Experiences and Perceived Benefits of Remotely Delivered Dance/Movement Therapy for Adult Cancer Patients: A Multi-Method Program Evaluation

Abstract

Background:

Dance/Movement Therapy (DMT) is increasingly used as a complementary treatment to address psychological and physical wellbeing. However, it is unknown how it can be leveraged in adult cancer care. This mixed methods program evaluation aimed to assess patient-reported benefits and satisfaction with the virtual DMT in an academic oncology setting.

Methods:

We developed, implemented, and evaluated a 6-week virtual, synchronous DMT program aiming to improve physical health, address mental distress, and foster social connection for cancer patients. We used deidentified program evaluation data to assess impact of DMT on patient-reported outcomes and patients’ satisfaction with the DMT program. Pre- and post-session data were analyzed using descriptive statistics and a paired t-test. Qualitative data were captured through semi-structured interviews and analyzed using thematic analysis.

Results:

Results from 39 participants (mean age 64.7±9.8), majority female (89.7%) with a history of breast cancer (43.6%), showed high satisfaction (100%) and unanimous program recommendation (100%). Significant improvements were noted in anxiety (−0.42±0.76, p=.009), distress [−0.35±0.80, p=.036), and sense of joy (0.73±1.18, p=.004), with a non-significant trend in increased physical activity (0.38±0.98, p=.057). Thematic findings indicated that DMT participation facilitated: (1) engagement in physical activity for improved physical health, (2) fostered creative expression, (3) improved mental state, and (4) helped build social connections and support.

Conclusion:

Our DMT program shows promise as a component of integrative cancer care. The mixed-method evaluation provides insightful information to generate hypotheses for future RCT studies aiming to evaluate the specific effects of DMT on patient experience and outcomes.

Introduction

Receiving a cancer diagnosis profoundly impacts mental health and overall well-being. While survival rates of 69% are historically high [1], approximately 25% of cancer survivors continue to face enduring psychosocial issues and overall mental health challenges [1, 2]. Studies have found a clear association between decreased psychosocial wellbeing and quality of life and lower survival rates in people with cancer [3]. Furthermore, patients’ psychosocial and physical health needs were exacerbated during the COVID-19 pandemic, as patients faced heightened levels of social isolation due to safety precautions and restrictions on in-person interactions [4, 5]. These conditions underscored the need for accessible and innovative approaches to support patients’ overall well-being.

Dance movement therapy (DMT), defined as the “psychotherapeutic use of movement to promote emotional, social, cognitive and physical integration of the individual” [6], is increasingly used as a complementary treatment in cancer care [7]. Research suggests that DMT has potential to target both psychological [8-11] and physical outcomes [8, 10, 12] and may also have a beneficial effect on quality of life among cancer patients [11, 13, 14]. However, despite the potential benefits of DMT, it is unknown how it can be leveraged to effectively support psychosocial and physical well-being in adult patients with cancer, particularly as many services have shifted to telehealth in the wake of COVID-19 pandemic. To the best of our knowledge, no study has described and evaluated remotely delivered DMT programs, making it unclear what constitutes the optimal approach for this promising modality. Furthermore, no study has explored the application and feasibility of virtual DMT among individuals with cancer.

We developed and piloted first DMT program, delivered via Integrative Medicine at Home (IM@Home) [15, 16], a robust group wellness online platform. This synchronous (live) virtual DMT program was specifically designed to help patients address mental distress, improve physical health, and foster social connection. Combining surveys administered pre- and post- DMT session with qualitative interviews, we assessed patient-reported benefits and satisfaction with the virtual DMT program. In this manuscript, we describe the DMT program, report results of our mixed-methods evaluation, and consider implications for the design of future DMT studies in cancer care settings.

DMT for Adult Cancer Patients – Conceptual Model

Through literature review [8-12, 14, 17-20], clinical observations, expert consultations, and anecdotal participant feedback, we developed a conceptual model of DMT for psychosocial and physical wellbeing among adult patients with cancer. Guided by questions on DMT's impact and mechanisms of change, our model (Figure 1) integrates dance and physical activity, creative expression, and psychotherapeutic processing within a therapeutic relationship and group setting. Aligned with the Biopsychosocial Model of Health [21], our framework explores how DMT uniquely impacts psychological, social, and behavioral health outcomes, promoting overall well-being.

Figure 1.

