Massage Therapy versus Simple Touch to Improve Pain and Mood in Patients with Advanced Cancer

Abstract

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.

Providing Massage Therapy for People with Advanced Cancer: What to Expect

“…These data confirm the safety of massage for patients with advanced cancer. 19 Massage therapists were instructed to record any reason that required them to stop the 30-minute treatment session early. In the 814 encounters there were only 13 notations (1.6%) of early termination.…”

Evidence For The Cancer Patients’ Pain Management: An Integrative Review

“…The massage was superior to the simple-touch [21], while the aromatic manual massage superimposed the manual massage with oil, with important effect in reducing pain and depressive symptoms [22].…”

“…The first study compared single-touch massage [21], the second compared the aromatic manual massage to general manual massage with oil, noting its effect on pain, anxiety, depression and life quality in patients with advanced cancer and palliative care [22]. The massage was superior to the simple-touch [21], while the aromatic manual massage superimposed the manual massage with oil, with important effect in reducing pain and depressive symptoms [22].…”

Urut Melayufor Poststroke Patients: A Qualitative Study

“…The effects of urut Melayu can be classified into physical, psychologic, and effects on daily living activities. One patient said: All the patients expressed their wish to possibly get urut Melayu more frequently as the urut made them feel ringan [relaxed, refreshed, rejuvenated, and re-energized; feeling of replenished energy] 8 . More than half of the patients reported that other people too had noticed that they had markedly improved following urut Melayu.…”