Background and Significance In the year 2016 the National Cancer Instruction

Background and Significance
In the year 2016 the National Cancer Instruction, estimated about 1,685,210 new cases of cancer would be diagnosed in the United States (“Cancer Statistics,” 2018). They also estimated that 95,690 people would die from this disease in the same year (“Cancer Statistics,” 2018). An unfortunate occurrence that is associated with the diagnosis of cancer is an increase in pain and a decrease in the individual’s quality of life.
Most of the time the pain that is associated with cancer comes from the tumors and their growth (“Coping with cancer,” 2018). As the tumors grow they begin to press on bones, nerves, or other organs in the body (“Coping with cancer,” 2018). The pain can also come from the cancer treatments themselves. This includes treatment such as chemotherapy; which can cause numbness and tingling in the hands and foot, also surgical treatments that cause pain (“Coping with cancer,” 2018).
This disease also affects the individual’s quality of life. These individual may experience anxiety associated with the fear of death (“Coping with cancer,” 2018). This diagnosis causes stress both mentally and physically for these individuals. After being diagnosed, the individual may have to quit they job leading to financial problems. After some time, this disease may take a toll on the activities that the individual can preform (“Coping with cancer,” 2018). The treatments also impact the quality of life for these people, this is because of the side effects associated with the treatments and the frequency in which the treatments need to be done is time consuming.
Previously, cancer patient were just being treated with traditional medication for the symptoms involved with this diagnosis. These patients’ pain has been treated with medications such as oxycodone and morphine. Although these medications, have side effects of their own, such as constipation. The anxiety and mood disorders have been treated with compazine and other antipsychotics. In the hospitals, they have also been using ondansetron to treat the vomiting associated with chemotherapy.
For a few years now massage therapy has been implemented to help reduce symptoms and increase the quality of life of cancer patients. This practice can be done in both a hospital and the home care setting. It is believed that massage therapy can reduce symptoms of pain, anxiety, depression, and anger, while improving sleep and quality of life in these patients. The area of integrative and holistic medicine has been up and coming lately. This popularity is due to the safety of this medicine (Olson, n.d). Also integrative medicine can focus on the whole body, while traditional medicine focuses on one system at one time. Integrative medicine helps an individual’s mind, body and soul (Olson, n.d). These integrative medicines, such as massage therapy, allows the patient to actively participate in their care (Olson, n.d). The patients enjoy the sense of control that is associated with integrative medicine techniques (Olson, n.d).
PICO Question
In cancer patients, what is the effect of massage therapy on pain and quality of life?
Description of Each Study
A pilot randomized controlled study, conducted by Toth et al. (2013), looked to explore the feasibility and effects of providing therapeutic massage at home for patients with metastatic cancer (Toth et al., 2013 pp. 650). This study included 39 patients. These participates were chosen based upon their clinical diagnosis, which meant they all had solid cancers with evidence of metastases. In this study, there were three interventions that were implemented. These interventions included; massage therapy (n=20), no-touch (n=10), and usual care (n=9). The patients in the massage therapy group received three visits over the first week of enrollment that lasted between 15 to 45 minutes. The no touch intervention was used to separate the effect of interacting with the massage therapist from the massage itself. This no-touch intervention did not have any healing intention. Finally, the patient in the usual-care group just completed the same questionnaires as the other two groups but did not receive visits from any massage therapist. Through these interventions the researchers aimed to look at two sets of outcomes. The primary outcomes looked at the management of pain, anxiety, and alertness through massage in these patients with metastatic cancer. The secondary outcomes looked to see if massage was able to improve the quality of life and sleep of these individuals. In this study, there were no significant changes from the baseline to one-week or one-month follow-ups in the primary outcomes. Although when looking at the secondary outcome, there was a significant improvement among quality of life in these patient in the massage group compared to the control group at the one-week mark (Physical well- being p = 0.005 and McGill Total p = 0.03). Unfortunately, the differences were no longer significant at the one-month follow up (Toth et al., 2013).
In a systematic review and meta-analysis conducted by Pan et al. (2013), they aimed to examine whether massage interventions provide any measurable benefit in breast cancer-related symptoms. In this meta-analysis, 18 randomized controlled trials (RCT) were included there was also a total of 3889 patients in these studies. Most of these studies were preformed in either Europe or North America. The age range of these individual was between 48 to 78 years of age. All of the patients in this study, had breast cancer ranging from stages 0-IV. The interventions with these RCT varied in length and intensity from 75- to 90-min group classes weekly over 3 weeks to 6 months. Also the styles of massage used varied among all RCTs, and included arm/shoulder, posture correction, coordination exercises for muscular strength, exercises to prevent lymph edema, soft tissue massage of the surgical scar, core stability exercises plus massage-myofascial, stroking, kneading, pressing, stretching the neck (Swedish techniques), and self-initiated support plus foot reflexology, or plus scalp massage. From the 18 RCT that this systematic review and meta-analysis looked at only four of these studies assessed the intervention of effect of massage groups on pain. The ways these studies measured pain were Visual Analogue Scale, Pressure pain thresholds, Profile of Mood State Questionnaire, Short Form-8 Health Survey, and Giessen Complaints Inventory. Substantial heterogeneity was present in the comparison of studies (P = 0.009, I2 = 63 %). Through the RCT studies a significant improvement was seen in pain in respects to cancer patients receiving massage therapy (SMD -0.33, 95 % CI -0.69, -0.03; P = 0.07). Although Pan et al. (2013), disagreed with this because of the lack of controlled for nonspecific effects. When assessing if massage therapy had an effect on quality of life; Satisfaction Questionnaire, Trial Outcome Index, Functional Assessment of Cancer Therapy, and Health-Related Quality of Life 36 were used in the three RCTs. No substantial heterogeneity was present in the comparison of studies (P = 0.95, I2 = 0 %). This meta-analysis agreed that there was no significant effect of massage on health-related quality of life (SMD 0.24, 95 % CI -0.44, 0.28; P = 0.05) (Pan et al., 2013).