Conceptual model of DMT for psychosocial and physical wellbeing among adult patients with cancer.

During DMT sessions, patients engage in gentle body workouts and tailored exercises, fostering a positive attitude towards physical activity and facilitating psychological adjustment. Improvisational, creative movement, guided by the therapist, helps patients recognize, name, and freely express emotions, enhancing understanding of their impact [22, 23]. This awareness of mental states allows patients to better grasp the connection between emotions, movement, and context, facilitating gradual mood changes and initiating shifts in habitual response patterns [22, 23].

Dance and movement not only reduce stress but also vitalize individuals [24], targeting symptoms like anhedonia and under-activity affecting patients’ quality of life. Dance and physical activity (i.e., guided or improvisational movement), strengthens, conditions and increases energy levels [24, 25]. Additionally, dance and movement modulate the neuroendocrine stress response [17], release tensions and toxins in the muscles [18], aiding relaxation and promoting mental well-being.

In an organized group setting led by a therapist, patients also find support, share experiences, and receive emotional support [18]. As a result, patients can feel less isolated, better understood, and more hopeful about their disease [26]. A trained DMT therapist guides a therapeutic process, identifies goals, and offers education. They also provide guidance and encouragement, helping patients develop coping strategies and resilience for improved quality of life.

Program Description

Based on the components described above we developed a 6-week DMT program offered virtually through the IM@Home platform at the Memorial Sloan Kettering Cancer Center (MSK). The program included six, one-hour group, live DMT sessions weekly on Zoom. Participation in all sessions was encouraged but not mandatory, and no special prerequisites or exercise equipment were needed. Sessions were led by a board-certified dance/movement therapist (JW) who is also an integrative medicine clinician. Each session followed the structure outlined in Table 1 below.

Table 1.

DMT session components

Session element	Time	Components and therapeutic goals
Verbal check-in	5 min	Verbal welcome and check-in with participants.
Warm-up	10 min	Therapist provides structured movement experiences to prepare the body for dance and movement by stimulating the nervous and cardiovascular system, strengthen the musculoskeletal system and increase flexibility. Attention is placed on enhancing body awareness, and body organization and alignment. Mindfulness practices and developmental movement sequences are used
Structured dance lesson	15 min	Therapist leads a structured dance lesson (choreography) incorporating range of dance styles to ease concerns or worries about not knowing “how” to dance and elicit sense of joy. The structured format helps people start moving to music, and aims to boost confidence, sense of accomplishment, and positively affect brain function, offering an extra benefit for patients experiencing ‘chemo brain’ or age-related cognitive challenges [27-29]
Unstructured period for free expression of movement	15 min	Therapist encourages self-guided creative movements to build emotional awareness and further the body-mind-emotion connection, promote emotional self-awareness in relation to one's body and cancer diagnosis, and explore themes related to one's life before, during, and after a cancer diagnosis through movement
Cooldown	5 min	Therapist provides a cooldown experience to 1) physically allow heart rate to safely decrease 2) offer space and time to bring themselves emotionally from the experience of expression and freedom of movement into closure 3) reconnect with one’s body to assess how they are feeling in relation to the start of the session
Closing & social connection	5 min	Group discussions, verbal reflection and processing of the experience, and social connection with peers to support building relationship and foster social connection and support

Methods

Design and Aims

An explanatory sequential mixed-methods design [30] was used to explore patient-reported benefits and satisfaction with participation in the virtual DMT program. The quantitative phase aimed to assess preliminary changes in anxiety, distress, sense of joy, and physical activity, and overall satisfaction with the program. The qualitative phase aimed to gain understanding of participants’ experiences, perceived benefits, and suggestions for program improvement. The Institutional Review Board of MSK approved the program evaluation (#18-445). The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Patient written consent for the publication of the study data was waived because this type of protocol indicates that waived consent and waiver of Health Insurance Portability and Accountability Act of 1996 authorization are appropriate.

Program Participants

Program participants were self-referred through the IM@Home workshop website. To participate in the program, patients had to be 18 years of age or older, with a diagnosis or history of cancer, English speaking, and registered for the DMT program. The IM@Home program has been described in detail elsewhere [15, 16].

Program Evaluation

Survey.

