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

Abstract

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-hour 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 group (WL, 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 and 3 months post-treatment 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. LMM analyses revealed less fatigue, cognitive dysfunction, and sleep disturbance for LD and TD compared to 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 to a waitlist control. Further, there were no significant differences between live- and telemedicine-delivery, suggesting telemedicine delivered ERL intervention may represent an effective and viable option for cancer survivors in remote areas.

eHealth and mHealth interventions in the treatment of fatigued cancer survivors: A systematic review and meta-analysis

“…The eHealth interventions used in the eligible studies were albeit heterogeneous and diverse in type and content. eHealth interventions adopted in the eligible studies included educational programs and behavior change interventions, including psycho‐educational modules on fatigue, anxiety, depression, diet, exercise, sleep, and social relationships, mindfulness‐based cognitive therapy, and an imagery‐based behavioral intervention . Two studies investigated a web‐based exercise intervention …”

“…A range of different outcome measures was used. In 6 studies (67%), a significant reduction in fatigue was reported for the intervention group relative to the comparison group after 9 weeks (CIS: P < 0.01); MFSI‐SF: P ≤ 0.001), after 12 weeks (BFI: P < 0.01); (BFI: P ≤ 0.001; FSS: P ≤ 0.001) and after 6 months of follow‐up (R‐PFS: P < 0.01); (CIS‐fatigue severity: P < 0.05) …”

“…Secondary outcomes included psychometric instruments to measure HRQoL, depression, psychological distress, sleep, pain, physical and mental functioning, and eating habits. Three out of 6 studies identified significantly improved HRQoL both 12 weeks and 6 months following completion of the web‐based intervention . Six studies included at least 1 outcome measure to assess depression.…”

“…A significant reduction in depression was reported at 9‐week, 12‐week, and 6‐month follow‐up. Psychological distress was assessed in only 2 studies, with 1 study indicating a clinically relevant decrease in psychological distress at 12 weeks of follow‐up . Likewise, sleep behavior (sleep quality and insomnia) was evaluated in 4 studies, all RCTs; 3 of these 4 studies revealed any significant improvement, which was measured 9 weeks, 12 weeks, and 6 months after the intervention.…”

Cancer Symptom Cluster Management

“…Studies testing interventions such as exercise (e.g., walking, Qigong), massage, and psychological strategies (e.g., guided imagery, virtual reality) have evaluated effects on overall symptom burden or symptom distress. 35–40 Secondary effects of physical symptom interventions on related psychological outcomes are also common. For example, changes in anxiety, mood, and sleep have been evaluated as secondary effects of interventions to reduce hot flash severity.…”