issue of lymphedema risk from acupuncture anywhere in the affected quadrant(s)? Thank you!

Answer —Beth DuPree, M.D., F.A.C.S.: The risk of lymphedema following an axillary node dissection is a risk that is present for life. Any stress on the lymphatic system could potentially initiate what I call a "cascade effect" where a previously asymptomatic arm could become affected by lymphatic channel blockage, otherwise known as lymphedema. In my patients who have had an axillary node dissection, I have them refrain from using acupuncture with needles as a modality of treatment. I prefer that they use vibrational acupuncture techniques on that affected arm. This is what I would call a "relative contraindication," not an absolute contraindication. I prefer to avoid any type of breakage in the skin surface in an arm that has had a level 1 and level 2 axillary lymph node dissection. In patients who have had only a sentinel node biopsy, I will discuss with them on a case-by-case basis whether I feel acupuncture with needles would be appropriate.

No massage during radiation?

Question from Moreca: Why would I not be able to receive massage therapy while I'm doing radiation treatments? Is it a problem for me, or is there some risk for the therapist?

Answers —Lorenzo Cohen, Ph.D: There's no reason why a woman with breast cancer receiving radiation couldn't receive massage concurrently.

Beth DuPree, M.D., F.A.C.S.: I agree. I don't think there's a contraindication either.

Lorenzo Cohen, Ph.D: The massage therapist needs to be aware of the diagnosis of cancer and they need to be appropriately trained to work with people with cancer. But that is a general rule of thumb that one should follow when you are undergoing radiation treatment. There is no contraindication for the massage therapist.

New research on Chinese medicine?

Question from Mcec: Is research being done on complementary treatments like Chinese medicine and qi gong to develop further their approaches in the fight against breast cancer, or do they mainly continue to use their thousands-years-old techniques?

Answer —Lorenzo Cohen, Ph.D: There is a lot of research being done around the world examining the benefits of indigenous medical systems such as Chinese medicine and Ayurvedic medicine, which comes from India, and their utility for fighting cancer. We have a grant funded by the National Cancer Institute to examine the role of traditional Chinese medicine in cancer treatments. We have projects examining the natural products, both from plants and animals, actually affecting the tumor. We are conducting acupuncture research, as well as examining the benefits of qi gong for women with breast cancer undergoing radiation treatment. The NIH as well as many pharmaceutical companies have a big interest in exploring the indigenous herbs from other countries seeking to discover new treatments for cancer.

Studies on yoga as exercise?

Question from Alton: Are there any studies either in process or already completed that assess the benefits of yoga as part of a weekly/daily fitness program on breast cancer side effects from chemo or radiation or of recurrence? I know that exercise is a very positive factor, and wonder if yoga is in "the mix" for research yet? Thanks!

Answer —Lorenzo Cohen, Ph.D: At M.D. Anderson we have a very active treatment program looking at the benefits of yoga for people with cancer. Our first study examined the benefits of a form of yoga from the Tibetan tradition for patients with lymphoma, and the main finding was an improvement in patients' sleep quality. We conducted a follow-up study for women with breast cancer who were undergoing active treatment or in the first year after treatment, and we found the yoga group compared with the control group had a reduction in intrusive thought, the unbidden, unwanted thoughts of cancer that intrude on our lives, and a reduction in cancer-related symptoms. We conducted a subsequent Hatha yoga study (yoga from the Indian tradition) for women undergoing radiation treatment, and found that by the end of radiation the women who had been doing yoga throughout treatment had a better quality of life than did the women who had not participated in yoga.

There is also research to suggest that for women who are feeling fatigued after treatment has ended, a program of yoga can be very helpful to alleviate symptoms. What is unique about yoga and other movement-based mind/body therapies is that they incorporate a calming, centering aspect of meditation at the same time as allowing the person to be physically active. Both of these together can be quite useful to help in the recovery and healing process.

Music for breast cancer patients?

Question from SuzR: I'm curious what types of music breast cancer patients find most helpful. I have used a wide variety of music to help me get through various stresses and procedures—is there a pattern to types that are deemed most helpful?