To evaluate patient experiences and satisfaction of key components of the program we designed a 6-item survey instrument in which participants rated their anxiety, distress, sense of joy (1 = 'not at all' to 5 = 'extremely'), physical activity (1 = 'poor' to 5 = 'excellent'), the extent to which they experienced positive social interactions during sessions (1 = 'not at all' to 5 = 'all of the time'), and whether they were able to freely and creatively express themselves (1 = 'not at all' to 5 = 'completely'). Survey completion was encouraged but not mandatory. The survey was distributed via Zoom’s poll feature before and at the end of the session.

To evaluate overall program satisfaction, at the end of the last (6^th) session, participants were asked to rate their satisfaction with DMT sessions on a 10-point Likert scale (1 = 'not at all satisfied' to 10 = 'extremely satisfied') and indicate how likely they were to recommend the program to another patient (1 = 'not at all likely' to 10 = 'extremely likely'). To evaluate the adherence, we also tracked participants’ attendance.

Qualitative Interviews.

To understand participants’ experiences, perceived benefits, and program feedback, we conducted optional semi-structured interviews with those attending at least 50% of the sessions. Interviews, lasting 30 to 60 minutes, were conducted via Zoom within a week of the last session completion and were audio-recorded with participants' permission.

Data Analysis

Survey data were entered into IBM SPSS version 24 [31] for analysis. Descriptive statistics were used to describe the sociodemographic, session attendance, and satisfaction with the program data. Pre- and post- survey data was analyzed using paired student t-test (p<.05 indicating statistical significance, two-sided).

Twelve participants expressed interest in post-program interviews, but due to scheduling constraints, only 8 completed the interviews. Recorded interviews were transcribed verbatim, reviewed for accuracy and de-identified, and imported into NVivo - a qualitative analysis software [32]. An inductive thematic analysis approach [33] was employed, with the primary author (KB) reviewing transcripts line-by-line. Initial codes were generated using the interview guide as a coding framework. Codes were then reviewed and compared across all transcripts, revised as needed, and systematized. To establish credibility during the coding process, KB engaged in reflexive journaling, had prolonged engagement with the data, and conducted peer debriefing with co-author (JW) [34]. Codes were aggregated into themes, reviewed, and examined for referential adequacy. The themes were then discussed with the co-author (JW) to ensure accurate representation of the data, modifications were made until consensus on themes was reached.

Results

Participants

A total of 39 participants (mean age 64.7±9.8; range 40- 81) took part in the program. The majority were female (35; 89.7%), white (30; 76.9%), non-Hispanic or Latino (32; 82.1%), and had diagnosis or history of breast cancer (17; 43.6%). Participant characteristics are described in Table 2 below.

Table 2.

Participant characteristics

Participant characteristics	N (%)
Age: mean, SD (range)	64.7±9.8 (40 - 81)
Gender
Female	35 (89.7)
Male	4 (10.3)
Race
White	30 (76.9)
Black and African American	3 (7.7)
Asian, Asian American	1 (2.6)
American Indian or Native American	1 (2.6)
Unknown	4 (10.3)
Ethnicity
Non-Hispanic or Latino	32 (82.1)
Hispanic or Latino	1 (2.6)
Unknown	6 (15.4)
Cancer Type
Breast	17 (43.6)
Prostate	3 (7.7)
Leukemia	3 (7.7)
Thyroid	2 (5.1)
Melanoma	2 (5.1)
Colorectal	2 (5.1)
Other*	10 (25.9)

^*Other included: Gynecological, Ophthalmic, Appendix, Ovarian, Uterine, Lymphoma

Attendance

We offered the DMT program twice (12 sessions) with a total of 105 nonunique session attendees. Among 39 unique participants who registered for the program, 19 (48.7%) attended 3 or more sessions. There were no adverse events reported by participants during the program.

Survey results

Change in symptoms.

Upon program completion, participants average anxiety scores decreased by 0.42 points (p=0.009, d=−0.56), and distress scores decreased by 0.35 (p=0.04, d=−0.43), where lower scores indicate less anxiety and distress. Participants average sense of joy scores increased by 0.73 (p=0.004, d=0.61), where higher score indicate improvement. For the anxiety and sense of joy, effect sizes were moderate (−0.56 and 0.61, respectively), suggesting reduction in anxiety and improvement in overall feeling of happiness and a sense of well-being with potential clinical significance. We also observed a non-significant trend in physical activity increase by 0.38 points (p=0.06, d=0.39) (Table 3).

Table 3.

