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IMAGINE & Implementation: Advancing Evidence-Based Integrative Oncology Care

Written by Peter Traversa on . Posted in Research Blog Postings.

Authors: Janet Liu, MA, C-IAYT, SIO Project Coordinator; Kelly McConnell, PhD, IMAGINE Project Co-Principal Investigator; IMAGINE Project Team

Introduction

The Implementing Massage & Acupuncture to Achieve Better Pain Management in Oncology Care (IMAGINE) project is a large-scale, patient-centered implementation initiative designed to translate evidence from the Integrative Medicine for Pain in Patients with Advanced Cancer Trial (IMPACT) into routine oncology care. IMPACT was a two-arm randomized controlled trial that compared acupuncture and massage for pain and symptom management among 300 patients with advanced cancer experiencing moderate to severe pain. Both interventions were found to be safe and equally effective in reducing pain and co-occurring symptoms.1

Building on this evidence, IMAGINE focuses on implementing the IMPACT acupuncture and massage protocols across 35 diverse cancer care settings in the United States. The overarching goal is to improve access to effective, non-pharmacologic symptom management strategies that reflect patient priorities, are feasible in real-world practice, and can be sustained over time. The project is a collaboration between Memorial Sloan Kettering Cancer Center and the Society for Integrative Oncology. Both IMAGINE and IMPACT were funded by the Patient-Centered Outcomes Research Institute (PCORI).

What Is Implementation and Why It Matters

Implementation science addresses the persistent gap between what is known to work and what is delivered in real-world care—the “know–do gap.” 2, 3 Historical and contemporary examples demonstrate that publication of evidence alone rarely leads to timely uptake of efficacious treatments. Factors such as clinical culture, professional roles, institutional workflows, and resource constraints strongly influence whether evidence-based practices are adopted. Implementation research explicitly examines these contextual factors and tests strategies to promote equitable, timely, and sustained use of effective interventions.4

IMAGINE is an implementation project because its primary aim is not to generate new efficacy data, but to support the adoption, integration, and sustained use of existing evidence-based interventions – acupuncture and massage therapy from IMPACT – in routine clinical practice. Rather than asking “Does this work?,” IMAGINE asks: How can this work for patients, clinicians, and health systems in everyday practice?

Why Implementation Matters for Integrative Oncology Clinicians

Integrative oncology includes numerous evidence-based treatments that improve patient symptoms and quality of life.5, 6 However, barriers in clinical care settings such as lack of knowledge about integrative oncology among oncology clinicians, inconsistent referral pathways, and variable practice standards make provision of these treatments difficult.7 Implementation science offers tools to overcome these barriers to:

  • Embed evidence-based integrative therapies into routine clinical workflows
  • Strengthen consistency, quality, and credibility of care delivery
  • Improve communication and collaboration with patients, clinicians, and health systems

Implementation Strategies

IMAGINE employs a multi-component implementation strategy, as combined approaches are more effective than single interventions in achieving practice change.

Educational Courses
A key barrier to implementation of acupuncture and massage in cancer care settings is limited oncology-specific training among licensed acupuncturists and massage therapists.7 IMAGINE provides structured educational courses to prepare acupuncturists and massage therapists to deliver the IMPACT protocols safely and consistently in oncology settings. These courses address clinical considerations unique to cancer care and support protocol fidelity.

Educational Materials
Patient- and clinician-facing educational materials support shared understanding and informed decision-making between integrative oncology clinicians and patients. These resources also address common knowledge gaps among oncology clinicians and patients, increase awareness of the evidence supporting acupuncture and massage, and facilitate communication within care teams. Materials include patient handouts, short videos, concise informational blogs, and recommended language for discussing integrative therapies in oncology contexts.

External Facilitation Meetings
Many integrative oncology clinicians report feeling siloed at their institution with few opportunities to consult with other clinicians in the field.8 To address this need, IMAGINE provides group external facilitation meetings to provide ongoing, tailored support to address site-specific barriers to implementation. Facilitated meetings create opportunities for peer learning, problem-solving, and feedback, particularly important for integrative medicine clinicians who often work in relative isolation within cancer centers. Facilitation focuses on IMPACT protocol fidelity, implementation progress, and effective engagement with oncology clinicians and patients.

