Supportive Care in Cancer

, Volume 27, Issue 5, pp 1775–1781 | Cite as

Reimagine: a randomized controlled trial of an online, symptom self-management curriculum among breast cancer survivors

  • S. K. SmithEmail author
  • K. MacDermott
  • S. Amarasekara
  • W. Pan
  • D. Mayer
  • M. Hockenberry
Original Article



Chronic pain, depression, and fatigue are common effects resulting from the cancer experience; new interventions are needed. This study examined the effect of Reimagine, an online symptom self-management curriculum that teaches coping skills, on key outcomes.


Adult breast cancer survivors with chronic pain were recruited from the Army of Women volunteer registry for this randomized controlled trial and randomized 1:1 to Reimagine or usual care conditions. Electronic surveys collected demographic, clinical, and outcome data at baseline and 18 weeks post-intervention.


Participants (N = 89) were mean age 56.7 ± 8.7 years; 67% married; 58% employed; mean years since diagnosis 8.2 ± 6.6; and 89% were in remission or cured of their breast cancer. There was a significant difference in the change in depression scores for treatment (M = − 1.7, SD = 4.5) and usual care (M = 0.3, SD = 3.8) conditions; t(85) = − 2.3, p = .03. Difference in the change in fatigue scores was significant for treatment (M = 4.8, SD = 9.0) and usual care (M = 1.2, SD = 6.6) conditions; t(87) = 2.2, p = .03. Most Reimagine users (94%) would recommend the curriculum to others.


These results suggest that Reimagine has an effect on depression and fatigue symptoms for breast cancer survivors. Online programs can be a feasible and effective alternative to in-person support. Additional research is recommended with larger and more diverse samples.


Breast cancer survivors Cancer survivorship Chronic pain Fatigue Depression Self care Randomized controlled trial Symptom management 



The authors wish to thank the breast cancer survivors who participated in this study. Recruitment was facilitated by the Dr. Susan Love Research Foundation.

Author contributions

Sophia Smith: Conceptualization, funding acquisition, software, project administration, data analysis, and writing—original draft, and writing—review and editing. Kristin MacDermott: Conceptualization, funding acquisition, software, and writing—review and editing. Wei Pan: Data analysis and writing—review and editing. Sathya Amarasekara: Data analysis and writing—review and editing. Marilyn Hockenberry: writing—review and editing.

Funding information

Trial (NCT02465892) was funded by Pfizer Independent Grants for Learning & Change (#16218019).

Compliance with ethical standards

Conflict of interest

All authors received support from money paid to Duke University as part of the Pfizer Independent Grants for Learning and Change award. The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Author names: S.K. Smith, PhD MSW; S. Amarasekara, MS; W. Pan, PhD; D. Mayer, PhD; M. Hockenberry, PhD

Ms. Kristin MacDermott, LMFT reports the following details of affiliation or involvement in an organization or entity with a financial or non-financial interest in the subject matter or materials discussed in this manuscript: Board membership and Employment by Pillars4Life, Inc.

Supplementary material

520_2018_4431_MOESM1_ESM.docx (26 kb)
ESM 1 (DOCX 26 kb)


