Massage therapy as a supportive care intervention for children with cancer

Oncology Nursing Forum, May, 2008 by Deborah Hughes, Elena Ladas, Diane Rooney, Kara Kelly

Massage therapy is among the most prevalent complementary and alternative medicine (CAM) practices used by the American public to promote health, prevent disease, and manage acute and chronic conditions. An ancient healing art characterized as a systematic manipulation of the soft tissues of the body, massage therapy consists of hands-on stroking, kneading, friction, and percussive or vibratory movements (Arkko, Pakarinen, & Kari-Koskinen, 1983; Ernst, 2003). Generally employed for pain reduction, massage therapy has been used with the intention to alleviate stress and muscle cramping, induce relaxation, improve circulation and lymph flow, promote muscle tone, increase range of motion, and encourage recovery from injuries and medical procedures. Preliminary research further suggests that massage therapy may be a beneficial body-based modality for a variety of immunologic illnesses, such as asthma and HIV (Hall, 2001).

Although recent reports in the United States have acknowledged the widespread use of massage therapy among adults and children with cancer as a noninvasive, therapeutic intervention, minimal investigation of massage by the healthcare community has been conducted to determine risks, benefits, and feasibility of incorporating the practice among cancer populations. In a survey of 85 physicians at a municipal hospital, 18% reported that they had inadequate information about massage therapy, 32% wanted massage therapy to be provided at the hospital as an intervention for their patients, and 32% reported having recommended massage therapy to patients (Boutin, Buchwald, Robinson, & Collier, 2000). Despite the growing popularity of the practice, massage therapy rarely is incorporated into patient care plans for children with cancer. Although research investigating the efficacy of massage has been conducted, only preliminary studies have been initiated in children with cancer.

Because children diagnosed with cancer must cope with a variety of stressors and symptoms related to illness and treatment (Docherty, 2003), healthcare professionals are increasingly recognizing the need for safe, effective, noninvasive supportive care interventions to improve the overall quality of life of patients. Stress, anxiety, and depression are highly prevalent among children with cancer (Kusch, Labouvie, Ladisch, Fleischhack, & Bode, 2000), and requirements for high-quality psychosocial care for children with cancer continue to emphasize coping not only for psychological but also behavioral means to manage internal and external stresses of cancer. Because chronic stress may lead to further immune suppression (Hernandez-Reif et al., 2004), any immune-supportive regimen may be valuable within the population. This review summarizes the literature on massage therapy to inform healthcare providers about the potential uses of massage for children with cancer. Observational and clinical studies included in this review were identified through repeated literature searches. The PubMed[R] database and online resources were searched for the terms massage, massage and cancer, and massage and children. Twenty-five clinical and 12 observational studies were retrieved.

History of Massage

Dating back to descriptions in early Chinese and Indian writings from approximately the eighth century BC, massage therapy has been recommended throughout history for a variety of medical and surgical conditions (Cole & Stovell, 1991; Field, 2002). Most of the great ancient cultures of the world have recorded the use of massage or rubbing techniques; Egyptians, Persians, and Japanese historical writings and artifacts often refer to the practice. References to Chinese pediatric massage date back to the Sui/Tang dynasty (581-907 AD). By the late 14th century, the practice was organized into an academic discipline in medical institutions (Cline, 2000).

Hippocrates (460-377 BC) wrote about benefits of massage in medical practice to relieve sprains and dislocations (Cole & Stovell, 1991); in 400 BC, he described the procedure as "medicine being the art of rubbing" (Field, 2002). In ancient times, massage was administered with bare hands, a cloth, or various instruments; oil often was used for its medicinal value or as a lubricant (Basmajian, 1985). Although massage use declined during the Middle Ages in the Western world, the practice resurfaced in the middle of the 18th century with support from the Swedish government. As medical technology advanced during the first half of the 20th century, interest in massage declined (Gecsedi, 2002), but by the 1950s, massage regained popularity and was recommended as a body-based treatment to reduce swelling for women with breast carcinoma (Tidy, 1952). Currently, population-based surveys in the United States indicate widespread interest in massage therapy as a therapeutic modality (National Center for Complementary and Alternative Medicine, National Institutes of Health, 2006). The practice of massage for infants and children began in India. Since the 1970s, massage therapy for infants has been practiced, researched, and taught in massage therapy schools in the United States (Field, 1995) and has been implemented in hospital-based programs for new parents.