Guest Editor’s Note: Cancer and its treatments often contribute to troubling symptoms, including fatigue, which has been correlated with poor treatment-related outcomes, including overall survival, in patients with cancer. Growing evidence indicates that mind-body therapies such as meditation, yoga, and tai chi, as well as exercise, are effective in managing cancer-related symptoms.
Karolina Bryl, PhD, DMT/DMP, CMA, RSMT/E
Researchers at the Integrative Medicine and Wellness Service developed Integrative Medicine@Home, a virtual, live mind-body therapy and fitness program, in response to the COVID-19 pandemic. In the IMPROVE trial, the program was shown to significantly reduce fatigue, as well as anxiety and depression. In this article, Dr. Karolina Bryl reports overall survival results from a secondary analysis of the IMPROVE trial.
Background
The Integrative Medicine for Patient-Reported Outcomes, Values, and Experience (IMPROVE) trial was conducted by the Integrative Medicine and Wellness Service at Memorial Sloan Kettering Cancer Center (MSKCC) in response to the challenges posed by the COVID-19 pandemic. Researchers evaluated whether a 12-week multimodality digital integrative medicine program, Integrative Medicine @Home (IM@Home), incorporating evidence-based mind-body therapies (eg, yoga and mindfulness) and structured exercise, could improve symptom burden and quality of life. A total of 200 patients with solid tumors receiving systemic therapy or radiation and experiencing moderate to severe fatigue were randomly assigned to IM@Home or an enhanced usual care control group that received access to on-demand meditation resources in addition to usual care. The IM@Home intervention was delivered remotely through multiple weekly class offerings using a scalable digital model that enabled patients to access care from home while addressing common barriers such as geographic distance, cost, and scheduling constraints. Results showed that IM@Home significantly reduced fatigue, anxiety, depression, and overall symptom burden compared with enhanced usual care, while also reducing emergency department visits, hospitalizations, and treatment disruptions.1,2
Secondary Analysis of the IMPROVE Trial
In this study, the investigators explored whether the improvements in symptoms and well-being observed in the IMPROVE trial translated into better long-term clinical outcomes, particularly overall survival.
Key Findings
This secondary analysis included 127 of the original 200 participants with solid tumors who experienced fatigue during systemic therapy. Results showed a clinically meaningful improvement in overall survival among patients assigned to the IM@Home intervention. At a median follow-up of 28.6 months, median overall survival was not reached in the IM@Home group, compared with 26.3 months in the control group. At 24 months, the estimated overall survival rate was 69.1% in the IM@Home group vs 52.6% in the control group (P = .037). In adjusted analyses accounting for tumor type and stage, IM@Home was associated with a lower risk of death (hazard ratio = 0.59), although the finding did not remain statistically significant in sensitivity analyses. According to the investigators, these findings suggest that a relatively brief, nonpharmacologic integrative medicine intervention may have meaningful downstream effects on survival.3
Context Within Integrative Oncology
These findings are particularly notable in the broader context of integrative oncology. Current clinical guidelines, including those from ASCO and the Society for Integrative Oncology, recommend mind-body therapies and exercise for symptom management in patients with cancer.4-8However, evidence linking these interventions to improved survival has been limited. This secondary analysis provides preliminary evidence that such interventions may also influence longer-term clinical outcomes.
“The observed improvement in overall survival suggests that addressing symptom burden through a structured integrative medicine program during active treatment may have broader clinical impact,” the study authors noted.
The authors highlighted several potential mechanisms that could explain the observed survival benefit, including reductions in fatigue and stress, as well as better adherence to cancer treatment. Improvements in symptom burden may enable patients to better tolerate and complete treatment, potentially contributing to improved long-term clinical outcomes.
Guest Editor
Jun J. Mao, MD, MSCE
Dr. Mao is the Laurance S. Rockefeller Chair in Integrative Medicine and Chief of Integrative Medicine Service at Memorial Sloan Kettering Cancer Center, New York.
“By targeting multiple domains simultaneously, the IM@Home intervention reflects a whole-person approach that may influence both psychological and physiological pathways relevant to cancer outcomes,” the study authors noted.
The authors emphasized that these findings should be interpreted with caution. The survival analysis was exploratory, and the trial was not originally powered to detect differences in overall survival. As with many behavioral interventions, unmeasured confounding factors, such as differences in participant engagement or motivation, may also have influenced the results. Despite these limitations, the findings are hypothesis-generating and provide a strong rationale for future trials specifically designed to evaluate survival outcomes.
Implications for Practice and Research
This study contributes to the growing body of evidence supporting integrative oncology. The findings reinforce the importance of addressing symptom burden as a core component of comprehensive cancer care, particularly given the established association between symptoms such as fatigue and poorer clinical outcomes. They also provide preliminary evidence that patient-centered, multicomponent interventions delivered in a fully digital format may have effects beyond symptom management and could influence longer-term clinical outcomes.
The intervention’s digital delivery model offers a scalable approach to expanding access to supportive care services, particularly for patients who face logistical barriers to in-person care. Another notable aspect of the study is its emphasis on patient-centered care. The intervention was designed to address patient-reported symptoms and experiences, aligning with a growing emphasis in oncology on prioritizing the patient experience alongside traditional clinical endpoints. The inclusion of multiple modalities also allows for individualized participation, which may enhance engagement and effectiveness.
Conclusions
The secondary survival analysis of the IMPROVE trial provides promising evidence that a digitally delivered integrative oncology program may improve not only symptom burden but also overall survival in patients undergoing systemic cancer treatment. Although additional research is needed to confirm these findings and clarify the underlying mechanisms, the study highlights the potential for integrative, patient-centered, and accessible interventions to play a broader role in cancer care. If confirmed in larger trials, these findings could support the broader integration of multimodal, nonpharmacologic interventions into standard oncology care.
REFERENCES
1. Mao JJ, Bryl K, Gillespie EF, et al: Randomized clinical trial of a digital integrative medicine intervention among patients undergoing active cancer treatment. npj Digit Med 14;8(1):29, 2025.
2. Bryl KL, Santos Teles M, Baser RE, et al: Reducing the rate of treatment disruptions through a digital structured exercise and mind-body program during systemic cancer therapy: A secondary analysis of a randomized clinical trial. Cancers (Basel) 18(6):984, 2026.
3. Daly B, Bryl K, Santos Teles M, et al: Survival results from the integrative medicine for patient-reported outcomes, values, and experience (IMPROVE) trial. JCO Oncol Adv 3:e2500154, 2026.
4. Carlson LE, Tripathy D, Zick SM, et al: The Society for Integrative Oncology–American Society of Clinical Oncology joint guidelines on integrative therapies for symptom management—Overview and key recommendations. J Integr Complement Med 30(7):596-601, 2024.
5. Bower JE, Lacchetti C, Alici Y, et al: Management of fatigue in adult survivors of cancer: ASCO–Society for Integrative Oncology guideline update. J Clin Oncol 42(20):2456-2487, 2024.
6. Carlson LE, Ismaila N, Addington EL, et al: Integrative oncology care of symptoms of anxiety and depression in adults with cancer: Society for Integrative Oncology–ASCO guideline. J Clin Oncol 41(28):4562-4591, 2023.
7. Andersen BL, Lacchetti C, Ashing K, et al: Management of anxiety and depression in adult survivors of cancer: ASCO guideline update. J Clin Oncol 41(18):3426-3453, 2023.
8. Mao JJ, Ismaila N, Bao T, et al: Integrative medicine for pain management in oncology: Society for Integrative Oncology–ASCO guideline. J Clin Oncol 40(34):3998-4024, 2022.
