Relief for Cancer Fatigue
By Massage Therapy Foundation Contributor
Relief for Cancer Fatigue
By Massage Therapy Foundation Contributor
Contributed by MK Brennan MS, RN, LMBT; Drew Rowe, LMT; Jacqueline Tibbett PhD, LMT
Of all the symptoms occurring after cancer treatments, cancer related fatigue (CRF) is the most prevalent regardless of the type of cancer and treatment. CRF is a sense of physical, emotional, and/or cognitive exhaustion that negatively impacts one's quality of life. This can last for months or even years following the end of cancer treatment and there are limited options for effectively treating the fatigue.
Methylphenidate is the only pharmacological agent to cause a small, but significant, improvement in CRF. Other non-pharmacological approaches, such as exercise, have also shown to provide small to moderate relief of CRF in a growing number of studies.
Cancer Fatigue & Massage
Massage therapy is widely used by cancer patients/survivors who look to integrative therapies for symptom relief but there hasn't been a randomized controlled trial investigating the impact of massage on the fatigue that often accompanies cancer and its treatment.
This month's Massage Therapy Foundation research review focuses on a pilot study, however, that evaluated the efficacy of Swedish Massage Therapy (SMT) for CRF in breast cancer survivors. Sixty-six women who had received surgery and radiation and/or chemotherapy/chemoprevention and had persistent CRF were recruited for the study and 57 were able to complete it.
All potential subjects were evaluated for comorbid conditions and/or medication usage that could contribute to the fatigue. The women recruited ranged in age from 18-72, were 3 months to 4 years outside their cancer treatment, and had a Brief Fatigue Inventory score of >25. Subjects were randomly assigned to the SMT group, the light touch (LT) group, or a wait list control (WLC) group.
The massage and light touch interventions were 45 minutes in duration and performed by licensed massage therapists who followed a script and treatment protocols that standardized their interactions with subjects. The massage included effleurage, petrissage, and tapotement while the light touch consisted of laying the hands lightly on the subject following the same sequence as the SMT from shoulders to feet with the women lying prone and then feet to shoulders and head with the women in the supine position.
Baseline scores were obtained that used several standardized and validated measures, including the Quality of Life Enjoyment andSatisfaction questionnaire, the Multidimensional Fatigue Inventory (MFI) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue Short Form.
The PROMIS is one of the most commonly used tools in clinical research to measure different aspects of a person's life in order to quantify how an intervention might make an impact on those. These measurement tools were also completed at visits 3 and 6 of the 6-week study. Those in the WLC group completed all of these forms at the beginning and end of the study period.
Those assigned to the SMT and LT groups also completed a preference/expectancy scale to indicate their preference for SMT or LT. This was done prior to informing the subjects of their treatment assignment. They also completed a Credibility/Expectancy questionnaire at their first assigned treatment session to assess their opinions about the credibility of the treatment to be effective and their expectations that their CRF will improve.
Both of these questionnaires were administered after a description of the treatment supports was read. The majority of the study subjects preferred to receive SMT rather than LT and also indicated that massage was the more logical treatment for relieving CRF. However, expectancy of either intervention improving CRF symptoms was not significantly higher for those assigned to SMT than those assigned to LT. This suggests that belief in the credibility of a therapy can be distinguished from the expectation that the intervention will actually improve one's symptoms.
Outcome of the Study
Findings from this early phase clinical trial demonstrate that six weekly sessions of SMT were superior to LT and WLC in reducing CRF symptoms. For example, there was a reduction in Multidimensional Fatigue Index total scores for the SMT and LT groups but the decrease in MFI fatigue for the SMT group exceeded the minimum clinically meaningful difference.
There was a significant increase in MFI fatigue scores in the WLC group. Additionally, the change in these scores did not correlate with the subject's preference or credibility scores. PROMIS Fatigue scores also decreased for SMT and LT groups while remaining the same for WLC. Quality of life scores improved for the SMT group when compared with both the LT and WLC subjects.
Limitations to the study included the small subject sample as well as the fact that fatigue is highly subjective and challenging to define and study. Future larger studies might do well to include objective measures, such as wearable devices that track activity levels. Finally, this study only included women breast cancer patients.
Further studies are warranted that include men and other types of cancer since CRF is not gender or cancer-type specific. As the researchers noted, "Although the results of this early phase feasibility study do not indicate the time since the end of chemotherapy and/or radiation or the presence versus absence of ongoing chemoprevention treatment during the study period, they had an impact tigue, and the potential influence of these factors on the effects of massage should be examined in a larger study."
Durability of CRF and quality of life improvements should also be investigated in future studies. This study is a good start to looking at a non-pharmacologic way to help minimize the symptoms of CRF for cancer survivors. As this study stated, there are approximately 15.5 cancer survivors in the U.S. and CRF can persist for months or years after treatment is completed.
Over 50 percent of cancer patients have been reported to use integrative therapies for symptom management and massage is one that is widely used. Being informed about CRF and the potential benefits that massage may have is valuable for therapists who are likely to have cancer survivors as clients based on these statistics. One further consideration that the review team would endorse is appropriate training of the massage therapists in oncology massage to help assure effectiveness while minimizing any unwarranted risks such as bruising or lymphedema.
Save the date for MTF's International Massage Therapy Research Conference (IMTRC) to be held May 9-10, 2019, in Alexandria, Virginia. Learn about the latest research, connect with colleagues, and gain insight into best practices in massage therapy. Held every three years, IMTRC brings together thought leaders and educators to discuss massage therapy innovations.
- Kinkead B, Schettler PJ, et al. Massage Therapy Decreases Cancer-Related Fatigue: Results From a Randomized Early Phase Trial. Cancer, 1 Feb 2018;124(3):546-554.