Pain Improvement After Healing Touch and Massage in Breast Cancer: an Observational Retrospective Study

Background: Healing Touch (HT) and Oncology Massage (OM) are nonpharmacologic pain interventions, yet a comparative effectiveness study has not been conducted for pain in breast cancer. Purpose: This breast cancer subgroup analysis compared the effectiveness of HT vs. OM on pain. Setting: The research occurred at an outpatient setting at an academic hybrid, multi-site, community-based cancer institute and Department of Supportive Oncology across four regional locations. Participants: Breast cancer outpatients along the cancer continuum who experienced routine clinical, nonexperimentally manipulated HT or OM. Research Design: The study was an observational, retrospective, comparative effectiveness post hoc subanalysis of a larger dataset. Patients reporting pain < 2 were excluded. Pre- and posttherapy pain scores and differences were calculated. Logistic regression modeled posttherapy pain by modality, adjusting for pretherapy pain. The proportions experiencing ? 2-point (clinically significant) pain reduction were compared with chi-square tests. Intervention: The study focused on the first session of either HT or OM. Main Outcome Measures: Pre- and posttherapy pain (range: 0 = no pain to 10 = worst possible pain). Results: A total of 407 patients reported pre- and posttherapy pain scores, comprised of 233 (57.3%) who received HT and 174 (42.8%) who received OM. Pretherapy mean pain was higher in HT (M=5.1, ± 2.3) than OM (M=4.3, ± 2.1) (p < .001); posttherapy mean pain remained higher in HT (M=2.7, ± 2.2) than OM (M=1.9, ± 1.7) (p < .001). Mean difference in pain reduction was 2.4 for both HT and OM. Both HT (p < .001) and OM (p < .001) were associated

A pilot study of oncology massage to treat chemotherapy-induced peripheral neuropathy (CIPN).

111 Background: Short- and long-term toxicity of platinum compounds and taxanes includes development of CIPN. With an increased interest regarding the role of complementary approaches for symptom control, we investigated massage therapy for symptomatic relief of chronic CIPN. Methods: This pilot study evaluated the optimum treatment schedule and initial efficacy of a standardized Swedish massage technique to treat lower extremity (LE) CIPN. Inclusion criteria: LE neuropathy attributed to oxaliplatin, paclitaxel, or docetaxel, no other history of attributable causes; self-reported neuropathy score ≥3, 0-10 scale; ≥ 6 months since last chemotherapy treatment; age ≥ 18. Patients (pts) were randomized to one of four groups: 1) LE massage 3 times (3X) week for 4 weeks; LE massage 2X week for 6 weeks; 3) head/neck/shoulder (control) massage 3X week for 4 weeks; or 4) control massage 2X week for 6 weeks. Massage completion rate was examined and symptoms of CIPN measured with the Pain Quality Assessment Scale [PQAS (Range: 0-10); subscales of SP (surface pain), DP (deep pain), and PP (paroxysmal pain)] at baseline and at 10 weeks. Results: 71 pts fulfilled inclusion criteria: 77.5% women; 57.7% (breast cancer), and 42.3% (GI cancer); mean age 60.3 y/o (range: 40-77). Average length of time since the end of chemotherapy was > 3 yrs. Mean massage completion rates (max = 12) were 8.9 (SD 4.2) for 3X week and 9.8 (4.0) for 2X week with no statistical differences. There were no statistically significant differences in PQAS scores at follow-up between site-specific massage groups (lower extremity vs controls). Pts who had massage 3X week reported statistically and clinically significantly improved PQAS scores versus those who had massage 2X week (change scores: PQAS-SP: -2.3 vs. -0.6, p = 0.001; PQAS-DP: -2.1 vs. -0.9, p = 0.008; PQAS-PP: -2.3 vs. -1.0, p = 0.025), with sustained improvement in the 3X week group, but minimal change in the 2X week group. Conclusions: We observed sustained reduction in pts with long-term CIPN up to 6 weeks after treatment completion for the more intensive 3X week massage group, regardless of treatment site. A large-scale efficacy trial is warranted to validate the role of oncology massage therapy for CIPN. Clinical trial information: NCT02221700.

