Psychologist Helps Breast Cancer Patients Cope with Radiation Treatment

Cancer Training Branch

Clinical psychologist Julie B. Schnur, Ph.D., is using an NIH Career Development Award* to study a promising cognitive-behavioral therapy (CBT) in combination with hypnosis to help breast cancer patients deal with the pain and emotional distress from skin damage caused by radiation treatment.

“I’ve always been interested in working with cancer patients,” noted Dr. Schnur who is an assistant professor in the Department of Oncological Sciences, Integrative Behavioral Medicine Program, at the Mount Sinai School of Medicine in New York City. Her first research project as an undergraduate was a qualitative study on childhood cancer survivors and their parents and the predictors of PTSD (post-traumatic stress disorder). She continued to pursue cancer research through her post-doctoral fellowship at Mount Sinai. “It’s a great experience to be able to continue to learn more about research and also use my clinical skills interacting with patients,” she said.

Dr. Schnur worked with her post-doctoral mentor Guy Montgomery, Ph.D., on his study of the CBT/hypnosis intervention to treat fatigue in breast cancer patients (see related story, page 26). Dr. Montgomery told her about the NIH career award program. “As I was talking with these patients about fatigue, they also started talking to me about the radiation-induced skin changes, how ugly they felt, how it interfered with their sleep, and how it hurt,” she recalled. Finding little information about the problem in medical literature, Dr. Schnur applied for the NIH grant to test the CBT/hypnosis method to combat the effects of acute skin toxicity in patients undergoing radiation.

The CBT involves teaching patients to identify negative thoughts and learn how to “debate” those thoughts – to ask themselves if negative thinking is helping them or causing them more stress – and helping the patients to exchange those thoughts for more helpful, positive thoughts. In twice-weekly sessions with the patients, Dr. Schnur discusses their CBT workbook entries and conducts brief hypnosis sessions to provide suggestions to reduce their overall stress levels and focus on coolness, “because the skin damage can feel like a burn”, as well as healing, reduced pain, and comfort.

She has completed the initial qualitative phase of the study, interviewing 20 breast cancer patients to develop a better description of the skin problems related to radiation toxicity. Dr. Schnur plans to enroll 144 women into a randomized clinical trial of CBT/hypnosis compared to a control group of patients who will receive non-therapeutic, twice-weekly consultations with her.

If the intervention proves effective, it could be a “terrific complement to current medical treatments for these patients,” Dr. Schnur said. “All of the distress and psychological reactions to this problem aren’t dealt with by a purely medical approach.”