Relaxation and guided imagery are widely used integrative therapies in cancer but their effects, alone and in combination, on cancer-related quality of life and mood in patients undergoing chemotherapy for colorectal cancer has not been documented. One hundred and fifty-one patients with newly diagnosed colorectal cancer (Duke's stage B, C or D) took part in a pragmatic randomized trial. They were randomized remotely to treatment as usual, relaxation, guided imagery, or relaxation plus guided imagery. The primary outcome measures (at 24 weeks after randomization) were: quality of life, measured by the Trial Outcome Index (TOI) of the colorectal version of the Functional Assessment of Cancer Therapy (FACT-C); and mood, measured by the relaxation subscale of the Mood Rating Scale (MRS-R). Primary analysis was by treatment allocated. Relaxation and guided imagery, alone and in combination, had no significant effect on the primary outcome measures, and little effect on secondary outcomes. Guided imagery increased TOI scores (the higher the better) by 0.2 (95% confidence interval (CI) -3.1 to +3.5) and MRS-R scores (the higher the better) by 1.8 (CI -6.2 to +9.7). Relaxation reduced TOI scores by 1.0 (CI -2.3 to +4.3) and MRS-R scores by 3.4 (CI -4.6 to +11.3). Compared to treatment as usual, therefore, the three other interventions did not have clinically significant effects on quality of life or mood in these patients attending an integrated oncology health service. This may be because the prevalence of distress throughout the study was much lower than that reported in other clinical trials and comparable populations, and/or because there was no training face to face. Future research should utilize live training sessions with or without audio recordings. [ABSTRACT FROM AUTHOR]