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Building Blocks

Massage Thearapy has a wide range of uses, from pure relaxation to helping people recover from injury. As a massage therapist, you may have watched the tension and anxiety ease from a client's shoulders, or perhaps you had a hand in getting an athlete back to peak condition.

Some of you, too, might work with populations where the benefits of massage therapy are more difficult to quantify or are a part of a larger treatment program, making pinpointing the benefit of therapeutic massage difficult. For the most part, cancer patients fall into this category. Anecdotal evidence continues to detail the relief massage therapy offers, but these accounts go only so far to persuade people of the merits of massage therapy.

And this is where research can help. By quantifying the benefits offered by massage therapy, scientific studies help build a foundation upon which massage therapists, and the people they help, can stand.

The Current Landscape

The American Cancer Society estimated 10,400 new cases of pediatric cancer were diagnosed in 2007.1 These children, especially those receiving chemotherapy and radiation, often experience adverse symptoms, including nausea, pain, anxiety, depression, weight loss and hair loss. Invasive treatments can leave patients feeling physically, mentally and emotionally drained.

Palliative care options such as massage therapy, however, are gaining in popularity. A 2003 study reported 33 percent of parents in a primary care setting use complementary and alternative medicine therapies (CAM), with massage therapy being the most commonly used.[2] Massage therapy is believed to improve circulation and immune function, help eliminate waste, dissolve soft adhesions, reduce swelling, and relieve the pain and stress associated with many illnesses.[3,4] The potential for increased immune function and decreased pain make massage therapy a potentially key palliative option for children with cancer.

There is little data, however, focusing on the effects massage therapy has on pediatric oncology and hematology patients. Tiffany Field, PhD, director of the Touch Research Institute at the University of Miami School of Medicine, has conducted research investigating massage therapy to treat premature and HIV-exposed newborns, as well as children with asthma, cystic fibrosis, diabetes and rheumatoid arthritis (RA).[3,9,10,11,12,13]

In these studies, children with RA had significantly lower stress hormone levels following massage therapy.[9] Participants with asthma reported decreased levels of anxiety after one day of treatment.10 Decreased anxiety and depression, and improved sleep patterns have been seen in children and adolescents with psychiatric problems.[3] Both behavioral and physiological functions in children appear to be enhanced by massage therapy, including growth, development, sleep, attentiveness and immune function, along with reduced pain, stress and anxiety.[3,9,10,12,13]

Despite some promising results, however, massage therapy is criticized for the lack of conclusive evidence using rigorous scientifically conducted studies.14 Clinical trials evaluating massage therapy suffer from small sample sizes and several confounding variables, particularly in pediatric populations.[3,14, 15] Conclusive data concerning the effects of massage therapy with pediatric cancer patients would help enhance the quality of care given to children with cancer. 

Taking the First Steps

A pilot study conducted in the Cancer Clinic at Shands Hospital at the University of Florida measured the physical and mental effects of massage therapy on 30 children with cancer and/or blood disease. The hypothesis was that massage therapy would have measurable benefits, both physically and mentally.

The study used a randomized controlled trial, with 15 children in the treatment group who received massage therapy as intervention, and 15 children in the control group who did not receive any massage-related treatment.

Measures of physical and mental well-being were completed before and after four massage therapy sessions. Inpatient treatment participants received one 20-minute Swedish massage session per day for four consecutive days. Outpatient treatment participants received one 20-minute Swedish massage session once a week for four weeks.

Thirty participants were randomly chosen from patients being cared for by the pediatric hematology and oncology division of the University of Florida. There were eight females and seven males in the control group and seven females and eight males in the treatment group, all between the ages of six months and 17. There were 14 inpatient and 16 outpatient participants.

