Massage/Aromatherapy Massage

To compare the efficacy of massage therapy to a social attention condition in Taiwanese patients with cancer with bone metastases

• A five-day, two-group trial with a pre/post-test design was used.
• The experimental intervention was 45 minutes of massage; condition control was caring therapist for a comparable amount of time.

• The sample was 72 patients with cancer with bone metastasis.
• Mean patient age was 50 years.
• The sample was 42% male and 58% female.
• The sample was Taiwanese, age 18 or older, oriented x3 (alert and normal), Chinese-speaking and reading, radiologically diagnosed with bone metastasis via bone scan, and reporting moderate bone pain of at least 4 on a 0–10 scale.
• Patients were excluded if they were regularly receiving massage therapy, were undergoing surgeries or procedures during admission, or had allodynia, thrombocytopenia, spinal cord compression syndrome, deep vein thrombosis, or other contraindications to massage therapy.

• Single site
• Inpatient setting
• Five hospital oncology units

• Patients were undergoing the active treatment phase of care.
• The study has clinical applicability for end-of-life and palliative care.

The study was a randomized, controlled clinical trial.

• Present Pain Intensity (PPI) – Visual Analog Scale (VAS)     
• Mood VAS
• Relaxation VAS
• Sleep VAS
• Symptom Distress Scale
• Demographic and medical profiles

• Pre- to postintervention effects: No statistical significance was shown in individual patients.
• Results from MANCOVAs showed statistically significant intervention effects on pain, mood, and relaxation VASs, but not the sleep VAS.
• There was a significant linear group by time effect on relaxation VAS in both groups: F (1, 69) = 10.39, p = 0.002, indicating a different pattern of change in relaxation VAS change scores between the groups.

This trial documented therapeutic effects of massage on improving pain intensity, mood status, and muscle relaxation in patients with metastatic bone pain. The study has clinical implications supporting massage therapy and other medical modalities for optimal improvement in patients with cancer with bone metastases.

• The study had a small sample, with less than 100 participants.
• The patient population was heterogeneous.
• The study involved a short course of therapy.
• The study lacked multidimensional measurement of pain and patient binding.

Massage therapy may play an important role in cancer bone pain, sleep, and, mood.

To determine the effects of massage on sleep quality in patients with breast cancer

A random sample of women in a chemotherapy clinic was obtained, and individuals randomly were assigned to control and experimental groups. Those in the experimental group received effleurage style massage therapy by a certified practitioner for 20 minutes three times a week for four weeks in the clinic. Patients in the control group received usual care. Study measures were obtained at baseline and at four weeks.

• N = 57
• MEAN AGE = 43.5 years
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: All had breast cancer and were an average of 3.5 months after surgery.
• OTHER KEY SAMPLE CHARACTERISTICS: About 13% in both groups were receiving hypnotics.

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

• PHASE OF CARE: Active antitumor treatment

• Single-blind RCT

• Pittsburgh Sleep Quality Index

In the experimental group, sleep latency, use of hypnotics, and sleep time improved (p < .001) from baseline. In the control group, sleep adequacy and use of hypnotics also improved (p < .05). No differences were seen in quality of life between groups.

Massage therapy may improve some aspects of sleep in women with breast cancer during active treatment.

• Small sample (less than 100)
• Baseline sample/group differences of import
• Risk of bias (no appropriate attentional control condition)
• Measurement/methods not well described
• Intervention expensive, impractical, or training needs
• Other limitations/explanation: The measurement used for quality of life is not described. The control group had overall lower sleep quality at baseline and more use of hypnotics. Because massage was done in the chemo clinic, whether contamination could have occurred with the control group in the same clinic is not clear. Reporting is unclear. Verbal discussion of results does not match tabular information.

Although this study does not provide strong support for the effectiveness of massage to improve sleep quality among women during therapy, massage is a low-risk intervention and these findings suggest that it might be helpful. For patients with sleep disturbance, massage may be an alternative that is helpful and preferred by some patients.

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.

A trained registered nurse (RN) provided 15 to 30 minutes of the light Swedish technique of effleurage and petrissage three times per week in the patients' hospital beds; sessions were 24 hours apart and at different times of the day and evening. The control group received 20 minutes of deliberate, focused communication. Outcomes were pain, sleep, symptom distress, and anxiety.

