Background. Cancer and Cancer Treatment cause Physical and Emotional Distress 3/4/2011. Cancer, Massage, and Symptom Relief

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1 Cancer, Massage, and Symptom Relief What does Research Tell Us about the Benefits of Massage? A Webinar with Tracy Walton, MS, LMT Part 2 of the Massage in Cancer Care Webinar Series Background Tracy Walton Author Educator Researcher Massage Therapist Specialist in massage therapy and cancer care Cancer and Cancer Treatment cause Physical and Emotional Distress Symptom relief is a high priority in cancer care 1

2 People turn to massage therapy for The Big Five in Cancer Care Support Companionship Escape Symptom relief Pain Nausea Fatigue Anxiety Depression Problems We Face We want to provide convincing evidence of massage benefits, but Often no research exists Some massage therapy research is overstated Commonly accepted effects of massage not always supported by solid research MTs not always trained to find, evaluate, and use research In this Webinar: Overview of research on massage and cancer Different types of evidence Highlight some of the strongest research Identify what the research tells us Identify what the research does not tell us 2

3 Then, we can.. Promote massage therapy using accurate information Move forward with the strongest research on massage and cancer Use the research well We are on solid ground Evidence Based Medicine Medical practice is guided by systematic research: The direction of the evidence from research The strength of the evidence from research Not all research is equal There are levels of evidence STRONGEST Levels Of Evidence WEAKEST 3

4 A single story of a single client experience Considered the weakest level of evidence A practitioner s formal write-up of a single client: Background Presentation Treatment Outcomes Even if published, one of the weakest levels of evidence A formal write-up of more than one case Cases are similar in presentation and treatment Highlights similarities and differences among cases 4

5 Randomized, Controlled Trial (RCT) Randomized, controlled trial (RCT) can generate convincing data about massage Typically given more weight than case series, but One RCT does not usually prove a point One RCT may suggest a massage benefit Need a number of RCTs saying the same thing to answer a question Researcher reviews the literature Assesses quality of studies Summarizes findings Reports impressions in the literature 5

6 Also called a Meta-Analysis Researcher reviews the research literature Assesses quality of studies, pools data Sophisticated meta-analytic statistical methods One source of good quantitative reviews is Cochrane Collaboration, This level carries the most weight Levels of Evidence What does Research Tell Us about Benefits of Massage for People with Cancer? What does the evidence suggest? How strong is the evidence? How do we use it responsibly and accurately? 6

7 Focus areas: What do Anecdotes Tell Us? Big 5 symptoms Relaxation Ease of movement Empowerment Quality of life (QOL) Coping abilities Better sleep And more! 7

8 What do Anecdotes Tell Us? Big 5 symptoms Relaxation Ease of movement Empowerment Quality of life (QOL) Coping abilities Better sleep And more! (See Lu et al., 2009) What Does a Case Series Tell Us? Cassileth and Vickers, 2004 Sample size: 1290 in- and outpatients Control: None 8

9 What Does a Case Series Tell Us? Cassileth and Vickers, 2004 Sample size: 1290 in- and outpatients Control: None Findings: Pain 40% Nausea 21.2% Fatigue 40.7% Anxiety 52.2% Depression 30.6% Post-White et al., 2003 What do RCTs Tell Us? Sample size: 164 outpatients in chemo Control/Comparisons: Standard care, Healing Touch, Caring presence 9

10 Post-White et al., 2003 What do RCTs Tell Us? Sample size: 164 outpatients in chemo Control/Comparisons: Standard care, Healing Touch, Caring presence Massage Findings: Anxiety Pain Analgesic use Mood Relaxation No change in nausea (!) What do RCTs Tell Us? Kutner et al., 2008 (The REST Study) Sample size: 380 people in hospice care, advanced cancer Control/comparison: Simple touch by hospice volunteers What do RCTs Tell Us? Kutner et al., 2008 (The REST Study) Sample size: 380 people in hospice care, advanced cancer Control/comparison: Simple touch by hospice volunteers Findings: Both professional MT and Simple Touch pain, mood, QOL Professional MT slightly superior in immediate pain, immediate mood 10

11 Phipps S et al., 2010 What do RCTs Tell Us? Sample size: 178 children in stem cell transplant Control/comparison: Standard care, parent interventions Phipps S et al., 2010 What do RCTs Tell Us? Sample size: 178 children in stem cell transplant Control/comparison: Standard care, parent interventions Findings: No differences between massage and standard care No differences between any groups Grealish L et al. (2000) What do RCTs Tell Us? Sample size: 87 inpatients Control: Quiet time 11