Physiological measures included a muscle tension scale to assess muscle soreness before and after each session. The range was from 1 to 5, with 1 indicating “my muscles feel really good” and 5 indicating “my muscles feel really sore.” The Child Health Questionnaire (CHQ) parent form17 was also used before treatment and upon completion of the entire series of massage sessions. General health, physical function and bodily pain were assessed. Standard methods were used to record blood pressure, respiratory rate and pulse rate before and after each session.

Psychological measures included the State and Trait Anxiety Inventory for Children18 to record levels of both situational and characteristic anxiety. Overall quality of life was measured using a “How I Feel” wellness scale, ranging from a 1, indicating “I feel really good,” to a 5, indicating “I do not feel good at all.” Discomfort levels ranging from a low of 0 to a high of 4 were also recorded after each session.

At the end of the second, third and fourth session, progress from each treatment or control session was reported by the patient on a scale of 0 to 10, 0 meaning no progress and 10 meaning maximal progress. Progress was defined as the patient feeling better overall, with less pain and tension. For participants unable to respond because of their age or illness, parents gave subjective answers based on their observations of their child.

Differences between the treatment group and control group were examined using a 2 x 2 analysis of variance (ANOVA) to compare before and after scores for significant differences between and within the treatment and control groups. Statistical significance was set at p ≤ .05. In cases of significant ANOVA findings, post-hoc analysis using Scheffe Multiple Comparisons tests were conducted to identify the source of significant differences between groups. The Kruskal-Wallis test was used to determine differences in progress from each treatment between the two groups. 

A Good Indication

A three-year study involving 1,290 adult patients indicated massage therapy was beneficial in reducing cancer-related symptoms.[5] A review of five non-pharmacologic strategies for managing cancer pain noted that massage therapy promoted relaxation, relieved muscle spasms, reduced pain and swelling, increased blood circulation and decreased heart rate.[6]

Hospitalized cancer patients reported much less pain and stress after two sessions of massage therapy. [7] Areas of chronic pain and tension were often relieved with the use of massage, and when used before chemotherapy, reduced anxiety and nausea. Therapeutic massage also helped reduce stress and increase quality of sleep.[7]

Breast cancer patients undergoing radiotherapy had fewer symptoms, more tranquility and vitality, and less tension when they received back massage.[8] Additionally, massage therapy has been known to help boost the number and function of the immune system's natural killer cells in patient populations.[7]

What Does This Mean?

On the muscle tension scale, there was no significant difference between participants in either group before treatment. But during the study, the mean score of the treatment group increased significantly, indicating reduced muscle soreness and tension. The control group showed no significant. change. There was also no significant difference in vital signs, including pulse rate and blood pressure, for participants in both groups either before or after treatment. The mean respiratory rate did decrease significantly in the treatment group when compared to the control group.

Based on parent responses on the CHQ, there were no significant differences between the two groups. When comparing each group’s response on the State and Trait Anxiety Inventory for Children, however, the mean values of the treated group’s state anxiety scores decreased significantly, while the control group’s scores stayed the same.

The mean report scores on the “How I Feel” and discomfort level scales suggest the treated group was feeling better than the control group and in significantly less discomfort. Finally, the treated group reported significant progress after the course of massage therapy sessions. On the other hand, the control group reported no change.

Overall, these results point to the idea that children who received massage therapy treatments reduced both mental stress and physical discomfort. These data provide supportive evidence suggesting massage therapy can reduce mental and physical distress in children with cancer and blood disease, and also has a positive impact on the quality of life for pediatric cancer patients. 

What's a Pilot Study

Pilot studies are typically preliminary investigations that help find a research methodology for issues that haven't previously been examined. These studies allow researchers and clinicians to design research programs that are a manageable size. A pilot study also helps identify barriers and challenges that might occur in any given population and setting, such as children with cancer in hospitals or clinics.

Study objectives, such as recruiting participants and finding valid measures to demonstrate results, can be particularly difficult. However, pilot studies allow for the collection of preliminary data to identify and correct any problems that threaten the validity of the research findings.