• The sample was comprised of 41 patients with cancer.
• Patients had leukemia, lymphoma, lung, gastrointestinal, genitourinary, head and neck, breast, and skin cancers.

• Inpatient
• Veteran’s administration hospital
• Midwestern United States

Patients were undergoing the active treatment phase of care.

The study used a quasiexperimental design, with pre- and postintervention comparison groups:  one arm received massage and the other was the control arm.

Verran and Snyder-Halpern Sleep Scale (VSH)

Sleep quality remained the same.

• The study had a small sample size and lacked random assignment to groups. Cohorts were treated sequentially.
• The sleep scale was not tested for validity and reliability with polysomnography.
• The RN must be trained in massage techniques.

Patients were randomly allocated to one of three groups:  (a) massage with lavender essential oil and an inert carrier oil, (b) massage with inert carrier oil, or (c) a control group without massage. Patients receiving weekly massages were not told which oils were used. The two massage groups received a standardized, 30-minute back massage weekly for four weeks. Patients in the control group completed the assessment scales weekly during the study period but did not receive massages. Outcomes were anxiety, aromatherapy, massage, pain, palliative care, and sleep.

• The sample was comprised of 42 patients with cancer.
• Median age was 73 years.

• Three specialist palliative care units
• South Thames region, United Kingdom

The study was a randomized, controlled trial.

• Visual analog scale (VAS) of pain intensity
• Modified Tursky Pain Descriptors Scale
• Verran and Snyder-Halpern Sleep Scale (VSH)
• Hospital Anxiety and Depression Scale (HADS)
• Rotterdam Symptom Checklist (RSCL)

No significant long-term benefits of aromatherapy or massage were demonstrated in terms of improving pain control, anxiety, or quality of life (QOL). Sleep scores improved significantly in the massage and the combined massage groups.

• Recruitment to the study was slow.
• Sample sizes were smaller than planned.
• The poor performance status and fatigue experienced by many patients made it difficult for them to complete the questionnaires and attend weekly treatment sessions.
• The study had a relatively high attrition rate (14%).
• Massage therapists were unable to tailor the treatment to individual patients, which may have undermined its true effect.

To test hypotheses regarding the effect of massage on anxiety, pain, nausea, sleep, and quality of life (QOL).

Patients were referred by their physicians and were provided a physician order for massage. Patients completed self-administered instruments prior to massage therapy and one week after therapy. Massage treatments lasted 30 minutes and were provided during treatment with chemotherapy and/or radiation therapy (RT) once per week for three weeks.

• The sample was comprised of 51 women with breast cancer.
• Mean age was 53 years.
• All patients were diagnosed with breast cancer; 27% had recurrence.
• The majority (78%) of patients were receiving only chemotherapy, and 61% were either also receiving concurrent RT or had RT planned in the future.
• The sample was 84% Caucasian, with 45% currently working full-time and 88% having at least some college education.

• Single site
• Outpatient
• Kansas

Patients were undergoing the active treatment phase of care.

The study used a pre-/posttest design.

• State-Trait Anxiety Inventory (STAI)
• Visual analog scale (VAS) for pain
• Symptom Distress Scale (SDS)
• Verran and Snyder-Halpern Sleep Scale (VSH)
• Functional Assessment of Cancer Therapy–Breast (FACT-B)

STAI scores were lower after massage therapy (p = 0.03). Sleep scale items that showed improvement with massage were soundness of sleep (p = 0.05), time from settling down to sleeping (p = 0.02), and overall sleep satisfaction (p = 0.01). FACT-B scores also showed improvement in several areas after massage therapy (p < 0.05). Effect sizes in these areas were moderate (≥0.3).

Provision of massage therapy during treatment for breast cancer may reduce anxiety and improve sleep and aspects of QOL.

• The study had a small sample, with less than 100 patients.
• The study lacked a control or comparison group.
• The study lacked blinding, and the massage therapist obtained all self-reported data.
• The study had a short duration of intervention and follow-up.
• The sample was highly educated and overwhelmingly Caucasian, with 52% of patients earning more than $50,000. The findings may not be generalizable to other socioeconomic and ethnic groups.

Massage therapy may assist women undergoing breast cancer treatment to better tolerate the impact of treatment, reduce anxiety, and improve sleep during active treatment.