12 Grealish L et al. (2000) What do RCTs Tell Us? Sample size: 87 inpatients Control: Quiet time Findings: Pain Nausea Relaxation What do RCTs Tell Us? Collinge W et al. (Manuscript in review) Sample size: 97 adult patient/care partner dyads Control: Care partner read to patient What do RCTs Tell Us? Collinge W et al. (Manuscript in review) Sample size: 97 adult patient/care partner dyads Control: Care partner read to patient Findings: Symptoms in both groups Greater improvement in massage/touch group Symptom reduction comparable to reports of professional MT from MSK Cancer Center 12

13 Collinge W et al. (Manuscript in review) Collinge W et al. (Manuscript in review) 13

14 What do Narrative Reviews Tell Us? Myers C et al., 2008 Data support the view that modified massage could benefit patients with anxiety, pain, and other symptoms Larger studies with more rigorous design needed What do Narrative Reviews Tell Us? Myers C et al., 2008 Data support the view that modified massage could benefit patients with anxiety, pain, and other symptoms Larger studies with more rigorous design needed Corbin L, 2005 Massage therapy can safely be used in people with cancer, but MTs need to be qualified to adapt massage Strongest evidence supports improvement of stress, anxiety 14

15 What do Quantitative Reviews Tell Us? Ernst E., 2009 Studies suggested massage could help many symptoms Quality of most studies too poor for firm conclusions What do Quantitative Reviews Tell Us? Ernst E., 2009 Studies suggested massage could help many symptoms Quality of most studies too poor for firm conclusions Jane SW., 2008 Studies inconsistent, often poorly designed Difficult to compare apples and oranges Recommended future studies use Equal massage doses Standard massage protocols Larger sample sizes Look at effects of massage over time Another Quantitative Review Moyer CA, et al. A Meta-Analysis of massage therapy research. Psychological Bulletin (1):3-18 Looked at general massage literature (not just effects on people with cancer) Looked at single dose of massage, and course of massage therapy. 15

16 Another Quantitative Review Moyer CA, et al. A Meta-Analysis of massage therapy research. Psychological Bulletin (1):3-18 Looked at general massage literature (not just effects on people with cancer) Conclusions: Single dose of MT state anxiety, BP, heart rate Did not affect negative mood, immediate assessment of pain, or cortisol level Course of MT trait anxiety and depression significantly Equivalent to reductions in psychotherapy (!) Summing Up 1 large case series Support for massage No control group Massage safe Cassileth & Vickers, 2004 Summing Up Post-White Kutner Phipps Grealish Collinge (in review) 5 sizeable RCTs Results mixed Themes: Big 5 symptoms, mood, relaxation Massage seems safe (with training and knowledge) 16

17 Mixed results Massage seems safe Summing Up Myers, 2008 Corbin, Narrative Reviews Support for symptom reduction, especially anxiety Massage safe but MT needs specialized knowledge Ernst, 2009 Jane, Quantitative Reviews Evidence not convincing Many studies flawed Studies too different to compare or pool data 17

18 So What Do We Say about Massage/Cancer Research? Massage appears to be safe Therapists need specialized knowledge So What Do We Say about Massage/Cancer Research? Avoid saying, Research proves PROOF Instead, use: Research suggests Research supports So What Do We Say about Massage/Cancer Research? What do I say? The body of research on massage therapy and cancer is small, but growing. The evidence does not provide firm conclusions about the benefit of massage. From the available research, there are some themes: the strongest support is for the view that massage can relieve pain and anxiety. 18

19 Back to the Story Essential Resources for Practicing Safely with People with Cancer and Cancer Histories Just released! Medical Conditions and Massage Therapy: A Decision Tree Approach. Philadelphia: LWW, Description and link at Find out more at Collinge, W. Touch, Caring & Cancer: Simple Instruction for Family and Friends View trailers at complete description at 19

20 Essential Resources for Practicing Safely with People with Cancer and Cancer Histories MacDonald, G. Medicine Hands: Massage Therapy for People with Cancer. Available at MacDonald, G. Massage for the Hospital Patient and Medical Frail Client. Available at Curties, D. Massage Therapy & Cancer. Available at Essential Resources for Practicing Safely with People with Cancer and Cancer Histories Cancer and Massage, a regular column at Massage Today. At Walton, T. Cancer & massage therapy: contraindications and cancer treatment. Free download, link at The Society for Oncology Massage 20

21 How to Find and Obtain Research PubMed. Massage Therapy Foundation. Cochrane collaboration at NIH Report Tool at ClinicalTrials.gov at International Journal of MT and Bodywork at Thank you! Questions? 62 Just released! Medical Conditions and Massage Therapy: A Decision Tree Approach. Philadelphia: LWW, Description and link at Find out more at Collinge, W. Touch, Caring & Cancer: Simple Instruction for Family and Friends View trailers at complete description at 21

