A randomized trial comparing live and telemedicine deliveries of an imagery-based behavioral intervention for breast cancer survivors: reducing symptoms and barriers to care.

OBJECTIVE: This multi-site randomized trial evaluates the quality of life (QOL) benefits of an imagery-based group intervention titled 'Envision the Rhythms of Life'(ERL). METHODS: Breast cancer survivors >6 weeks post-treatment were randomized to attend five weekly 4-h group sessions at a community center with therapist present (live delivery (LD), n = 48), therapist streamed via telemedicine (telemedicine delivery (TD), n = 23), or to a waitlist control (WL) group (n = 47). Weekly individual phone calls to encourage at-home practice began at session one and continued until the 3-month follow-up. Seven self-report measures of QOL were examined at baseline, 1-month and 3-month post-treatments including health-related and breast cancer-specific QOL, fatigue, cognitive function, spirituality, distress, and sleep. RESULTS: The Bonferroni method was used to correct for multiple comparisons, and alpha was adjusted to 0.01. Linear multilevel modeling analyses revealed less fatigue, cognitive dysfunction, and sleep disturbance for LD and TD compared with WL across the follow-up (p's < 0.01). Changes in fatigue, cognitive dysfunction, sleep disturbance, and health-related and breast cancer-related QOL were clinically significant. There were no differences between LD and TD. CONCLUSIONS: Both the live and telemedicine delivered ERL intervention resulted in improvements in multiple QOL domains for breast cancer survivors compared with WL. Further, there were no significant differences between LD and TD, suggesting telemedicine delivered ERL intervention may represent an effective and viable option for cancer survivors in remote areas.

The experience of imagery as a post-treatment intervention in patients with breast cancer: program, process, and patient recommendations.

PURPOSE/OBJECTIVES: To better understand the common themes of women participating in an imagery program designed to improve quality of life (QOL). RESEARCH APPROACH: Qualitative. SETTING: Classroom setting at Alaska Regional Hospital in Anchorage. PARTICIPANTS: 10 women with a confirmed diagnosis of breast cancer who had completed conventional care participated in a six-class, eight-week-long imagery program titled Envision the Rhythms of Life (ERL). METHODOLOGIC APPROACH: Focus group audio recordings and notes were interpreted with the Krueger focus group method and confirmed by an outside evaluator. MAIN RESEARCH VARIABLES: Breast cancer survivors' descriptions of imagery practice and experience as they created passive, active, and targeted imagery. FINDINGS: Participants reported the importance of engaging passive and active imagery, letting targeted imagery take on a life of its own, performing homework, understanding the science, practicing, hearing imagery stories, engaging all the senses, trusting imagery, and group interaction. Imagery practice improved mood state. CONCLUSIONS: When delivered by expert imagery trainers in collaboration with oncology nurses, ERL can improve breast cancer survivors' QOL. The present study is one of few reports that evaluated survivors' imagery experiences from a clinical trial and produced significant QOL improvements. INTERPRETATION: The present study provides oncology nurses understanding of the psychological risks faced by breast cancer survivors after completion of primary care and explains the critical need for post-treatment programs for survivors dealing with post-traumatic stress disorder, depression, anxiety, or high levels of stress.

Imagery intervention for recovering breast cancer patients: clinical trial of safety and efficacy.

In a phase I National Cancer Institute (NCI)-funded clinical trial, 34 breast cancer survivors, six weeks to one year post-treatment, were recruited to participate in a 6-class, 8-week long imagery stress reduction program entitled "Envision the Rhythms of Life." Patients practiced imagery during and between sessions. Outcomes for quality of life and cortisol rhythm were assessed pre- to post-intervention, in two subsets of survivors (intravenous [IV] chemotherapy, or no IV chemotherapy). Thirty survivors completed the 8-week program. Quality of life outcomes demonstrated statistically and clinically significant outcomes for the functional assessment of cancer therapy-general (FACT-G) global index (p<.001), representing improvements in survivor quality of life related to physical, social/family, emotional, and function well-being. Survivors also improved significantly on the breast cancer (p<.001) and spiritual subscales (p = .008.) Brief symptom inventory (BSI) assessment reported significant improvement for the global index (p<.001) which included the categories of depression, somatization and anxiety. At eight weeks, cortisol rhythm, a biochemical indicator of stress and likelihood of cancer recurrence, produced a trend toward improvement for the fifth time point of the day (p = .18). Likert-based stress scales showed highly significant reductions in stress (p<.0001) with subjects practicing imagery the most producing the best scores. Outcomes suggest the imagery program may significantly improve survivor quality of life and reduce stress.