Answers —Lorenzo Cohen, Ph.D: This is a very interesting question. I think that music is very personal, and what may be useful for one person may not be for another. It is important when thinking about or wanting to use music to help therapeutically to not only focus on songs that may be slow and relaxing, but also to think about how the music makes you feel. As music is very personal, what may be uplifting to one person may be very sad for another person, due to how they associate with that music. As far as I know, there is no specific research that has examined specific forms of music being more or less useful for helping with the recovery process.

Beth DuPree, M.D., F.A.C.S.: I ask my patients what music they would like to listen to when going to sleep in the operating room. Many will bring a CD with them to play in the operating room to listen to, which is clearly their preference, and others prefer that I pick the music, as they want me to be happy when performing the surgery! Either way works great with me.

Comment on acupressure, guided imagery?

Question from CarolW: I utilize acupressure treatment to combat pain and nerve damage from sentinel node biopsy and also use guided imagery, specifically Dr. Bernie Siegel's tapes and CDs. Any comment on those?

Answers —Beth DuPree, M.D., F.A.C.S.: There is a clinical trial that was performed in southern California using guided imagery in a pre-operative setting. The study looked at women undergoing hysterectomies, and the groups were divided into those patients receiving standard preoperative nursing instructions, and those patients receiving guided imagery tapes or CDs to use the week before surgery, the day before surgery, and immediately before surgery. The study showed a decrease in the number of days admitted to the hospital, an average of $2,000 less in charges per patient, and an overall sense of well-being that was expressed by the patients participating in the guided imagery. The usage of pain medicine was also decreased in the guided imagery group. I have not listened to Dr. Seigel's tapes or CDs, but if they are a source of a healing modality that is helping to combat and treat pain from the sentinel node biopsy, then I can certainly see how they can be effective given the results of other trials looking at guided imagery.

Lorenzo Cohen, Ph.D: Acupressure can be very useful for helping to combat different forms of pain. We know from research that it is not necessary to puncture the skin to get some of the benefits that come from the knowledge of Chinese meridian-based systems on which acupuncture is based.

Therapies to help nausea, taste?

Question from LindW: Is there any way to use adjunctive treatment to diminish nausea and especially the altered taste effect of chemotherapy and Neulasta? For example, I had a piece of Italian creme cake 7 days after my treatment, and it tasted like licorice! Nothing tastes right. Is there anything else I can do to help with this

Answers —Beth DuPree, M.D., F.A.C.S.: I have had several patients who have had the sensation or the side effect of altered tasting after chemotherapy. Most patients experience a metallic taste during the chemotherapy session itself, and I recommend to those patients that they bring a Slurpee or their favorite flavor of water ice in order to gently bathe their mouths with a pleasing taste during the chemotherapy. As for an altered sense of taste seven days after chemotherapy, I am not sure of the cause of that process. But one would think this would be a self-limited process that will correct itself, as I have had no patients who have had continued problems once their chemotherapy is completed. For nausea, again acupressure can be used during chemotherapy. As many people have seen on cruise ships, the acupressure bands around the wrist are used to help combat the feeling of nausea that comes with seasickness. Acupuncture can also be very effective in combating chemotherapy and post-operative nausea as well.

Lorenzo Cohen, Ph.D: Different mind/body techniques such as guided imagery or meditation can also be useful in combating the nausea and other symptoms that women experience during chemotherapy.

Therapies for after treatment?

Question from CSD: Are there alternative therapies to help survivors after treatment is completed? I have found it hard to focus on the "normal" issues of aging without feeling like I must have some kind of medical treatment for everything! I have been doing yoga, which helps a bit.

