Page 2534 - Hematology_ Basic Principles and Practice ( PDFDrive )

Chapter 156 Integrative Therapies in Patients With Hematologic Diseases 2257

chemotherapy including stem cell transplantation found that acu- higher natural killer (NK) cells and lymphocyte cells during massage.
puncture was safe among those with severe thrombocytopenia. 27 Similarly, in a study in human immunodeficiency (HIV) patients,
there was a significant increase in NK cell fighter toxicity during the
Massage and Touch Therapies massage period. In some trials, there is a short-term effect on NK cell
activity; however, long-term clinical effect has not been demonstrated.
A significant effect of effleurage massage on cellular immunity, cor-
Overview and Definitions tisol, oxytocin, anxiety, depression, or quality of life has also not been
demonstrated in more rigorous randomized clinical trials. In another
Massage has been defined by some as “rhythmic and methodical randomized clinical study, dopamine levels, NK cells, and lympho-
stretching and compressing of the muscles and connective tissue cytes increased from the first to last day of the massage therapy. In a
through the touch of the therapist’s hands.” There are many types of study of children with HIV, a control arm had a greater relative risk
massage and hands-on soft tissue therapies (Table 156.4). Therapies of CD4 count decline than the massage therapy children. Lympho-
include Swedish massage, aromatherapy massage, reflexology, acu- cyte loss was also more extensive in the control participants, and more
pressure, and manual lymphatic drainage massage. Swedish massage of the control group than the massage group lost greater than 50/
3
provides broad, flowing, soothing strokes (effleurage), generally mm CD8 lymphocytes. The immediate effects of massage therapy
applied with a lotion or massage oil from distal to proximal areas on are decreased anxiety, depressed mood, and anger. The long-term
extremities. In addition, there is usually gentle kneading of soft tissues effects of massage include reduced depression and hostility as well as
(petrissage). Aromatherapy has often been combined with massage in increased urine meridopamine, serotonin values and NK cell number,
which selected scented oils are blended with the usual massage oil to and lymphocytes. However, it is not clear that these results were
enhance the beneficial effects of both physical and emotional well- statistically significant.
being. Reflexology focuses on manual pressure to specific areas of the Weaknesses exist in many of the massage therapy studies reported
feet that, in traditional Chinese medicine, are linked with remote to date such as small sample sizes and lack of controls. Most of the
areas of the body. Acupressure massage uses the meridian theory of practitioners have not been blinded to the hypothesis of the studies.
traditional Chinese medicine in which focal pressure is applied to Furthermore, no systematic approach has been identified to deter-
acupuncture needle sites with the goal of adjusting the flow of energy mine the optimal number of massage treatments in a trial and
similar to the theory in acupuncture. Manual lymphatic drainage is within-group comparisons. Strong evidence shows that massage
the application of light, flowing strokes of massage in specific patterns therapy can be very helpful in alleviating anxiety and stress in patients.
with the goal of alleviating lymph edema after lymph node resection However, more rigorous study designs, adequate statistical power,
or radiation therapy. better identification of predictors for response to massage, and study
of the psychologic and biologic mechanisms are needed. There is also
a need for larger sample sizes and rigorous design reporting on
Research on Usage and Effectiveness massage therapy.

28
Corbin has reviewed the value of massage as well as the difficulties
in performing scientific research. Many randomized clinical trials use Safety
a crossover arm and attempt interventions that try to control for the
placebo effect. The various measurement tools used to assess outcomes The concern that massage therapy can spread a tumor is unfounded.
involve numeric rating scales, visual analog scales, profile of mood However, direct pressure over known tumor sites is usually discour-
status, the S state trait anxiety inventory, the European Organization aged. In general, massage therapy of all types is quite safe. The NCI
for Research and Treatment of Cancer quality of life questionnaire, urges massage therapists to take specific precautions with all cancers
and others. In a critical review of potential benefits of massage, Joske and avoid massaging open wounds, bruises, or areas with skin break-
29
et al identified eight randomized controlled clinical studies in down. Also massage directly over tumor sites, areas with a thrombosis,
hematology/oncology patients totaling more than 357 patients. and sensitive areas after radiation therapy should be avoided.
Specifically, there was evidence of anxiety reduction with less benefit
for analgesia. In autologous bone marrow transplantation patients,
the massage group had significantly decreased distress and nausea Nutrition and Supplements
scores early in the trial, but these were not long standing. Massage
therapy has been found to reduce state anxiety and boost mood in Nutrition
many metaanalyses, probably its most beneficial attribute. Pain may
be alleviated, but this has not been demonstrated to be statistically Nutritional guidelines for patients with hematologic malignancies
significant. Numerous studies have shown trends not only in decreased should be based on the recommendations of the American Cancer
anxiety but also in nausea, pain, fatigue, and depression. Society and the World Cancer Research Fund/American Institute for
To date, there is little evidence suggesting that massage therapies Cancer Research (WCRF/AICR). 30,31 The AICR clearly states that
have any effect on immune function or survival outcomes in cancer survivors should follow its nine nutrition and physical activity
31
hematology/oncology patients. A small randomized study did find guidelines for risk reduction. Adherence to the WCRF/AICR cancer
prevention guidelines has been associated with a 34% lower hazard
of death (95% confidence interval [CI], 0.59–0.75) compared with
participants within the lowest adherence. Moreover, the WCRF/
TABLE Massage or Body Manipulation AICR score was also significantly associated with a lower hazard of
156.4 dying from cancer, circulatory disease, and respiratory disease. 32
• Swedish massage The first recommendation is to be as lean as possible without
• Aromatherapy massage being underweight, a recommendation that has been further endorsed
33
• Reflexology by the American Society of Clinical Oncology. A recent meta-
• Acupressure analysis among adults with leukemia, found that obesity is associated
• Shiatsu with an increased risk (relative risk [RR] of 1.26; 95% CI, 1.17–1.37;
• Manual lymphatic drainage p < .001) of leukemia and is associated with reduced mortality (RR,
• Reiki 1.29; 95% CI, 1.11–1.49; p = .001). Obesity has also been associated
• Deep tissue massage with an increased incidence of acute myeloid leukemia (AML) (RR,
• Rolfing 1.53; 95% CI, 1.26–1.85; p < .001), chronic lymphocytic leukemia
(RR, 1.17; 95% CI, 1.08–1.27; p < .001), chronic myeloid leukemia