1. Översiktlig projektbeskrivning

Engelsk titel

The effect of massage for women with breast cancer

Sammanfattning av projektet

Föreliggande avhandling har studerat effekten av lätt massage för patienter med bröstcancer med fokus på illamående, ångest, depression, livskvalitet, stress och immunfunktion. Upplevelsen av att få massage under pågående cellgiftsbehandling har också beskrivits. Sammanfattningsvis visar resultaten från de två första studierna att lätt massage kan sänka illamående i samband med cellgiftsbehandling. Patienterna upplevde också att massagen gav dem en paus från de negativa känslor som fanns förknippade med cellgiftsbehandling.

Typ av projekt

Forskningsprojekt

MeSH-termer för att beskriva ämnesområdet

Inlagda MeSH-termer

Massage

Group of systematic and scientific manipulations of body tissues best performed with the hands for the purpose of affecting the nervous and muscular systems and the general circulation.

Breast Neoplasms

Tumors or cancer of the human BREAST.

Nausea

An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses.

Anxiety

Feeling or emotion of dread, apprehension, and impending disaster but not disabling as with ANXIETY DISORDERS.

Depression

Depressive states usually of moderate intensity in contrast with major depression present in neurotic and psychotic disorders.

Stress

A pathological process resulting from the reaction of the body to external forces and abnormal conditions that tend to disturb the organism's homeostasis.

Immunity

Nonsusceptibility to the invasive or pathogenic effects of foreign microorganisms or to the toxic effect of antigenic substances.

Quality of Life

A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment; the overall condition of a human life.

Adult

A person having attained full growth or maturity. Adults are of 19 through 44 years of age.

Antineoplastic Agents

Substances that inhibit or prevent the proliferation of NEOPLASMS.

Drug Therapy

Empathy

An individual's objective and insightful awareness of the feelings and behavior of another person. It should be distinguished from sympathy, which is usually nonobjective and noncritical. It includes caring, which is the demonstration of an awareness of and a concern for the good of others. (From Bioethics Thesaurus, 1992)

Female

Humans

Members of the species Homo sapiens.

Middle Aged

Pain Measurement

Scales, questionnaires, tests, and other methods used to assess pain severity and duration in patients or experimental animals to aid in diagnosis, therapy, and physiological studies.

Relaxation Techniques

The use of muscular relaxation techniques in treatment.

Stress, Psychological

Stress wherein emotional factors predominate.

Sweden

Women's Health

The concept covering the physical and mental conditions of women.

Treatment Outcome

Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series.

Projektets delaktighet i utbildning

Avhandling
D-uppsats / Magisterexamen
C-uppsats / Kandidatexamen
ST-läkarutbildning
Annan utbildning
Ej del i utbildning

3. Processen och projektets redovisning

Pågående aktiviteter

Planering och förberedelse före datainsamling
Datainsamling pågår
Analys av insamlade data pågår
Författande av skriftlig redovisning / publikation pågår
En eller flera publikationer från projektet är publicerade
Slutfört och inget mer görs inom ramen för detta projekt

Projektstart (när planeringen påbörjas och börjar dokumenteras skriftligt)

