A new study has found that oncology massage therapy can provide symptomatic relief for a common and difficult-to-treat side effect of cancer treatment. Patients with chemotherapy-induced peripheral neuropathy experienced a sustained reduction in lower-extremity pain up to 6 weeks after completion of massage treatment when they received an intensive therapy schedule of three massages per week. These findings will be presented by Lopez et al at the upcoming 2019 Supportive Care in Oncology Symposium (Abstract 111).
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“Chemotherapy-induced peripheral neuropathy can be a challenging symptom to manage. This study builds upon integrative oncology methods to improve the quality of life for cancer survivors,” said study author Gabriel Lopez, MD, Associate Professor in the Department of Palliative, Rehabilitation, & Integrative Medicine and Medical Director of the Integrative Medicine Center at The University of Texas MD Anderson Cancer Center. “These findings introduce oncology massage as an additional option to help with symptom control and offer new insight into which massage treatment schedule may provide patients with the greatest benefit.”
Study Methods
This pilot study investigated important questions about massage dosing, including length of time of each massage session (30 minutes) and total number (up to 12) and frequency of treatments (two vs three times per week). In addition to a treatment group where the affected lower extremities were treated with a standardized massage protocol, the study also included a control group where an area uninvolved by neuropathy was treated. The protocol included use of a Swedish massage technique, as compared to Shiatsu, deep-tissue, or other massage techniques, delivered by two oncology massage therapists (massage therapists who have expertise in working with patients with cancer).
Symptoms of chemotherapy-induced peripheral neuropathy were measured with the Pain Quality Assessment Scale (PQAS). This scale ranges from 0 to 10 with subscales of surface pain, deep pain, and paroxysmal pain. Participants were assessed at baseline, end of treatment (4 vs 6 weeks depending on treatment group) and again at end of study (10 weeks).
This study included patients 18 years old or older experiencing lower extremity neuropathy attributed to treatment with oxaliplatin, paclitaxel, or docetaxel with no other history of attributable causes, such as history of diabetes. As part of criteria for inclusion in this study, patients’ baseline self-reported neuropathy score had to be greater than or equal to 3 on a 10-point scale where 10 is the worst possible neuropathy, and must have had at least 6 months or more pass since their last chemotherapy treatment.
The primary aim of the study was to compare completion rates of two massage treatment protocols (twice weekly for 6 weeks vs three times weekly for 4 weeks). Secondary aims included an exploration of initial treatment efficacy.
Patients were randomized to one of four groups: two treatment groups (lower extremity massage twice weekly for 6 weeks vs three times weekly for 4 weeks) and two control groups (head/neck/shoulder massage twice weekly for 6 weeks vs three times weekly for 4 weeks).
Key Findings
The final assessment included 71 patients. Of these, the average length of time since their last neurotoxic chemotherapy treatment was greater than 3 years.
“These findings introduce oncology massage as an additional option to help with symptom control and offer new insight into which massage treatment schedule may provide patients with the greatest benefit.”— Gabriel Lopez, MD
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Regarding the primary aim, mean massage completion rates were 8.9 sessions for those receiving massages three times per week and 9.8 sessions for those receiving massages two times per week, with no statistical differences.
Exploring the secondary aim (initial efficacy), those who had massage three times per week reported statistically and clinically significant improvement in PQAS pain scores vs those who had massage two times per week. Sustained improvement was observed at 10 weeks (end of study) in the three times per week group.
PQAS-specific scores were:
- PQAS surface pain: 2.3-point reduction with massage three times a week vs 0.6-point reduction with two times a week (P = .001)
- PQAS deep pain: 2.1-point reduction with three times a week vs 0.9-point reduction with two times a week (P = .008)
- PQAS paroxysmal pain: 2.3-point reduction with three times a week vs 1.0-point reduction for two times a week (P = .025).
Next Steps
Now that this study has offered insight into questions about treatment schedule and initial efficacy, Dr. Lopez and his team plan to move forward with a large-scale efficacy study using the three times per week massage dosing schedule.
Disclosure: For full disclosures of the study authors, visit coi.asco.org.
