Mind-Body Treatments for the Pain-Fatigue-Sleep Disturbance Symptom Cluster in Persons with Cancer
Open accessAbstract
Context Co-occurring pain, fatigue, and sleep disturbance comprise a common symptom cluster in patients with cancer. Treatment approaches that target the cluster of symptoms rather than just a single symptom need to be identified and tested.Objectives To synthesize evidence regarding mind-body interventions that have shown efficacy in treating two or more symptoms in the pain-fatigue-sleep disturbance cancer symptom cluster.Methods A literature search was conducted using CINAHL, Medline, and PsychInfo databases through March 2009. Studies were categorized based on the type of mind-body intervention (relaxation, imagery/hypnosis, cognitive-behavioral therapy/coping skills training [CBT/CST], meditation, music, and virtual reality), and a preliminary review was conducted with respect to efficacy for pain, fatigue, and sleep disturbance. Mind-body interventions were selected for review if there was evidence of efficacy for at least two of the three symptoms. Forty-three studies addressing five types of mind-body interventions met criteria and are summarized in this review.Results Imagery/hypnosis and CBT/CST interventions have produced improvement in all the three cancer-related symptoms individually: pain, fatigue, and sleep disturbance. Relaxation has resulted in improvements in pain and sleep disturbance. Meditation interventions have demonstrated beneficial effects on fatigue and sleep disturbance. Music interventions have demonstrated efficacy for pain and fatigue. No trials were found that tested the mind-body interventions specifically for the pain-fatigue-sleep disturbance symptom cluster.Conclusion Efficacy studies are needed to test the impact of relaxation, imagery/hypnosis, CBT/CST, meditation, and music interventions in persons with cancer experiencing concurrent pain, fatigue, and sleep disturbance. These mind-body interventions could help patients manage all the symptoms in the cluster with a single treatment strategy.
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Meta-analysis confirms that psychological interventions such as CBT reduce physical symptoms across the cancer continuum into survivorship.
“Meta-analysis confirms that psychological interventions such as cognitive behavioral therapy (CBT) are effective in reducing physical symptoms across the cancer continuum into survivorship [15].”
From Acceptance and commitment therapy in adult cancer survivors: a systematic review and conceptual model (2021) · cites this paper as [15]
The Discussion (page unavailable) reports that CBT/CST was efficacious in 14 of 21 studies, and that reviewed patients included people receiving treatment and people who had completed it. But the Method describes a systematic narrative review, not a meta-analysis; the Discussion says the authors did not calculate effect sizes. The Conclusions say these interventions hold promise, rather than confirming effectiveness across the cancer continuum. (LLM, conf=0.90)
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Barsevick, A. M., Dudley, W. N., & Beck, S. L. (2006) · Nursing Research · doi:10.1097/00006199-200609000-00009 · Cited by 79 · see citing works
Recognition and Diagnosis of Breakthrough Pain
Payne, R. (2007) · Pain Medicine · doi:10.1111/j.1526-4637.2006.00269.x · Cited by 75 · see citing works
Pain???Clinical Manual (2nd Edition)
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The use of relaxation for the promotion of comfort and pain relief in persons with advanced cancer
Sloman, R., Brown, P., Aldana, E., & Chee, E. (1994) · Contemporary Nurse · doi:10.5172/conu.3.1.6 · Cited by 67 · cited 1× · see citing works
“Four studies tested imagery interventions in hospitalized patients with cancer pain, and all reported beneficial effects; one in a pretest-posttest design(45) and three when compared to treatment-as-usual or attention control conditions.(39,46,47) Conversely, Haase et al.”
BackgroundMeditation as an Intervention for Chronic Pain: An Integrative Review
Teixeira, M. E. (2008) · Holistic Nursing Practice · doi:10.1097/01.hnp.0000326006.65310.a7 · Cited by 66 · see citing works
Haase, O., Schwenk, W., Hermann, C., & Müller, J. M. (2005) · Diseases of the Colon & Rectum · doi:10.1007/s10350-005-0114-9 · Cited by 64 · cited 3× · see citing works
“Conversely, Haase et al.(40) found no significant differences in pain and no differences in fatigue between patients receiving an imagery”
BackgroundInfluentialBrief cognitive‐behavioral audiotape interventions for cancer‐related pain
Anderson, K. O., Cohen, M. Z., Mendoza, T. R., Guo, H. Y., Harle, M. T., & Cleeland, C. S. (2006) · Cancer · doi:10.1002/cncr.21964 · Cited by 58 · cited 1× · see citing works
“usual,(33) positive mood manipulation, distraction, and a no-treatment control condition.(34) Biofeedback-assisted relaxation resulted in greater pain relief when compared to attention control (e.”
ResultMusic improves sleep quality in older adults
Lai, H., & Good, M. (2006) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2006.03693.x · Cited by 57 · see citing works
Music imagery for adults with acute leukemia in protective environments: a feasibility study
Burns, D. S., Azzouz, F., Sledge, R., Rutledge, C., Hincher, K. J., Monahan, P. O., & Cripe, L. D. (2007) · Supportive Care in Cancer · doi:10.1007/s00520-007-0330-z · Cited by 54 · cited 2× · see citing works
“Burns et al.(93) compared music with standard care in a sample of hospitalized patients receiving intensive chemotherapy and found no significant difference in fatigue between groups.”
