Guided Imagery And Progressive Muscle Relaxation as a Cluster of Symptoms Management Intervention in Patients Receiving Chemotherapy: A Randomized Control Trial

Abstract

ObjectivePatients receiving chemotherapy often experience many different symptoms that can be difficult to alleviate and ultimately negatively influence their quality of life. Such symptoms include pain, fatigue, nausea, vomiting and retching, anxiety and depression. There is a gap in the relevant literature on the effectiveness of cognitive-behavioural and relaxation techniques in symptom clusters. The study reflects this gap in the literature and aimed to test the effectiveness of Guided Imagery (GI) and Progressive Muscle Relaxation (PMR) on a cluster of symptoms experienced by patients undergoing chemotherapy.MethodsThis was a randomized control trial with 208 patients equally assigned either in the intervention or the control group. Measurements in both groups were collected at baseline and at completion of intervention (4 weeks). Patients were assessed for pain, fatigue, nausea, vomiting and retching, anxiety and depression. The overall management of the cluster was also assessed based on the patients’ self-reported health related quality of life-HRQoL. Chi-square tests (X2), independent T-tests and Linear Mixed Models were calculated.ResultsPatients in the intervention group experienced lower levels of Fatigue (p<0.0.0225), and Pain (p = 0.0003) compared to those in the control group and experienced better HRQoL (p<0.0001) [PRE-POST: Intervention: Pain 4.2(2.5) - 2.5(1.6), Fatigue 27.6(4.1) - 19.3(4.1), HRQoL 54.9(22.7) - 64.5(23), Control: Pain 3.5(1.7) - 4.8(1.5), Fatigue 28.7(4.1) - 32.5(3.8), HRQoL 51.9(22.3)– 41.2(24.1)]. Nausea, vomiting and retching occurred significantly less often in the intervention group [pre-post: 25.4(5.9)– 20.6(5.6) compared to the control group (17.8(6.5)– 22.7(5.3) (F = 58.50 p<0.0001). More patients in the control group (pre:n = 33-post:n = 47) were found to be moderately depressed compared to those in the intervention group (pre:n = 35-post:n = 15) (X2 = 5.93; p = 0.02).ConclusionThis study provided evidence that the combination of GI and PMR can be effective in the management of a cluster of symptoms in cancer patients receiving chemotherapy. These techniques can complement existing management measures to achieve a comprehensive management of this symptom cluster and increase patients HRQoL.Trial RegistrationClinicalTrials.gov NCT01275872

Randomized controlled trial of a brief cognitive‐behavioral strategies intervention for the pain, fatigue, and sleep disturbance symptom cluster in advanced cancer

“…Consistent with our findings, Mosher and colleagues reported limited improvement in lung cancer‐related pain, fatigue, and breathlessness with training in cognitive‐behavioral and emotion‐focused symptom coping strategies (including relaxation and imagery) as compared with education and support. Our findings contrast with a recent trial demonstrating that a 4‐week imagery and relaxation intervention reduced pain and fatigue in the context of a cancer symptom cluster (pain, fatigue, nausea, vomiting, anxiety, and depression) . However, their intervention included music as an additional active component and was evaluated in patients with early stage, non‐metastatic cancer .…”

A prospective exploration of symptom burden clusters in women with breast cancer during chemotherapy treatment

“…The relevant literature reveals that most of the research on symptoms has been focused either on a single symptom, such as for example fatigue, or on their associated symptoms, such as anxiety and depression [25]. A symptom cluster is a condition where two or more symptoms that are related to each other occur simultaneously [6]. …”

Role of Progressive Muscle Relaxation in Preventing and Alleviating of Nausea and Vomiting Caused by Chemotherapy among Cancer Patients: A Systematic Review of Six Randomized Controlled Trials

“…Of which, nausea and vomiting (CINV) is the most distressing one [7]. Serious nausea and vomiting not only lead to malnutrition, electrolyte disturbances, and dehydration [8], but also greatly impair functional status and the quality of life in cancer patients underwent chemotherapy [9]. It is noted that cancer patients suffering from distressing nausea and vomiting always interrupt chemotherapy regime [10].…”