Survey results

Outcome	N	Pre	Post	Change	SD	t	p	Cohen’s d
Anxiety	26	1.73	1.31	−0.42	0.76	−2.85	0.009*	−0.56
Distress	26	1.62	1.27	−0.35	0.80	−2.21	0.036*	−0.43
Sense of Joy	26	2.88	3.62	0.73	1.19	3.14	0.004*	0.61
Physical Activity	26	3.27	3.65	0.38	0.98	1.99	0.057	0.39

Social Engagement and Creative Expression.

Participants reported having experienced positive social interactions (21/21; 100%) and being able to express their feelings freely and creatively (21/21; 100%) during sessions.

Satisfaction with the program.

Among the 21 unique responses from our satisfaction survey, all 21 (100%) participants expressed being “extremely satisfied” with the program, and 21 (100%) were “extremely likely” to recommend it to others.

Qualitative results

Perceived Benefits

Four themes that describe in which ways participation in the DMT program helped participants to engage in a pleasurable physical activity and improve physical health, freely and creatively express difficult emotions in a supportive environment, relax and improve mental state and build connection with others and receive support. Themes are presented in Table 4 and discussed below with verbatim exemplar statements.

Table 4.

Qualitative findings

Theme and definition	Exemplar quotes
Improve Physical Health: Participation in DMT program engaged participants in a regular pleasurable physical activity and as a result improved their physical strength, energy, balance, and flexibility.	I often say to my husband that I had to get cancer to be in better physical shape now than I was thirty years ago, and this is because of the program. It makes you feel better physically. My activity level is so much better, better than it ever was in my life. I've retired and so I have the time, without pressure, to move and do things. I tried to do something physical every day, and I know that sounds like not a lot, but for me it's absolutely a lot either take a long walk or do a class. I loved it, I will say that if I did the class, I felt like I didn't have to do anything else that day. It felt so good. I noticed changes, like in my balance, and my flexibility also definitely has improved.
Foster Creative Expression: DMT provided a creative outlet for individuals to express themselves in a supportive and therapeutic environment.	My comfort level with movement and also my surroundings improved. I am much more appreciative of performance and creativity in a sense. You know, I had some big feelings going on, and I put them there [dance], and it was great. It was a wonderful outlet, you know, to kind of just, get my mind off things. I think for me, having creative outlets, no matter what your art is, is just essential to life. It has always been for me, and I would imagine it's pretty important to most people, you know, and expressing yourself through dance, you know, is beautiful.
Improve Mental State: Participation in DMT helped individuals connect with their emotions, increase emotional self-awareness, and process their feelings in relation to their body and life experiences, including a cancer diagnosis.	Just learning a dance, and you know the repetitiveness of it, made me feel like I accomplished a little something. Like by the end of the class I was better, I could accept more of myself, so I was very happy with the program. It is definitely a therapy for me. I do show up for it, even if it's hard for me to show up. You know, I find it sometimes very difficult to show up, but if I do, I'm never sorry, because at the end I always feel better. I always say yes, of course this is exactly what I needed. I need a place to put all this [stress] and having it so accessible like this via Zoom really has been a miracle for me. It's really helped me so much, and I'm so grateful. As I mentioned, mentally, absolutely like this is, this is medicine for me. I cannot think of the time ever when I took a dance class or any other of the classes and felt worse mentally afterwards.
Build Social Connection: Participants valued building a supportive community where they could connect with peers who share similar experiences.	It was nice to have conversation. It was very nice although at first it felt weird getting to know people on zoom you know… but with time you get to know a little bit about each other's lives. Well, with everybody in the group it was such a positive environment. Dance is one of those unique things. I think that's very individual and community oriented at the same time, right like those of us who have danced, we've experienced that.

Improve Physical Health.

Numerous comments indicated that DMT program emerged as a cornerstone for participants seeking to integrate a consistent and enjoyable physical activity routine into their lives. The DMT sessions were instrumental in effecting tangible improvements in physical strength, energy levels, balance, and flexibility. One participant provided a thorough explanation of this experience:

I feel like my shoulder movement, flexibility, and range of motion improved from dance because therapist had us doing like back strokes, forward strokes, you know all kinds of emotions with our arms and shoulders that really extended my range of motion.

Foster Creative Expression.

