Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial.
BACKGROUND
Small studies of variable quality suggest that massage therapy may relieve pain and other symptoms.


OBJECTIVE
To evaluate the efficacy of massage for decreasing pain and symptom distress and improving quality of life among persons with advanced cancer.


METHODS
Multisite, randomized clinical trial.


METHODS
Population-based Palliative Care Research Network.


METHODS
380 adults with advanced cancer who were experiencing moderate-to-severe pain; 90% were enrolled in hospice.


METHODS
Six 30-minute massage or simple-touch sessions over 2 weeks.


METHODS
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.


RESULTS
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]).


CONCLUSIONS
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.


CONCLUSIONS
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.
Kutner
Jean S
JS
School of Medicine, College of Nursing, University of Colorado Denver, Denver and Aurora, Colorado, USA. jean.kutner@ucdenver.edu
Smith
Marlaine C
MC
Corbin
Lisa
L
Hemphill
Linnea
L
Benton
Kathryn
K
Mellis
B Karen
BK
Beaty
Brenda
B
Felton
Sue
S
Yamashita
Traci E
TE
Bryant
Lucinda L
LL
Fairclough
Diane L
DL
D000339:Affect / Q000187:drug effects*; D006801:Humans; D008405:Massage / Q000009:adverse effects; D009369:Neoplasms / Q000150:complications* / Q000523:psychology; D059408:Pain Management; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life; D016037:Single-Blind Method
J Soc Integr Oncol. 2007 Fall;5(4):139-46
19087757
Cancer Nurs. 2001 Jun;24(3):180-4
11409061
Pain. 1999 May;81(1-2):129-34
10353500
J Pain Symptom Manage. 1996 Nov;12(5):273-82
8942122
J Soc Integr Oncol. 2008 Winter;6(1):19-28
18302907
Cancer Nurs. 2000 Oct;23(5):327-36
11037952
Support Care Cancer. 1998 Nov;6(6):539-41
9833305
Complement Ther Nurs Midwifery. 2000 Nov;6(4):169-75
11858299
Integr Cancer Ther. 2003 Dec;2(4):332-44
14713325
J Palliat Med. 2002 Jun;5(3):397-406
12133244
Ann Intern Med. 2008 Feb 19;148(4):295-309
18283207
J Pain Symptom Manage. 2004 Sep;28(3):244-9
15336336
Clin Nurs Res. 2007 May;16(2):85-99; discussion 100-2
17452429
Am Psychol. 1998 Dec;53(12):1270-81
9872050
Ann Emerg Med. 1996 Apr;27(4):485-9
8604867
Cancer Control. 2005 Jul;12(3):186-95
16062166
BMJ. 2000 Feb 19;320(7233):513-4
10678876
Emerg Med J. 2001 May;18(3):205-7
11354213
Nurs Res. 1986 Mar-Apr;35(2):101-6
3633503
J Palliat Med. 2004 Jun;7(3):405-7
15265348
Palliat Med. 2004 Mar;18(2):87-92
15046404
Cancer Nurs. 1993 Apr;16(2):93-101
8477405
Cancer. 2000 Oct 15;89(8):1854-65
11042583
Holist Nurs Pract. 1991 Oct;6(1):24-31
1918182
Health Qual Life Outcomes. 2007 Aug 03;5:51
17683554
J Holist Nurs. 2006 Sep;24(3):152-61
16880409
J Pain. 2003 Sep;4(7):407-14
14622683
J Pain Symptom Manage. 1997 May;13(5):254-61
9185430
Eur J Cancer. 1994;30A(9):1326-36
7999421
ANS Adv Nurs Sci. 1982 Jul;4(4):44-61
6808905
AACN Clin Issues. 2000 Feb;11(1):77-96
11040555
J Clin Oncol. 1999 Jan;17(1):361-70
10458255
Cancer. 2000 Sep 1;89(5):1162-71
10964347
JAMA. 1999 Jan 13;281(2):163-8
9917120
J Pain Symptom Manage. 2001 Jun;21(6):473-80
11397605
Qual Life Res. 1994 Jun;3(3):183-9
7920492
Ann Intern Med. 2008 Feb 19;148(4):W60-6
18283201
ANS Adv Nurs Sci. 1984 Jan;6(2):42-9
6322674
Cochrane Database Syst Rev. 2004;(2):CD002287
15106172
Hosp J. 2000;15(3):31-53
11315685
World Health Organ Tech Rep Ser. 1990;804:1-75
1702248
Palliat Support Care. 2003 Sep;1(3):231-7
16594423
Curr Oncol. 2007 Apr;14(2):45-56
17576465
Ann Acad Med Singap. 1994 Mar;23(2):129-38
8080219
J Psychosom Res. 2004 Jul;57(1):45-52
15256294
Palliat Med. 2001 Sep;15(5):363-71
11591087
Expert Rev Pharmacoecon Outcomes Res. 2004 Apr;4(2):171-8
19807521
Palliat Med. 1997 Jan;11(1):3-20
9068681
Eur J Pharmacol. 2001 Oct 19;429(1-3):1-11
11698022
Cancer. 1987 Sep 1;60(5):1151-8
3300951
J Pain Symptom Manage. 2007 Sep;34(3):227-36
17572055
J Pain Symptom Manage. 1996 Oct;12(4):209-20
8898504
Stat Med. 2001 Apr 15;20(7):1009-21
11276032
Palliat Med. 2003 Jun;17(4):300-7
12822844
Cancer Invest. 2004;22(4):526-36
15565810
Neurology. 1997 Feb;48(2):332-8
9040716
Pain. 1995 May;61(2):277-284
7659438
J Pain Symptom Manage. 2000 Nov;20(5):374-87
11068159
Cancer Invest. 2004;22(5):678-87
15581048
Cancer. 1998 Jul 1;83(1):173-9
9655308
Lancet. 1985 May 25;1(8439):1204-6
2860399
J Pain Symptom Manage. 1999 Jul;18(1):9-16
10439568