2003-01-01

Datum för påbörjande av datainsamling

2003-06-01

Datum då projektet är slutrapporterat

2007-11-23

Publikationer från detta projekt

1. The effect of massage for women with breast cancer.
   Billhult Annika.
   Göteborg: Göteborgs Universitet; 2007. ISBN 978-91-628-7284-7. [Source: User]
2. The effect of massage on immune function and stress in women with breast cancer - A randomized controlled trial.
   Billhult A, Lindholm C, Gunnarsson Ronny, Stener-Victorin E.
   Autonomic neuroscience : basic & clinical 2009[Source: PubMed®]
   [Links: PMID: 19376750 | DOI länk]
3. The effect of massage on cellular immunity, endocrine and psychological factors in women with breast cancer -- a randomized controlled clinical trial.
   Billhult A, Lindholm C, Gunnarsson Ronny, Stener-Victorin E.
   Autonomic neuroscience : basic & clinical 2008:140(1):88-95.[Source: PubMed®]
   [Links: PMID: 18474451 | DOI länk]
4. The experience of massage during chemotherapy treatment in breast cancer patients.
   Billhult Annika, Stener-Victorin Elisabet, Bergbom Ingegerd.
   Clinical nursing research 2007:16(2):85-99; discussion 10.[Source: PubMed®]
   [Links: PMID: 17452429 | DOI länk]
5. Massage relieves nausea in women with breast cancer who are undergoing chemotherapy.
   Billhult Annika, Bergbom Ingegerd, Stener-Victorin Elisabet.
   Journal of alternative and complementary medicine (New York, N.Y.) 2007:13(1):53-7.[Source: PubMed®]
   [Links: PMID: 17309378 | DOI länk]

4. Detaljerad projektbeskrivning

Bakgrundsbeskrivning

Breast cancer is the most common type of cancer in females, affecting about 6500 women yearly in Sweden (Socialstyrelsen, 2004). Not only do women need to face the worries of a serious illness, but must also go through number of treatments with many side effects. Treatment options available for breast cancer are surgery, chemotherapy, radiation and hormonal therapy. These treatments often entail numerous troublesome side effects such as pain, nausea, weakness and fatigue (Foltz et al., 1996; Hickok et al., 1999). Patients continue to experience discomfort despite pharmacological treatment. In addition, many patients with breast cancer experience post-operative stress (Luecken et al., 2004; Millar et al., 2005), and as many as 50% of all patients with breast cancer experience depression and anxiety in the year after diagnosis (Burgess et al., 2005). In turn, patients’ quality of life is compromised (Avis et al., 2005).
Many patients, seek non-pharmacological treatments to complement the regular medical care. Literature shows that up to 66% of patients with breast cancer are users of complementary treatments (Henderson and Donatelle, 2004). Massage is a form of complementary therapy that has existed for 3000 years (Tappan, 1998). There are many massage techniques such as petrissage, effleurage, hacking, friction and kneading (Vickers and Zollman, 1999). However, many cancer patients experience petrissage, kneading etc. as uncomfortable and heavy-handed. Thus, effleurage seems to be the method best suited to cancer patients and the most suitable technique for the present thesis.

Effects of massage
Massage effects have been studied in several contexts. However, there are difficulties in comparing studies due to the different techniques used, duration and interval of massage, and area of body massaged. The AMTA (American Massage Therapy Association) defines massage as “manual soft tissue manipulation, and includes holding, causing movement, and/or applying pressure to the body” (Attrieved at: http://www.amtamassage.org/about/definition.html). As the definition suggests, there are a variety of ways to administer massage in terms of amount of pressure used etc. Nevertheless, previous studies point out several areas of positive effects of massage.
The effect of massage has been studied on depression and anxiety in children and it was found that urinary cortisol and norepinephrine levels decreased in the massage group (Field et al., 1992). The effect of massage has also been evaluated on anxiety in adults. Healthy subjects were allocated to either massage or rest in a chair. EEG was monitored before, during and after the sessions. In addition, before and after the sessions, the subjects performed math computations, completed POMS Depression and State Anxiety Scales and provided a saliva sample for cortisol. Findings showed that massage therapy offered benefits in not just alleviating the physiological effects of anxiety, but also in improving mental alertness (Field et al., 1996). Another study demonstrated positive effects of massage on anxiety in institutionalized patients (Fraser and Kerr, 1993).
Furthermore, the effect of massage on immune function has been studied. Ironson et al. (1996) investigated the effect of massage on immune function in 29 men (20 HIV+, 9 HIV-). Results showed that daily massages for 20 days increased the number and function of NK natural killer (NK) cells. In addition, cortisol as well as anxiety levels decreased and relaxation increased in the massage group. Diego et al. (2001) studied 24 young patients infected with HIV. Improvement on immune function, as measured with NK cell number, was shown after massage twice weekly for 12 weeks. Patients were allocated to either massage or progressive relaxation. Positive effects of massage on anxiety and depression were also seen in this study. In addition, the effect of a single massage treatment on NK cells and anxiety has been investigated. Nine healthy adults with anxiety prior to an exam were massaged for one hour. Positive effects were seen on NK cells function as well as Spielbergers State Trait Anxiety Inventory (S-STAI) and VAS measuring stress (Zeitlin et al., 2000).