BackgroundSymptom Interactions as Mechanisms Underlying Symptom Pairs and Clusters
Parker, K. P., Kimble, L. P., Dunbar, S. B., & Clark, P. C. (2005) · Journal of Nursing Scholarship · doi:10.1111/j.1547-5069.2005.00037.x · Cited by 53 · cited 1× · see citing works
“may, therefore, help to improve the painfatigue-sleep disturbance symptom cluster.(28) Mind-body interventions may be useful in altering negative thoughts about cancer, the underlying cause of symptoms, or in reframing how the symptoms are interpreted.”
BackgroundTsai, P.-S., Chen, P.-L., Lai, Y., Lee, M., & Lin, C. (2007) · Cancer Nursing · doi:10.1097/01.ncc.0000290805.38335.7b · Cited by 53 · cited 1× · see citing works
“, time spent with a nurse).(35) Domar et al.”
BackgroundSymptom Clusters in Elderly Patients With Lung Cancer
Gift, A. G., Jablonski, A., Stommel, M., & Given, C. W. (2004) · Clinical journal of oncology nursing · doi:10.1188/04.onf.202-212 · Cited by 53 · see citing works
A Pain Management Program for Chronic Cancer-Treatment–Related Pain: A Preliminary Study
Robb, K. A., Williams, J. E., Duvivier, V., & Newham, D. J. (2006) · Journal of Pain · doi:10.1016/j.jpain.2005.08.007 · Cited by 51 · cited 2× · see citing works
“Robb et al.54 demonstrated a significant reduction in pain intensity among adults with chronic cancer pain after participating in a six-month pain-focused CBT intervention.”
BackgroundTreatment-Related Symptom Clusters
Honea, N. J., Brant, J. M., & Beck, S. L. (2007) · Seminars in Oncology Nursing · doi:10.1016/j.soncn.2007.01.002 · Cited by 51 · see citing works
Clinical Management of Symptom Clusters
Williams, L. A. (2007) · Seminars in Oncology Nursing · doi:10.1016/j.soncn.2007.01.006 · Cited by 50 · see citing works
Education for pain management: A pilot study
Dalton, J. A. (1987) · Patient Education and Counseling · doi:10.1016/0738-3991(87)90077-2 · Cited by 49 · see citing works
A pilot study to predict success with guided imagery for cancer pain
Kwekkeboom, K. L., Kneip, J., & Pearson, L. (2003) · Pain Management Nursing · doi:10.1016/s1524-9042(02)54213-2 · Cited by 42 · see citing works
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“Vilela et al.73 found no significant differences in pain, fatigue, or sleep disturbance in patients with head and neck cancer using a CST intervention compared to control.”
Effectiveness of an hypnotic imagery intervention on reducing alexithymia
Gay, M., Hanin, D., & Luminet, O. (2008) · Contemporary Hypnosis · doi:10.1002/ch.344 · Cited by 37 · see citing works
HART, J. K. (2008) · Alternative and Complementary Therapies · doi:10.1089/act.2008.14604 · Cited by 31 · see citing works
Symptom Clusters Related to Specific Cancers
Gift, A. G. (2007) · Seminars in Oncology Nursing · doi:10.1016/j.soncn.2007.01.003 · Cited by 27 · cited 1× · see citing works
“Recent evidence has demonstrated that certain symptoms tend to co-occur or ‘‘cluster’’ together, exacerbating the overall symptom experience.(1,2) In some cases, there may be shared mechanisms causing each of the symptoms to occur (e.”
BackgroundThe therapist as a travelling companion to the chronically ill: hypnosis and cancer related symptoms
Ebell, H. (2008) · Contemporary Hypnosis · doi:10.1002/ch.348 · Cited by 16 · cited 1× · see citing works
“Four studies tested imagery interventions in hospitalized patients with cancer pain, and all reported beneficial effects; one in a pretest-posttest design(45) and three when compared to treatment-as-usual or attention control conditions.(39,46,47) Conversely, Haase et al.”
BackgroundCognitive-behavioral approaches to chronic pain.
Lebovits, A. (2007) · Primary psychiatry · Cited by 12 · see citing works
Recent developments in the study of hypnotic pain reduction: a new golden era of research?
Milling, L. S. (2008) · Contemporary Hypnosis · doi:10.1002/ch.362 · Cited by 7 · cited 2× · see citing works
“The mental images may also alter expectations for outcome, such that the desired outcome occurs automatically in response to the new image.(44) Imagery/hypnosis interventions served as the experimental intervention in six studies (Supplementary Table 3).”
