title: 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-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.
authors.affiliation: Mind Matters Research LLC, 7926 Port Orford Dr., Anchorage, AK, 99507, USA.
authors.forename: Lyn W
authors.initials: LW
authors.lastname: Freeman
authors.affiliation: Arctic Skye Family Medicine, 561 S Denali Suite E, Palmer, AK, 99645, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: White
authors.affiliation: Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, USA.
authors.forename: Chelsea G
authors.initials: CG
authors.lastname: Ratcliff
authors.affiliation: Mind Matters Research LLC, 7926 Port Orford Dr., Anchorage, AK, 99507, USA.
authors.forename: Sue
authors.initials: S
authors.lastname: Sutton
authors.affiliation: Alaska Oncology and Hematology LLC, 2925 DeBarr Road, Suite 300, Anchorage, AK, 99508, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Stewart
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
authors.forename: J Lynn
authors.initials: JL
authors.lastname: Palmer
authors.affiliation: Cancer Center Program, Alaska Regional Hospital, 2801 DeBarr Rd, Anchorage, AK, 99508, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Link
authors.affiliation: Department of General Oncology and the Integrative Medicine Department, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D001521:Behavior Therapy / Q000379:methods*; D001943:Breast Neoplasms / Q000523:psychology / Q000534:rehabilitation*; D060825:Cognitive Dysfunction / Q000209:etiology / Q000517:prevention & control*; D005221:Fatigue / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy; D008875:Middle Aged; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000209:etiology / Q000517:prevention & control*; D029181:Spirituality; D017741:Survivors / Q000523:psychology*; D017216:Telemedicine; D014850:Waiting Lists
keywords: breast cancer; cancer survivorship; guided imagery; quality of life; telemedicine