The Big One

As promised last week, this is my inaugural post on a study about the effects of massage therapy on cancer patients. Specifically this study, from Memorial Sloan-Kettering Cancer Center (I call it the Sloan-Kettering or MSKCC study). I’ll copy the abstract here:

Massage is increasingly applied to relieve symptoms in patients with cancer. This practice is supported by evidence from small randomized trials. No study has examined massage therapy outcome in a large group of patients. At Memorial Sloan-Kettering Cancer Center, patients report symptom severity pre- and post-massage therapy using 0-10 rating scales of pain, fatigue, stress/anxiety, nausea, depression and “other.” Changes in symptom scores and the modifying effects of patient status (in- or outpatient) and type ofmassage were analyzed. Over a three-year period, 1,290 patients were treated. Symptom scores were reduced by approximately 50%, even for patients reporting high baseline scores. Outpatients improved about 10% more than inpatients. Benefits persisted, with outpatients experiencing no return toward baseline scores throughout the duration of 48-hour follow-up. These data indicate thatmassage therapy is associated with substantive improvement in cancer patients’ symptom scores.

– Cassileth, Barrie R., PhD and Andrew J. Vickers, PhD. “Massage Therapy for Symptom Control: Outcome Study at a Major Cancer Center.” Journal of Pain and Symptom Management 28.3 (2004): 244-249. Print.

When I read the article for the first time back in March of 2012 I wasn’t terribly impressed. Two years and dozens of studies later, I have a much greater appreciation for this paper.

Some of the results:

  1. All symptoms studied showed improvement immediately following massage. (Table 2. Ibid, 246.)
  2. When the severity of the predominant symptom was of at least moderate severity: massage had the strongest effect on anxiety (59.9% improvement) and the weakest effect on fatigue (42.9% improvement). These improvement were consistent regardless of the severity of the baseline score. (Table 3. Ibid, 246-7)
  3. Once the baseline score was adjusted for outpatients showed a greater improvement of around 10% higher than inpatients. (Ibid, 246)
  4. There was no statistically significant difference between light touch and Swedish massage  in symptom improvement, and both had better outcomes than foot massage. (Ibid, 246)
  5. The effects of massage appeared to be cumulative  when symptoms were studied for sessions two through five in the individuals they followed who received five session. (Ibid, 247)
  6. The effects of massage on inpatients were not long-lasting. They hypothesized that scores would return to baseline in approximately one day. (Table 5. Ibid, 247)
  7. They found no evidence that outpatient scores ever returned to baseline scores. (Fig. 1. Ibid, 247-8)

Pretty interesting results, I’d say. Certainly they make a compelling case for including massage therapy as part of standard cancer treatment. Particularly in outpatient settings (like the one I worked in). Now let me get picky about the details.

First the pros:

  1. Size- This is a study of 1,290 patients and 3,359 massages given over a period of 3 years. That is approximately 100 times the sample size of many of the other “large” groups studied.
  2. Comparison of different types of massage used. So many studies are just massage vs. control group. I really like that they compared outcomes for Swedish, light touch, and foot massage.
  3.  Attempting to avoid bias by having other staff rather than therapists give patients the cards to rate their symptoms. Maybe it seems like a small detail, but I’ve already covered my love of those.

Now  the cons:

  1. The two different session lengths for inpatients and outpatients (20 minutes vs 60 minutes respectively) were not really accounted for. They are not separated in Tables 2, 3, and 4. 20 minutes of massage seems to be right on the border of getting into the parasympathetic (“Rest and Digest”) state that is such a valuable part of massage. I think this accounts in part for the foot massage seeming less effective than the other two.
  2. Correlating with number one. The study adjusted for the different baseline scores between in- and outpatients, but not for different session lengths. Is probably a significant physiological difference between a 20- and a 60 minute massage (This question requires more science! And to their credit, the authors admit, “The relationship between the length of massage treatment and the size and duration of effects is worthy of future research.” Ibid, 248)
  3. Finally, I would have liked more specific information about how the sessions were given. Swedish and light touch are broad enough terms, that I want more information about how they were actually applied to patients. No one else could replicate this aspect of the study with much accuracy.
  4. lack of a control group. I’m kind of on the fence about this one, because this is studying clinical rather than mechanistic outcomes. I’d still have included a group where people got 20 or 60 minutes of quiet time (Unless they were getting interrupted during the massage sessions. We don’t know [see #3 above]!).

That’s the Sloan-Kettering study and my super-fun science dabbler take on it! There are more posts like this to come. I was thinking of doing one a month, but this post is really long and it took a long time to write. So, it probably won’t become a regular thing until I learn to be more concise. Or if this post proves to be wildly popular.

Please be respectful of the community. Offensive language and/or ad hominem attacks are unwelcome.

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