Therapeutic Massage Intervention for Hospitalized Patients with Cancer: A Pilot Study

F orty-two (42) percent of Americans use some form of alternative medicine, spending 21.2 billion dollars annually,1 and one of the most commonly sought alternative and complementary medicine (ACM) therapies is therapeutic massage, which was used by an estimated 11 percent of the U.S. adult population in 1998. In that year, adults made an estimated 114 million office visits to receive massage treatments.2 Massage has been used as a therapeutic intervention for a variety of illnesses for thousands of years. The Asian roots of massage go back a t lea s t to 1000 BC and so do the or ig in s o f Ayurvedic medicine. Descriptions of massage appear in the ancient medical texts of India, China, Japan, and Tibet. The European roots of massage can be traced back to the seventh century BC. Massage was associated with the cures offered at the temples of Aesculepius and was described in the writings of Hippocrates. Massage has been used to promote relaxation and relieve pain and has been suggested as a useful adjunctive treatment for symptom control for patients at the end of life. Pain is one of the most common symptoms experienced by dying patients. More than 40 percent of patients’ families reported that patients experienced severe pain in the last 3 days of life.3 Others have reported that 60 percent of patients who have cancer have pain.4,5 In many cases (42 percent), pain was inadequately treated in patients with cancer.6 Nearly 80 percent of hospitalized patients have reported pain, while less than half had any mention of pain noted in progress notes by their doctors.7 Even in palliative medicine and in hospice settings, 64–88 percent of patients had inadequately relieved pain, and the most severe symptoms occurred 2 days prior to death.8 During the last 7 days of life, narcotic usage increased significantly. Although symptoms of pain and nausea were reduced, drowsiness worsened substantially and resulted in worse symptom distress scores. Between 15 and 20 percent of patients needed treatment for pain, requiring complete sedation to obtain relief.9 Caregivers often experience symptoms of anxiety and sadness near the end of a patient’s life. Grief phenomena have been welldescribed. Compared to their experience 6 months following death, feelings of sadness are most intrusive in the 6 weeks following the patient’s death as are symptoms such as tearfulness, depression, and anxiety.10 Physical symptoms, such as pain, are most prominent at 6 weeks as well. Small studies have suggested that interventions that provide support to caregivers can improve their satisfaction with care as well as decreasing their physical and emotional stress.11 Only a few studies on the use of massage at the end of life have been reported. In a small study of massage given to patients in a hospice, investigators reported that slow-stroke back massage resulted in changes in vital signs, suggesting improved relaxation.12 Other studies have indicated that massage may be useful in managing cancer pain.13,14 Studies on other populations have suggested a number of potential benefits of massage that are relevant to patients with metastatic cancer. For example, massage has been shown to promote relaxation, reduce anxiety and depression, and improve sleep patterns.15–18 In addition, other studies have indicated that massage may reduce patients’ experience of pain ,13 ,14 ,19–22 ease breathing,23 faci l i tate weight gain,24–26 and increase alertness.27 Finally, data indicate that giving as well as receiving massage may reduce anxiety and depression,28 suggesting that caregivers may benefit from providing massage to patients. In this pilot study, we provided daily massage to hospitalized patients with metastatic or end stage lung or gastrointestinal (GI) cancer. Hospital admissions were screened daily to identify eligible patients. Patients received daily therapeutic massage and family caregivers were also instructed in the use of massage during hospitalization. Data were collected from massage therapists’ detailed documentation and from patients’ daily questionnaires about their experiences with the massage therapy. We also collected data from medical records via chart reviews and interviews with patients’ nurses and physicians.