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Massage Therapy versus Simple Touch to Improve Pain and Mood in Patients with Advanced Cancer: A Randomized Trial

Jean S. Kutner, MD, MSPH; Marlaine C. Smith, RN, PhD; Lisa Corbin, MD; Linnea Hemphill, APRN, BC, MSN; Kathryn Benton, MSPH; B. Karen Mellis, BS; Brenda Beaty, MSPH; Sue Felton, MA; Traci E. Yamashita, MS; Lucinda L. Bryant, PhD, MSHA; and Diane L. Fairclough, DrPH
[+] Article and Author Information

ClinicalTrials.gov registration number: NCT00065195.


From the School of Medicine, College of Nursing, and School of Public Health, University of Colorado Denver, Denver and Aurora, Colorado, and Florida Atlantic University, Boca Raton, Florida.


Acknowledgment: The authors thank the on-site study teams, staff, patients and families at the study sites: Catholic Hospice, Miami, Florida; Circle of Life Hospice & Palliative Care, Springdale, Arkansas; Hope Hospice and Community Services, Fort Myers, Florida; HospiceCare in the Berkshires, Pittsfield, Massachusetts; Hospice & Palliative CareCenter, Winston-Salem, North Carolina; Hospice & Palliative Care of Cape Cod, Cape Cod, Massachusetts; Hospice & Palliative Care of the Charlotte Region, Charlotte, North Carolina; Hospice of Saint John, Lakewood, Colorado; Hospice Partners, Hillside, Illinois; LifePath Hospice, Tampa, Florida; Midwest Palliative & Hospice CareCenter, Glenview, Illinois; Pikes Peak Hospice, Colorado Springs, Colorado; San Diego Hospice, San Diego, California; The Denver Hospice, Pathways Program, Denver, Colorado; The Washington Home, Washington, DC; and the University of Colorado Cancer Center, Aurora, Colorado.

Grant Support: By the National Institutes of Health and National Center for Complementary and Alternative Medicine (1R01AT01006-01A2), Mendel/Asarch Lung Cancer Family Foundation Grants Program, Paul Beeson Physician Faculty Scholars in Aging Research Award, and Robert Wood Johnson Generalist Physician Faculty Scholars Program (Dr. Kutner).

Potential Financial Conflicts of Interest: None disclosed.

Reproducible Research Statement:Study protocol and data set: Available from Dr. Kutner (e-mail, jean.kutner@ucdenver.edu). Massage and simple touch protocols are available online at http://www.annals.org (Appendix). Statistical code: Available from Dr. Fairclough (e-mail, diane.fairclough@ucdenver.edu).

Requests for Single Reprints: Jean S. Kutner, MD, MSPH, Division of General Internal Medicine, B180, University of Colorado Denver School of Medicine, PO Box 6511, Academic Office 1, Aurora, CO 80045; e-mail, jean.kutner@ucdenver.edu.

Current Author Addresses: Dr. Kutner, Ms. Mellis, Ms. Felton, and Ms. Yamashita: Division of General Internal Medicine, University of Colorado Denver School of Medicine, Mail Stop B180, PO Box 6511, Aurora, CO 80045.

Dr. Smith: Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431.

Dr. Corbin: Division of General Internal Medicine, University of Colorado Denver School of Medicine, Mail Stop F743, PO Box 6510, Aurora, CO 80045.

Ms. Hemphill: 10061 East Mexico Avenue, Denver, CO 80247.

Ms. Benton, Ms. Beaty, and Dr. Fairclough: Colorado Health Outcomes Program, University of Colorado Denver School of Medicine, Mail Stop F443, PO Box 6508, Aurora, CO 80045.

Dr. Bryant: University of Colorado Denver School of Public Health, 4200 East 9th Avenue, Box C245, Denver, CO 80262.

Author Contributions: Conception and design: J.S. Kutner, M.C. Smith, L. Corbin, L. Hemphill, D.L. Fairclough.

Analysis and interpretation of the data: J.S. Kutner, M.C. Smith, L. Corbin, K. Benton, B. Beaty, T.E. Yamashita, L.L. Bryant, D.L. Fairclough.

Drafting of the article: J.S. Kutner, M.C. Smith, L. Corbin, L. Hemphill, K. Benton, D.L. Fairclough.

Critical revision of the article for important intellectual content: J.S. Kutner, M.C. Smith, L. Corbin, K. Benton, B.K. Mellis, B. Beaty, T.E. Yamashita, L.L. Bryant.

Final approval of the article: J.S. Kutner, M.C. Smith, L. Corbin, K. Benton, L.L. Bryant, D.L. Fairclough.

Provision of study materials or patients: B.K. Mellis.

Statistical expertise: K. Benton, D.L. Fairclough.

Obtaining of funding: J.S. Kutner, M.C. Smith.

Administrative, technical, or logistic support: M.C. Smith, B.K. Mellis, S. Felton, T.E. Yamashita.

