Massage/Aromatherapy Massage

Massage/Aromatherapy Massage

PEP Topic 
Chemotherapy-Induced Nausea and Vomiting—Adult
Description 

Massage therapy involves the manipulation of the soft-tissue with various hand movements (e.g., rubbing, kneading, pressing, rolling, slapping, tapping). Massage therapy can elicit a relaxation response as measured by decreases in heart rate, blood pressure, and respiration. Often, massage is complemented with aromatherapy (i.e., essential oils combined with a carrier cream or oil to manipulate the soft tissues). Aromatherapy has been used together with massage in some studies. An aromatherapy massage is massage therapy delivered by a therapist while aromatherapy oils are administered by inhalation. Massage with or without aromatherapy has been studied in patients with cancer for management of anxiety, caregiver strain and burden, constipation, chemotherapy-induced nausea and vomiting, depression, lymphedema, pain, sleep-wake disturbances, and fatigue.

Effectiveness Not Established

Research Evidence Summaries

Ahles, T.A., Tope, D.M., Pinkson, B., Walch, S., Hann, D., Whedon, M., … Silberfarb, P.M. (1999). Massage therapy for patients undergoing autologous bone marrow transplantation. Journal of Pain and Symptom Management, 18, 157-163.

doi: 10.1016%2FS0885-3924%2899%2900061-5
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Intervention Characteristics/Basic Study Process:

Patients scheduled to undergo bone marrow transplant were randomly assigned to receive either massage therapy or standard treatment. Patients in the massage therapy group received three 20-minute sessions of shoulder, neck, head, and facial massage per week. The average length of stay was three weeks, so as many as nine sessions were reported during patients’ hospital stays. Massages were performed by a trained, healing arts specialist with more than 10 years of experience.

 

Sample Characteristics:

  • The sample consisted of 34 patients.
  • The mean age of patients was 41 years ± 9.3.
  • Race and ethnicity were not reported.
  • All patients were bone marrow transplant recipients.
  • The majority of the patients had breast cancer (65%); the remaining diagnoses were acute myelogenous leukemia, non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, or other (ovarian cancer or acute promyelocytic leukemia).

Setting:

Participants were inpatients and were scheduled for bone marrow transplant at Dartmouth-Hitchcock Medical Center in New Hampshire.

Study Design:

The study design was a randomized, controlled clinical trial.

Measurement Instruments/Methods:

  • Numeric scales from 0-10 were used to evaluate nausea, with 0 representing an absence of the symptom and 10 representing an extreme level of the symptom.
  • Total dosages of opioids, anxiolytics, and antiemetics were recorded because of confounding effects of the drugs on anxiety, nausea, and emotional distress.
  • Data were collected prior to and following the patients’ first, fifth, and final massages (on day 7 and at mid-treatment and predischarge).

Results:

Patients in the massage group experienced significantly larger reductions in nausea than the standard group at day 7. The strongest effects were seen immediately after massage when patients experienced a reduction in diastolic blood pressure, nausea, distress, and anxiety. How long the positive effects were maintained is difficult to evaluate.

Limitations:

  • The sample is small and from one institution.
  • The timing of massage was variable.

Billhult, A., Bergbom, I., & Stener-Victorin, E. (2007). Massage relieves nausea in women with breast cancer who are undergoing chemotherapy. The Journal of Alternative and Complementary Medicine, 13(1), 53-57.

doi: 10.1089/acm.2006.6049
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Intervention Characteristics/Basic Study Process:

In this prospective trial, patients were randomly assigned to one of two groups. Patients in the intervention group received five massage sessions (effleurage), lasting about 20 minutes. Patients in the control group received visits by a hospital staff member (attention control).

Sample Characteristics:

  • The study consisted of 39 patients with breast cancer who were enrolled prior to the start of their third cycles of chemotherapy.
  • The intervention group had 19 patients and the control group had 20 patients.

Study Design:

This was a prospective trial with random assignment.

Measurement Instruments/Methods:

  • Patients completed a 100-mm visual analog scale (VAS) for nausea and anxiety before and immediately after the massage intervention or after the staff visit for the control group.
  • The Hospital Anxiety and Depression (HAD) Scale was completed before the first and last massage sessions.

Results:

  • No differences were found in anxiety as measured by the VAS between the groups.
  • No differences were found between groups or within groups over time in anxiety or depression as measured by the HAD.
  • The authors stated that nausea was significantly reduced in the massage group, as measured by the VAS; they did not report raw scores but, rather, “percentage improved.”

Conclusions:

Interpretation of the findings as written was difficult. Although the authors concluded that massage reduced nausea, nausea was not assessed at expected problem points. For example, severe nausea was measured 30 minutes into the chemotherapy infusion after patients received antiemetic prophylaxis with 5-HT3 and steroid.

Limitations:

  • The hospital staff (nurses and nurses' aides) delivered the massage intervention after one day of training.
  • No control was provided for consistency or adequacy of the intervention.
  • Only nausea was assessed, not vomiting.
  • Nausea was assessed by VAS immediately before and after the massage, but the massage was delivered during the chemotherapy infusion and nausea measured right after.
  • The measurement period did not coincide with when nausea is expected to occur or be most severe. For example, nausea was measured prior to the start of massage, but nausea would not be expected to be present or severe at this time.