BackgroundThe Preoperative Use of the Relaxation Response with Ambulatory Surgery Patients
Domar, A. D., Noe, J. M., & Benson, H. (1987) · Hospital Topics · doi:10.1080/00185868.1987.10543609 · Cited by 4 · see citing works
Decker (1992) · doi:10.1002/1097-4679(199205)48:3
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- [83]Chlan L Snyder M Lindquist R Music therapy Complementary / Alternative Therapies in Nursing 1998 3rd ed. New York Springer Publishing 243 257
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Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology
Swarm, R. A., Paice, J. A., Anghelescu, D. L., Are, M., Bruce, J. Y., Buga, S., Chwistek, M., Cleeland, C. S., Craig, D. S., Gafford, E. F., et al. (2019) · Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2019.0038 · Cited by 627 · see citing works
Paice, J. A., Portenoy, R. K., Lacchetti, C., Campbell, T. C., Cheville, A. L., Citron, M. L., Constine, L. S., Cooper, A., Glare, P. A., Keefe, F., et al. (2016) · Journal of Clinical Oncology · doi:10.1200/jco.2016.68.5206 · Cited by 604 · see citing works
“Furthermore, psychological-based interventions showed promise, with moderate and significant effects on pain reported in six systematic reviews that considered acceptance-based interventions, patient education, relaxation, guided imagery, meditation, hypnosis, and music interventions.(45,52-55) Finally, interventional…”
BackgroundInfluentialMiaskowski, C. A., Barsevick, A. M., Berger, A. M., Casagrande, R. J., Grady, P. A., Jacobsen, P. B., Kutner, J. S., Patrick, D. L., Zimmerman, L. M., Xiao, C., et al. (2016) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djw253 · Cited by 507 · see citing works
Portenoy, R. K. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60236-5 · Cited by 491 · see citing works
Psychological and behavioral approaches to cancer pain management
Syrjala, K. L., Jensen, M. P., Mendoza, M. E., Yi, J. C., Fisher, H. M., & Keefe, F. J. (2014) · Journal of Clinical Oncology · doi:10.1200/jco.2013.54.4825 · Cited by 344 · see citing works
Swarm, R. A., Abernethy, A. P., Anghelescu, D. L., Benedetti, C., Blinderman, C. D., Boston, B., Cleeland, C. S., Coyle, N., deLeon-Casasola, O. A., Eilers, J., et al. (2010) · Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2010.0076 · Cited by 333 · see citing works
Glare, P. A., Davies, P. S., Finlay, E., Gulati, A., Lemanne, D., Moryl, N., Oeffinger, K. C., Paice, J. A., Stubblefield, M. D., & Syrjala, K. L. (2014) · Journal of Clinical Oncology · doi:10.1200/jco.2013.52.4629 · Cited by 329 · see citing works
Emotional foundations of music as a non-pharmacological pain management tool in modern medicine
Bernatzky, G., Presch, M., Anderson, M., & Panksepp, J. (2011) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2011.06.005 · Cited by 284 · see citing works
Troublesome Symptoms in Cancer Survivors: Fatigue, Insomnia, Neuropathy, and Pain
Pachman, D. R., Barton, D. L., Swetz, K. M., & Loprinzi, C. L. (2012) · Journal of Clinical Oncology · doi:10.1200/jco.2012.41.7238 · Cited by 282 · see citing works
Wayne, P. M., Lee, M. S., Novakowski, J., Osypiuk, K., Ligibel, J., Carlson, L. E., & Song, R. (2018) · Journal of Cancer Survivorship · doi:10.1007/s11764-017-0665-5 · Cited by 251 · see citing works
“, exercise, meditation), impact individual as well as constellations of symptoms [11] represents a rich area for further research.”
BackgroundBerger, A. M., Mitchell, S. A., Jacobsen, P. B., & Pirl, W. F. (2015) · CA A Cancer Journal for Clinicians · doi:10.3322/caac.21268 · Cited by 200 · see citing works
“components presents an additional constraint when interpreting the findings.(225,299,300)”
BackgroundCancer‐related fatigue and its impact on functioning
Minton, O., Berger, A. M., Barsevick, A. M., Cramp, F. L., Goedendorp, M. M., Mitchell, S. A., & Stone, P. C. (2013) · Cancer · doi:10.1002/cncr.28058 · Cited by 190 · see citing works
“tigue, including yoga, relaxation, mindfulness-based stress reduction, acupuncture, medical Qigong, massage, healing touch, Reiki, and combined modality interventions that include aromatherapy, lavender foot soaks, and reflexology.(34,40) However, the studies examining these interventions have tended to have small and…”
BackgroundCancer‐Related Fatigue: State of the Science
Mitchell, S. A. (2010) · PM&R · doi:10.1016/j.pmrj.2010.03.024 · Cited by 189 · see citing works
So, W. K. W., Law, B. M. H., Ng, M. S. N., He, X., Chan, D. N. S., Chan, C. W. H., & McCarthy, A. L. (2021) · Cancer Medicine · doi:10.1002/cam4.3794 · Cited by 181 · see citing works
Cancer-related and treatment-related fatigue
Wang, X. S., & Woodruff, J. F. (2014) · Gynecologic Oncology · doi:10.1016/j.ygyno.2014.10.013 · Cited by 173 · see citing works
Wang, C., Sun, Y.-L., & Zang, H.-X. (2013) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2013.03.008 · Cited by 163 · see citing works
Complementary Therapies and Integrative Medicine in Lung Cancer
Deng, G. E., Rausch, S. M., Jones, L. W., Gulati, A., Kumar, N. B., Greenlee, H., Pietanza, M. C., & Cassileth, B. R. (2013) · CHEST Journal · doi:10.1378/chest.12-2364 · Cited by 165 · see citing works
Kwekkeboom, K. L., Abbott‐Anderson, K., Cherwin, C. H., Roiland, R. A., Serlin, R. C., & Ward, S. E. (2012) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2011.12.281 · Cited by 148 · see citing works
“Cancer diagnosis Lung 10 (23) 15 (35) 25 (29) Prostate 6 (14) 9 (21) 15 (17) Colorectal 6 (14) 4 (9) 10 (12) Gynecologic 21 (49) 15 (35) 36 (42)”
Self-citationMitchell, S. A., Hoffman, A. J., Clark, J. C., DeGennaro, R., Poirier, P., Robinson, C. B., & Weisbrod, B. L. (2014) · Clinical journal of oncology nursing · doi:10.1188/14.cjon.s3.38-58 · Cited by 131 · see citing works
“…have predominantly been studied using open-label and/or uncontrolled study designs and small sample sizes with no random assignment, making it difficult to draw conclusions about efficacy (Finnegan-John et al., 2013; Kwekkeboom et al., 2010; Shneerson, Taskila, Gale, Greenfield, & Chen, 2013).”
