Therapeutic Touch

Therapeutic Touch

PEP Topic 
Radiodermatitis
Description 
Therapeutic touch (TT) or healing touch is an energy therapy where the practitioner’s hands move through the patient’s energy field to assess and treat energy field imbalances (Shames & Keegan, 2000). The specially trained practitioner deliberately “centers” intention from an external focus to an internal focus of calm, then moves his or her hands over the patient’s body, but does not actually touch the body.  Therapeutic touch has been studied as an intervention of anxiety and pain in patients with cancer.
 
Shames, K.H., & Keegan, L. (2000). Touch: Connecting with the healing power. In B.M. Dossey, L. Keegan, & C.E. Guzzetta (Eds.), Holistic nursing: A handbook for practice (3rd ed., p. 614). Gaithersburg, MD: Aspen.

Effectiveness Not Established

Research Evidence Summaries

Younus, J., Lock, M., Vujovic, O., Yu, E., Malec, J., D'Souza, D., & Stitt, L. (2015). A case-control, mono-center, open-label, pilot study to evaluate the feasibility of therapeutic touch in preventing radiation dermatitis in women with breast cancer receiving adjuvant radiation therapy. Complementary Therapies in Medicine, 23, 612–616. 

doi: 10.1016/j.ctim.2014.11.003
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Study Purpose:

To evaluate the feasibility of therapeutic touch (TT) in preventing radiation-induced dermatitis in patients with breast cancer who are receiving radiation treatment

Intervention Characteristics/Basic Study Process:

Women with stage I and II breast cancer who had received conservative surgery and were receiving adjuvant radiation therapy were recruited for the study. TT treatment was administered three times a week following radiation therapy. Feasibility was defined as a threshold of 15 of 17 patients completing all TT treatment. The preventive effectiveness evaluation was conducted by documenting the “time to develop” and “worst grade of radiodermatitis.” Patients were followed weekly while on treatment and for one week post-treatment.

Sample Characteristics:

  • N = 49   
  • AGE = 18–80 years
  • FEMALES: 100%
  • CURRENT TREATMENT: Radiation
  • KEY DISEASE CHARACTERISTICS: Breast cancer
  • OTHER KEY SAMPLE CHARACTERISTICS: Patient who had completed lumpectomy, sentinel lymph node biopsy, or axillary lymph node dissection

Setting:

  • SITE: Single site   
  • SETTING TYPE: Outpatient    
  • LOCATION: London Regional Cancer Program, London

Phase of Care and Clinical Applications:

PHASE OF CARE: Active antitumor treatment

Study Design:

Prospective case cohort study with two arms: The control arm received the TT treatment and the experimental arm received no treatment.

Measurement Instruments/Methods:

  • Common Terminology Criteria for Adverse Events (CTCAE), version 3.0
  • European Organization for Research and Treatment of Cancer (EORTC) cosmetic rating system
  • EORTC Quality of Life Questionnaire Core-30 (EORTC QLQ-C30)
  • Profile of Mood Status (POMS)
  • Brief Fatigue Inventory (BFI)

Results:

Forty-nine patients participated in the study (17 in the TT and 32 in the control). A comparison of the two groups for the worst grade of radiodermatitis showed no difference (p = 0.661). The control group median time to develop the worst toxicity was 31 days (95% confidence interval [CI] [23, 35], standard error = 1.3767); in the TT group, it took 22 days to develop the worst toxicity (95% CI [18, 24], standard error = 1.769, p < 0.001). In the control cohort, the worst grade of radiation dermatitis was grade 3 noted in one patient; in the TT cohort, the worst grade was grade 2 noted in nine patients (53%). The most common toxicity grade in 15 patients was grade 2, and three patients did not develop toxicity. There was no difference between the cohort for overall EORTC cosmetic score and no significant difference before or after the study in quality of life, mood, or fatigue scores.

Conclusions:

This study was the first evaluation of TT in patients with breast cancer using objective measures and, although it was feasible for the management of radiation induced dermatitis, it was not able to detect any significant benefit on the CTCAE toxicity grade. It also did not show any improvement in outcomes for fatigue, quality of life, or mood.

Limitations:

  • Small sample (< 100)
  • Risk of bias (no blinding)
  • Risk of bias (no appropriate attentional control condition)
  • Key sample group differences that could influence results
  • Feasibility for radiation-induced dermatitis management but not for prevention

Nursing Implications:

Although introducing the alternative therapy into a comprehensive cancer center was feasible and acceptable, the authors did not observe side effects and therefore were not able to detect a significant benefit of TT treatment as it related to toxicity grading or even when the toxicity developed. Because it did not improve quality of life, mood, or fatigue outcomes, it is unlikely to be effective in preventing radiation-induced dermatitis in patients with breast cancer. More studies need to be conducted in this area of alternative therapy.

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