resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
First Annual ICD-10 Updates Take Effect
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place.
National Board Apologizes for Testing Issues
The National Board of Chiropractic Examiners (NBCE) has issued a formal apology following a series of computer-based testing malfunctions that impacted two separate examinations (March and June 2016) and caused "widespread confusion and frustration" to the nearly 1,500 examinees taking the tests.
Upgrade to "Parker 2.0" in Las Vegas
Continuing your education and refining your practice: two key elements of a successful chiropractic career. Parker Seminars promises both as it celebrates its 65th anniversary in Las Vegas next February, according to Parker University President, Dr. William Morgan, and seminar consultant Dr. Mark Sanna.
Pediatric Asthma: A Case Study
I have had very good success with pediatric asthma, combining acupuncture with Chinese herbal products. Treatment is given over four to eight months, twice monthly, with herbal formulas rotated every month.
Four Ways to Attract Patients
Acupuncturist A has been in practice for six years and has struggled since day one. She spends as much time and money on marketing as she can, but since her practice is slow, her budget isn't that big.
Going Beyond Just Feeling Good
We all know that most patients come to us for some pain complaint: neck pain, back pain, sciatica, carpal tunnel, etc. We also all know that acupuncture is a great first-line care for these issues, as well as supporting overall health and wellness.
Natural Cancer Prevention: Pomegranate for the Prostate
In recent years, the ingestion of pure pomegranate juice (8 ounces per day) has been shown in clinical studies with human subjects to slow, and to some degree, reverse, the progression of prostate cancer – the second leading cause of cancer death in North American men.
Pediatric Footwear: Function Over Fashion
As practitioners, it is not uncommon for parents to bring us their children to treat or ask us questions related to the pediatric population. Children's feet tend to be a perplexing region for parents and practitioners alike.
Treating Peripheral Neuropathy: Multi-Faceted Approach Including Laser Therapy
Peripheral neuropathy affects at least 20 million people in the United States1 and nearly 60 percent of all people with diabetes suffer from diabetic neuropathy. Many suffer from the disorder without ever identifying the cause.
Getting Paid by Medicare Is Getting a Major Adjustment
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law to implement a new approach to clinician payments and replace the Sustainable Growth Rate formula.
Dysautonomia: The Medical Condition You May Already Be Treating
TCM practitioners have spent thousands of years healing patients without knowing or needing the names of their diseases as defined by allopathic medicine. We have syndrome names that are both poetic and efficient.
Workers' Back Pain: Causes, Costs & Solution
You will want to share two important papers published in the past several months. Why? When read separately, each provides valuable information relevant to your patients, community and practice; together, they tell a compelling story.
Using the Lens of Chinese Medicine
One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine.
U.S. Olympians Have a DC in Their Corner
It's probably old news to you that doctors of chiropractic play an increasingly prominent role in treating athletes, from youth sports participants to weekend warriors, to elite / professional competitors.
Power to the Patient
Against a backdrop of splintered political parties, polarizations within nations, civil unrest, and distrust of established government (such as the growing anti-Washington, D.C. sentiment) comes the not-so-surprising finding that health care authorities and practitioners (with perhaps the exception of insurers) are turning over more and more powers to the individual patient.
Integrative Cancer Care: Chiropractic for Chemotherapy-Induced Hiccups
Hiccups (singultus) are a frequent occurrence during cancer treatment. The cause of the hiccups may be the chemotherapy drug itself, such as Cisplatin; or the prophylactic use of corticosteroids such as Decadron, which is used to prevent nausea and/or vomiting.
Update from the International AIDS Conference
The 21st International AIDS Conference in Durban, South Africa, brought together more than 15,000 of the world's leading scientists, activists, funders, policy makers, and consumers from 153 countries.
ITB Syndrome: Treat the Tensor Fascia Latae
Iliotibial band syndrome is usually the result of repetitive knee flexion, such as in runners or cyclists. Pain may be experienced in the knee and/or the hip. The patient may express a sense of the hip dislocating, popping or snapping.
Decoding the Mystery of Medical Insurance Acceptance
In the constantly evolving profession of acupuncture, one of the least understood areas is medical insurance acceptance. The profession is filled with controversy surrounding this topic: Is it ethical?
Six Things Every DC Should Know About the Zika Virus
The Zika outbreak continues to spread across the continental United States and U.S. territories. We offer this brief overview on this important public health problem for the practicing doctor of chiropractic.
February, 2007, Vol. 07, Issue 02
Learning From the Largest Study on Cancer and Massage
By Tracy Walton, LMT, MS
The body of research on cancer and massage is growing. One study often cited to support massage therapy programs for cancer patients was performed by the Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City.Authored by Barrie Cassileth and Andrew Vickers, it's titled "Massage Therapy for Symptom Control: Outcome Study at a Major Cancer Center," and is the largest published study on cancer and massage to date. MSKCC is not new to the massage arena. Therapists have provided Swedish massage, light-touch massage and foot massage since 1999, and both inpatients and outpatients receive the work.
The "Big Five" Cancer Symptoms
Health care for cancer patients focuses on what some people call "The Big Five" symptoms patients face: pain, nausea, fatigue, anxiety and depression. Medications can help somewhat, but these five symptoms still can cause much suffering along the cancer journey. Massage therapists have offered anecdotal reports of symptom relief in their clients. If their experiences turn out to be true for significant numbers of people, this indeed will be news.
So far, only small studies have suggested a link between massage and symptom relief, and it's too early to claim "proof." Cassileth and Vickers strengthen the suggested link with this observational study of their clinical offerings, documenting their patients' responses to massage in a systematic way.