One of the most valuable uses of pilot data is to find funding and other resources to continue research efforts. Although the power and validity of a pilot study's findings are limited, the data can be used to identify challenges, make modifications and garner support for further research with a larger sample size.

Going Forward

Both clinicians and researchers can help determine the role massage therapy might play in treating diverse patient populations, such as pediatric cancer patients. Though research can pose many challenges, and require some preparation and training, these studies provide direction and insight into the process of collecting data in new settings with diverse populations, particularly in areas where there is little research. These studies can provide preliminary data to justify funding and resources for further investigation.

Massage therapists can use pilot studies to develop experience and knowledge in the research process, and to advance their own research while also contributing to the advancement of their profession. Though studies such as the one discussed in this article contribute to creating a foundation, there is still a lot to be done.


  1. Cancer Facts & Figures 2007. The American Cancer Society: Atlanta, 2007.
  2. Loman DG. “The use of complementary and alternative health care practices among children.” J Pediatr Health Care. 2003 Mar-Apr;17(2):58–63.
  3. Field T. “Massage therapy for infants and children.” J Dev Behav Pediatr. 1995 Apr;16(2):105–111.
  4. Yates J. A Physician's Guide to Therapeutic Massage: Its Physiological Effects and their Application to Treatment. Canada: Massage Therapists’ Association of British Columbia, 1990.
  5. Cassileth BR, Vickers AJ. “Massage therapy for symptom control: outcome study at a major cancer center.” J Pain Symptom Manage. 2004 Sep; 28(3):244–249.
  6. Sellick SM, Zaza C. “Critical review of 5 nonpharmacologic strategies for managing cancer pain.” Cancer Prev Control. 1998 Feb;2(1):7–14.
  7. Ironson G, Field T, Scafidi F, et al. “Massage therapy is associated with enhancement of the immune system cyto-toxic capacity.” Int J Neurosci. 1996 Feb; 84(1-4):205–17.
  8. Lerner M. Choices in Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer. Library of Congress Cataloging-in-Publication Data: Adobe Perpetua and Frutiger by DEKR Corporation. 1994:361–578.
  9. Field T, Hernandez-Reif M, Seligman S, et al. “Juvenile rheumatoid arthritis: benefits from massage therapy.” J Pediatr Psychol. 1997 Oct;22(5):607–17.
  10. Field T, Henteleff T, Hernandez-Reif M, et al. “Children with asthma have improved pulmonary functions after massage therapy.” J Pediatr. 1998 May;132(5):854–858.
  11. Field T, Hernandez-Reif M, LaGreca A, et al. “Massage therapy lowers blood glucose levels in children with diabetes mellitus.” Diabetes Spectrum. 1997 Jul;10(3):237–39.
  12. Hernandez-Reif M, Field T, Krasnegor J, et al. “Children with cystic fibrosis benefit from massage therapy.” J Pediatr Psychol. 1999 Apr;24(2):175–81.
  13. Scagfidi F, Field T, Schanberg S, et al. “Massage stimulates growth in preterm infants: a replication.” Infant Behav Dev. 1990 Apr-Jun;13(2):167–88.
  14. Fernandez C, Stutzer C, MacWilliam L, et al. “Alternative and complementary therapy use in pediatric oncology patients in British Columbia: prevalence and reasons for use and nonuse.” J Clin Oncol. 1998 Apr;16(4):1279–1286.
  15. Cawley N. “A critique of the methodology of research studies evaluating massage.” Eur J Cancer Care. 1997 Mar;6(1):23–31.
  16. American Psychological Association. “Ethical principles of psychologists and code of conduct.” Am Psychologist. 1992 Dec;47(12):1597–1611.
  17. Landgraf JM, Abetz L, Ware JE. The CHQ User's Manual. New England Medical Center: Boston, 1996.
  18. Spielberger CD, Edwards CD, Lushene RE, et al. STAIC Preliminary Manual. Consulting Psychologists Press: Palo Alto, 1971.
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