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

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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.

What is the problem and what is known about it so far?

When patients are near the end of life, the goals of medical care often change from trying to cure disease to trying to make the patient comfortable. Pain and depressed mood are common problems for patients with advanced cancer. Drugs can help these symptoms, but they don't always work and can have side effects. Many patients also seek relief from nondrug treatments, such as massage. Massage might help to improve pain and mood through psychological effects of the therapist's attention, as well as through physical or biological effects. However, few high-quality studies of massage, especially in seriously ill patients, have been published.

Why did the researchers do this particular study?

To find out whether massage improves pain and mood in patients with advanced cancer.

Who was studied?

380 adults with advanced cancer who had at least moderate pain. Most of the patients were in hospice care.

How was the study done?

The researchers assigned patients at random to receive up to six 30-minute sessions of either massage therapy or simple touch over 2 weeks. Massage was performed by a trained massage therapist according to a standard procedure. Simple touch involved having an untrained "therapist" place both hands on the patient for 3 minutes at 10 body sites. Both groups used unscented massage cream but no music or scented oils. Therapists in both groups were instructed to limit conversation to providing instructions or responding to therapy-related questions. Patients decided whether to attend each of the 6 sessions.

The researchers measured the immediate effect of treatment by having the therapist administer brief questions about pain and mood before and immediately after the session. To measure improvement over time, researchers had patients respond to questionnaires about pain, mood, quality of life, and use of pain medications at the start of the study and each week for 3 weeks. The pain measurements were on a scale of 0 (no pain) to 10 (worst pain).

What did the researchers find?

Of the 380 patients in the study, 298 patients completed at least 1 treatment session and all completed the questionnaires. Immediately after treatment, patients in both groups reported improvements in pain and mood. The changes in the massage group were statistically larger than those in the simple-touch group, but all changes were small. Over time, pain, mood, quality of life, and pain medication use were the same in both groups.

What were the limitations of the study?

Many patients did not attend all of the assigned treatment sessions. The people who measured pain and mood after treatments knew which treatment the patient had gotten, and the patients' answers were not anonymous. This could have influenced the measurement, possibly making improvements seem better than they actually were.

What are the implications of the study?

Compared with simple touch, massage provides some improvement in pain and mood immediately after treatment, but the improvement does not last over time.