Luckett, T., Davidson, P., Green, A., Boyle, F., Stubbs, J., & Lovell, M. (2013) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2012.07.021 · Cited by 99 · see citing works
Tibetan sound meditation for cognitive dysfunction: results of a randomized controlled pilot trial
Milbury, K., Chaoul, A., Biegler, K. A., Wangyal, T., Spelman, A. R., Meyers, C. A., Arun, B., Palmer, J. L., Taylor, J. A., & Cohen, L. G. (2013) · Psycho-Oncology · doi:10.1002/pon.3296 · Cited by 114 · see citing works
Yeh, C. H., Chien, L.-C., Lin, W.-C., Bovbjerg, D. H., & Londen, G. J. V. (2015) · Cancer Nursing · doi:10.1097/ncc.0000000000000303 · Cited by 112 · see citing works
Stable Symptom Clusters and Evolving Symptom Networks in Relation to Chemotherapy Cycles
Rha, S. Y., & Lee, J. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.08.008 · Cited by 108 · see citing works
Self-citationMind–Body Therapies in Integrative Oncology
Elkins, G. R., Fisher, W. I., & Johnson, A. K. (2010) · Current Treatment Options in Oncology · doi:10.1007/s11864-010-0129-x · Cited by 108 · see citing works
“• The technique of meditation has been operationalized as providing training in a self-directed mental exercise to intentionally and continually focus the mind on a single target perception [ 9 ].”
BackgroundMethodResultInfluentialPsychosocial Issues in Cancer Pain
Porter, L. S., & Keefe, F. J. (2011) · Current Pain and Headache Reports · doi:10.1007/s11916-011-0190-6 · Cited by 97 · see citing works
“Preliminary evidence suggests that yoga and meditation may produce improvements in pain and related symptoms such as fatigue and distress [45, 46].”
BackgroundMathew, A., Doorenbos, A. Z., Jang, M. K., & Hershberger, P. E. (2021) · Journal of Cancer Survivorship · doi:10.1007/s11764-020-00938-z · Cited by 91 · see citing works
Dikmen, H. A., & Terzioğlu, F. (2018) · Pain Management Nursing · doi:10.1016/j.pmn.2018.03.001 · Cited by 92 · see citing works
Anderson, J. G., & Taylor, A. G. (2012) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2011.0022 · Cited by 91 · see citing works
“Research suggests that guided imagery may aid the reduction of cancer pain.(16,17) Various types of meditation have been shown to improve quality of Table 5.”
BackgroundKwekkeboom, K. L., Zhang, Y., Campbell, T. C., Coe, C. L., Costanzo, E. S., Serlin, R. C., & Ward, S. E. (2018) · Psycho-Oncology · doi:10.1002/pon.4883 · Cited by 88 · see citing works
“In addition, rationale provided during training may counter commonly held beliefs that cancer symptoms cannot be managed, raise expectations for symptom improvement, and facilitate patients' ability to actively control their symptom experience.(22,23) We hypothesized that such strategies could be effective in simultan…”
BackgroundSelf-citationOpportunities for cannabis in supportive care in cancer
Kleckner, A., Kleckner, I., Kamen, C., Tejani, M., Janelsins, M., Morrow, G., & Peppone, L. (2019) · Therapeutic Advances in Medical Oncology · doi:10.1177/1758835919866362 · Cited by 78 · see citing works
Maindet, C., Burnod, A., Minello, C., George, B., Allano, G., & Lemaire, A. (2019) · Supportive Care in Cancer · doi:10.1007/s00520-019-04829-7 · Cited by 92 · see citing works
Kwekkeboom, K. L., Abbott‐Anderson, K., & Wanta, B. (2010) · Oncology nursing forum · doi:10.1188/10.onf.e151-e159 · Cited by 80 · see citing works
Self-citationThe mechanisms of pain tolerance and pain-related anxiety in acute pain
Cîmpean, A., & David, D. (2019) · Health Psychology Open · doi:10.1177/2055102919865161 · Cited by 82 · see citing works
“As Kwekkeboom et al. (2010) noted, the generation of “crossover” treatments has the possible benefit of using a single intervention to simplify treatment, which may reduce costs.”
BackgroundInfluentialComplementary therapies for symptom management in cancer patients
Bhatnagar, S., & Satija, A. (2017) · Indian Journal of Palliative Care · doi:10.4103/ijpc.ijpc_100_17 · Cited by 76 · see citing works
“This is done using counseling approach or programmed education.[17] It involves techniques such as autogenic training, biofeedback, hypnosis, imagery, meditation, problem-solving, and systematic desensitization.”