In this study, symptom cards were distributed to patients. These cards asked them to rate their symptoms on a 0-10 scale at baseline (pre-massage) and post-massage, five to 15 minutes afterward. Three years' worth of patients led to a large sample size.
Cards were returned for several thousand massage sessions, and the study staff pared them down to only the initial sessions for 1,290 different patients. Because of when the cards were completed, they supplied data only on immediate effects on symptoms, if any. To see about sustained effects on symptom relief, investigators followed up with approximately one-quarter of the patients by phone, 24 to 48 hours after their massage session. A large amount of data was collected.
Control Group or No Control Group?
It's important to note the absence of a control group in this study. This was not a "randomized, controlled clinical trial (RCT)." In an RCT, patients in the study are randomized to either an intervention (massage) group or a non-intervention (control) group, the intervention is applied (or not, in the case of the control), and the same measurements are taken from both groups for comparison. A control group is a key feature of a study because, if treatment X appears to be effective for symptom Y, it's extremely important to know whether symptom Y would have improved without treatment X. Symptoms tend to come and go, and symptoms improve for all sorts of reasons. Thus, a control/comparison group is vital if you want to isolate any effects that are specific to massage.
In class, I often am asked, "Why did this group carry out such a large study without bothering to include a control group? Isn't it a lot of wasted work?" This is an important question. For the goals of the study, a control group wasn't necessary. One goal was to see whether existing clinical services seemed to be helping people. Another was to check feasibility: whether massage therapy could indeed be delivered at high volume in a major cancer center. Even though the massage program had been up and running and was theoretically feasible, because it already was happening, numbers like this make feasibility real. This observational self-study was the perfect design for these particular goals.
A controlled clinical trial of this size would be very costly. However, such an observational study lays a foundation for one, paving the way for funding. The authors mentioned their plans for an RCT in the paper, and a look at the MSKCC Web site shows that one currently is underway on massage at the end of life. Moreover, the data from this observational study support not only the researchers themselves, but also the rest of us in seeking funding and support for RCTs on cancer and massage. So, their efforts were in no way wasted.
What Did They Find?
The researchers found what you might expect − immediate, dramatic reductions in all five symptoms. Notably, in patients who initially scored a given symptom at 4 or more, the average improvements in that symptom ranged from 42.9 percent in fatigue to 59.9 percent in anxiety. Patients who had Swedish and light-touch massage had stronger responses than those who received foot massage, but there was little difference in the outcomes between Swedish and light-touch massage.
Those were the immediate, post-massage effects. Follow-up scores looking for sustained effects were obtained from inpatients two to five hours after treatment and from outpatients 24 to 48 hours later. Improvement in outpatients' symptoms persisted over that time period. In contrast, inpatient scores, which initially had improved, started to worsen in just a few hours after massage treatment. This is an interesting difference!
Although it's tempting to focus only on massage benefits, other data about the massage protocols and other factors also were interesting. For example, investigators found that Swedish massage and foot massage were more commonly administered than light-touch massage, and that foot massage was used more often for inpatients than outpatients. The latter may reflect practical issues in massage with inpatients − being able to easily reach the feet of a patient surrounded by equipment, no need for repositioning, and so on. Swedish massage and light-touch massage were balanced between in- and outpatients. Moreover, the average length of the massage session for an inpatient was just 20 minutes, while the average session for outpatients was 60 minutes in length. This is a wide range in dose, an important clinical factor. In my experience, massage therapists are good for some lively conversation about the needed, tolerated and best massage dose for any given symptoms!
These data provide rich opportunity for speculation. Why did the outpatients seem to do better than the inpatients? Is it a function of the difference in massage dose? Is it a function of the type of massage protocols or how ill the patients were in the first place? Is it harder to sustain the benefits of massage in a hospitalized patient in an acute health crisis than in an outpatient? These questions call for further study.
The investigators themselves stated, "Major, clinically relevant, immediate improvements in symptom scores were reported following massage therapy. Given the observational nature of this study, we cannot make conclusions about the cause of this effect." Their caution is well-advised. If you cite this study in support of massage therapy for this population, always mention it was an observational study, rather than a controlled trial that would establish clearer cause and effect. Use the word "suggest" rather than "prove." However, also note that this study offered clinical outcomes similar to smaller controlled trials in this population. See my summary of two such massage trials in the May 2006 and November 2006 issues of Massage Today.
Even without a control group, this study offers therapists, hospital administrators and health care providers a stronger foundation for massage. If you are building a case for a massage therapy program in your facility, note that MSKCC found it feasible for inpatients and outpatients at high volume. If your prospective client is nervous about receiving massage during cancer treatment or isn't sure it would help, a study like this suggests other people found it safe and helpful. This study gathers together 1,290 valuable, individual stories of massage into one place and offers them to us to scrutinize, learn from and appreciate. Studies such as this move the work forward. They inspire us by their example, move us to ask further questions and help us to envision a future when massage therapy is part of regular cancer care.
Author's Note: The article is indexed at www.pubmed.gov. Search the author to yield the abstract and ordering information, or request a reprint from the author in writing at MSKCC. Cassileth BA, Vickers, AJ. Massage therapy for symptom control: outcome study at a major cancer center. Journal of Pain and Symptom Management 2004;28(3):244-9. Memorial Sloan-Kettering Cancer Center, Integrative Medicine. "Our Research." Available at www.mskcc.org/mskcc/html/1990.cfm. Accessed 12-06.
Click here for more information about Tracy Walton, LMT, MS.
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