IMAGINE Outcomes

The primary outcome for IMAGINE is reach or the number of patients with pain who are treated with the IMPACT protocol. Reach is an indicator of the impact of the implementation strategies on patient care.

Other IMAGINE outcomes include:

  • Adoption: The number of sites and providers who use the IMPACT protocols
  • Effectiveness: The number of acupuncture/massage referrals and visits and patient self-report ratings of pain and co-morbid symptoms pre- and post-treatment
  • Fidelity: Provider utilization of the core components of the IMPACT protocol

Conclusion: From Evidence to Impact

Closing the research-to-practice gap requires more than strong evidence—it requires intentional implementation. IMAGINE uses multiple implementation strategies to support the reach, adoption, sustainability, and real-world impact of evidence-based acupuncture and massage therapy for pain in people with cancer. These strategies, combined with the community being created among IMAGINE sites creates the foundation for ongoing collaboration and national growth of integrative oncology.

**Learn more about IMAGINE and implementation science at the 2026 International Conference of the Society for Integrative Oncology pre-conference workshop, “Applying Implementation Science to Advance High-Quality Integrative Oncology Care: Lessons from the IMAGINE Project,” on September 29, 2026. The SIO Conference will be held September 29–October 1 at the MGM Grand Casino in Detroit, Michigan. For details, visit https://integrativeonc.org/sio-2026-conference/.

References

  1. Epstein AS, Liou KT, Romero SAD, Baser RE, Wong G, Xiao H, Mo Z, Walker D, MacLeod J, Li Q, Barton-Burke M, Deng GE, Panageas KS, Farrar JT, Mao JJ. Acupuncture vs massage for pain in patients living with advanced cancer: the IMPACT randomized clinical trial. JAMA Netw Open. 2023;6(11):e2342482. doi:10.1001/jamanetworkopen.2023.42482
  2. Chu F. Implementation science: why should we care? J Med Libr Assoc. 2024;112(3):281-285. doi:10.5195/jmla.2024.1919
  3. Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015 Sep 16;3(1):32. doi: 10.1186/s40359-015-0089-9. PMID: 26376626; PMCID: PMC4573926.
  4. Schmitt M, Hawkins M, Florsheim P. Key determinants in implementation processes: a systematic review using the Consolidated Framework for Implementation Research (CFIR). Implement Sci Commun. 2025;6(1):89. doi:10.1186/s43058-025-00712-1
  5. Semeniuk G, Bahadini B, Ahn E, Zain Z, Cheng J, Govindarajan A, Rose J, Lee RT. Integrative oncology and the clinical care network: challenges and opportunities. J Clin Med. 2023;12(12):3946. doi:10.3390/jcm12123946
  6. Gowin K, Muminovic M, Zick SM, Lee RT, Lacchetti C, Mehta A. Integrative therapies in cancer care: an update on the guidelines. ASCO Educ Book. 2024;44:e431554. doi:10.1200/EDBK_431554
  7. Veleber S, Cohen MR, Weitzman M, Maimon Y, Adamo CA, Siman J, Lu W, Sajdyk T, & Stone JAM. Characteristics and challenges of providing acupuncture and Chinese herbal medicine in oncology treatment: report of survey data and experience of five unique clinical settings. Integr Cancer Ther. 2024;23:15347354241226640. doi:10.1177/15347354241226640
  8. Zia FZ, Olaku O, Bao T, Berger A, Deng G, Fan AY, Garcia MK, Herman PM, Kaptchuk TJ, Ladas EJ, Langevin HM, Lao L, Lu W, Napadow V, Niemtzow RC, Vickers AJ, Shelley Wang X, Witt CM, Mao JJ. The National Cancer Institute’s conference on acupuncture for symptom management in oncology: state of the science, evidence, and research gaps. J Natl Cancer Inst Monogr. Nov 1 2017;2017(52)doi:10.1093/jncimonographs/lgx005.