resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
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.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.