Guided Imagery And Progressive Muscle Relaxation as a Cluster of Symptoms Management Intervention in Patients Receiving Chemotherapy: A Randomized Control Trial
Open accessAbstract
OBJECTIVE: Patients 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. METHODS: This 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. RESULTS: Patients 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). CONCLUSION: This 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 REGISTRATION: ClinicalTrials.gov NCT01275872.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Patients are recommended various forms of psychotherapy such as relaxation, guided imagery, mindfulness meditation, music therapy, occupational therapy, and breathing exercises.
“Patients are also recommended various forms of psychotherapy [10,11,12], such as relaxation and guided imagery [13,14], mindfulness meditation (mindfulness-based stress reduction) [14], music therapy [15,16], occupational therapy [17,18,19], and breathing exercises [20,21,22].”
From The Effect of Vinyasa Yoga Practice on the Well-Being of Breast-Cancer Patients during COVID-19 Pandemic (2023) · cites this paper as [14]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Modern Applied Statistics with S
Venables, W., & Ripley, B. (2010) · Statisctics and computing/Statistics and computing · doi:10.1007/978-0-387-21706-2 · Cited by 16,188 · see citing works
Interpreting the significance of changes in health-related quality-of-life scores.
Osoba, D., Rodrigues, G., Myles, J., Zee, B. C.-Y., & Pater, J. L. (1998) · Journal of Clinical Oncology · doi:10.1200/jco.1998.16.1.139 · Cited by 2,973 · see citing works
Linear Mixed Models: A Practical Guide Using Statistical Software
West, B. T., Welch, K. B., & Gałecki, A. T. (2006) · Thammasat University Digital Collections · Cited by 1,392 · see citing works
Akaike Information Criterion Statistics.
Grove, D., Sakamoto, Y., Ishiguro, M., & Kitagawa, G. (1988) · Journal of the Royal Statistical Society Series D (The Statistician) · doi:10.2307/2348776 · Cited by 1,184 · see citing works
Akaike information criterion statistics
(1987) · Mathematics and Computers in Simulation · doi:10.1016/0378-4754(87)90094-2 · Cited by 1,099 · see citing works
Symptom clusters and their effect on the functional status of patients with cancer.
Dodd, M. J., Miaskowski, C., & Paul, S. M. (2001) · PubMed · Cited by 775 · see citing works
Turner, J. A., Holtzman, S., & Mancl, L. (2007) · Pain · doi:10.1016/j.pain.2006.09.005 · Cited by 530 · see citing works
Longitudinal Data Analyses Using Linear Mixed Models in SPSS: Concepts, Procedures and Illustrations
Shek, D. T. L., & Ma, C. M. S. (2011) · The Scientific World JOURNAL · doi:10.1100/tsw.2011.2 · Cited by 425 · see citing works
Development and Validation of the Cancer Fatigue Scale
Okuyama, T., Akechi, T., Kugaya, A., Okamura, H., Shima, Y., Maruguchi, M., Hosaka, T., & Uchitomi, Y. (2000) · Journal of Pain and Symptom Management · doi:10.1016/s0885-3924(99)00138-4 · Cited by 407 · see citing works
Increased Theta and Alpha EEG Activity During Nondirective Meditation
Lagopoulos, J., Xu, J., Rasmussen, I., Vik, A., Malhi, G. S., Eliassen, C. F., Arntsen, I. E., Sæther, J. G., Hollup, S., Holen, A., et al. (2009) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2009.0113 · Cited by 354 · see citing works
Cancer-Related Fatigue and Sleep Disorders
Roscoe, J. A., Kaufman, M. E., Matteson-Rusby, S. E., Palesh, O. G., Ryan, J. L., Kohli, S., Perlis, M. L., & Morrow, G. R. (2007) · The Oncologist · doi:10.1634/theoncologist.12-s1-35 · Cited by 327 · see citing works
Bardia, A., Barton, D. L., Prokop, L. J., Bauer, B. A., & Moynihan, T. J. (2006) · Journal of Clinical Oncology · doi:10.1200/jco.2006.08.3725 · Cited by 243 · see citing works
Physical Functioning of Elderly Cancer Patients Prior to Diagnosis and Following Initial Treatment
Given, B. A., Given, C. W., Azzouz, F., & Stommel, M. (2001) · Nursing Research · doi:10.1097/00006199-200107000-00006 · Cited by 239 · see citing works
Liu, L., Fiorentino, L., Natarajan, L., Parker, B. A., Mills, P. J., Sadler, G. R., Dimsdale, J. E., Rissling, M. B., He, F., & Ancoli‐Israel, S. (2008) · Psycho-Oncology · doi:10.1002/pon.1412 · Cited by 221 · see citing works
Jacobsen, P. B., Meade, C. D., Stein, K., Chirikos, T. N., Small, B. J., & Ruckdeschel, J. C. (2002) · Journal of Clinical Oncology · doi:10.1200/jco.2002.08.301 · Cited by 201 · see citing works
The Index of Nausea, Vomiting, and Retching: a new format of the lndex of Nausea and Vomiting.