DMT emerged as a powerful outlet for creative expression within a supportive and non-judgmental environment. The program provided a unique platform where individuals could channel their creativity freely, unencumbered by societal expectations or judgment. One participant emphasized the intrinsic value of this creative outlet, articulating, "The ability to use your own creativity and express myself in the class without any expectations and judgement was the most important to me."

Improve Mental State.

Participation in DMT facilitated a way to connect with emotions and fostered increased emotional self-awareness. This newfound emotional self-awareness helped to process difficult feelings in relation to their bodies and life experiences and became instrumental in navigating complex feelings associated with a cancer diagnosis. Numerous comments attested to the therapeutic power of the immersive dance experience, describing how it offered relief from stress and depression creating a mental space of calmness. As described by one participant:

When you get involved in the classes and start moving and dancing, it gets your mind off the stress and depression. During the class, for 45 minutes, you're not thinking about it. I think mentally it puts me in a calmer state.

Build Social Connection.

The DMT’s value extended beyond individual benefits, fostering a sense of community among participants. Participants cherished the opportunity to form a supportive community, where shared experiences became the foundation for empathetic understanding. This communal setting, akin to a support group, provided a safe space for participants to communicate openly about their feelings, fostering a collective voice for self-expression. One participant eloquently conveyed this sense of community, stating:

Knowing what it was other people are feeling, what is helping them cope, it was almost like being in a support group, but also being able to communicate with others and say how you are feeling, it would give us a voice to express ourselves.

Program feedback

During qualitative interviews participants also reported satisfaction with remote delivery of the program pointing the accessibility of the service, for example “having it so accessible like this via Zoom really has been a miracle for me. It's really helped me so much, and I'm so grateful.” Another participant shared that having the program offered remotely was helpful:

Some of us are still hesitant to do things without masks, especially indoors. Having the Zoom classes is fantastic, and being able to show some creativity on Zoom, where you're not in a room where everybody else is looking at you or you at them, and comparing, you feel freer, it is freeing to be creative in that way, a way I'd never been creative before.

Participants also indicated satisfaction with a group format: “It was easier to talk to and connect with others in this small 8–10-person group,” and appreciated the role of the instructor who “made us all feel very comfortable with whatever level of movement we had.” Furthermore, participants valued the optional audio/video participation, for example:

Most times I don't even have my camera on, just because my setup is so weird […] but even though my camera is off, I am still able to see others which is really cool […] and I feel that energy, even if I'm not putting that energy out there for others.

Participants also expressed a wish for the sessions to be longer to allow for “more time to connect and chat after the session, we often stayed longer anyways” and that the program is added to the regular IM@Home schedule.

Discussion

In this study, we evaluated a live, synchronous virtual DMT program aimed at enhancing psychosocial and physical well-being in adults with cancer. To our knowledge this is the first report of a virtual application of DMT for this population. Our findings demonstrate that the DMT program, offered synchronously in a virtual format, was feasible and well accepted. Our data also suggest that DMT has the potential to improve patient-reported outcomes, as we identified promising signals in reduced anxiety and distress, and increased sense of joy. We also observed a potential trend towards improved physical activity. These findings can be leveraged to improve DMT programming and develop a more refined intervention for further pilot testing.

The virtual delivery of our program was well received. All participants reported being extremely satisfied with the program and were highly likely to recommend it. Nearly half of the thirty-nine people registered attended half, or more, of the session. Our attendance rates were comparable to other studies of exercise interventions [35] or yoga [36-38] but higher than in traditional community dance programs [39]. This could be due to the therapeutic support as a motivational component where participants not only follow a dance routine but also process their experience with a therapist. Furthermore, literature suggests common reasons for dropout from various support programs among cancer patients include high symptom burden, accessibility issues (i.e., lack of finances for program, or transport costs), and lack of time. In our program, participants valued the virtual delivery as it allowed them to engage in healing activities from the comfort and convenience of their own homes, mitigating barriers imposed by physical distance, transportation issues, or time constraints. This suggests acceptability of a remotely delivered DMT program, confirming that this modality can be implemented successfully via telehealth.

Participants also commented on structure of the program suggesting that longer and more sessions would be helpful to further promote social support and engage in psychotherapeutic processing. Although length of our intervention was based on the expert feedback and therapist experience, further adapting the dosage and assessing impact of DMT dosing is warranted to ensure participants attain benefits whilst also ensuring the intervention is realistic and achievable. Furthermore, future studies should explore strategies to further improve accessibility and adherence, such as having sessions at varied times, offering make-up sessions, or implementing rolling entry (open vs closed group). Contacting participants immediately after missed classes to determine reasons for absence could also enhance adherence. Moreover, capturing the perspectives of participants attending less than 50% of session would further explore patients’ experiences, beliefs, and barriers to participation, ultimately leading to improved care and treatment for all patients.

