Serra, D., Parris, C. R., Carper, E., Homel, P., Fleishman, S. B., Harrison, L. B., & Chadha, M. (2012). Outcomes of guided imagery in patients receiving radiation therapy for breast cancer. Clinical Journal of Oncology Nursing, 16, 617–623. 

To examine the effects of guided imagery on patient distress and symptoms during radiotherapy.

Patients received instruction on guided imagery during the first few days of radiotherapy treatment and participated in sessions with a nurse immediately prior to radiotherapy treatments. Sessions lasted about 30 minutes and involved relaxation and breathing exercises with visualization of a calming experience and setting. Patients were provided with a CD for home practice. Study measures were performed at baseline and at the end of radiotherapy treatments. Pre- and postsession pulse, blood pressure, and thermal biofeedback measures were obtained.

• The study reported a sample of 66 women; only 11 remained for the final measures.
• Mean age was 57 years (range 28–77).
• All patients had breast cancer and were undergoing active radiotherapy. Most were also receiving adjuvant chemotherapy and/or hormonal therapy.

• Single site
• Outpatient

A quasiexperimental design was used.

• Distress thermometer and visual analog scale (VAS) subscales
• EuroQol EQ-5D questionnaire
• Thermal biofeedback

EQ-5D subscale scores for anxiety and depression declined from a mean of 1.42 to 1.26 by the end of treatment (p = 0.01). There was a decline in overall distress scores (p = 0.04), but no significant changes occurred in depression, sleep, or fatigue scores. Patients showed immediate postsession reduction in respiratory rate and blood pressure but no significant differences in thermal biofeedback findings.

The findings suggest that relaxation and imagery can be helpful to patients during radiotherapy.

• The study had a small sample size, with less than 100 patients.
• The study had risks of bias due no control group, no blinding, and no random assignment.
• Patient withdrawals were 10% or greater.
• It is not known whether patients used the intervention between sessions.

Findings suggest that relaxation therapy and imagery can be helpful to patients during radiotherapy treatment; however, this study had substantial design limitations that limited the strength of the evidence. Relaxation and imagery, and particularly patients’ use of these techniques on their own, pose no patient risks and can be a practical intervention that is helpful to patients during active treatment.