Massage Therapy Gives Relief From Chemo-Related Neuropathy

Roxanne Nelson, RN, BSN

October 28, 2019

SAN FRANCISCO ― Massage therapy can provide symptomatic relief for chronic chemotherapy-induced peripheral neuropathy (CIPN), a new study suggests.

The number of weekly massage sessions that a patient received made a difference in symptom control.

A statistically and clinically significant improvement in scores on the Pain Quality Assessment Scale (PQAS) was seen among patients who received massage therapy three times a week as opposed to those who received it twice a week.

A sustained improvement in CIPN was observed at 10 weeks in the group that received the most intensive regimen.

"This study builds upon integrative oncology methods to improve the quality of life for cancer survivors, and there are currently limited options for the relief of CIPN pain," said study author Gabriel Lopez, MD, associate professor and medical director of the Integrative Medicine Center at the University of Texas MD Anderson Cancer Center, Houston.

"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," he added.

Lopez presented the study results here at the Supportive Care in Oncology Symposium (SCOS) 2019.

This meeting, which was organized by the American Society of Clinical Oncology (ASCO), was previously known as the Palliative Care in Oncology Symposium.

In 2017, the name was changed to Palliative and Supportive Care in Oncology Symposium to be more inclusive, inasmuch as palliative care still tends to be associated only with end-of-life care. The name has now been shortened to reflect the wide range of supportive care services, an ASCO spokesperson explained to Medscape Medical News.

Common Side Effect of Chemotherapy

CIPN is a common side effect of both short- and long-term treatment with platinum compounds and taxanes and can have a profound impact on quality of life, Lopez noted.

As there is an increased interest in the role that complementary approaches may play for symptom control, his team decided to investigate the effects of massage for symptomatic relief of chronic CIPN.

Their pilot study examined the optimum treatment schedule and initial efficacy of a standardized Swedish massage technique in treating symptoms associated with CIPN of the lower extremities.

The cohort included 71 patients with CIPN that developed following exposure to oxaliplatin, paclitaxel, or docetaxel. The patients self-reported a neuropathy score ≥3 on a scale of 0–10, and their last chemotherapy treatment occurred at least 6 months before the study period.

More than three quarters of the cohort were women (77.5%). Most patients had either breast cancer (57.7%) or gastrointestinal cancer (42.3%). The mean age was 60.3 years, and the average time since the end of chemotherapy was more than 3 years.

The primary aim of the study was feasibility, Lopez explained, to see whether patients would attend for massage therapy two or three times a week.

The secondary goal compared outcomes as they related to treatment frequency (2 vs 3 times per week).

All massages were given by therapists trained in oncology massage. "An oncology massage differs from a regular massage in that it refers to a specific set of techniques and is provided by therapists who have special training and who are familiar with the unique needs of cancer patients," said Lopez.

Patients were randomly assigned to one of four regimens:

  • lower-extremity massage three times a week for 4 weeks;

  • massage twice a week for 6 weeks;

  • head/neck/shoulder massage three times a week for 4 weeks (control group); or

  • control massage twice a week for 6 weeks.

Symptoms were measured with the PQAS. Scores ranged from 0 to 10, with subscales for surface pain, deep pain, and paroxysmal pain. The patients were assessed at baseline, at the end of treatment (4 vs 6 weeks, depending on treatment group), and again at the end of the study at 10 weeks.

Results Show Massage Is Feasible

For the primary endpoint of feasibility, the mean massage completion rates were 8.9 sessions for those who received massages three times per week and 9.8 sessions for those who received the intervention two times per week. There was no statistical difference between the two.

With regard to subscales, for the PQAS-Surface Pain, there was a 2.3-point reduction for the patients who received massage three times a week, vs a 0.6-point reduction for those who received it two times a week (P = .001).

Likewise, for PQAS-Deep Pain, there was a 2.1-point reduction with treatment 3 times a week, vs a 0.9-point reduction for treatment two times a week (P = .008). For PQAS-Paroxysmal Pain, there was a 2.3-point reduction, vs 1.0-point reduction (P = .025).

Completion rates were comparable between the twice-a-week and the three-times-a-week groups. "There was sustained symptom reduction for up to 6 weeks after treatment complete for the group having massage therapy three times a week," said Lopez.

Lopez commented that the team will be using this information as they move toward conducting a larger randomized trial "where we have a proper control group that doesn’t receive massage therapy."

Validation Needed

In a discussion of the paper, Charles Loprinze, MD, a medical oncologist from the Mayo Clinic, Rochester, Minnesota, reiterated that massage therapy is a common component of integrative therapy and that in this trial, massage therapy given three times a week was "a bit" better than massage therapy given twice a week.

"As for clinical applications, the currently available data do not mean we should immediately suggest to people get a massage for their neuropathy and that, yes, insurance will pay for it," he said.

With that said, "a massage may be comfortable, and there is no reason not to get one if a patient with peripheral neuropathy wants one," Loprinze explained. "As for the impact on future patient care, we need to wait for the phase 3 trial. And then, if this trial is positive, it will be a very nice treatment for patients with peripheral neuropathy."

Loprinze added that several other nonpharmaceutical treatments are being studied for CIPN, including exercise and cryo-compression.

Commenting on this study in an ASCO statement, Joseph Rotella, MD, who is on the 2019 Supportive Care in Oncology Symposium News Planning Team, said: "Finding evidence to support complementary therapies, such as massage therapy, is imperative as we look for ways to improve quality of life from treatment through survivorship.

"This study provides important results that can help inform future studies to further validate the role of oncology massage therapy for CIPN," he added.

The study was funded by an Institutional Research Grant. Lopez has disclosed no relevant financial relationships. Several coauthors have disclosed relationships with industry, as noted in the abstract.

Supportive Care in Oncology Symposium (SCOS) 2019: Abstract 111, presented October 26, 2019.

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