Discussing Oncology Massage Research: an Interview with Danielle Gentile, PhD

This interview introduces the Journal’s readers to a new massage therapy researcher, Danielle Gentile, PhD, who is a Health Services Researcher and Assistant Professor of Medicine in the Depart-ment of Supportive Oncology at the Levine Cancer Institute for Atrium Health in Charlotte, North Carolina. Dr. Gentile’s research focuses on social media in health care, integrative oncology, and the effects of integrative modalities—including mas-sage therapy—on pain in patients with cancer. In the interview, Dr. Gentile describes what excites her about the field of massage therapy and how she integrates massage therapists into her research.

A pilot study of oncology massage to treat chemotherapy-induced peripheral neuropathy (CIPN).

e23067 Background: Short- and long-term toxicity of platinum compounds and taxanes includes development of CIPN. Although anti-neuropathic medications are available, there is increased interest by health care providers and patients (pts) regarding the role of complementary approaches for symptom control. Therefore, we explored the role of massage therapy for symptomatic relief of chronic CIPN. Methods: This pilot study evaluated the optimum treatment schedule and initial efficacy of two treatment schedules of a standardized Swedish massage technique to treat lower extremity (LE) CIPN. Inclusion criteria: LE neuropathy attributed to oxaliplatin, paclitaxel, or docetaxel, no other history of attributable causes (concurrent upper extremity neuropathy allowed); self-reported neuropathy score ≥3, 0-10 scale; ≥ 6 months since last chemotherapy treatment; age ≥ 18. Pts were randomized to one of four groups: 1) LE massage 3 times (3X) week for 4 weeks; LE massage 2X week for 6 weeks; 3) head/neck/shoulder (control) massage 3X week for 4 weeks; or 4) control massage 2X week for 6 weeks. Massage completion rate was examined and symptoms of CIPN measured with the Pain Quality Assessment Scale [PQAS (Range: 0-10); subscales of PQAS-SP (surface pain), PQAS-DP (deep pain), and PQAS-PP (paroxysmal pain)] at baseline and at 10 weeks. Results: 71 pts fulfilled inclusion criteria: 77.5% women; 57.7% (breast cancer), and 42.3% (GI cancer); mean age 60.3 y/o (range: 40-77). Average length of time since the end of chemotherapy was > 3 yrs. Mean massage completion rates (max = 12) were 8.9 (SD 4.2) for 3X week and 9.8 (4.0) for 2X week with no statistical differences. There were no statistically significant differences in PQAS scores at follow-up between site-specific massage groups (lower extremity vs controls). Pts who had massage 3X week reported statistically and clinically significantly improved PQAS scores versus those who had massage 2X week (change scores: PQAS-SP: -2.3 vs. -0.6, p = 0.001; PQAS-DP: -2.1 vs. -0.9, p = 0.008; PQAS-PP: -2.3 vs. -1.0, p = 0.025), with sustained improvement maintained in the 3X week group, but minimal change in the 2X week group. Conclusions: We observed sustained reduction in pts with long-term CIPN up to 6 weeks after treatment completion for the more intensive 3X week massage group, regardless of massage treatment site. A large-scale efficacy trial is warranted to validate the role of oncology massage therapy for CIPN. Clinical trial information: NCT02221700.

Integrating Oncology Massage Into Chemoinfusion Suites: A Program Evaluation

Objective: This article reports on the development, implementation, and evaluation of an integrative clinical oncology massage program for patients undergoing chemotherapy for breast cancer in a large academic medical center. Materials and Methods: We describe the development and implementation of an oncology massage program embedded into chemoinfusion suites. We used deidentified program evaluation data to identify specific reasons individuals refuse massage and to evaluate the immediate impact of massage treatments on patient-reported outcomes using a modified version of the Distress Thermometer delivered via iPad. We analyzed premassage and postmassage data from the Distress Thermometer using paired t test and derived qualitative data from participants who provided written feedback on their massage experiences. Results: Of the 1,090 massages offered, 692 (63%) were accepted. We observed a significant decrease in self-reported anxiety (from 3.9 to 1.7), nausea (from 2.5 to 1.2), pain (from 3.3 to 1.9), and fatigue (from 4.8 to 3.0) premassage and postmassage, respectively (all P < .001). We found that 642 survey participants (93%) were satisfied with their massage, and 649 (94%) would recommend it to another patient undergoing treatment. Spontaneous patient responses overwhelmingly endorsed the massage as relaxing. No adverse events were reported. Among the 398 patients (36%) who declined a massage, top reasons were time concerns and lack of interest. Conclusion: A clinical oncology massage program can be safely and effectively integrated into chemoinfusion units to provide symptom control for patients with breast cancer. This integrative approach overcomes patient-level barriers of cost, time, and travel, and addresses the institutional-level barrier of space.