BackgroundMethodResultInfluentialDe Paolis, G., Naccarato, A., Cibelli, F., D'Alete, A., Mastroianni, C., Surdo, L., Casale, G., & Magnani, C. (2019) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2018.12.014 · Cited by 89 · see citing works
Gori, A., Topino, E., Sette, A., & Cramer, H. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.10.044 · Cited by 76 · see citing works
Jahn, P., Kuß, O., Schmidt, H., Bauer, A., Kitzmantel, M., Jordan, K., Krasemann, S., & Landenberger, M. (2014) · Pain · doi:10.1016/j.pain.2014.01.006 · Cited by 72 · see citing works
“The SCION-PAIN program group patients did respond to the PMR offering and included this in their pain management strategies as an option for self-management [35].”
MethodKwekkeboom, K. L., & Bratzke, L. C. (2015) · The Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000000274 · Cited by 70 · see citing works
Self-citationRambod, M., Sharif, F., Pourali-Mohammadi, N., Pasyar, N., & Rafii, F. (2013) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2013.11.004 · Cited by 68 · see citing works
Interventions for cancer-related fatigue: a scoping review
Pearson, E. J. M., Morris, M. E., Stefano, M. D., & McKinstry, C. (2016) · European Journal of Cancer Care · doi:10.1111/ecc.12516 · Cited by 68 · see citing works
Adult Cancer Pain, Version 2.2025, NCCN Clinical Practice Guidelines In Oncology
Swarm, R. A., Youngwerth, J. M., Agne, J. L., Anițescu, M., Are, M., Buga, S., Butler, T., Chwistek, M., Cleary, J. F., Copenhaver, D. J., et al. (2025) · Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2025.0032 · Cited by 74 · see citing works
The effect of meditative movement on sleep quality: A systematic review
Wang, F., Lee, O. E., Feng, F., Vitiello, M. V., Wang, W.-D., Benson, H., Fricchione, G. L., & Denninger, J. W. (2015) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2015.12.001 · Cited by 67 · see citing works
Rambod, M., Pasyar, N., & Shamsadini, M. (2019) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2019.101678 · Cited by 65 · see citing works
Opioids for cancer pain: the challenge of optimizing treatment
Plante, G. E., & VanItallie, T. B. (2010) · Metabolism · doi:10.1016/j.metabol.2010.07.010 · Cited by 63 · see citing works
Shahriari, M., Dehghan, M., Pahlavanzadeh, S., & Hazini, A. (2017) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_147_14 · Cited by 62 · see citing works
“Progressive muscle relaxation is a physical stimulation and mental peace with emphasis on muscle systematic stretching and release (contraction‐release).[15] Progressive muscle relaxation can be applied in all stages of cancer patients and can notably reduce cancer complications.”
BackgroundKaragözoğlu, Ş., & Kahve, E. (2013) · Applied Nursing Research · doi:10.1016/j.apnr.2013.07.002 · Cited by 60 · see citing works
“In cancer patients, there is a strong association between depression and fatigue (Dimeo et al., 2004; Kwekkeboom et al., 2010; Winell & Roth, 2004) and between anxiety and fatigue (Brown & Kroenke, 2009; Li & Yuan, 2011; Mansky & Wallerstedt, 2006; Oh & Seo, 2011; Reddick, Nanda, Campbell, Ryman, & Gaston-Johansson, 2…”
BackgroundInfluentialExplaining fatigue in ANCA-associated vasculitis
Basu, N., McClean, A., Harper, L., Amft, E. N., Dhaun, N., Luqmani, R. A., Little, M. A., Jayne, D. R. W., Floßmann, O., McLaren, J., et al. (2013) · Lara D. Veeken · doi:10.1093/rheumatology/ket191 · Cited by 57 · see citing works
Usual and Worst Symptom Severity and Interference With Function in Breast Cancer Survivors
Berger, A. M., Visovsky, C. M., Hertzog, M. A., Holtz, S., & Loberiza, F. R. (2012) · The Journal of Supportive Oncology · doi:10.1016/j.suponc.2011.11.001 · Cited by 57 · see citing works
Lipschitz, D. L., Kuhn, R., Kinney, A. Y., Donaldson, G. W., & Nakamura, Y. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2012.12.021 · Cited by 55 · see citing works
“As an alternative to conventional treatments for sleep disturbance in cancer patients and survivors (besides in many other clinical populations), non-pharmacological or behavioral interventions such as mind-body therapies have increasingly shown promise (Carlson and Bultz, 2008; Kwekkeboom et al., 2010).”
BackgroundMusic's Use for Anesthesia and Analgesia
Matsota, P. K., Christodoulopoulou, T. C., Smyrnioti, M., Pandazi, A., Kanellopoulos, I., Koursoumi, E., Karamanis, P., & Kostopanagiotou, G. G. (2012) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2010.0235 · Cited by 55 · see citing works
Benson Relaxation Technique in Reducing Pain Intensity in Women After Cesarean Section
Solehati, T., & Rustina, Y. (2015) · Anesthesiology and Pain Medicine · doi:10.5812/aapm.22236v2 · Cited by 51 · see citing works
“Several studies showed that relaxation is effective in reducing pain (12, 14-22).”