Rhodes, V. A., & McDaniel, R. W. (1999) · PubMed · Cited by 180 · see citing works
Cheung, Y. L., Molassiotis, A., & Chang, A. M. (2002) · Psycho-Oncology · doi:10.1002/pon.638 · Cited by 165 · see citing works
Development of reliable and valid measures of nausea and vomiting
Rhodes, V. A., Watson, P. M., & JOHNSON, M. H. (1984) · Cancer Nursing · doi:10.1097/00002820-198402000-00003 · Cited by 162 · see citing works
Burns, D. S. (2001) · Journal of Music Therapy · doi:10.1093/jmt/38.1.51 · Cited by 161 · see citing works
A systematic review of guided imagery as an adjuvant cancer therapy
Roffe, L., Schmidt, K., & Ernst, E. K. (2005) · Psycho-Oncology · doi:10.1002/pon.889 · Cited by 161 · see citing works
Gaston‐Johansson, F., Fall‐Dickson, J. M., Nanda, J. P., Ohly, K. V., Stillman, S., Krumm, S. K., & Kennedy, M. J. (2000) · Cancer Nursing · doi:10.1097/00002820-200008000-00004 · Cited by 140 · see citing works
León‐Pizarro, C., Gich, I. J., Barthe, E., Rovirosa, Á., Farrus, B., Casas, F., Verger, E., Biete, A., Craven–Bartle, J., Sierra, J., et al. (2007) · Psycho-Oncology · doi:10.1002/pon.1171 · Cited by 129 · see citing works
Yoo, H. J., Ahn, S. H., Kim, S. B., Kim, W. K., & Han, O. S. (2005) · Supportive Care in Cancer · doi:10.1007/s00520-005-0806-7 · Cited by 122 · see citing works
Armstrong, T. S., Cohen, M. Z., Eriksen, L. R., & Hickey, J. V. (2004) · Journal of Nursing Scholarship · doi:10.1111/j.1547-5069.2004.04038.x · Cited by 121 · see citing works
Kim, S.-D., & Kim, H. (2005) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2004.00938.x · Cited by 110 · see citing works
Relaxation and Imagery for Anxiety and Depression Control in Community Patients With Advanced Cancer
Sloman, R. (2002) · Cancer Nursing · doi:10.1097/00002820-200212000-00005 · Cited by 109 · see citing works
Relaxation to reduce nausea, vomiting, and anxiety induced by chemotherapy in Japanese patients
Arakawa, S. (1997) · Cancer Nursing · doi:10.1097/00002820-199710000-00005 · Cited by 102 · see citing works
Assessment of Symptom Clusters in People With Cancer
Paice, J. A. (2004) · JNCI Monographs · doi:10.1093/jncimonographs/lgh009 · Cited by 99 · see citing works
Charalambous, A., Giannakopoulou, M. D., Bozas, E., & Paikousis, L. (2015) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2015/270876 · Cited by 97 · see citing works
Self-citationBerry, D. L., Moinpour, C. M., Jiang, C. S., Ankerst, D. P., Petrylak, D. P., Vinson, L. V., Lara, P. N., Jones, S., Taplin, M. E., Burch, P. A., et al. (2006) · Journal of Clinical Oncology · doi:10.1200/jco.2005.04.8207 · Cited by 88 · see citing works
Mapping EORTC QLQ-C30 onto EQ-5D for the assessment of cancer patients
Kim, S., Jo, M., Kim, H. J., et al. (2012) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-10-151 · Cited by 66 · see citing works
Kwekkeboom, K. L., Hau, H., Wanta, B., & Bumpus, M. (2008) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2008.04.002 · Cited by 65 · see citing works
RELAXATION AND THE RELIEF OF CANCER PAIN
Sloman, R. (1995) · Nursing Clinics of North America · doi:10.1016/s0029-6465(22)00115-3 · Cited by 61 · see citing works
Potthoff, K., Schmidt, M. E., Wiskemann, J., Hof, H., Klassen, O., Habermann, N., Beckhove, P., Debus, J., Ulrich, C. M., & Steindorf, K. (2013) · BMC Cancer · doi:10.1186/1471-2407-13-162 · Cited by 60 · see citing works
Kontodimopoulos, N., Ntinoulis, K., & Niakas, D. A. (2010) · European Journal of Cancer Care · doi:10.1111/j.1365-2354.2009.01170.x · Cited by 58 · see citing works
The influence of guided imagery on chemotherapy-related nausea and vomiting.