The effect of oncology massage in the treatment and prophylaxis of patient-reported distress during cancer treatment.

191 Background: Distress (DS) levels are usually elevated across the disease course of cancer patients. Massage Therapy (MT) can improve patient-reported DS levels. We characterize the effect of MT on DS prevention and treatment, and compare the outcomes between single and multiple treatment sessions. Methods: This was a prospective single arm intervention with pre/post assessment using the validated NCCN DS Thermometer for patients on active chemotherapy who agreed to receive at least one MT session over a 10-week period. Results: 62 pts were included. 34/62 (55%) had DS when accruement started (X = 3.82, 6±4, M = 3, SD 2.32). 33/34 (97%) had improvement of DS after 1st session regardless of the type of DS on an average of 25% (p < 0.05). From 1st MT session to beginning of 2nd MT session (5±3 wks), DS had improved in 78% (14/18) of pts on an average of 31% (p < 0.001). 4/18 (22%) reported DS worsening chronically (X = 3.5, M = 3.5). 28/28 (100%) who had no DS reported initially did not develop it by the end of their participation. Conclusions: DS is prevalent among cancer patients and can affect treatment outcomes and overall quality of life. Regardless of type and source of DS, MT resulted in relief of patient-reported DS in a cumulative manner. MT may even appear to delay or prevent the onset of DS. Further studies are needed to determine if the improvement in DS is singularly from the MT intervention the patients received or from the emotional support that the therapist provided. A randomized study is also necessary to determine frequency and total duration of optimal treatment to confirm MT’s prophylactic and therapeutic ability for DS.

Oncology massage impact on patient with cancer and caregiver self-reported symptoms as part of an integrative oncology program at a comprehensive cancer center.

79 Background: Massage as a manual therapy has shown benefit for symptomatic relief in patients with cancer and their caregivers. We explored the impact of a single massage session on self-reported symptoms in an outpatient clinic at a comprehensive cancer center. Methods: Patients and caregivers received oncology massage treatments (30 or 60-min duration) at our Integrative Medicine Center outpatient clinic from Sep 2012-Jan 2015. Participants completed a modified Edmonton Symptom Assessment Scale (ESAS; 0-10 scale, 10 most severe) pre- and post-massage. ESAS individual items and subscales scores of Physical Distress (PHS), Psychological Distress (PSS), and Global Distress (GSD) were analyzed. We used paired t-tests with a Bonferroni correction (i.e., p < .001) to examine pre/post massage self-reported symptoms. Results: Initial massage visits for 164 patients and 39 caregivers were analyzed. Highest symptoms burden (means) at baseline for patients were Sleep 3.93, Fatigue 3.70, and poor sense of Well-Being 3.62; for caregivers Distress 4.14, Sadness 3.43, and Sleep 3.21. Although patients reported significantly more physical symptoms (F = 27.56, P < .0001) compared to caregivers at baseline, groups did not differ in regard to psychological symptom burden (P = .75). Massage therapy was associated with significant improvements in PHS, PSS, and GSD for both patients and caregivers at P < .0001. Including participants with symptom report ≥ 1, massage resulted in a clinically significant improvement (reduction ≥ 1) in pain, fatigue, sleep, distress, dry mouth, sadness, numbness, anxiety, wellbeing for patients; pain, fatigue, distress, sadness, numbness, anxiety, wellbeing for caregivers. Regarding massage duration, there were no significant effects for 30 vs 60-min duration on pre/post ESAS difference scores. Conclusions: A single 30- or 60-minute massage session resulted in acute relief of self-reported symptoms in patients and caregivers. Further study is warranted regarding optimal massage dose and frequency.