BackgroundInfluentialSymptom Clusters and Quality of Life in Subjects With COPD
Lim, K. E., Kim, S. R., Kim, H. K., & Kim, S. R. (2017) · Respiratory Care · doi:10.4187/respcare.05374 · Cited by 49 · see citing works
Yennurajalingam, S., Kang, D.-H., Hwu, W., Padhye, N. S., Masino, C., Dibaj, S. S., Liu, D. D., Williams, J. L., Lu, Z., & Bruera, E. D. (2017) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2017.08.027 · Cited by 51 · see citing works
Emotional distress among adult survivors of childhood cancer
Oancea, S. C., Brinkman, T. M., Ness, K. K., Krull, K. R., Smith, W. A., Srivastava, D. K., Robison, L. L., Hudson, M. M., & Gurney, J. G. (2014) · Journal of Cancer Survivorship · doi:10.1007/s11764-013-0336-0 · Cited by 48 · see citing works
“Cognitive remediation approaches have shown promise in treating cognitive late effects of childhood cancer treatment [33–35], while pharmacologic, cognitive-behavioral, and complementary medicine approaches have been used for the management of cancer-related pain [36, 37].”
BackgroundImpact of Clinical Pharmacy Services on KAP and QOL in Cancer Patients: A Single-Center Experience
Wang, Y., Wu, H., & Xu, F. (2015) · BioMed Research International · doi:10.1155/2015/502431 · Cited by 48 · see citing works
“Sleep disturbance not only caused depression patients, interfered with their daily activities, and reduced quality of life but also impaired cancer-treatment adherence, affected the treatment outcomes, and even possibly increased patients’mortality [24, 25].”
BackgroundSymptom clusters in patients with nasopharyngeal carcinoma during radiotherapy
Xiao, W., Chan, C. W. H., Fan, Y., Leung, D. Y. P., Xia, W., He, Y., & Tang, L. (2017) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2017.02.004 · Cited by 48 · see citing works
Cebolla, A., Luciano, J. V., Demarzo, M., Navarro‐Gil, M., & García‐Campayo, J. (2013) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-11-6 · Cited by 47 · see citing works
“Research studies on such mitigating effects suggest that mindfulness alters the contextual evaluation of pain [5], reduces pain catastrophising and pain sensitivity [6], reduces psychopathological symptoms [11,12], and alters pain-related anxiety [13].”
BackgroundAssessment and Management of Cancer-Related Fatigue
Borneman, T. R. (2013) · Journal of Hospice and Palliative Nursing · doi:10.1097/njh.0b013e318286dc19 · Cited by 47 · see citing works
Cancer Pain Management and Bone Metastases: An Update for the Clinician
Schneider, G., Voltz, R., & Gaertner, J. (2012) · Breast Care · doi:10.1159/000338579 · Cited by 43 · see citing works
Bailey, D. E., Hendrix, C. C., Steinhauser, K. E., Stechuchak, K. M., Porter, L. S., Hudson, J., Olsen, M. K., Muir, A. J., Lowman, S. G., DiMartini, A. F., et al. (2016) · Patient Education and Counseling · doi:10.1016/j.pec.2016.10.017 · Cited by 43 · see citing works
Tarrasch, R., Neiderman, N. N. C., Ben-Ami, S., Kaufman, B., Pfeffer, R., Ben-David, M. A., & Gamus, D. (2017) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2017.0023 · Cited by 44 · see citing works
“Findings of this study are in line with conclusions of the review of mind–body treatments for the pain-fatigue-sleep disturbance cluster in cancer patients.(22) This review demonstrated that fatigue and sleep disturbances were the most common symptoms improved by mind–body interventions, while relaxation, which is oft…”
Common and Co-Occurring Symptoms Experienced by Patients With Gastric Cancer
Lin, Y., Docherty, S. L., Porter, L. S., & Bailey, D. E. (2020) · Oncology nursing forum · doi:10.1188/20.onf.187-202 · Cited by 43 · see citing works
Xiao, W., Chow, K. M., So, W. K. W., Leung, D. Y. P., & Chan, C. W. H. (2016) · Cancer Nursing · doi:10.1097/ncc.0000000000000313 · Cited by 39 · see citing works
“Managing a symptom cluster as a whole instead of single symptoms could be more efficient and effective.(7,8) A recent review on managing symptom clusters identified several interventions, pharmacological and nonpharmacological, being tested on patients with cancer.”
BackgroundGuan, H., Xu, Y., & Zhao, D. (2022) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2022/1373170 · Cited by 38 · see citing works
“Mind-body interventions such as relaxation, hypnosis, meditation, and music interventions for cancer patients who experience pain, fatigue, and sleep disturbances helped patients manage all symptoms in a group with a single treatment strategy [109].”
BackgroundUpdate on interventions focused on symptom clusters
Berger, A. M., Yennurajalingam, S., & Million, R. (2013) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0b013e32835c7d88 · Cited by 40 · see citing works
“A variety of mind–body treatments have demonstrated beneficial effects on a single symptom, but few studies have focused on the response of concurrent symptoms to a single treatment strategy [16].”
BackgroundHarorani, M., Davodabady, F., Farahani, Z., Hezave, A. K., & Rafiei, F. (2020) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2020.102344 · Cited by 38 · see citing works
Mikolasek, M., Witt, C. M., & Barth, J. (2021) · JMIR Cancer · doi:10.2196/16785 · Cited by 36 · see citing works
“Such MBM treatments can have beneficial effects on cancer-related symptoms, such as pain, fatigue, and sleep disturbance [9-11].”
BackgroundBragard, I., Étienne, A.-M., Faymonville, M.-É., Coucke, P., Lifrange, É., Schroeder, H., Wagener, A., Dupuis, G., & Jérusalem, G. (2017) · PubMed · doi:10.1080/00207144.2017.1276363 · Cited by 36 · see citing works
“Similarly, hypnosis also seems to be effective for BC patients for pain (Kwekkeboom, Cherwin, Lee, & Wanta, 2010), anxiety and depression symptoms (Cramer et al., 2015), fatigue (Montgomery et al., 2007), and sleep disturbances (Kwekkeboom et al., 2010).”