Cassileth, B.R., & Vickers, A.J. (2004). Massage therapy for symptom control: Outcome study at a major cancer center. Journal of Pain and Symptom Management, 28, 244-249.

doi: 10.1016%2Fj.jpainsymman.2003.12.016
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Intervention Characteristics/Basic Study Process:

Patients with cancer received light touch, Swedish, or foot massage. No control group was included.

Sample Characteristics:

  • The study consisted of 1,290 participants. Of these, 1,255 reported on the nausea question.
  • Researchers were unable to ascertain which patients were receiving chemotherapy.
  • Patients were self-referred or referred by a physician.

Setting:

The study was conducted in Inpatient and outpatient settings.

Measurement Instruments/Methods:

A visual analog scale (VAS) was used to measure nausea and vomiting, pain, fatigue, stress, anxiety, and depression.

Results:

Just more than half (51%) experienced a decrease in nausea.

Limitations:

A risk of bias exists for nontraditional treatment.

Grealish, L., Lomasney, A., & Whiteman, B. (2000). Foot massage: A nursing intervention to modify the distressing symptoms of pain and nausea in patients hospitalized with cancer. Cancer Nursing, 23, 237-243.

doi: 10.1097/00002820-200006000-00012
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Intervention Characteristics/Basic Study Process:

  • Participants were assigned randomly to one of three factor-control groups.
  • Patients were given a 10-minute foot massage (five minutes per foot) on three consecutive days from 7–8 pm.
  • Patients were given slow and firm massage or gentle strokes toward the heart, from the base of the toes up the foot and lower leg to the knee.
  • Patients received a short foot massage before study enrollment to reduce the possibility of anticipatory anxiety.

Sample Characteristics:

  • The study consisted of 87 participants.
  • The sample was 60% female and 40% male.
  • Patients ranged in age from 18-88 years.
  • To be included, patients had to have
    • Been diagnosed with cancer.
    • Been 18 years or older.
    • Reported pain or nausea.
    • Had not received surgery in the last six weeks.
  • Primary cancer sites varied, and 32 participants had metastatic disease.

Setting:

All participants were in the inpatient setting. No further setting description was provided.

Measurement Instruments/Methods:

  • Patients reported symptoms using a 100-mm visual analog scale (VAS) with 0 mm = no nausea, and 100 mm = vomiting or dry retching.
  • Heart rate and subjective data were measured at two intervals: before massage and 10–20 minutes after completion of massage.
  • On control nights, participants stayed quietly in bed and did a quiet activity with the same measurements.

Results:

Evidence suggested that massage reduces feelings of nausea. No significant difference was found between the control session pretest mean nausea score and post-test mean nausea score. In contrast, the mean nausea scores for the massage sessions decreased.

  • In session 1, t = 3.117, p = 0.0012, and the mean difference was 6.4 mm.
  • In session 2, t = 3.178, p = 0.0011, and the mean difference was 4.9 mm.

Limitations:

  • The study did not control for medications, although they were recorded.
  • Findings were not correlated with diagnosis, type of cancer, metastases, or treatment schedules.
  • The long-term effects of massage are unknown.
  • Pain and relaxation were measured as well as nausea and vomiting.

Systematic Review/Meta-Analysis

Fellowes, D., Barnes, K., & Wilkinson, S. (2005). Aromatherapy and massage for symptom relief in patients with cancer. Cochrane Database of Systematic Reviews 2005, Art. No.: CD002287.

doi: 10.1002/14651858.CD002287.pub2
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Search Strategy:

Databases searched were CENTRAL (Cochrane Library, Issue 1, 2002), MEDLINE (1966-May 2002), CINAHL (1982-April 2002), British Nursing Index (1994-April 2002), EMBASE (1980-week 25, 2002), AMED (1985-April, 2002), PsycINFO (1887-April, 2002), SIGLE (1980-March, 2002), CancerLit (1975-April, 2002), and Dissertation Abstracts International (1861-March, 2002). Reference lists of relevant articles were searched for additional studies.

Literature Evaluated:

Reviews were included if they

  • Were randomized controlled trials (RCTs).
  • Were controlled before-and-after studies or interrupted time-series studies.
  • Studied aromatherapy or massage for patients with cancer.
  • Measured changes in patient-reported levels of physical or psychological distress or quality of life (QOL) using reliable and valid tools.

Sample Characteristics:

  • A total of 10 reports met inclusion criteria. Of these, 8 were RCTs, representing 357 patients.
  • Most studies measured anxiety, depression, and pain; two demonstrated a reduction in nausea.

Results:

Two studies assessed the symptom of nausea. Both studies showed a reduction in nausea in hospitalized patients.

Limitations:

  • Although the studies were RCTs, the sample sizes were small.
  • Assessing the effect of aromatherapy was difficult because different essential oils were used.
  • The degree to which variation in massage style affects outcomes is not known.

Nursing Implications:

  • Longer follow-up studies are needed with larger samples.
  • No harm was involved, but evidence was mixed as to effect of aromatherapy enhancement to massage to a clinically significant level.

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