Effects of massage in cancer patients

Massage has previously been shown to relieve pain, reduce depression, suffering, anxiety and lowering blood pressure in patients with cancer (Weinrich and Weinrich, 1990; Ferrell-Torry and Glick, 1993; Wilkinson et al., 1999; Grealish et al., 2000; Wilkie et al., 2000; Hernandez-Reif et al., 2000; Smith et al., 2002; Soden et al., 2004). Furthermore, massage has been shown to relieve nausea in cancer patients (Grealish et al., 2000). In addition, one study examined the effect of massage on immune function in breast cancer patients. Hernandez-Reif et al. (2004) tested immune function in a randomized controlled study where 27 women were allocated either to massage (n=15) or to a control consisting solely of standard medical care. Results revealed an increase in natural killer (NK) cell number and lymphocytes in the massage group.

Qualitative studies of massage effects in cancer patients

The effects of massage are usually studied through blood pressure, pain and nausea (Weinrich and Weinrich, 1990; Hernandez-Reif et al., 2000; Grealish et al., 2000). Only a few studies of patient experience of massage have been done. We have (Billhult and Dahlberg, 2001) investigated patient experience of massage integrated into daily care at an oncology unit. We found that the essential meaning of receiving massage as getting a meningful relief from suffering. Five themes were identified; an experience of being special, a positive development with the personnel, a sense of feeling strong, a balance between autonomy and dependence, and just feeling good. Corner, Cawley, & Hildebrand (Corner et al., 1995) reported positive effects of massage such as relaxation, release of tension and stiffness, and pain relief in a quasi-experimental study of fifty-two patients with cancer.

Possible explanations to the effects of massage

The exact physiological mechanism of the effect of massage is unknown. However, the gate control theory offers an explanation of the pain-relieving effect of massage (Melzack and Wall, 1965). Central endocrine and neuroendocrine effects such as increased release of oxytocin and decreased blood pressure can also account for the positive effects of massage (Uvnäs-Moberg et al., 1993; Lund et al., 1999, 2002). Oxytocin seems to have an anxiolytic effect, resulting in relaxation which in turn decreases nausea. Thus, relaxation may explain the effect of massage on nausea. Benson et al. (Benson et al., 1974) described this phenomenon as a decrease in activity of the sympathetic nervous system in relaxed states. Morrow (Morrow, 1986) studied the effect of relaxation on chemotherapy-induced nausea in 92 cancer patients and reported a significant decrease in duration and severity of post-treatment nausea in the relaxation group. Furthermore, higher serotonin concentrations may also explain the pain-relieving effect of massage (Ironson et al., 1996; Hernandez-Reif et al., 2004). The effect of massage may be due to a shift in the autonomic nervous system (ANS) from a state of sympathetic to parasympathetic response. This theory is debated though, and no general consensus exist (Moyer et al., 2004).
To the authors knowledge, only a few previous studies investigated the effect of stroking only on cancer patients (Sims 1986, Bredin 1999, Billhult 2001). In addition, after testing different types of massage, finding effleurage to be the most suited to cancer patients, this thesis set out to investigate the effect of light massage, or stroking.

Syfte

The specific aims of the thesis are to describe and study;
1.The effect of massage on nausea, anxiety and depression in breast cancer patients undergoing chemotherapy.
2.The experience of massage in patients with breast cancer during chemotherapy treatment.
3.The effect of repeated massage on immunity by studying the number and activity of circulating NK cells, CD4+ and CD8+ T cells, cortisol, anxiety, depression and quality of life in patients with breast cancer.
4.The immediate effect of a single massage on immunity, cortisol, pulse and blood pressure in patients with breast cancer.