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Funding Sources:
National Center for Complementary and Alternative Medicine (NCCAM) http://nccam.nih.gov/

Mendel-Asarch Lung Cancer Family Foundation

This 3-year, national multi-site randomized clinical trial was conducted to demonstrate the efficacy of massage therapy for decreasing pain and symptom distress in patients with advanced stage cancer.  The study is the largest of its kind ever conducted and was funded by a $1.2 million grant from the Mendel/Asarch Lung Cancer Family Foundation and the National Institutes of Health.  Enrollment and data collection were completed in October 2006 with a total of 388 participants. Results are posted below.

Participants were randomly assigned to receive massage therapy or a control intervention, “non-moving touch” along with their usual hospice care.  Patients in both groups received up to six 30-minute treatment sessions in a 2-week time frame by either trained massage therapists (MT arm) or study personnel with no body or energy work training (NMT arm), following specific study treatment protocols.  Along with pulse and respiration, the Memorial Pain Assessment Card was measured immediately prior to and following each treatment. Intention to treat analyses compared the two treatment arms, using a repeated measures model that accommodates incomplete data.

Patient interviews, using standardized instruments to measure pain (Brief Pain Inventory), quality of life (McGill Quality of Life Questionnaire), and symptom distress (Condensed Memorial Assessment Scale), were conducted at four intervals:  one prior to receiving treatment, two during the treatment sessions and one a week after receiving the final treatment session.  Information regarding both pharmacologic and non-pharmacologic interventions was also collected.

Massage has potential to be an efficacious and effective therapy for palliative care.  There is evidence to support the potential for massage therapy to facilitate pain management, decrease anxiety and depression, promote relaxation and enhance quality of life in a variety of patient populations. Massage therapy may augment traditional analgesics and may enhance alertness. There are a few studies with small sample sizes that support one or more of these outcomes with patients with cancer and/or those receiving hospice care.  Massage can be integrated easily into routine hospice care, and even family members can learn effective massage techniques to comfort loved ones during the last days of their lives. 

RESULTS

EFFICACY OF MASSAGE THERAPY FOR DECREASING PHYSICAL AND EMOTIONAL SYMPTOM DISTRESS AND IMPROVING QUALITY OF LIFE IN ADVANCED CANCER J.S. KUTNER1; M.C. SMITH2; L. CORBIN3; L. HEMPHILL4; D. FAIRCLOUGH3. 1University of Colorado Denver, Denver, CO; 2Florida Atlantic University, Boca Raton, FL; 3University of Colorado Denver, Aurora, CO; 4Denver VAMC, Denver, CO.  (Tracking ID # 171857)

BACKGROUND: This study evaluated the efficacy of massage therapy (MT) compared to “non-moving touch” (NMT) for decreasing pain, improving quality of life, and lessening physical and emotional symptom distress among persons with advanced cancer.

METHODS: Multi-site randomized clinical trial comparing MT to NMT among English-speaking adults with advanced cancer who had at least moderate pain (>= 4 on 0 – 10 scale) in the week prior to study enrollment. Participants received up to six 30 minute treatments over a two-week period by trained massage therapists (MT arm) or study personnel with no body or energy work training (NMT arm), following specific study treatment protocols. Outcomes were collected at baseline, at weeks 1, 2 and one week after the final treatment, and immediately prior to and following each treatment. Weekly outcome measures included pain (Brief Pain Inventory – BPI, 0 - 10 scale), quality of life (McGill Quality of Life Questionnaire – MQOL, 0 – 10 scale), and non-pain symptom distress (Condensed Memorial Assessment Scale – MSAS, 0 – 4 scale). The Memorial Pain Assessment Card (MPAC – pain and mood scales, 0 – 10 scale), was measured immediately prior to and following each treatment. Intention to treat analyses compared the two treatment arms, using a repeated measures model that accommodates incomplete data.

RESULTS: 382 patients were randomized (190 MT, 192 NMT). The average age was 65.5 years (SD 14.3). 60% were women, 91% were White, 78% were at home. The most common cancer was lung (25%), followed by breast (16%). All except 2 had known metastases; 27% had bony metastases. 58% had concomitant medical conditions. Average pain intensity at study enrollment was 4.4 (0 – 10 scale), with worst pain intensity of 7.8 in the prior week. There were no differences between the study groups in baseline characteristics, number of treatments received or duration of follow up. Participants received, on average, 4.1 treatment sessions. Both study groups experienced improvement in pain, quality of life and non-pain symptom distress over the course of the study, but there were no statistically significant differences between the study arms (Table). Both MT and NMT were associated with improvement in pain and mood (MPAC) measured immediately prior to and following each treatment session (MT: pain improved by 1.84 points, mood improved by 1.55 points; NMT: pain improved by 1.02 points, mood improved by 0.98 points), however, MT was superior for pain by 0.81 points (p<0.0001) and for mood by 0.57 points (p=0.0004).

CONCLUSIONS: MT provided greater short-term improvement in pain and mood than did simple touch, findings that were not sustained over time. Improvements in pain, non-pain symptom distress, and quality of life in both study arms may indicate that attention and touch, which is simple and inexpensive to provide, may be beneficial to persons with advanced cancer.
MT vs. NMT: No differences over study period

Study contact:
Jean Kutner, MD, MSPH
jean.kutner@ucdenver.edu