BackgroundResultSheikh-Wu, S. F., Downs, C. A., & Anglade, D. (2020) · Oncology nursing forum · doi:10.1188/20.onf.e107-e119 · Cited by 36 · see citing works
“A symptom cluster of pain, fatigue, and sleep disturbances is the most common, occurring in more than 40% of cancer survivors (Kwekkeboom et al., 2009; Kwekkeboom, Tostrud, et al., 2018; Miaskowski et al., 2017; Mosher & DuHamel, 2012).”
BackgroundCancer-Related Fatigue—Is There a Role for Complementary and Integrative Medicine?
David, A., Hausner, D., & Frenkel, M. A. (2021) · Current Oncology Reports · doi:10.1007/s11912-021-01135-6 · Cited by 35 · see citing works
The effect of massage therapy on the quality of sleep in breast cancer patients.
Kashani, F., & Kashani, P. (2014) · Europe PMC (PubMed Central) · Cited by 35 · see citing works
Complementary and Alternative Medicine and Breast Cancer
Subramani, R., & Lakshmanaswamy, R. (2017) · Progress in molecular biology and translational science · doi:10.1016/bs.pmbts.2017.07.008 · Cited by 35 · see citing works
Eaton, L. H., Brant, J. M., McLeod, K., & Yeh, C. H. (2017) · Clinical journal of oncology nursing · doi:10.1188/17.cjon.s3.54-70 · Cited by 33 · see citing works
“ONS.ORG APPENDIX B. PUTTING EVIDENCE INTO PRACTICE: EFFECTIVENESS NOT ESTABLISHED FOR BODY-BASED INTERVENTIONS STUDY INTERVENTION SAMPLE AND DESIGN FINDINGS LIMITATIONS Acupuncture Bao et al., 2013 Acupuncture 47 patients with breast cancer on aromatase inhibitors; RCT No difference in pain outcomes between groups Sam…”
InfluentialMind-Body Therapies: Evidence and Implications in Advanced Oncology Practice
Mayden, K. D. (2012) · Journal of the Advanced Practitioner in Oncology · doi:10.6004/jadpro.2012.3.6.2 · Cited by 32 · see citing works
“The studies demonstrated improvements in all three symptoms, but the majority of support favored fatigue and sleep disturbance (Kwekkeboom et al., 2010).”
Effect of acupressure on pain in Iranian leukemia patients: A randomized controlled trial study
Nia, H. S., Sharif, S. P., Yaghoobzadeh, A., Yeoh, K. K., Goudarzian, A. H., Soleimani, M. A., & Jamali, S. (2017) · International Journal of Nursing Practice · doi:10.1111/ijn.12513 · Cited by 31 · see citing works
Survivorship: Pain Version 1.2014
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Challenges and concerns of persistent opioid use in cancer patients
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“Concurrent symptoms are burdensome for these patients and often impact their functional status, quality of life, and mood.(3) When multiple symptoms occur simultaneously, their interrelationship is likely complex and warrants multivariate analyses to describe it comprehensively.”
BackgroundSchaffer, L., Jallo, N., Howland, L. C., James, K. S., Glaser, D. N., & Arnell, K. (2013) · The Journal of Perinatal & Neonatal Nursing · doi:10.1097/jpn.0b013e3182870426 · Cited by 29 · see citing works
“about positive physical or emotional effects.(28,29) This technique captures the power of the mind by including mental imaging of the senses to form connection”
Pain-related diseases and sleep disorders
Roizenblatt, M., Neto, N. S. R., Tufik, S., & Roizenblatt, S. (2012) · Brazilian Journal of Medical and Biological Research · doi:10.1590/s0100-879x2012007500110 · Cited by 29 · see citing works
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“[19,20] It is therefore imperative to shift the focus of management strategy from a single symptom to the symptom cluster as a whole.”
Guided imagery effects on chemotherapy induced nausea and vomiting in Iranian breast cancer patients
Hosseini, M.-S., Tirgari, B., Forouzi, M. A., & Jahani, Y. (2016) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2016.07.002 · Cited by 28 · see citing works
“These kinds of therapies are particularly appealing options for the treatment of cancer symptoms in addition to pharmacological strategies, as these methods have beneficial outcomes including few negative side effects, ability to be used by patients independently with sufficient training and being inexpensive [12].”
BackgroundMiladinia, M., Jahangiri, M., Kennedy, A. B., Fagerström, C., Tuvesson, H., Safavi, S. S., Maniati, M., Javaherforooshzadeh, F., & Karimpourian, H. (2022) · Palliative Medicine · doi:10.1177/02692163221129158 · Cited by 27 · see citing works
Henneghan, A. M., & Harrison, T. C. (2014) · Journal of Holistic Nursing · doi:10.1177/0898010114539191 · Cited by 27 · see citing works
Wiggenraad, F., Bolam, K. A., Mijwel, S., van der Wall, E., Wengström, Y., & Altena, R. (2020) · Integrative Cancer Therapies · doi:10.1177/1534735420905003 · Cited by 26 · see citing works
Grégoire, C., Faymonville, M.-É., Vanhaudenhuyse, A., Jérusalem, G., Willems, S. J., & Bragard, I. (2020) · Quality of Life Research · doi:10.1007/s11136-020-02655-7 · Cited by 26 · see citing works
“Indeed, complementary and alternative medicine, such as hypnosis, is estimated to be used by 43% of patients with cancer [30, 31], and is becoming popular because of its ease of integration into cancer care [32].”
