A Study on Massage and Symptom Relief
By Tracy Walton
A Study on Massage and Symptom Relief
By Tracy Walton
This column is devoted largely to the rewards and challenges of working with people who have been diagnosed with cancer. To that end, I will discuss clinical practice, research and education, all of which are important to this work. In particular, because people have a keen interest in the research on massage and cancer, I've compiled research on the topic and made it available in a bibliography at http://tracywalton.com/id8.html.
The number of studies on this topic is growing, but the quality of research varies, as it does in any discipline. Some studies show good, solid research methods, and others suffer flaws that compromise the integrity of the investigators' findings. In this column, I'd like to share one of my favorites. The work by Janice Post-White and her colleagues, based at the University of Minnesota in Minneapolis and the United Hospital in Saint Paul, is wonderfully designed.1
The investigators studied 230 people in chemotherapy. They looked at immediate symptom relief just after a session, and at overall effects from a course of four weekly treatments. They compared massage therapy to three other types of care: Healing Touch (HT), a specific type of energy therapy derived from therapeutic touch, including both off- and on-body components;2 Caring Presence (P), in which a provider was present in the treatment room with the patient, but with no touch involved; and a control condition of Usual Care (UC), consisting of standard medical care provided to patients, but with no special intervention.
To best describe the design of the project, I ask you to imagine you were a patient recruited for it. After consenting to the study, you were randomized to one of three groups - MT, HT, or P - receiving a 45-minute session of the intervention each week over four weeks. Although you had free choice to join up with the study, and were free at any time to leave it, you did not get to choose your group assignment - it was chosen for you randomly. Your vital signs were taken before and after each session, and you were asked questions about your symptoms at those time points to determine the immediate effects of the intervention. At the beginning of the first session and the beginning of the fourth session in the series, researchers asked you additional questions about pain, nausea and mood, and questions about your use of other complementary therapies. You were asked to keep a log of your medication use, and it was collected from you at each weekly session.
One interesting feature of this study is that investigators used a "crossover design," meaning each research subject served as his or her own control. You went through two, four-week periods in this study - one week getting an intervention such as MT, HT or P, and one week as a "control subject," in which you completed the same kinds of measurements but received no intervention, just your usual medical care (UC). The order in which you spent time in the control and treatment conditions was random: some of you had the four weeks of treatment first; some of you had the control period first. A several-day "washout period" took place in between, to be sure the first period didn't influence the second one.
One thing I admire about this study is how researchers timed the sessions. Because the patients were in chemotherapy, they were subject to the ups and downs of strong medical treatment, which can follow a cyclical pattern after the drug is delivered. Symptoms such as nausea, anxiety, profound fatigue and pain can ebb and flow during chemotherapy, depending on how the patient responds to it. How someone feels depends a lot on when you ask. Unfortunately, this variability can significantly "confound" or muddy the outcomes of a research study. What if fatigue is measured at a particularly bad point in one chemotherapy cycle, but at a better point in another? It would make it hard to assess the true effects of massage on fatigue.
The authors anticipated this and made sure that the two sets of measurements, one over a four-week control period and one over a four-week treatment period, occurred at the same time point in identical chemotherapy cycles. Their care with this timing is one key to the solid design of this study.
After all this, what were their findings? Some highlights: They found that MT and HT reduced pain, improved mood and increased relaxation more than presence or the usual care control. These modalities also lowered respiration rate, heart rate and blood pressure. These were immediate effects of the sessions, but they were consistent across all four sessions. Only massage significantly lowered anxiety, and only HT significantly reduced fatigue. No intervention lowered nausea, but investigators found that the timing of the weekly sessions was such that the patients' nausea scores were already low, and it's difficult to significantly reduce a symptom that is low in the first place. This is called a "floor effect," and since nausea typically is worse in the few days following chemotherapy and then resolves, higher nausea scores didn't get picked up in the weekly sessions (the first massage right before the first infusion; the second a whole week later). Finally, over a four-week course of massage therapy, patients used less pain medication than those in the other groups, and less than they did during their control group experience.
Does this study "prove" that massage helps? In general, it's good to steer clear of that term until we have enough additional well-designed studies to provide convincing numbers. The field needs a large body of evidence for such a strong statement. Certainly, the findings suggest benefit and the authors cite other studies that corroborate their findings. The most consistent finding among studies on massage and cancer is its effect on anxiety, which is supported by this paper. In my own promotion of massage, whether speaking or teaching, I'm finally starting to feel the support of those numbers. And, if you're an individual in chemotherapy, finding symptom relief with massage, you feel supported no matter what the numbers show. You're not likely to stop what you're doing to wait for the data to catch up with your experience.
This is a wonderful study, worth reading closely. In the growing body of research on massage therapy, this is one of the largest, strongest works to date. I'm planning a research update, including this study, at the Atlanta AMTA convention this fall. I appreciate the dialogue that flows from this work.
- Post-White J, Kinney ME, Savik KS, Gau JB, Wilcox C, Lerner I. Therapeutic massage and healing touch improve symptoms in cancer. Integrative Cancer Therapies 2003;2(4):332-344.
- Information on healing touch is available at www.healingtouchinternational.org.