Improving Pain Management for Women with Metastatic Breast Cancer: Development and Proof-of-Concept Study of a Videoconference Hypnosis Intervention - Summary Over 168,000 women are living with metastatic breast cancer (MBC) in the United States. Pain is common in individuals with MBC, and can be associated with the cancer itself as well as with cancer treatments. Not surprisingly, painmanagement is a critical component of comprehensive cancer care in the MBC setting.It is widely held that comprehensive cancer pain management should incorporate both pharmacologic and non- pharmacologic approaches. Pharmacologic approaches to MBC pain can include opioids, antidepressants, anti- seizure medications, and corticosteroids. Unfortunately, such treatments often have side effects of their own. Furthermore, some pain medications may be contraindicated for patients with comorbidities, and some may be less palatable to patients for reasons like fear of addiction. Fortunately, non-pharmacolgic treatments can have meaningful benefits with no adverse effects. Hypnosis is an evidence-based, mind-body technique, which has a long tradition in adjunctive cancer symptom management, especially for pain. Hypnosis has strong efficacy data for controlling multiple types of pain, has no known specific adverse effects, and self-hypnosis can be taught to patients to self-manage their pain. Additional hypnosis benefits include rapid onset of action and low patient burden. Hypnosis is a particularly apt fit for the MBC setting as once patients learn self-hypnosis, they can use it to self-manage the heterogeneous types of pain they experience. To our knowledge, no hypnosis intervention has been developed or tested as a stand-alone behavioral intervention for the large and growing number of women living with MBC. Those with metastatic cancer often have different needs than those with earlier-stage cancers (e.g., differing pain severity, chronicity, heterogeneity), which is why research is needed focused on their experience. Additionally, despite providers routinely conducting teletherapy since the pandemic, there have been only a handful of studies testing videoconference hypnosis (V- HYP), and none in cancer. Telehealth is the new norm, and is the least burdensome approach for patients whose pain might be a barrier to in-person attendance. Thus, data is clearly needed to guide tele-hypnosis intervention designs and delivery. The proposed project will begin to fill these research gaps. The goal of this study, guided by the ORBIT model and neuromatix pain theory, is to: 1) develop, refine, and test the acceptability of V-HYP and videoconference attention control (V-AC) interventions for MBC pain (Aim 1). Intervention content and format will be informed by qualitative data and acceptability surveys during successive 5-person cohorts for each arm [n=30 (15 V-HYP, 15 V-AC)]. We anticipate that V-HYP will involve 3 weekly sessions with at-home practice; 2) Women with MBC (n=60) will be enrolled in a randomized feasibility (Aim 2) and proof-of-concept (Aim 3) study. We will examine feasibility with regard to a priori benchmarks, and changes in pain over time (4-week follow-up). Results of this project will directly inform a future RCT to evaluate V-HYP efficacy, to understand mediators and moderators of V-HYP effects, and to establish cost-effectiveness.
