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Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial.
Ann Intern Med. 2008 Sep 16; 149(6):369-79
Marcin Chwistek, Fox Chase Cancer Center, PA, USA. F1000 Oncology
09 Oct 2008 | New Finding, Clinical Trial, Confirmation
This clinical trial evaluated the effectiveness of massage as compared to simple touch in a population of hospice patients with advanced cancer. Massage and simple touch, when provided by trained and experienced practitioners, can be safe and very valuable for patients at the end of life, enhancing their quality of life by reducing pain and improving mood.
In this study, participants received up to six 30-minute sessions of either massage therapy or simple touch over 2 weeks. Patients in both groups noticed immediate improvement in pain and mood following the treatment, but the changes in the massage group were statistically larger. This effect, however, was not sustained over time. This is a unique study, given the relatively large number of enrolled patients (380), as well as the fact that these were hospice patients, a population that has traditionally been considered quite difficult to study. Additionally, this study addresses the use of complementary and alternative medicine (CAM) modalities to treat pain and other symptoms in an advanced cancer population. This population has a significant interest in integrating CAM modalities into their treatment plans.
It is difficult to set up a control group for massage therapy; however, by providing a standardized and simple touch intervention, the investigators were able to control for attention, touch and healing intent. The study also confirmed that massage is safe for patients with metastatic cancer. In addition, it demonstrated feasibility of the hospice-based research network.
The participants self-reported pain and mood, and those who obtained the immediate treatment outcomes were not blinded to treatment.
Competing interests: No potential interests relevant to this article were reported.
Chwistek M: "This clinical trial evaluated the effectiveness of massage as compared to simple touch in a..." Evaluation of: [Kutner JS et al. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial. Ann Intern Med. 2008 Sep 16; 149(6):369-79]. Faculty of 1000, 09 Oct 2008. F1000.com/1123205#eval580343
Short form
Chwistek M: 2008. F1000.com/1123205#eval580343
Faculty of 1000 evaluations, dissents and comments for [Kutner JS et al. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial. Ann Intern Med. 2008 Sep 16; 149(6):369-79]. Faculty of 1000, 09 Oct 2008. F1000.com/1123205
Short form
Faculty of 1000: 2008. F1000.com/1123205
Small studies of variable quality suggest that massage therapy may relieve pain and other symptoms.To evaluate the efficacy of massage for decreasing pain and symptom distress and improving quality of life among persons with advanced cancer.Multisite, randomized clinical trial.Population-based Palliative Care Research Network.380 adults with advanced cancer who were experiencing moderate-to-severe pain; 90% were enrolled in hospice.Six 30-minute massage or simple-touch sessions over 2 weeks.Primary outcomes were immediate (Memorial Pain Assessment Card, 0- to 10-point scale) and sustained (Brief Pain Inventory [BPI], 0- to 10-point scale) change in pain. Secondary outcomes were immediate change in mood (Memorial Pain Assessment Card) and 60-second heart and respiratory rates and sustained change in quality of life (McGill Quality of Life Questionnaire, 0- to 10-point scale), symptom distress (Memorial Symptom Assessment Scale, 0- to 4-point scale), and analgesic medication use (parenteral morphine equivalents [mg/d]). Immediate outcomes were obtained just before and after each treatment session. Sustained outcomes were obtained at baseline and weekly for 3 weeks.298 persons were included in the immediate outcome analysis and 348 in the sustained outcome analysis. A total of 82 persons did not receive any allocated study treatments (37 massage patients, 45 control participants). Both groups demonstrated immediate improvement in pain (massage, -1.87 points [95% CI, -2.07 to -1.67 points]; control, -0.97 point [CI, -1.18 to -0.76 points]) and mood (massage, 1.58 points [CI, 1.40 to 1.76 points]; control, 0.97 point [CI, 0.78 to 1.16 points]). Massage was superior for both immediate pain and mood (mean difference, 0.90 and 0.61 points, respectively; P < 0.001). No between-group mean differences occurred over time in sustained pain (BPI mean pain, 0.07 point [CI, -0.23 to 0.37 points]; BPI worst pain, -0.14 point [CI, -0.59 to 0.31 points]), quality of life (McGill Quality of Life Questionnaire overall, 0.08 point [CI, -0.37 to 0.53 points]), symptom distress (Memorial Symptom Assessment Scale global distress index, -0.002 point [CI, -0.12 to 0.12 points]), or analgesic medication use (parenteral morphine equivalents, -0.10 mg/d [CI, -0.25 to 0.05 mg/d]).The immediate outcome measures were obtained by unblinded study therapists, possibly leading to reporting bias and the overestimation of a beneficial effect. The generalizability to all patients with advanced cancer is uncertain. The differential beneficial effect of massage therapy over simple touch is not conclusive without a usual care control group.Massage may have immediately beneficial effects on pain and mood among patients with advanced cancer. Given the lack of sustained effects and the observed improvements in both study groups, the potential benefits of attention and simple touch should also be considered in this patient population.
PMID: 18794556
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