SummaryThe the oncology clinics at Beth Israel
SummaryThe goal of this study was to determine the feasibility and effects of providing therapeutic massage at home for patients with metastatic cancer by investigating the impact of massage on pain, anxiety, alertness, quality of life, and sleep (Toth et al., 2013).Research Questions & Study DesignThe authors mentioned that while pharmacologic agents exist to help manage symptoms for oncology patients, they often come with unwanted side effects. Their research questions were whether in-home massage was a feasible option for patients with metastatic cancer, and whether or not it could provide symptom relief. This study examined the effect therapeutic massage (independent variable) had on the primary outcomes of pain, anxiety, and alertness and secondary outcomes of quality of life and sleep (dependent variables). This was a randomized controlled trial, with patients randomized between three intervention groups: massage, “no-touch” alternative, and usual care. The “no touch intervention” consisted of the presence, but not touch, of the massage therapists. “Usual care” participants did not have any meetings other than the 1-week and 1-month assessments. We agreed that the study design was appropriate to answer the research questions. However, we found some weaknesses as described in the following sections. Sample & SettingParticipants were drawn from the oncology clinics at Beth Israel Deaconess Medical Center (BIDMC), a large academic medical center in Boston, MA. The type of sampling used was most likely convenience samplingbecause all participants that were selected were patients of the clinic where the research was being done, and lived within 25 miles of the facility. Participant eligibility was based on the clinical diagnosis of metastatic cancer (end-of-life), and therefore the study did not include oncology patients with less severe diagnoses. In addition, the participants were 95% white and 82% female, and 56% had breast cancer (as opposed to other types of cancer) which is not representative of the general population, and therefore limits external validity. All massage therapy and control interventions occurred in the patients’ homes, which was appropriate for their research question of feasibility.Research MethodsParticipants received up to three treatments of either massage therapy or no-touch interventions within the first week. The length and schedule of treatments were determined by the patient. Participants first had a baseline assessment, and then pre- and post-interventions assessments for each session. One-week and one-month follow up assessments were also performed. All data collected were subjective and self-reported with the exception of pulse and respiratory rate, two biophysiologic measurements that were collected by massage therapists before and after interventions were performed.The subjective assessment tools used in this study included the Visual Analogue Scale (assessment of anxiety, pain, and alertness before and after interventions), the Brief Pain Inventory Short Form (pain severity and location), an adaptation of the Katz Index of Independence in Activities of Daily Living, and standardized scales to assess anxiety, alertness, mood, quality of life, and sleep quality. The researchers did not specifically address the reliability and/or validity of the Visual Analogue Scale as a measurement tool, but it is a commonly used scale to measure subjective experiences. They did state that the Brief Pain Inventory Short Form “has been used as an outcome measure in patients with advanced cancer” and the subscales used “have documented internal consistency (Cronbach’s alpha=0.87) and discriminative validity” (Toth et al., 2013, p. 652).A significant bias issue in this study is that massage therapists may influence patients to give ratings that prove the benefits of massage, and participants are more likely to give positive reviews when asked to self-report symptom assessments directly to their massage therapists. The study also did not state that they used any statistical analyses to assess for potentially significant inter-rater reliability issues.Study Findings & LimitationsThe results supported the original hypothesis that “providing massage and no-touch control interventions at home by professional therapists is feasible” (Toth et al., 2013, p. 655). Regarding outcomes, they found a significant improvement in short-term quality of life for the patients who received massage therapy, and the results suggested that other therapeutic benefits (i.e. improved sleep quality and pain reduction) could also be associated with therapeutic massage. However, many of their results did not show statistical significance, likely due to their small sample size, and some biases were identified since the study was not double blind (i.e. patient expectations influencing outcomes).The main criticism we had of this study was that both cancer symptoms and massage are widely variable. Limitations were set in order to provide guidelines that the massage therapist should follow, but many of the techniques varied depending on patient preferences, severity of symptoms, and massage therapist training. The effect inevitable variations in massage technique necessitates a larger sample size. Given that this was a pilot study, it is clear that more research needs to be done to determine all of the benefits of massage, as well as other complementary therapies, for symptom management and health promotion in general. Collection of data on the effects of massage on longevity and pain medication usage would also be beneficial.Research RelevanceThis study emphasized the importance of exploring complementary therapies as adjunct treatment options for patients that are not experiencing symptom control from pharmacologic agents alone. This is especially applicable to oncology patients, as they tend to suffer from inadequate symptom control at a higher rate than other patient groups. No adverse events occurred during this study, making it a fairly low-risk nonpharmacologic intervention that could help metastatic cancer patients better manage their symptoms. This intervention is potentially easily implementable, with a moderate cost.