Massage Therapy For Oncology Patient Pain
Overview
This study aimed to investigate the impact of massage therapy (MT) as a nonpharmacologic approach for addressing various symptoms experienced by children, adolescents, and young adults with hematologic and/or oncologic conditions. The researchers focused on two patient groups: those with sickle cell disease (SCD) and those with hematologic and/or oncologic conditions excluding sickle cell disease (HemOnc).
Conducting a retrospective review of 3015 massage therapy sessions provided to 243 patients between 2019 October and 2021 December, the review found that patients in the SCD group had higher pretreatment levels of pain, stress, and anxiety compared to those in the HemOnc group. Nonetheless, all patients, regardless of their condition, reported significant reductions in pain, stress, and anxiety after receiving massage therapy. Interestingly, the HemOnc group experienced greater mean pain reduction than the SCD group.
These findings support the clinical effectiveness of MT in alleviating acute pain, stress, and anxiety among children, adolescents, and young adults with hematologic and/or oncologic conditions. However, further research is necessary to determine the optimal utilization of massage therapy in this population.
By employing a certified pediatric massage therapist, this study adds to the body of knowledge on nonpharmacologic approaches to improve the well-being of young patients facing hematologic and/or oncologic conditions. With its focus on the positive effects of MT, this research provides valuable insights into potential integrative therapies for symptom management in this vulnerable population.
Introduction
Children, adolescents, and young adults facing hematologic and/or oncologic conditions, such as cancer and sickle cell disease (SCD), endure various challenges during their treatment, including managing stress, anxiety, fatigue, and pain. Pain, in particular, has been reported by pediatric patients and their families as the most distressing aspect of cancer treatments, impacting their quality of life, mental health, and behavior. To address these symptoms and offer psychosocial support, many cancer centers have integrated evidence-based interventions like massage therapy (MT) into their services.
Recent reviews of cancer center websites have revealed that MT is available in a significant number of comprehensive cancer centers and community hospitals. Several randomized controlled trials (RCTs) and systematic reviews have also demonstrated the benefits of MT for pediatric patients with cancer, showing decreases in pain, stress, anxiety, and nausea.
Moreover, an RCTs involving hospitalized children with cancer found significant reductions in pain intensity and interference with walking after MT sessions.
However, according to the latest clinical practice guidelines, there is currently insufficient or inconclusive evidence to make integrative treatment recommendations for pediatric cancer pain. More research is needed to establish the clinical effectiveness of massage therapy in this population. Furthermore, there is a notable lack of studies examining MT among children and adolescents with SCD, despite the potential benefits for pain reduction, functional improvement, and mental well-being.
Existing clinical trials on MT have limitations, including small sample sizes and a focus on specific massage therapy techniques for narrowly defined conditions, hindering the ability to create specialized treatments for patients. The qualifications of MT providers have also varied across studies, with few incorporating certified pediatric massage therapists (CPMT). Additionally, there is a gap in understanding the delivery and characteristics of massage therapy within the pediatric hematology and oncology population, such as patients’ chief complaints, body regions addressed, techniques used, and applied pressure.
To address these gaps, this retrospective study aims to describe the clinical delivery of massage therapy and compare its effectiveness in managing anxiety, stress and pain between two patient groups: those with sickle cell disease alone (SCD) and those with hematologic and oncologic conditions with the exception of sickle cell disease (HemOnc). This research seeks to shed light on the potential benefits of MT in different patient populations and contribute to improved pain management and well-being in pediatric hematology and oncology settings.
Method
This retrospective study aimed to review individualized massage therapy (MT) sessions provided to pediatric patients (ages ≤ 39 years) with hematologic and/or oncologic conditions at the University Hospitals Rainbow Babies and Children’s Hospital (UHRBC) main campus between October 2019 and December 2021. Patients without a hematologic or oncologic diagnosis receiving MT were excluded from the analysis.
UH ConnorWhole Health initiated the MT program in October 2019, offering massage thearpy services to pediatric patients in both inpatient and outpatient hematology/oncology units. A certified pediatric massage therapist (CPMT) collaborated with the medical team and child life services to enhance patient care and psychosocial support. The CPMT conducted MT sessions (approximately 20–30 minutes) based on patient/family requests or medical team referrals, documenting all sessions in the electronic health record (EHR). Patient-reported outcomes (PROs), including pain, stress, and anxiety, were assessed using numeric rating scales (NRS) before and after MT sessions. The focus of each session was determined collaboratively with the patient and their family, based on a symptom assessment conducted by the CPMT.
The study was approved by the UH Cleveland Medical Center Institutional Review Board, adhering to the Declaration of Helsinki, and a waiver of informed consent was obtained for this retrospective chart review.