Answers —Beth DuPree, M.D., F.A.C.S.: Breast cancer is a diagnosis which changes one's perspective on the world. It is very important to realize that once you have gone through an illness that requires you to face your mortality, you no longer look at life the way you did prior to breast cancer. Patients who feel as though they will return to their so-called "normal" life when their cancer therapy is completed are often at a loss to be able to regain that area that they had originally come from. That is not to say that this is a bad thing, but understand that going through the process of the diagnosis and treatment of breast cancer brings about a shift in how you view the world and yourself. Breast cancer requires you to become focused in the moment. There's no going back to the past to change things that have been undone, and fear about what the future holds needs to be released.

So from my perspective, it's about resetting what the norm is in your life and creating a sense of well-being and wellness in each and every day. Aging is a wonderful process that occurs naturally, and is something that all of us hope to experience with a healthy existence. Yoga can be a wonderful way to totally bring you to a place where you become present in the moment, and the more that you can begin to live in the moment, the more you will realize what a gift the present truly is.

Lorenzo Cohen, Ph.D: In terms of what one should be physically taking, it is very difficult to know. There are many herbs, supplements, vitamins, and special diets that people are told about that are being claimed to be useful for cancer treatment or cancer prevention. Unfortunately, there isn't a lot of information in this area, which makes it very complicated in trying to navigate which way to turn. It is always best to try and receive the majority of the positive benefits from the supplements through eating a healthy diet. That doesn't just mean low-fat or high fiber, but it means eating a diet that is rich in varieties of vegetables, for example. Eating fresh vegetables and in general eating a balanced diet.

There is, however, a lot more information available today than even just a few years ago on many herbs and supplements. When looking for information on the Internet, it is important to try to focus on authoritative websites that are either sponsored by universities or academic medical centers or by government agencies. One such website that we feel is very useful, specifically for information on complementary and integrative medicine for cancer, is our website at www.mdanderson.org/cimer where we provide authoritative reviews on over 80 different modalities specifically relevant to cancer. There are, however, many others including Natural Medicine, Natural Standard, the National Cancer Institute, and the American Cancer Society.

Qi gong, yoga and recurrence rates?

Question from kkost: Is there any research on the impact of qi gong or yoga on recurrence rates?

Answer —Beth DuPree, M.D., F.A.C.S.: To the best of my knowledge, I do not believe that there are any prospective randomized trials looking at recurrence rates looking at qi gong or yoga. Again, one of the focuses of complementary medicine and integrative therapies is an understanding of the difference between curing disease and healing. If someone's cancer is physically removed from their body and the cancer no longer exists, but that patient sits alone in the darkness of their home living in fear that cancer will return, they are technically cured of their disease but are not healed. In contrast, someone whose cancer [still exists], although they may not be cured of cancer, they can certainly find healing and therefore be positively affected by a modality that helps them to reach that safe place.

Treating tamoxifen side effects?

Question from AnneC: I have a lot of problems with tamoxifen—extreme vaginal burning and dryness, extremely heavy periods, very fatigued, and body aches. I take Effexor for night sweats but still have the other symptoms. My oncologist doesn't seem to have any solutions. Are there complementary possibilities?

Answer —Beth DuPree, M.D., F.A.C.S.: The side effects of tamoxifen that mimic menopausal symptoms can be very devastating. Acupuncture has been successful in clinical trials used in women for hot flashes. As far as the vaginal dryness and the burning sensation, there are personal lubricants such as Astroglide that can help with the symptoms of the vaginal dryness. As for the extremely heavy periods, this is something that I would absolutely discuss with your gynecologist to determine if this is normal for you or if it is caused by an increase in stimulation to the lining of your uterus.

What can help with insomnia?

Question from ABerry: What has been shown to help the most with insomnia?

Answer —Lorenzo Cohen, Ph.D: It is hard to answer the question concerning what has been shown to work the most or most effectively. There are many different causes of insomnia, and insomnia is a very common problem especially in the Western hemisphere, if not around the globe. There are, of course, many prescription medications that are useful sleep aids. But we also know that they do not always improve the specific stages of sleep that are most important for restoration, such as deep sleep.