Troesch, L. M., Rodehaver, C. B., Delaney, E. A., et al. (1993) · PubMed · Cited by 52 · see citing works
Molassiotis, A. (2000) · European Journal of Cancer Care · doi:10.1046/j.1365-2354.2000.00220.x · Cited by 52 · see citing works
The Effects of Guided Imagery on the Immune System: A Critical Review
Trakhtenberg, E. F. (2008) · International Journal of Neuroscience · doi:10.1080/00207450701792705 · Cited by 50 · see citing works
Golan‐Vered, Y., & Pud, D. (2012) · Pain Practice · doi:10.1111/j.1533-2500.2012.00554.x · Cited by 42 · see citing works
Chemotherapy-induced Nausea/Vomiting and Functional Status in Women Treated for Breast Cancer
Lee, J., Dibble, S. L., Pickett, M., et al. (2005) · Cancer Nursing · doi:10.1097/00002820-200507000-00002 · Cited by 38 · see citing works
The Chinese Translation of the Index of Nausea, Vomiting, and Retching
Fu, M. R., Rhodes, V. A., & Xu, B. (2002) · Cancer Nursing · doi:10.1097/00002820-200204000-00010 · Cited by 34 · see citing works
Behavioral treatment of chemotherapy-induced nausea and vomiting.
Morrow, G., & Hickok, J. T. (1993) · PubMed · Cited by 30 · see citing works
Pathak, P., Mahal, R. K., Kohli, A., & Nimbran, V. (2013) · International Journal of Advanced Nursing Studies · doi:10.14419/ijans.v2i2.715 · Cited by 28 · see citing works
Scott, D. W., Donahue, D. C., Mastrovito, R. C., et al. (1986) · Cancer Nursing · doi:10.1097/00002820-198608000-00005 · Cited by 19 · see citing works
Flagged first, then by citations
Research works printed but not linked: 4
- [19]Mosby. Mosby Medical Dictionary (8th Eds). St Louis: Mosby/Elsevier; 2008.
- [29]Zung W. How normal is anxiety? Current concepts (entire edition). Durham, NC: Upjohn; 1980.
- [30]Beck AT, Steer RA, Brown GK. BDI-II, Beck Depression Inventory: manual (2nd ed.) Boston: Harcourt, Brace, and Company; 1996.
- [35]Guidelines for Selecting the Covariance Structure in Mixed Model Analysis, Chuck Kincaid, paper 198–30, SAS software proceedings. Available: http://www2.sas.com/proceedings/sugi30/198-30.pdf
Cited by
Sorted by citations
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
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
Gok Metin, Z., Karadas, C., Izgu, N., Ozdemir, L., & Demirci, U. (2019) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2019.09.003 · Cited by 108 · see citing works
Charalambous, A., Giannakopoulou, M., Bozas, E., & Paikousis, L. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-026809 · Cited by 70 · see citing works
Self-citationPsychological interventions for women with non-metastatic breast cancer
Jassim, G. A., Doherty, S., Whitford, D. L., & Khashan, A. S. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008729.pub3 · Cited by 58 · see citing works
Zok, A., Matecka, M., Zapala, J., Izycki, D., & Baum, E. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20043770 · Cited by 12 · see citing works
“Patients are also recommended various forms of psychotherapy [10–12], such as relaxation and guided imagery [13,14], mindfulness meditation (mindfulness-based stress reduction) [14], music therapy [15,16], occupational therapy [17–19], and breathing exercises [20–22].”
Background
- Authors
- Charalambous, A., Giannakopoulou, M., Bozas, E., Marcou, Y., Kitsios, P., & Paikousis, L.
- Affiliations
- University of Turku (FI)
- National and Kapodistrian University of Athens (GR)
- Bank of Cyprus Oncology Center (CY)
- Corresponding author
- Charalambous, Andreas
- Giannakopoulou, Margarita
- Bozas, Evaggelos
- Marcou, Yiola
- Kitsios, Petros
- Paikousis, Lefkios
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2016-06-24
- Volume
- 11
- Issue
- 6
- Pages
- e0156911
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4920431
- OpenAlex
- W2463089356
- Cited by
- 135
- References
- 44
- Citations by year
- 2026: 4 · 2025: 12 · 2024: 12 · 2023: 21 · 2022: 19 · 2021: 24 · 2020: 8 · 2019: 11 · 2018: 14 · 2017: 9 · 2016: 1
- FWCI
- 6.28
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Ktisis at Cyprus University of Technology (Cyprus University of Technology) (submittedVersion, other-oa)
- UTUPub (University of Turku) (submittedVersion, other-oa)
- UTUPub (University of Turku) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Ktisis at Cyprus University of Technology (Cyprus University of Technology) (submittedVersion)
- Funders
- Cyprus University of Technology (INT-480619-2010)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Keywords
- guided imagery, progressive muscle relaxation, symptom clusters, chemotherapy side effects, cancer patients, fatigue, pain, nausea and vomiting, anxiety, depression, health-related quality of life, relaxation techniques, cognitive-behavioural intervention, symptom management, mindfulness-based interventions, mindfulness-based cognitive therapy, mindfulness-based stress reduction, mindfulness-based acceptance and commitment therapy
- MeSH terms
- Adult, Aged, Antineoplastic Agents, Anxiety, Fatigue, Female, Humans, Male, Middle Aged, Nausea, Neoplasms, Pain, Quality of Life, Relaxation Therapy, Vomiting, Treatment Outcome, Imagery, Psychotherapy, Disease Management, Drug-Related Side Effects and Adverse Reactions
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