Data extracted from eligible EHR records included demographic information, clinical characteristics, and MT intervention details. Descriptive statistics were used to analyze patient demographics and intervention characteristics. Chi-square tests, Fisher’s exact tests, and t-tests were used to compare demographic characteristics between the HemOnc (without SCD diagnosis) and SCD groups. Unadjusted single-session effects of MT on pain, stress, and anxiety were examined using paired t-tests for patients reporting symptoms of 1/10 or higher on the NRS. A mixed model, accounting for multiple sessions on the same patient, was used to summarize mean NRS scores and compare pretreatment and change scores between the SCD and HemOnc groups.
This study contributes valuable insights into the impact of massage therapy on symptom management in pediatric patients with hematologic and/or oncologic conditions. By analyzing PROs and intervention characteristics, the research aims to shed light on the clinical effectiveness of MT and potential differences in response between the SCD and HemOnc patient groups.
Result
Between 2019 October and 2021 December, the CPMT delivered 3015 individualized massage therapy (MT) sessions to 243 pediatric patients with hematologic and/or oncologic conditions. Among them, 171 patients were in the HemOnc group, while 72 were in the SCD group.
The CPMT delivered care during 1494 encounters, with 537 sessions in the inpatient setting (median length of stay: 5 days) and 957 sessions in the outpatient clinic. Most inpatients were discharged from the specialty hematology/oncology unit, and MT in the outpatient setting coincided with medical oncology clinic/infusion center visits. Patients received a median of four sessions, with those in the HemOnc group receiving significantly more sessions than the SCD group.
The patient population was predominantly White and Black/African American, non-Hispanic, female, and covered by Medicaid or private insurance. Patients in the SCD group were more likely to be Black/African American and have Medicaid coverage. The differences in sex, ethnicity, or mean age between the two groups were not significant.
The MT sessions focused on various chief complaints, including muscle tension, need for relaxation, and pain, among others. Common locations for these complaints were the back, lower extremities, neck, and shoulders.
Out of the 3015 sessions, 1398 involved massage therapy interventions, while 1617 included assessments and psychosocial support without hands-on MT. MT interventions primarily occurred with patients in the supine position and involved precautions for issues related to patients’ blood counts and other conditions. The most common pressure rating used by the CPMT was 3, followed by 2, 1, and 0. MT techniques included acupressure and fascial release.
Complete pre- and posttreatment scores were available for pain, stress, and anxiety among patients aged 7–28 years. Patients in the sickle cell disease group noted higher pretreatment anxiety, stress and pain than those in the HemOnc group. In the combined sample, statistically significant and clinically meaningful reductions in pain, stress, and anxiety were observed. These improvements were consistent within the unadjusted and adjusted groups. After adjustment, the HemOnc group reported greater pain reduction than the SCD group. Reductions in pain that were clinically significant were more frequent in the HemOnc group.
MT sessions also led to improvements in well-being, tension, and range of motion. Additionally, a small percentage of patients fell asleep during massage therapy sessions.
Conclusion
This study provides valuable insights into the clinical effectiveness of massage therapy in managing pain, stress, and anxiety among pediatric patients with hematologic and/or oncologic conditions, particularly in the HemOnc group. It demonstrates the potential benefits of MT as an integrative therapy for symptom management in this vulnerable population.
This retrospective study aimed to describe the clinical delivery of massage therapy (MT) and compare its effectiveness in managing acute pain intensity, stress, and anxiety between two patient groups: those with hematologic and/or oncologic conditions (HemOnc) and those with sickle cell disease (SCD). The study took place at a large pediatric academic medical center where massage therapy services were integrated into both inpatient and outpatient care, providing psychosocial support alongside symptom management in collaboration with the medical team.
The CPMT played a crucial role in conducting systematic assessments, providing psychosocial support and interventions, offering psychoeducation, facilitating communication, and delivering MT sessions. Patients in the HemOnc group had a mean age between 10 and 14 years, and malignant hematology conditions were prevalent. Female sex was slightly more common in both groups, and Black/African American patients made up a higher proportion within the combined sample and HemOnc group.
MT interventions lasted around 32 minutes on average and were safely administered despite a high prevalence of coagulation defects, neutropenia, and immune system disorders. Patients in both groups reported statistically significant and clinically meaningful reductions in pain, stress, and anxiety after MT sessions. Notably, the SCD group reported higher pretreatment pain, stress, and anxiety, emphasizing the significance of massage therapy for this population.
The study supports the inclusion of SCD patients within pediatric integrative oncology programs and the clinical effectiveness of massage therapy as an evidence-based, nonpharmacologic pain modality. The research highlights the importance of qualified CPMTs conducting assessments to tailor massage therapy techniques to each patient safely. Despite some limitations, such as lack of PRO data collection in the entire sample and potential response bias, the study’s large sample size and diverse population strengthen its findings.
This research underscores the potential benefits of massage therapy as part of a comprehensive treatment approach for children, adolescents, and young adults with hematologic and/or oncologic conditions. Further investigations are warranted to optimize massage therapy intervention delivery and explore its synergistic effects with other integrative treatments, providing patients with enhanced support throughout their treatment journey.
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