22 Contact Information Tracy Walton at Reach us at 64 Additional Questions on Facebook Facebook.com/DrBenBenjamin Some questions I cannot answer Some questions I can answer 65 Massage in Cancer Care 1. Cancer, Massage, and the Myth of Metastasis: Why Skilled Massage Won t Spread Cancer--Prerecorded 2. Cancer, Massage, and Symptom Relief: What does Research Tell Us about the Benefits of Massage? 3. Cancer, Massage, and Safety Essentials: How is Oncology Massage Unique? 4. Cancer, Massage, and Unstable Tissues: Hidden Contraindications 5. Cancer, Massage, and the Vital Organ Principle More Hidden Contraindications 6. Cancer, Massage, and Detoxification Does Massage Have a Role, or Not? 66 22

23 References Cassileth BR, Vickers AJ. Massage therapy for symptom control: outcome study at a major cancer center. Journal of Pain and Symptom Management Sep 2004;28(3): Corbin L. Safety and efficacy of massage therapy for patients with cancer. Cancer Control Jul 2005;12(3): Ernst E. Massage therapy for cancer palliation and supportive care: a systematic review of randomised clinical trials. Support Care Cancer Jan 13. Grealish L, Lomasney A, Whiteman B. Foot massage. A nursing intervention to modify the distressing symptoms of pain and nausea in patients hospitalized with cancer. Cancer Nurs Jun;23(3): Jane SW, Wilkie DJ, Gallucci BB, Beaton RD. Systematic review of massage intervention for adult patients with cancer: a methodological perspective. Cancer Nurs Nov-Dec;31(6):E Review. Kutner J, et al. Methodological challenges in conducting a multi-site randomized clinical trial of massage therapy in hospice. Journal of Palliative Medicine 2010: 13:6;739:744. Click here for an abstract. Kutner J, et al. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer. Annals of Internal Medicine: September 16, 2008; 149:6; Lu W, Ott MJ, Kennedy S, Mathay MB, Doherty-Gilman AM, Dean-Clower E, Hayes CM, Rosenthal DS. Integrative Tumor Board: a case report and discussion from Dana-Farber Cancer Institute. Integr Cancer Ther Sep;8(3): References, continued Menard MB. Making Sense of Research (2nd ed). Toronto: Curties-Overzet Publications, Moyer, C, et al. Does massage therapy reduce cortisol? A comprehensive quantitative review. Journal of Bodywork & Movement Therapies (2011)15:3-14. Moyer C, et al. A meta-analysis of massage therapy research. American Psychological Association, Inc. 2004;130(1):1,3-18. Myers C, Walton T, Small B. The value of massage therapy in cancer care. Hematology/Oncology Clinics of North America 2008;22: Phipps S, Barrera M, Vannatta K, Xiong X et al. Complementary therapies for children undergoing stem cell transplantation: report of a multisite trial. Cancer 2010 Jul 12. (Epub ahead of print) Phipps S, Dunavant M, Gray E, Rai SN. Massage therapy in children undergoing hematopoietic stem cell transplantation: results of a pilot trial. Journal of Cancer Integrative Medicine 2005;3(2): Phipps, S. Reduction of distress associated with paediatric bone marrow transplant: complementary health promotion interventions. Pediatric Rehabilitation 2002;5(4): Post-White J, Kinney ME, Wavik K, Gau JB, Wilcox C, Lerner I. Therapeutic massage and healing touch improve symptoms in cancer. Integrative Cancer Therapies 2003;2(4): Walton T. "Massage Research in Massage Practice," in Medical Conditions and Massage Therapy: A Decision Tree Approach. Philadelphia: Lippincott Williams & Wilkins, Photo/Illustration Credits Slide 7,8, Susan Mapel Slide 9, Fotolia Slide 10, 11, Fotolia Slide 12, Stephen Fischer Slide 14, Microsoft gallery Slide 42, Susan Mapel Slide Anecdotes Fotolia (1 on left); Rhoda Baer (2 in middle); Fotolia (3 on rt.) All the colorful line drawings describing the levels of evidence are by Lenni Armstrong, scientific illustrator,

24 Other Webinars Available on Demand Unraveling the Mystery of Low Back Pain Unraveling the Mystery of Cervical Pain Unraveling the Mystery of Shoulder Pain Unraveling the Mystery of Knee Pain Unraveling the Mystery of Ankle Pain All Webinars Available at 70 SPECIAL OFFER JOIN the Benjamin Institute ing List & Receive a FREE Ebook on the Low Back Go to: And click Join Our Mailing List 71 CONTEST How to enter: Write a review of a Massage in Cancer Care webinar on Facebook ( You re eligible for one entry per webinar What you can win: Autographed copy of Medical Conditions and Massage Therapy: A Decision Tree Approach A complete set of the Massage in Cancer Care webinar series to give to a friend or colleague 72 24