Meditation, other forms of stress management, and physical activity can all be helpful in improving sleep quality. Although there has been little research in the role of acupuncture when treating sleep disorders, it should still be considered and tried as a technique to help with this problem. As was mentioned earlier, the only downside to acupuncture is a bit of time and a bit of money. If it doesn't work, then there hasn't been a great loss and if it does work, it feels like a miracle. Melatonin is something else that could be tried. However, this remains somewhat controversial. One of the newer pharmaceutically produced sleep aids on the market is what's called a melatonin agonist, meaning that this product stimulates the release of melatonin in the brain. It is thought to help with insomnia.

What is emotional writing?

Question from AngelaX: What is emotional writing? Does it improve your physical health?

Answer —Lorenzo Cohen, Ph.D: Emotional writing, or what is often called expressive writing, is a very specific intervention that has been studied since the mid-1980s. Dr. James Pennebaker originally conducted this research with undergraduates, and had them write their deepest thoughts and feelings about the most traumatic events in their lives. The idea in one's writing is to write things that perhaps you have never shared with anyone else, to really dig deeply inside yourself and put that on paper. This form of expressive writing is typically done very acutely for three or four different sessions over a one-week period of time. It is very different from journaling, because the objective here is to do it just for a short period of time, and to really delve deeply into your feelings about a difficult situation.

This specific form of writing has been found to have an effect on mainly physical outcomes. People have investigated changes in the immune system and found that people will respond faster to a vaccination if they were in the writing group as compared with the control group, and their immune function increases compared with a control group. A study comparing women with breast cancer at the end of their treatment found fewer visits to the clinic in the follow-up period with breast cancer related issues if they had been in this very brief expressive writing group. A small study that we did for people with kidney cancer found improved sleep quality after only four sessions of this expressive writing. There is a lot of ongoing research around the world looking at this particular form of writing and what the physical and psychological benefits can be. It is important to note that there can be an increase in negative mood for a short period of time after doing this type of writing. But what is also unique about this type of writing is that you as the writer can titrate how deeply you go.

Techniques to boost immunity?

Question from Bricker: Are there any techniques that boost immunity?

Answer —Lorenzo Cohen, Ph.D: In the world of cancer and our health in general, we are always under the belief that an increase in our immune system functioning is a good thing. But what's important to consider is that higher is not always better when it comes to our immune systems, and if we look to other indigenous medicines of the world, the focus is typically on balance. So if one has an increase in certain aspects of our immune system, that could actually be associated with different disease states. We know that arthritis and other inflammatory disorders are due to an overactive immune system, at least in terms of certain components. We now know that the majority of cancers are due to an inflammatory process and not due to a decrease in our immune surveillance systems when cells go awry.

With that said, there is research showing that stress, chronic stress in particular, stresses parts of the immune system that are useful in combating cancer. Chronic stress can increase inflammatory processes, and can have a direct impact on aspects of cell functioning which novel drug discoveries and cancer treatments are trying to target. So any type of mind/body modality that can help you to manage unwanted stress in your life will help to bring your immune system more in balance. There are a number of herbs and supplements that purportedly help to boost the immune system. What is again important to note is that if you have a well-functioning immune system, boosting it may not be very helpful. In terms of herbs and supplements, it is important to always discuss this with your oncologist and health care provider as well as people who are knowledgeable in the area of cyto-medicine.

Hypnosis and fear of recurrence?

Question from Momof2: How can hypnosis help with the fear of recurrence?

Answer —Beth DuPree, M.D., F.A.C.S.: Hypnosis is a form of focused concentration. It is not a modality in which control is lost. It can be very helpful in helping someone to gain a sense of control over issues in their life that they may feel are surrounding them. Hypnotherapy as a modality can be successful in alleviating desires such as smoking and overeating; as well, it can be used in alleviating a fear such as a fear of heights, a fear of abandonment, and therefore can also be helpful in alleviating the fear that many times paralyzes someone when diagnosed with cancer. There are hypnotherapy and meditative tapes and CDs that are very good at promoting the healing process. My favorites are those of Brian Weiss, a psychiatrist who has used hypnotherapy very successfully in his clinical practice for these such symptoms.