Exploring the effects of remote delivery of DMT for patients with cancer gains further importance in the post-pandemic context, providing not only an accessible alternative to traditional in-person therapy, but also a platform for essential social connection. Over 50% of individuals diagnosed with cancer experience loneliness, predominantly due to the impact of social distancing and isolation during the COVID-19 pandemic [40]. Cancer-related loneliness is a recognized risk factor for diminished mental (e.g., anxiety, depression) [41, 42] and physical health (e.g., fatigue, sleep disturbance) [43, 44], associated with lower quality of life, higher cancer incidence, and overall mortality [43, 45]. Consequently, addressing and providing suitable support for loneliness among cancer patients is imperative. In our virtual DMT program, we successfully built-in time for social connection and peer support into the session structure. Furthermore, dance, creative expression, and interpersonal experiences positively impact social health [43], mitigating feelings of loneliness and isolation. As a result, participants experienced positive social interactions and valued building a supportive community where they could connect with peers who share similar experiences.

Our DMT program produced promising signals for symptom management. Although we did not use validated instruments and had no formal pre-post testing, DMT resulted in potentially clinically meaningful immediate short-term reductions in anxiety and distress, along with an increase in sense of joy. We also detected a trend for improved physical activity levels. Our results align with other DMT studies indicating potential benefits on mood, distress, vitality, and quality of life among cancer patients [8, 11, 14, 18]. In our case, however, baseline symptom burden was relatively low, suggesting the potential for even larger impact of DMT for those with moderate to severe symptoms. Future studies should further examine these outcomes with validated instruments and employ strategies to maximize study retention, limit attrition, and to confirm the sustainability of changes over time. Additionally, future DMT programs may explore the clinical benefits of DMT for people with cancer with prior clinical diagnoses of a depressive and/or anxiety disorders.

Another aspect to consider in future DMT research is the selection of appropriate outcomes. Although researchers traditionally have focused on the negative effects of the cancer experience, there is growing evidence that positive changes are also common in cancer patients [46]. For example, developing a greater sense of joy can help people cope with the challenges and stress related to cancer [47]. Attaining joy in the context of cancer involves accepting the condition, fostering hope, pursuing happiness, and finding meaning in life. Strategies for experiencing joy include participating in a supportive community, engaging in positive activities like dance, or engaging in self-paced and self-guided creative movements to assist in processing of the cancer experience. In our study, participants reported the most change in sense of joy, suggesting it may be one of the key therapeutic mechanisms through which DMT influences psychosocial and physical health. Considering the characteristics of the population, future DMT research should carefully consider the selection and reporting of positive outcome measures, enabling examination as potential moderators of intervention effects.

Limitations

Our study has limitations as a program evaluation; it did not involve rigorous pre- and post-testing, a comparison group, or long-term follow-up, nor was it designed to assess how DMT impacts outcomes. Furthermore, we did not use validated instruments to assess changes in outcomes and did not include moderate to severe symptom burden as criteria for participation which may limit the program's impact due to floor or ceiling effects and selection bias. Although participants commented on their preference regarding length and number of the session, we did not assess the impact of DMT dosing, and are unable to comment on optimal treatment duration. In this program evaluation we only interviewed participants who attended at least 50% of the sessions which may lead to a biased perspective of preferred dose and intensity. Future research should make efforts to include infrequent session attendees in qualitative interviews to understand program impact and barriers to participation. Our data comes from a small convenience sample of self-referred participants, primarily white non-Hispanic breast cancer patients limiting its generalizability due to potential sampling bias. The program's completion in an academic cancer center that has a long tradition of offering DMT services further restricts generalizability beyond this setting.

Conclusions

Despite these limitations, our study is the first program evaluation of a virtual, synchronous DMT program for adult cancer patients. The results suggest that our DMT program is feasible and acceptable, with potential for improving physical health, addressing mental distress, and fostering social connection among cancer patients. Future randomized controlled trials are needed to establish the specific efficacy of DMT on patient-reported outcomes.