Collection and assembly of data: J.S. Kutner, M.C. Smith, L. Hemphill, K. Benton, B.K. Mellis, S. Felton, T.E. Yamashita.


Ann Intern Med. 2008;149(6):369-379. doi:10.7326/0003-4819-149-6-200809160-00003
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Massage seemed to have immediately beneficial effects on pain and mood among patients with advanced cancer. Both the massage and simple-touch groups had statistically, although not clinically, significant improvements in pain and quality of life over time despite no increases in total analgesic medication use. Although clinically significant change in symptom distress as measured by the MSAS has no definition, the observed improvements were minimal. Dispelling common concerns about the safety of massage in cancer, we found no statistically significant differences in adverse events or deaths among this advanced cancer population. This study provides a promising model for future clinical trials in the hospice and palliative care population, demonstrating feasibility of the hospice-based research network as a venue for conducting randomized trials.

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Figures

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Figure 1.
Study overview: timing of study procedures.
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Figure 2.
Study flow diagram.

Assessments refer to the weekly or sustained outcomes. Immediate outcome data collection occurred in conjunction with every treatment session. IQR = interquartile range; max = maximum; min = minimum.

* Number who had any treatment: 113 + 38 for massage therapy and 93 + 54 for control.

† Number with baseline or any sustained outcome assessments: 188 − 17 for massage therapy and 192 − 15 for control.

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Figure 3.
Immediate and sustained pain outcomes.

We obtained estimates and 95% CIs from a mixed-effects model adjusted for age, comorbid conditions, sex, experience with massage therapy, worst pain in past week at study entry, and functional status (Karnofsky Performance Scale score). Top. Immediate outcomes: mean change in pain before and after treatment, according to treatment number and group. We measured pain before and after treatment for immediate outcomes with the Memorial Pain Assessment Card (MPAC) (0- to 10-point scale; 10 = worst pain). Mean pain changes for immediate outcomes are the mean changes in pain before and after assessments at each treatment visit. The number of participants (massage therapy/control) with treatments at each visit is noted below the graph. Bottom. Sustained outcomes: mean pain, according to assessment number and treatment group. We measured the sustained outcome of pain with the Brief Pain Inventory (BPI) (0- to 10-point scale; 10 = worst pain). The number of participants (massage therapy/control) with sustained assessments at each visit is noted below the graph.

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Appendix Figure.
Immediate and sustained effects.

Effect sizes with 95% CIs and P values shown for study outcomes according to massage therapy (squares) and control (circles) groups. Data represent improvement if greater than 0 and worsening if less than 0. Effect sizes adjusted for age, comorbid conditions, sex, experience with massage therapy, worst pain in past week at study entry, and functional status (Karnofsky Performance Scale score). BPI = Brief Pain Inventory; MPAC = Memorial Pain Assessment Card; MQOL = McGill Quality of Life Questionnaire; MSAS = Memorial Symptom Assessment Scale.

* Primary end points.

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Comments

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Massage Therapy improves pain and mood in advanced cancer
Posted on November 15, 2008
mark k chelmowski
Aurora Advanced Healthcare
Conflict of Interest: None Declared

The article by Kutner et al. (1) suggests that massage therapy and to a lesser degree, simple touch provides immediate pain relief and improvement in mood. There was no lasting relief measured, prompting the editors to comment that "the absence of sustained effects demonstrates the need for more effective strategies to manage pain at the end of life." I would argue that temporary relief of suffering is still very much worthwhile. If I had advanced cancer and could feel better for an hour or two or three after a massage, I would request this, especially since it appears to have no adverse effects. The pain relief after an injection of morphine or while enjoying an excellent meal are all temporary. Even though their effects, like massage and touch in individuals with advanced cancer, may not be sustained, I would argue that they are very much worthwhile and can make our lives all the better.

Reference:

1. Jean S. Kutner, Marlaine C. Smith, Lisa Corbin, Linnea Hemphill, Kathryn Benton, B. Karen Mellis, Brenda Beaty, Sue Felton, Traci E. Yamashita, Lucinda L. Bryant, and Diane L. Fairclough Massage Therapy versus Simple Touch to Improve Pain and Mood in Patients with Advanced Cancer: A Randomized Trial Ann Intern Med 2008; 149: 369-379

Conflict of Interest:

None declared

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Summary for Patients

Massage Therapy to Improve Pain and Mood in Patients with Advanced Cancer

The summary below is from the full report titled “Massage Therapy versus Simple Touch to Improve Pain and Mood in Patients with Advanced Cancer. A Randomized Trial.” It is in the 16 September 2008 issue of Annals of Internal Medicine (volume 149, pages 369-379). The authors are J.S. Kutner, M.C. Smith, L. Corbin, L. Hemphill, K. Benton, B.K. Mellis, B. Beaty, S. Felton, T.E. Yamashita, L.L. Bryant, and D.L. Fairclough.

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