  1. 1.
  2. 2.
    van den Beuken-van Everdingen M (2012) Chronic pain in cancer survivors: a growing issue. J Pain Palliat Care Pharmacother 26(4):385–387. CrossRefGoogle Scholar
  3. 3.
    Glare PA, Davies PS, Finlay E, Gulati A, Lemanne D, Moryl N, Oeffinger KC, Paice JA, Stubblefield MD, Syrjala KL (2014) Pain in cancer survivors. J Clin Oncol 32(16):1739–1747. CrossRefGoogle Scholar
  4. 4.
    Fortner BV, Demarco G, Irving G, Ashley J, Keppler G, Chavez J, Munk J (2003) Description and predictors of direct and indirect costs of pain reported by cancer patients. J Pain Symptom Manag 25(1):9–18CrossRefGoogle Scholar
  5. 5.
    So WK, Marsh G, Ling WM, Leung FY, Lo JC, Yeung M, Li GK (2009) The symptom cluster of fatigue, pain, anxiety, and depression and the effect on the quality of life of women receiving treatment for breast cancer: a multicenter study. Oncol Nurs Forum 36(4):E205–E214. CrossRefGoogle Scholar
  6. 6.
    Syrjala KL, Jensen MP, Mendoza ME, Yi JC, Fisher HM, Keefe FJ (2014) Psychological and behavioral approaches to cancer pain management. J Clin Oncol 32(16):1703–1711. CrossRefGoogle Scholar
  7. 7.
    Breivik H, Cherny N, Collett B, de Conno F, Filbet M, Foubert AJ, Cohen R, Dow L (2009) Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 20(8):1420–1433. CrossRefGoogle Scholar
  8. 8.
    van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J (2007) Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 18(9):1437–1449. CrossRefGoogle Scholar
  9. 9.
    Johannsen M, Farver I, Beck N, Zachariae R (2013) The efficacy of psychosocial intervention for pain in breast cancer patients and survivors: a systematic review and meta-analysis. Breast Cancer Res Treat 138(3):675–690. CrossRefGoogle Scholar
  10. 10.
    Greenlee H, DuPont-Reyes MJ, Balneaves LG, Carlson LE, Cohen MR, Deng G, Johnson JA, Mumber M, Seely D, Zick SM, Boyce LM, Tripathy D (2017) Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin 67(3):195–232. CrossRefGoogle Scholar
  11. 11.
    Carlson LE, Zelinski E, Toivonen K, Flynn M, Qureshi M, Piedalue KA, Grant R (2017) Mind-body therapies in cancer: what is the latest evidence? Curr Oncol Rep 19(10):67CrossRefGoogle Scholar
  12. 12.
    Cramer H, Lauche R, Paul A, Langhorst J, Kummel S, Dobos GJ (2015) Hypnosis in breast cancer care: a systematic review of randomized controlled trials. Integr Cancer Ther 14(1):5–15. CrossRefGoogle Scholar
  13. 13.
    Paice JA, Ferrell B (2011) The management of cancer pain. CA Cancer J Clin 61(3):157–182. CrossRefGoogle Scholar
  14. 14.
    Smith SK, O'Donnell JD, Abernethy AP, MacDermott K, Staley T, Samsa GP (2015) Evaluation of Pillars4life: a virtual coping skills program for cancer survivors. Psycho-Oncology 24(11):1407–1415. CrossRefGoogle Scholar
  15. 15.
    National Comprehensive Cancer Network (2017) NCCN clinical practice guidelines in oncology: adult cancer pain.
  16. 16.
    Abernethy AP, Herndon JE, Coan A, Staley T, Wheeler JL, Rowe K, Smith SK, Shaw H, Lyerly HK (2010) Phase 2 pilot study of pathfinders: a psychosocial intervention for cancer patients. Support Care Cancer 18(7):893–898. CrossRefGoogle Scholar
  17. 17.
    Cleeland CS, Ryan KM (1994) Pain assessment: global use of the brief pain inventory. Ann Acad Med 23(2):129–138Google Scholar
  18. 18.
    Kroenke K, Strine TW, Spitzer RL, Williams JB, Berry JT, Mokdad AH (2009) The PHQ-8 as a measure of current depression in the general population. J Affect Disord 114(1–3):163–173CrossRefGoogle Scholar
  19. 19.
    Webster K, Cella D, Yost K (2003) The functional assessment of chronic illness therapy (FACIT) measurement system: properties, applications, and interpretation. Health Qual Life Outcomes 1(79):79. CrossRefGoogle Scholar
  20. 20.
    Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M (2001) Effect of a self-management program on patients with chronic disease. Eff Clin Pract 4(6):256–262Google Scholar
  21. 21.
    Spence J, Titov N, Johnston L, Jones MP, Dear BF, Solley K (2014) Internet-based trauma-focused cognitive behavioural therapy for PTSD with and without exposure components: a randomised controlled trial. J Affect Disord 162:73–80CrossRefGoogle Scholar
  22. 22.
    Johansson R, Ekbladh S, Hebert A, Lindström M, Möller S, Petitt E, Poysti S, Larsson MH, Rousseau A, Carlbring P, Cuijpers P, Andersson G (2012) Psychodynamic guided self-help for adult depression through the internet: a randomized controlled trial. PLoS One 7(5):e38021CrossRefGoogle Scholar
  23. 23.
    Holmqvist M, Vincent N, Walsh K (2014) Web- vs. telehealth-based delivery of cognitive behavioral therapy for insomnia: a randomized controlled trial. Sleep Med 15(2):187–195. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Duke University School of NursingDurhamUSA
  2. 2.Duke Cancer InstituteDurhamUSA
  3. 3.The MacDermott Method, Inc.Beverly HillsUSA
  4. 4.University of North Carolina at Chapel Hill School of NursingChapel HillUSA

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