The Study Question
Does massage therapy improve quality of life for hospice patients and their caregivers?
Massage therapy is one of the most popular and widely used integrative therapies among hospice patients and their caregivers. However, relatively little research has been conducted to support its use, and the results of recent research have been contradictory.
This pilot study assessed the impact of a massage therapy intervention for hospice patients on patient symptom severity, caregiver quality of life (QOL) and overall patient satisfaction.
The study methods: The study used a prospective, open label design to assess feasibility and estimate outcome effect size. People in hospice care with poorly controlled symptoms and their caregivers were recruited from a single hospice program. Baseline symptom severity and QOL measures were collected.
Patient participants received up to three sessions of massage therapy at intervals of at least one week apart. Symptom measures were again collected within 72 hours following massage therapy sessions. Patients who completed at least three sessions of massage therapy completed a final symptom assessment and satisfaction survey. Caregivers completed a final assessment of symptoms and QOL.
Symptom severity, pain, depression and anxiety were measured using the Edmonton Symptom Assessment Scale-revised, a commonly used measure in palliative care. QOL was measured using the Linear Analogue Self-Assessment (LASA), a 12-item self-report tool that assesses overall QOL and nine dimensions of QOL: mental well-being, physical well-being, emotional well-being, social activity, spiritual well-being, pain frequency, pain severity, fatigue and social support on an 11-point Likert scale.
The massage therapy interventions were all provided at home by the same certified massage therapist trained in oncology massage and individualized to the patient based on their condition. Each session lasted between 20 to 45 minutes. A typical session included two to five minutes of pre-massage assessment and positioning, 20 to 45 minutes of massage, and two to five minutes of post-massage assessment. Caregivers were allowed to be present during the massage sessions but did not receive any instruction in how to provide massage.
Of the 27 paired patients and caregivers, 15 completed the study. The majority of patient participants (70 percent) had a primary hospice diagnosis of cancer. Most caregivers (74 percent) were spouses of the patient.
No significant differences were observed on symptoms severity or QOL in either the hospice patient group or their caregivers.
However, in contrast to the symptom severity results, hospice patients who completed all three of the massage therapy sessions reported very high satisfaction with massage therapy, with 13 (86.7 percent) very satisfied and two (13.3 percent) somewhat satisfied. None indicated dissatisfaction.
In terms of subjective ratings of effectiveness, 66.7 percent of patients rated massage therapy as very effective for stress relief, 100 percent for relaxation, 60 percent for pain relief, and 66.7 percent for feeling of wellness. All other patients rated massage therapy as somewhat effective for each. All patients said they would recommend massage therapy to others.
Limitations of the Study
Studies with people in hospice care are challenging to conduct and tend to have high attrition rates, as this study did. Combined with the small sample size, any effect would have been more difficult to detect. The lag time between the massage session and completion of outcome measures may have contributed to the discrepancy between the high rates of satisfaction reported and the lack of any observed differences on measures of symptom severity.
Implications for evidence-informed practice: Massage therapy appears to offer some benefit for people in hospice care, most particularly in terms of perceived satisfaction with relaxation, stress relief, and sense of well-being. More research is needed to document these or other potential benefits.
Massage Therapy in Hospice
1. Lopez G, Liu W, Milbury K, Spelman A, Wei Q, Bruera E, Cohen L. "The effects of oncology massage on symptom self-report for cancer patients and their caregivers." Support Care Cancer. 2017 Dec;25(12):3645-3650.
2. Genik LM, McMurtry CM, Marshall S, Rapoport A, Stinson J. "Massage therapy for symptom reduction and improved quality of life in children with cancer in palliative care: A pilot study." Complement Ther Med. 2020 Jan;48:102263.