Another systematic review and meta-analysis conducted by Boyd et al. (2016), was first to rigorously assess the quality of massage therapy research and evidence for its efficacy in treating pain, function-related and health-related quality of life in cancer populations. In this meta-analysis 16 articles were included in the qualitative analysis. In the quantitative assessment 9 articles were included. These RCT used different types of massage as the intervention. The types of massage techniques used were massage therapy, Thai massage, therapeutic massage, and lymphatic drainage. Treatment dosages varied from one single 10-minute session to 15 daily 45-minute sessions over a 3-week course. In the qualitative analysis, 31.5% of the sample population was male and 68.5% was female with the mean age of 57.2 across the studies. This study looked at the effects of massage on pain in patients with metastatic cancer, colorectal cancer, advanced cancer, breast cancer, pediatric cancer, and non-specified cancer. When comparing the pain effect of massage therapy to no treatment, there were three studies that were looked at (n=167). The standardized mean difference (SMD) of -0.20 (95% CI, -0.99 to 0.59; I2 1?4 82.60%) at post-treatment for the meta-analysis. Due to the small size, apparent heterogeneity, and inconsistency across the pooled studies no recommendation was made for massage compared to no treatment for reducing pain. When looking at quality of life, 14 studies were used. Six studies displayed significant results for quality of life outcomes. Two studies displayed non-significant results. Based on this only weak recommendations were made (Boyd et al., 2016).
Consistencies and Inconsistencies in Results with Reasons for Variation
The inconsistencies involved with the pilot RCT performed by Toth et al. (2013), associated with quality of life significant that appeared after 1-week, then disappeared. Was believed to be due to their small sample size. Toth et al. (2013) also believed that with longer study they would have got a significant result for pain (Toth et al., 2013).
In the Pan et al. (2013) systematic review there were some inconsistencies. The meta-analysis that was done found no significant difference pain or quality of life, although the RCT that Pan et al. (2013) reviewed found significant difference in pain. Pan et al. (2013) felt that the RCT studies for pain were inadequately controlled for nonspecific effects. This is because in a few of the RCT studies patients were taking antiemetic or analgesics, therefore the message therapy itself could not be seen (Pan et al., 2013).
In the Boyd et al. (2016) meta-analysis, the three studies used to look at pain results were inconsistent; one produced a very large effect compared to no treatment (SMD 1?4 -0.813), another produced a much smaller effect (SMD1?4-0.182), and a third producing no effect (SMD1?40.388) at all. Some of these inconsistencies stem from the definition of the term massage (Boyd et al., 2016).
Strengths and Weaknesses of the Research Designs and Methods.
When looked at the RCT preformed by Toth et al. (2013), there were several limitations they encountered. One of the limitations was the small sample size they had, which ended up limiting their statistical power. Also during their study the authors were not blinded to either the pre or post intervention data collection. The expectation that the patient in the massage therapy group would have a beneficial out may have created a bias as well. Finally, heterogeneity in the type and stage of cancer of this study’s patients may have resulted in variation of the effects of the interventions (Toth et al., 2013).
In the meta-analysis preformed by Pan et al. (2013), It was explained that it was difficult to draw sound conclusions about the reliability of massage as a treatment opinion. This is because of the small sample size and variable quality of the RCT studies used. Also the assessment tools used for measurement are inconsistent. This caused a limitation in the generalization of the pooled results. The heterogeneity in studies was mentioned due to variation in comparison groups, lengths of intervention, and primary outcome measures. Also some of the RCT studies did not adequate describe various parts of their study. Due to the shortage of data there maybe a lack of significance (Pan et al., 2013).
Due to the inconsistent and missing data from the RCT studies the Boyd et al. (2016) meta-analysis reviewed they could not make a recommendations. Boyd et al. (2016) suggested that researchers should utilize standard reporting guidelines, as well as CONSORT Guidelines when developing protocols and reporting clinical trials to ensure critical study elements are carried out and reported. The Boyd et al. (2016) study stated, “the wide variety in the types, styles, dosages, and naming conventions of massage that made it difficult to define “massage.”” Also the control groups in the RCT studies that Boyd et al. (2016) looked at needed to be identified more appropriately. A strengthen of this meta-analysis is the way they began their study by defining what definition they were using for pain and message therapy (Boyd et al., 2016).
Conclusion
None of the studies used it this paper could definitely stated the massage therapy had a significant effect of either pain or quality of life. Although it is believed that with more adequate studies a significant result maybe be seen in the future. The studies used in this paper did state the safely involved with this intervention; therefore there is no harm in repeating these studies. Another item that needs to be assessed in the future is a cost analysis. In the Boyd et al. (2016) meta-analysis they mention the need for this to find which intervention is most practical and appropriate for implementation (Boyd et al., 2016).
Recommendation
Future studies are needed to see if this intervention will be beneficial for cancer patients. These studies should focus larger sample sizes, better definitions of massage, better ways to measure results, less variation, and longer studies. The studies should be both home and hospital based.