Massage therapy for cancer patients: a reciprocal relationship between body and mind


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1891200/

Curr Oncol. Apr 2007; 14(2): 45–56.

S.M. Sagar, MD,* T. Dryden, MEd RMT, and R.K. Wong, MD*

Abstract

Some cancer patients use therapeutic massage to reduce symptoms, improve coping, and enhance quality of life. Although a meta-analysis concludes that massage can confer short-term benefits in terms of psychological wellbeing and reduction of some symptoms, additional validated randomized controlled studies are necessary to determine specific indications for various types of therapeutic massage. In addition, mechanistic studies need to be conducted to discriminate the relative contributions of the therapist and of the reciprocal relationship between body and mind in the subject. Nuclear magnetic resonance techniques can be used to capture dynamic in vivo responses to biomechanical signals induced by massage of myofascial tissue. The relationship of myofascial communication systems (called “meridians”) to activity in the subcortical central nervous system can be evaluated. Understanding this relationship has important implications for symptom control in cancer patients, because it opens up new research avenues that link self-reported pain with the subjective quality of suffering. The reciprocal body–mind relationship is an important target for manipulation therapies that can reduce suffering.

Keywords: Massage, cancer, clinical trials, mechanistic studies, functional magnetic resonance imaging, magnetic resonance spectroscopy, meridians, brain

1. INTRODUCTION

Therapeutic massage is increasingly used in medical treatment programs to reduce symptoms, improve coping, and enhance quality of life 1,2. Cancer patients use therapeutic massage to improve symptom control and their personal sense of wellbeing.

The largest published report on therapeutic massage is a prospective, nonrandomized, observational study of patients treated at the Memorial Sloan–Kettering Cancer Center in New York City 3. That study evaluated changes in symptom scores for pain, fatigue, stress and anxiety, nausea, and depression. Participants included 1290 cancer patients and 12 licensed massage therapists. Three variations of massage (selected mainly by the patients) were used: Swedish, light touch, and foot massage. The main outcome measures were data from symptom cards collected by independent observers that were recorded before and after the first session of massage. Symptom scores declined in severity by approximately 50%. Swedish and light touch massage were found to be superior to foot massage. However, the effects of massage were short-term.

This intriguing observational study illustrates many of the challenges in the research into therapeutic massage. The results indicated that the size of the effect for massage in cancer patients is clinically important, and the authors have since begun a randomized controlled trial.

The strength of the pilot study was the systematic collection of data from a large number of patients. Its main weakness was that it lacked a randomized control group, and therefore uncertainty remains regarding whether the intervention (massage) was the only factor that led to the improvement in the patients’ symptom scores. The patients were mainly self-selected and probably believed that the intervention would be of benefit. Symptom improvement may be a consequence of conscious belief of benefit (the placebo effect) rather than the physical manipulation or touch. In addition to the manual therapy, other ambient factors such as verbal communication, background music 4,5, and the scent of massage oils or aroma-therapy products 6,7 may have influenced outcome. The largest effect of massage therapy may be on the reduction of trait anxiety and depression, with a course of treatment providing benefits similar in magnitude to those of psychotherapy 8,9.

Currently there is a dearth of randomized controlled trials of massage therapy in cancer patients. The ones that have been reported show conflicting results that may be a consequence of variation in technique and use of non-validated symptom scores 1013.

A recent prospective randomized trial completed by the department of radiation oncology, CHUM Hôpital Notre-Dame, and the Canadian Touch Research Centre in Montreal 14 evaluated the effects of massage therapy on anxiety levels in patients undergoing radiation therapy. In a 6-month period, 100 patients undergoing radiation therapy were randomly assigned to either massage sessions or control sessions. The massage group received a 15-minute massage session before radiotherapy over 10 consecutive days. The control group did not receive massage. The State–Trait Anxiety Inventory and a Visual Analog Scale were used to evaluate both groups.

Following massage, anxiety scores in the patients were significantly reduced (by 43%) as compared with pre-massage scores. In both groups, patients experienced an average 20% reduction in anxiety between the first and the last radiotherapy session, but that result did not reach statistical significance. The massage therapy was associated with an immediate significant decrease in anxiety scores before radiotherapy (procedural anxiety), but it appeared to have no major impact on situational anxiety. However, the period of intervention and assessment was quite short, and so no conclusions can be drawn regarding long-term outcomes.

