Massage Reduces Stress and Improves Immune Function in Cancer Patients

Patients with cancer suffer a wide range of physical symptoms coupled with psychological stress. Moreover, cancer chemotherapy induces immunosuppression and consequently causes respiratory infections. Massage therapy has been reported to reduce symptoms in cancer patients via an increase in psychosocial relaxation and to enhance and/or improve immune function.  In the present study, we determined whether leg massage could induce psychosocial relaxation and activate the first line of the host defense system. To assess effects of rest and leg massage, 15 healthy volunteers rested on a bed for 20 min on the first day, and 3 days later the subjects received a standardized massage of the legs for 20 min with non-aromatic oil. Twenty-nine cancer patients also received the same standardized massage of the legs. Anxiety/stress was assessed before and just after the rest or the massage. In the cancer patients, leg massage promoted psychosocial relaxation and reinforced first-line host defenses by creating an increase in secretion of antimicrobial peptides. (7) Some patients with advanced cancer make use of complementary therapies for the reduction of anxiety and stress. These patients can suffer distressing end-of-life symptoms, which conventional treatments might not relieve satisfactorily. Studies have suggested that complementary therapies could be useful for reducing distress in patients with cancer and these benefits are applicable at the end-of-life stage in advanced cancer. One study examined salivary chromogranin A (CgA) as a biomarker for relieving stress following a hand massage in terminally ill patients. The study group comprised 34 inpatients in palliative care units. Each of these patients received a 5-minutemassage hand massage and measures were taken before and after. The brief hand massage appears to reduce levels of stress according to the salivary CgA (p < 0.05). In addition, researchers found statistically significant changes in patient satisfaction with hand massage. (18) In a study conducted in Sweden, researchers examined the short-term effects of light pressure effleurage on circulating lymphocytes by studying the number and activity of peripheral blood natural killer cells in patients with breast cancer compared to a control group.  Light pressure effleurage massage decreased the deterioration of natural killer T-cell activity occurring during radiation therapy. Furthermore, it lowered heart rate and systolic blood pressure in cancer patients. (20)

Massage therapy is one of the most widely used complementary and alternative therapies to alleviate stress and physical and psychological complaints associated with cancer and to improve health-related quality of life. The primary objective of this randomized, two-armed, parallel group, clinical trial is to verify the effects of continuous Japanese massage therapy, referred to as Anma therapy, for cancer survivors. The secondary objective is to confirm the immediate effects of a single Anma massage session for cancer survivors. Sixty cancer survivors older than 20 years of age who have had histologically confirmed uterine cervical, endometrial, ovarian, fallopian tube or peritoneal cancer in the past, but with no recurrence for more than 3 years since receiving standard medical treatment, were recruited by gynecologists in medical facilities. They were randomly assigned to one of two groups (n = 30 each): an Anma massage group receiving a 40-min Anma massage session once weekly over a 2-month intervention period (total of eight Anma massage sessions) and a control group being followed by medical doctors and receiving no Anma massage sessions. The primary end point is the severity of physical subjective symptoms that cancer survivors report in daily life, assessed using a Visual Analogue Scale. Secondary end points are urine and saliva analyses, psychological condition and health-related quality-of-life scores as determined on the basis of a self-report questionnaire. Using the findings of this trial, massage professionals should be able to explain the benefits conferred by Anma massage to cancer survivors and provide higher-quality information to better inform patients regarding their decisions about whether to receive such therapy.

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Massage Reduces Pain in Cancer Patients

Another co-morbidity associated with cancer is pain. Integrative oncology is the synthesis of mainstream cancer care and evidence-based complementary therapies. Neuropathic pain and general pain are part of a complex process involving the whole physical and psychosocial being.  Therefore, treatment requires an integrative management approach. Complementary strategies include massage therapies, acupuncture, fitness, and mind-body techniques, which take advantage of the reciprocal relationship between the mind and body. (9)  One study examined massage to reduce pain and improve mood in advanced cancer patients. Primary outcomes were immediate and sustained positive change in pain. Secondary outcomes were immediate change in mood and sustained change in quality of life, symptom distress and pain medication use. Researchers concluded that massage was superior for both reducing immediate pain and improving mood. (24)

Massage Reduces Constipation in Cancer Patients

Often a result of the treatment for cancer, constipation is a major problem that many cancer patients have to endure.  Massage has been shown to increase intestinal motility and relieve constipation.  A randomized controlled clinical trial evaluated the effect of aromatherapy massage on constipation and improved quality of life in cancer patients. The degree of constipation was measured using a constipation assessment scale, severity level of constipation and the frequency of bowel movements.  The results of this study reported the score of the constipation assessment scale of the aroma massage group was significantly lower than the control group. Apart from the improvement in bowel movements, the results showed significantly improved quality of life in physical and support domains of the aroma massage group. (4)

Massage for Breast Cancer Patients

Specific to breast cancer, a statistically significant, clinically small beneficial effect was found from the addition of manual lymph drainage massage to compression therapy for upper extremity lymphedema volume. (3) In a recent randomized, single blinded, clinical trial, 120 women who had breast surgery involving dissection of axillary lymph nodes was treated by a physical therapist with a physical therapy program including manual lymph drainage, massage of scar tissue, and progressive active and action assisted shoulder exercises. This group also received an educational strategy. The control group received the educational strategy only. A survival analysis showed a significant difference, with secondary lymphoedema being diagnosed four times earlier in the control group than in the intervention group. The study concluded that early manual lymph drainage could be an effective intervention in the prevention of secondary lymphoedema in women for at least one year after surgery for breast cancer involving dissection of axillary lymph nodes. (14) Another study investigated the efficacy of classical massage on stress perception and mood disturbances in 34 women diagnosed with primary breast cancer. Patients were randomized into a massage intervention group or control group. For a period of 5 weeks, the intervention group (n = 17) received biweekly 30-min classical massages. At the conclusion of the study, perceived stress and cortisol serum levels (p = 0.03) were significantly reduced after massage therapy compared with baseline and with the intervention group. (12)  In one study, breast cancer patients experienced a reduction in several quality of life symptom concerns after only 3 weeks of massage therapy.  Patients reported post-massage decreases for state anxiety, improved sleep quality, and quality of life showed significant improvement. (19) Another study examined how aromatherapy massage influenced psychological and immunologic parameters in 12 breast cancer patients. The patients received a 30 minute aromatherapy massage twice a week for 4 weeks (eight times in total). The results showed that anxiety was reduced in one 30 min aromatherapy massage in a State-Trait Anxiety Inventory (STAI) test and also reduced in eight sequential aromatherapy massage sessions in the Hospital Anxiety and Depression Scale (HADS) test. The results further suggested that aromatherapy massage improved the immunologic state. (23)

One study, completed in 2012, revealed a positive response to reflexology. This longitudinal randomized controlled trial was conducted in thirteen medical oncology clinics across the country. The participants were 385 women with advanced stage breast cancer that were receiving chemotherapy and/or hormonal therapy. The purpose of the study was to evaluate the safety and efficacy of reflexology on the health-related quality of life, physiological function, and symptoms of these cancer survivors. A longitudinal comparison revealed significant improvements in physical functioning for the reflexology group compared to the control group (p = 0.04). Severity of dyspnea was reduced in the reflexology group compared to the control group (p < 0.01) and the LFM group (p = 0.02). The researchers concluded that reflexology may be added to existing evidence-based supportive care to improve health-related quality of life for patients with advanced-stage breast cancer during chemotherapy and/or hormonal therapy. Reflexology can be recommended as a safe complementary treatment for dyspnea and enhancing functional status in women with advanced stage breast cancer.

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