Miladinia, M., Baraz, S., Shariati, A., & Malehi, A.S. (2016). Effects of slow-stroke back massage on symptom cluster in adult patients with acute leukemia: Supportive care in cancer nursing. Cancer Nursing. Advance online publication. 

To examine the effects of slow-stroke back massage on the symptom cluster of fatigue, pain, and sleep disturbance

Patients were assigned to massage or usual care control groups according to a fixed approach such that the first three patients entered into the study were assigned to the intervention, the next three to control, and so on. Massage was provided by two oncology nurses who had four months of professional training. The intervention group received 10-minute massage sessions every other day for four weeks in a special room in an outpatient setting. Control patients were given social attention. Data collectors were blinded to the study assignment. Soothing music was provided during the massages.

• N = 60   
• MEAN AGE = 34.5 years
• MALES: 51.7%, FEMALES: 48.3%
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: All had acute leukemia and were between the first and third chemotherapy cycles
• OTHER KEY SAMPLE CHARACTERISTICS: Intensity of at least 3 on numeric scales for pain, fatigue, and sleep disorders; and a score of at least 5 on the Pittsburgh Sleep Quality Index (PSQI)

• SITE: Single site   
• SETTING TYPE: Outpatient    
• LOCATION: Iran

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Palliative care 

• Single-blind, randomized, controlled trial

• Numeric rating scales for pain, fatigue, and sleep quality
• Pittsburgh Sleep Quality Index (PSQI)

Repeated measures ANOVA showed a significant difference in pain, fatigue (p = 0.001), and sleep disorder intensity (p = 0.015) from baseline to the end of week 5. By the end of week 4, PSQI scores showed improvement in the intervention group compared to controls (p = 0.003). Trends showed a consistent decline in pain, fatigue, and sleep disturbance intensity during the four weeks in which massage was done in the intervention group, while in the control group, intensity of these symptoms increased.

Sessions of slow-stroke back massage were shown to reduce intensity of pain, fatigue, and sleep disturbance.

• Small sample (< 100)
• Risk of bias (no appropriate attentional control condition)
• Unintended interventions or applicable interventions not described that would influence results
• The effect of the music component cannot be determined.
• It is unclear if the attempted attention control provided was similar in amount of time to time spent with intervention patients.
• Lack of any sample contamination could not be assured. 
• At the end of the four weeks, increasing symptom intensity was shown in the massage group

Massage was shown to be of benefit in dealing with the symptoms of pain, fatigue, and sleep disturbance during the treatment phase for patients with leukemia. Nurses can apply massage as a low-risk intervention. Trend results in this study suggest that massage likely has only short-term effects as symptom intensity levels began to rise after the four-week intervention. Ongoing research is needed to evaluate the optimum frequency and timing  of massage and duration of effects.