Healing Touch

• FINAL NUMBER STUDIES INCLUDED = 13 
• TOTAL PATIENTS INCLUDED IN REVIEW = 1,003
• SAMPLE RANGE ACROSS STUDIES = 16–230 patients
• KEY SAMPLE CHARACTERISTICS: Various tumor types, patients in active treatment undergoing chemotherapy or radiation therapy

PHASE OF CARE: Active antitumor treatment
 
APPLICATIONS: Palliative care

Interventions considered to be BT were healing touch, Reiki, and therapeutic touch. The effect on pain was examined in seven studies. There were some mixed findings, but most showed a reduction in pain over short time periods. Fatigue was assessed in five studies. These demonstrated fatigue reduction post-treatment, but data were conflicting over a longer period of four to eight weeks. Anxiety and depression were examined in seven studies. All but one found a significant reduction in mood disorders, but a study comparing Reiki, sham Reiki, and usual care found no difference between the sham and actual Reiki groups. Most studies were of descriptive or quasi-experimental design; potential confounding variables were not examined, and placebo effects could not be ruled out.

Studies using biofield therapies for relief of pain, anxiety, fatigue, and depression generally showed benefit; however, the evidence is not strong due to the limitations of the studies included.

Low-quality design studies and the short duration of study follow-up

BT therapies have not demonstrated effectiveness in well-designed clinical studies; however, though it is weak, evidence suggests potential benefit. There were no adverse effects of these interventions reported. Biofield therapies are not expensive and are low-risk, so they can be considered in the management of cancer-related symptoms. Well-designed clinical trials are needed to establish efficacy.

To examine the effects of healing touch on natural killer (NK) cell activity, mood, and specific clinical and quality-of-life outcomes among women receiving chemoradiation for locally advanced cervical cancer

After consent, patients randomized to one of three treatment arms: healing touch, relaxation, and control (usual care). The healing touch and relaxation interventions were administered individually four days per week throughout chemoradiation, on nonchemotherapy days, immediately following radiation. Healing touch participants received on average 15.25 (±6.97) sessions versus 11.75 (±5.20) sessions for relaxation (p = 0.08). Psychosocial surveys were completed for a total of four assessments (including baseline) over six weeks of chemoradiation. Each healing touch or relaxation session lasted 20–30 minutes and was delivered by experienced practitioners.

• The sample was composed of 51 participants.
• The mean age of the healing touch group was 48.1 years (SD = 16.0 years); the range of ages was 25–82 years. The mean age of the relaxation group was 43.1 years (SD = 9.6 years); the range of ages was 24–60 years. The mean age of the usual-care group was 48.0 years (SD = 13.8 years); the range of ages was 26–77 years.
• Female: 100%, with stages IB1–IVA cervical squamous or adenocarcinoma. All patients were receiving a standard six-week course of chemoradiation.

• Single site
• Outpatient
• Iowa, United States

Active treatment

Prospective, randomized clinical trial with repeated measures

• Center for Epidemiological Studies Depression Scale (CESD). Scores of 16 or higher indicate ‘‘probable cases of depression.”
• Two subscales from the Profile of Mood States-Short Form (POMS-SF), to differentiate effects on anxiety versus depressed mood.
• Functional Assessment of Cancer Therapy (FACT) quality-of-life measure.
• Fatigue Symptom Inventory (FSI).
• Five-item scale, modified from the Treatment Credibility Scale (TCS), administered at study entry to assess patient expectations before receiving group assignment.
• Mean of three blood pressure measurements taken at two-minute intervals before and three measurements after the second relaxation or healing touch session, in weeks 1, 3, and 5, to assess extent of relaxation
• Clinical and demographic information.
• Immune measures as quantified by NK cell activity.

• Healing touch group showed preservation of NK cell activity over time, as compared to NK activity in the other two groups, which had significant declines in NK cell activity over time (weeks 1–6). The usual-care group showed a 68% drop in NK cell activity. The relaxation group showed a 43.7% drop in NK cell activity. The healing touch group showed a 26.6% decrease in NK cell activity.
• Authors reported a significant decline in depression in the healing touch group over time (p = 0.03), but the other two groups did not show such a decline. By week 6, mean CESD scores of healing touch patients were below 16 (the cutoff for clinical depression), whereas mean scores of the relaxation and usual-care groups were still in the depressed range (p = 0.07).
• Anxiety significantly decreased in all groups over time.
• Authors reported no significant effects on quality of life or fatigue in any group.

Results indicate that, in patients with cervical cancer who are undergoing chemoradiation, healing touch may be effective in preventing some aspects of decreased immunity and reducing depressed mood.

• The study had a small sample size, with fewer than 100 participants.
• The study was possibly underpowered and had a risk of bias due to no blinding to the treatment condition. Relaxation was offered as a way to control for expectation of active treatment.
• Brachytherapy protocol changes over the course of the study may be a confounding factor.

Complementary interventions may be an important adjunct for patients during active treatment, in both improving depressed mood as well as maintaining immunocompetence. However, the intervention must be feasible and acceptable to patients. This very well-reported study took five years to accrue a final sample of 51 patients (fewer than one patient per month), which illustrates the complexity of performing such research.

All participants received four weekly 45-minute sessions of therapeutic massage (MT), healing touch (HT), or presence (P) and four weekly sessions of a standard care control. Credentialed practitioners who were also registered nurses delivered MT and HT. The three interventions all included music, a centering message, and a message to focus on breathing and letting go of extraneous thoughts. The order of the conditions was randomized. MT included a written Swedish massage protocol using massage gel. For HT, the protocol developed by Healing Touch International was used, and touch and nontouch techniques were used. Energy techniques used included centering, unruffling, magnetic unruffling, full-body connection, mind clearing, chelation, and lymphatic drain to modulate the energy field. For P, participants lied on a table listening to relaxing music. An MT or HT therapist sat with the participant during the session. The purpose was to be attentive and caring but to avoid therapy or physical intervention. In the control group, symptoms and vital signs were assessed.

• Of the 230 adults who consented to participate, 164 completed all eight sessions.
• Of those who completed the study, mean age was 54.7 years, 87% were female, 98% were Caucasian, and 68% were married.
• The majority had stage III or IV disease, and 52% had breast cancer.
• Mean time since diagnosis was 17.4 months.
• All participants rated fatigue, pain, anxiety, or nausea as greater than 3 on a scale of 0 to 10.

Patients were from two outpatient chemotherapy clinics in the Midwest.

Patients were undergoing the active treatment phase of care.

This was a randomized, two-period crossover (between one of the interventions and standard care) study.

• Profile of Mood States (POMS) for fatigue
• Blood pressure
• Heart rate
• Respiratory rate
• Pain
• Nausea
• Medication use
• Anxiety
• Mood disturbance
• Satisfaction

Compared to the control group, there was no effect of presence on fatigue. When comparing individual interventions to their matched control periods, the effect of MT on fatigue was close to significance (p = 0.057). HT was found to reduce fatigue (p = 0.028).

There was no clear evidence that one intervention was superior to the other, but MT and HT seemed to be more effective than presence alone or standard care in improving fatigue.

• Interventions also included centering, breathing, and music, which may confound the results.
• The commitment to complete the study was great, and the dropout rate was high.
• Cross-over designs may be more appropriate for healthy participants or those with earlier stage disease.
• The study design was complex. There was no blinding, there was variability in the research assistant and practitioners collecting assessments, and there was variation in the intervention technique.
• A greater number of participants assigned to the presence group dropped out due to treatment preference.
• A registered nurse certified in massage or healing touch therapy is required.