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.

BYOB(ananas)

One of the first types of posts I envisioned for my blog was to share scientific studies on massage, and my opinion on them. Time hasn’t been on my side so far, but, I think the New Year is a good time to start. Beginning with my next blog post, I’ll introduce a study and then talk about what it means for LMTs and their clients. I might also share ways that further studies could be improved.

Before we begin that, it seems appropriate to give some background about me. My education, and my strengths and weaknesses from a scientific perspective. I don’t want to inflate my credentials, or claim expertise that I don’t have.

I have a Bachelor of Science in Biology from the University of Illinois at Urbana-Champaign. My class was the last year that Biology General was a major, but my courses would have made me a Micro- and Cellular Biology major these days. I was interested in the minutiae of life, that’s for sure.

My strengths first: I was trained in the scientific method. I designed experiments, carried them out, and then interpreted the results. If I recall correctly, I never received below an A- in any of my science courses (though I’d need to check my transcript to be certain, and I haven’t managed to de-clutter that part of the apartment yet). This gives me a stronger scientific foundation than most of the massage therapists I have met so far.

On to weaknesses: No advanced training! I took graduate-level courses, but those do not a Master’s degree make. I got better grades than most of my college classmates, but I still only have a B.S. The other big weakness of mine to keep in mind is that it’s been close to ten years since I graduated from college, and there was a long period of time when I wasn’t really using these skills. I’m still not using them to the extent that I might like.

So, that’s me in a nutshell. I guess you could call me a well-informed dabbler, rather than an expert. Scientific research into massage is still so new though, I think a curious person like me could come in handy. Someday I’d like to help move things along even.

The research posts will get tagged as “Science Monkey” for those who want to look out for them (either to read or avoid, no judgment here). First up: the massive Sloan-Kettering study that is still the talk of Oncology Massage.

Client Education: a Massage Bonus

One of the biggest possible side effects of cancer treatment is the risk of lymphedema (LE). Unlike many of the other side effects, this one is for life. If you had lymph nodes removed, irradiated, or tested from your neck, axilla, or groin as part of your treatment, you run the risk of developing LE.

I see it as my responsibility to help educate clients about LE. What it is, what it does, and how I can help support the work of a Complete Decongestive Therapist (CDT)* with Manual Lymphatic Drainage. But I think my most important job is to educate clients on how to minimize their risk of triggering it. The National Lymphedema Network’s position paper on LE risk reduction is the number one resource that I give to all oncology clients who may be at risk for developing LE. You can check it out for yourself here.

It is a long document. I find it a little overwhelming to read through sometimes, and I have no reason to worry about developing LE personally. Sometimes I feel almost, well, guilty for sending people who are already stressed out and overwhelmed a link to this big document. As if I’m overburdening their system with information, the same as I could do if my massage were too forceful.

I squash those worries by thinking of my nightmare scenario: someone coming to me with LE saying, “If only I would have known…”. I warn people that it’s a long document, and to read it in pieces if need be. But I’m going to give it to every single person I see who might need it. And recommend that they check out the rest of NLN’s website. Because there is so much information about the topic, and I hope that people find comfort and empowerment there too.

*As a Certified Manual Lymphatic Drainage Therapist I do not meet the minimum basic standards to treat someone with LE. I am trained and qualified to give MLD to someone with LE, but they need to be under the supervision of a CDT to get exercise, bandaging, and other therapy. This is my dream certification, but I need a to achieve a pretty high level of success in my business before I can justify going for it. The blog post announcing that will require GIFs. Really big, sparkly ones, and a space background (and a midi-player, I will transform this blog into a  90’s website when I’m ready celebrate signing up to take that class).

Complementary vs Alternative

Massage is considered one of the world’s oldest professions. There are paintings of people performing manual therapy on the walls of Egyptian pyramids, and it is also mentioned in the early Chinese classic “The Yellow Emperor’s Inner Cannon”. These are just two examples of many.

Yet, despite all this evidence of massage’s ancient roots, it is still considered by many to be “New Age” or “Alternative”. I don’t feel the need to address massage as a new age practice, but I would like to discuss the difference between complementary and alternative medicine (CAM).

Here are the definitions from the National Center for Complementary and Alternative Medicine (NCCAM) nccam.nih.gov:

  • “Complementary” generally refers to using a non-mainstream approach together with conventional medicine.

  • “Alternative” refers to using a non-mainstream approach in place of conventional medicine.

To me, massage fits the definition of complimentary medicine quite nicely. When I worked in the chemotherapy infusion center it was alongside the medical team. The massage could often reduce treatment anxiety in the patients, and alleviate some of the side-effects of the chemo, but getting the patient their conventional treatments always came first. Massage by itself isn’t going to cure cancer, though I really wish it could, but improving quality of life is incredibly valuable. Now, NCCAM is starting to consider massage as shifting from complementary to conventional medicine because so many medical centers are starting to include it.

They also state that there is very little true alternative medicine. They consider systems like Ayurvedic and traditional Chinese medicine as being more of a gray area between the two. Probably it is dependent on how individual practitioners present themselves and their treatments. I don’t see massage as having that same wiggle room.

I think that as we learn more about how stress and anxiety effect our bodies, massage will become even more popular as a preventative therapy. I know that I, and most of my clients, see massage as a vital component of self-care and wellness.