BackgroundCastellar, J. I., Fernandes, C. A., & Tosta, C. E. (2014) · Integrative Cancer Therapies · doi:10.1177/1534735414534730 · Cited by 25 · see citing works
Systematic Review for the Medical Applications of Meditation in Randomized Controlled Trials
Kim, D.-Y., Hong, S.-H., Jang, S.-H., Park, S., Noh, J.-H., Seok, J.-M., Jo, H.-J., Son, C., & Lee, E. J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19031244 · Cited by 24 · see citing works
Li, R., Shen, X., Zhang, L., Chan, Y., Yao, W., Zhang, G., & Li, H. (2023) · Asia-Pacific Journal of Oncology Nursing · doi:10.1016/j.apjon.2023.100243 · Cited by 24 · see citing works
PainDroid: an android-based virtual reality application for pain assessment
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“Finally, VR technology has also been well-reported in a series of studies [34–36] to be an effective aid in reducing pain through hypnosis, as well as shown to decrease pain in persons with cancer [18, 39, 45].”
BackgroundAcar, K., & Aygın, D. (2019) · Journal of PeriAnesthesia Nursing · doi:10.1016/j.jopan.2019.05.006 · Cited by 23 · see citing works
“Techniques such as hypnosis, biofeedback, meditation, and imagery are effective with the interaction between mind and body.(2) The general purpose in these applications is to benefit from the self-healing capacity of body by influencing the mind.”
BackgroundThe Comprehensive Cancer Center
Aljurf, M., Majhail, N. S., Koh, M., Kharfan-Dabaja, M. A., & Chao, N. J. A. (2021) · Springer eBooks · doi:10.1007/978-3-030-82052-7 · Cited by 23 · see citing works
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Music as Non-Pharmacological Pain Management in Clinics*
Bernatzky, G., Strickner, S., Presch, M., Wendtner, F., & Kullich, W. (2012) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780199586974.003.0019 · Cited by 23 · see citing works
“…of a nurse using music therapy to reduce the acute pain Wound care after orthopaedic s. Individualtailored music therapy X Pain, negative feelings ↓ ; own spiritual strength ↑ Kwekkeboom et al. (2009 ) Investigation of different interventions on fatigue, pain, sleep disturbances in cancer…”
BackgroundMethodTuran, G. B., Özer, Z., & Sariköse, A. (2024) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2024.102580 · Cited by 21 · see citing works
The Effect of Benson Relaxation on Quality of Sleep of Cancer Patients
Efendi, S., Agus, A. I., Syatriani, S., Amir, H., Alam, R. I., Nurdin, S., Batara, A. S., & Ikhtiar, M. (2022) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2022.8295 · Cited by 21 · see citing works
“Some methods of complementary clinical treatment can be useful interventions for treating pain, fatigue, and sleep disorders in cancer patients such as hypnosis, training, cognitive behavioral care, relaxation, pain music therapy, and fatigue [12].”
MethodHan, J., Cheng, H.-L., Bi, L., & Molasiotis, A. (2023) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2023.102954 · Cited by 16 · see citing works
Bean, H. R., Stafford, L., Little, R., Diggens, J., Ftanou, M., Alexander, M., Francis, P. A., Bei, B., & Wiley, J. F. (2020) · Trials · doi:10.1186/s13063-020-4196-4 · Cited by 22 · see citing works
Guided Imagery for Pain Control
Burhenn, P., Olausson, J. M., Villegas, G., & Kravits, K. G. (2014) · Clinical journal of oncology nursing · doi:10.1188/14.cjon.501-503 · Cited by 20 · see citing works
“The primary aim of the pilot study was not to test the efficacy of guided imagery because that has been previously documented in the literature (Astin et al., 2003; Deng & Cassileth, 2013; Kwekkeboom et al., 2010; Portenoy, 2011).”
- Authors
- Kwekkeboom, K. L., Cherwin, C. H., Lee, J. W., & Wanta, B.
- Affiliations
- University of Wisconsin–Madison (US)
- Corresponding author
- Kwekkeboom, Kristine L.
- Venue
- Journal of Pain and Symptom Management
- Publisher
- Elsevier BV
- Published
- 2010-01
- Volume
- 39
- Issue
- 1
- Pages
- 126-138
- ISSN
- 0885-3924 (ISSN-L)
- PMC
- PMC3084527
- OpenAlex
- W1971153042
- Cited by
- 228
- References
- 106
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 9 · 2023: 11 · 2022: 14 · 2021: 21 · 2020: 16 · 2019: 13 · 2018: 18 · 2017: 14 · 2016: 12 · 2015: 13 · 2014: 17 · 2013: 16 · 2012: 19
- FWCI
- 1.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain and Symptom Management (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Nursing Research (P20NR008987)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Keywords
- mind-body interventions, cancer pain, cancer-related fatigue, sleep disorders, symptom clusters, cognitive behavioral therapy, coping skills training, relaxation, meditation, music therapy, virtual reality, symptom management
- MeSH terms
- Fatigue, Humans, Neoplasms, Pain, Sleep Wake Disorders, Mind-Body Therapies, Pain Management
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