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