Oncology massage therapy might be a helping hand for patients suffering from chronic chemotherapy-induced peripheral neuropathy, according to data presented at the 2019 Supportive Care in Oncology Symposium.¹ The results of the pilot study supported the premise that patients who received massages three times per week had sustained improvement in chemotherapy-induced peripheral neuropathy up to 6 weeks after treatment completion, regardless of massage treatment site. Even patients with lower-extremity chemotherapy-induced peripheral neuropathy who received massage to unaffected sites of the head, neck, and shoulders experienced significant symptom relief, the study authors reported.

“These outcomes provide initial evidence of efficacy for oncology massage in providing relief from chronic chemotherapy-induced peripheral neuropathy,” said Gabriel Lopez, MD, Associate Professor in the Department of Palliative Care, Rehabilitation, and Integrative Medicine and Medical Director of the Integrative Medicine Center at The University of Texas MD Anderson, Houston. “Even though there are a variety of antineuropathic medications available, oncology massage may be one nonpharmacologic, complementary approach to consider for symptom control.”

These outcomes [with massage therapy] provide initial evidence of sustained pain reduction for patients with chronic chemotherapy-induced peripheral neuropathy.

— Gabriel Lopez, MD

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As Dr. Lopez explained, oncology massage refers to a specific set of techniques using Swedish massage that are provided by therapists who are trained to work with patients who have cancer, taking into account the specific needs of this unique population, including site precautions, pressure level modification, and bolstering. According to the National Center for Complementary and Integrative Health, massage therapy falls under the category of Mind and Body Practices, and the National Cancer Institute (NCI) reports this service is being offered in nearly 75% of NCI-designated cancer centers.

“The challenge is to understand how complementary approaches such as oncology massage can help provide relief for symptoms associated with cancer treatment,” said Dr. Lopez, who noted that the Society for Integrative Oncology Clinical Practice Guidelines, endorsed by ASCO, include recommendations for the use of integrative therapies such as massage for the management of depression and mood disorders. “The goal is to further establish the evidence needed to ensure that we’re using these therapies safely and appropriately during and after cancer care.”

Chemotherapy-induced peripheral neuropathy, caused by short- and long-term toxicity of platinum compounds and taxanes, is one context of interest, said Dr. Lopez. There are limited options for symptomatic relief for patients with this complication.

For this pilot study, Dr. Lopez and colleagues evaluated the optimal treatment schedule and initial efficacy of a standardized Swedish massage protocol to treat lower-extremity chemotherapy-induced peripheral neuropathy. The researchers compared two massage protocols—lower-extremity (site affected by chemotherapy-induced peripheral neuropathy) vs head/neck/shoulder (alternate site)—and two massage schedules: 3 times per week for 4 weeks vs 2 times per week for 6 weeks.

Patients included in the analysis had gastrointestinal or breast malignancies, and lower-extremity neuropathy was attributed to treatment with oxaliplatin, paclitaxel, or docetaxel. Patients had to report a pain score of at least 3 out of 10 and were required to have at least 6 months from their last chemotherapy treatment for eligibility.

Improvement in Pain Scores

As Dr. Lopez reported, a total of 71 patients fulfilled the inclusion criteria (mean age, 60 years). The results showed comparable completion rates between the twice-weekly and thrice-weekly treatment groups, said Dr. Lopez, which may aid in future study design. Analysis of initial efficacy, however, demonstrated statistically significant improvement in Pain Quality Assessment Scale scores for patients receiving massage three times per week when compared with the less intensive regimen. There was also evidence of sustained pain reduction. Patients randomly assigned to massage three times per week for 4 weeks showed sustained improvement in the chemotherapy-induced peripheral neuropathy up to 6 weeks after completion of the massage treatment.

Interestingly, said Dr. Lopez, a comparison of lower-extremity vs alternate site (head/neck/shoulder) massage treatment protocols found no difference in the effectiveness of pain relief. “This is surprising because the enrollment criteria for patients required lower-extremity neuropathy,” he said. “However, massage to the uninvolved area of the head/neck/shoulders showed just as much symptomatic improvement as massage to the area with neuropathy.” ■

DISCLOSURE: Dr. Lopez reported no conflicts of interest.

REFERENCE

1. Lopez G, Eng C, Overman M, et al: A pilot study of oncology massage to treat chemotherapy-induced peripheral neuropathy. 2019 Supportive Care in Oncology Symposium. Abstract 111. Presented October 26, 2019.