BACKGROUND Small studies of variable quality suggest that massage therapy may relieve pain and other symptoms. OBJECTIVE Evaluate efficacy of massage for decreasing pain and symptom distress and improving quality of life among persons with advanced cancer. DESIGN Multi-site randomized clinical trial. SETTING Population-based Palliative Care Research Network (PoPCRN). PATIENTS 380 adults with advanced cancer experiencing moderate-severe pain; 90% were enrolled in hospice. INTERVENTION Six 30-minute massage or simple touch sessions over two weeks. MEASUREMENTS Primary outcomes were immediate (Memorial Pain Assessment Card, MPAC, 0 – 10 scale) and sustained (Brief Pain Inventory, BPI, 0 – 10 scales) change in pain. Secondary outcomes were immediate change in mood (MPAC 0 – 10 scale) and 60-second heart and respiratory rates and sustained change in quality of life (McGill Quality of Life Questionnaire, MQOL, 0 – 10 scale), symptom distress (Memorial Symptom Assessment Scale, MSAS, 0 – 4 scale), and analgesic medication use (parenteral morphine equivalents (milligrams/24 hours). Immediate outcomes were obtained just prior to and following each treatment session. Sustained outcomes were obtained at baseline and weekly for 3 weeks. RESULTS 298 were included in the immediate outcome analysis and 348 in the sustained outcome analysis. 82 did not receive any allocated study treatments (37 massage, 45 control). Both groups demonstrated immediate improvement in pain (massage -1.87 points (CI, -2.07, -1.67), control -0.97 points (CI, -1.18, -0.76)) and mood (massage 1.58 points (CI, 1.40, 1.76), control 0.97 points (CI, 0.78, 1.16)). Massage was superior for both pain and mood (mean difference 0.90 and 0.61 points, respectively, P<0.001). There were no between group mean differences over time in pain (BPI Mean 0.07 (CI, -0.23, 0.37), BPI Worst -0.14 (CI, -0.59, 0.31)), quality of life (MQOL Overall 0.08 (CI, -0.37, 0.53)), symptom distress (MSAS Global Distress Index -0.002 (CI, -0.12, 0.12)), or analgesic medication use (parenteral morphine equivalents -0.10 (CI, -0.25, 0.05). LIMITATIONS The immediate outcome measures were obtained by unblinded study therapists, possibly leading to reporting bias and the overestimation of beneficial effect. The generalizability to all advanced cancer patients is uncertain. The differential beneficial effect of massage therapy over simple touch is not conclusive in the absence of a “usual care” control arm. CONCLUSIONS Massage may have immediately beneficial effects on pain and mood among patients with advanced cancer. Given the lack of sustained effects and the observed improvements in both study arms, the potential benefits of attention and simple touch should also be considered in this population.

Acupuncture may improve PD-related fatigue, but real acupuncture offers no greater benefit than sham treatments. PD-related fatigue should be added to the growing list of conditions that acupuncture helps primarily through nonspecific or placebo effects. © 2016 International Parkinson and Movement Disorder Society.

Conventional care for patients with cancer can safely incorporate massage therapy, although cancer patients may be at higher risk of rare adverse events. The strongest evidence for benefits of massage is for stress and anxiety reduction, although research for pain control and management of other symptoms common to patients with cancer, including pain, is promising. The oncologist should feel comfortable discussing massage therapy with patients and be able to refer patients to a qualified massage therapist as appropriate.