The most recent publication of a randomized controlled trial of massage for cancer patients is a multicentre study from four U.K. cancer centres and a hospice 15. A total of 288 cancer patients, referred to complementary therapy services for clinical anxiety or depression, or both, were allocated randomly to a course of aromatherapy massage or to usual supportive care alone. Reduction in anxiety and depression was significant at 2 weeks after the intervention, but not at 6 weeks. The authors concluded that aromatherapy massage is an effective therapeutic option for the short-term management of mild-to-moderate anxiety and depression in patients with cancer. They suggested that the benefits of aromatherapy massage need to be compared with those of psychological interventions for this patient group.

To be able to design appropriate randomized controlled clinical trials, a better mechanistic understanding of therapeutic massage is required. In particular, the physiologic pathways involved need to be understood, including the connection between myofascial manipulation, blood flow, and central nervous system adaptations. Prolonged intervention with massage therapy may possibly induce more permanent neuro-physiologic adaptations because of neural plasticity.

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One thought on “Massage therapy for cancer patients: a reciprocal relationship between body and mind

  1. Very long and scientific article, but worth scanning, at least. I thought I should post the conclusion, and people can read that and go back into the article to find information that interests them.

    3. CONCLUSION: CHALLENGES FOR THERAPEUTIC MASSAGE RESEARCH

    The mechanistic links between manipulation of body tissues and corresponding relief from a broad range of symptoms are not fully understood. The effects are distributed, and reciprocal interplay between the body and mind is evident. We have literally just “touched” the surface of meridian research, but the meridian system appears to be an important communication link between myofascial tissue and the nervous system. This traditional communication system appears to link biochemical, electrical, and physiologic changes in the myofascial tissue with subcortical neurologic activity and changes in cognitive experience. The implications for symptom control in cancer patients are important, opening up new research avenues that link self-reported pain with the subjective quality of suffering. The reciprocal body–mind relationship and its manipulation is an important target for therapies that can reduce suffering.

    The U.S. National Center for Complementary and Alternative Medicine held a conference titled The Biology of Manual Therapies during June 9–10, 2005, at the National Institutes of Health (nih) in Bethesda, Maryland 66. The goal was to define three to five of the most critical research questions involved in gaining an understanding of the biology of manual therapies. Table II outlines the research recommendations. Table III lists current clinical trials involving massage and cancer (found by searching the nih clinical trials database at clinicaltrials.gov). At June 2006, seven studies investigating the effects of massage therapy in cancer patients were registered and active.

    TABLE II
    Recommendations from the Conference on the Biology of Manual Therapies, National Institutes of Health, National Center for Complementary and Alternative Medicine; Bethesda, Maryland; June 9–10, 2005

    TABLE III
    Current North American clinical trials involving therapeutic massage and cancer patients

    More work is required on the methodology for conducting clinical trials of therapeutic massage. Validation of the massage technique is essential. In clinical practice, both the site of massage and the technique may vary according to the practitioner’s personal judgment. In an intent-to-treat study, such variation may be valid, but excellent records should be kept to determine that the therapy was within acceptable degrees of freedom. When comparing various massage-therapy techniques, rigorous validation of the practitioners’ interventions is necessary. The design of sham massage is challenging. The control may involve touching non-therapy sites only, using untrained volunteers, providing education only, or employing a waiting list control. In addition, because thoughts of intent to heal are considered important, sham therapists may be asked to use personal distraction techniques. Defined subject populations (with appropriate inclusion and exclusion criteria) and validated outcome scales are essential.

    In addition to the manual therapy itself, ambient factors such as environment, music, and aroma can influence outcome. The objectivity of research is complicated by the relationship and transference between therapist and client. The possibility exists that benefits may come about more from factors such as the recipient’s attitude toward massage therapy, the therapist’s personal characteristics and expectations, and the interpersonal contact and communication that take place during treatment than from the specific form of massage therapy used or the site to which it is applied.

    Only a combination of mechanistic research and well-designed clinical trials will clarify the reciprocal relationship between body and mind and will determine the utility of manual therapies for symptom control in cancer patients.

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