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MASSAGE THERAPY AND BREAST CANCER PAIN

Proposal by: Sarah Brader, Maria Garcia, Meghan Simarro, & Norma Taylor

BACKGROUND
The role of nurses to incorporate non-traditional therapy options
is rapidly growing. A recent rise in supplemental medication in
breast cancer patients has been reported from 65% to 80%
(Klafke et al., 2015). Breast cancer patients suffer a broad range
of physical and psychosocial discomforts including breast pain,
arm dysfunction, lymphedema, fatigue, and anxiety (Listing et al.,
2009). Currently, the National Comprehensive Cancer Network
recommends the use of massage for refractory cancer pain
(Cassileth & Vickers, 2004). Research indicates relief from
psychosocial and physical aspects of pain to improve patients
quality of life (Lengacher et al., 2006; Listing et al., 2009).
Despite increasing awareness of the benefits of massage therapy,
this additional care is not being implemented for breast cancer
patients.

PURPOSE STATEMENT
The aim of this study is to evaluate the effect of massage on pain
in patients with breast cancer.

HYPOTHESIS
After receiving a 20 minute effleurage massage from a licensed
massage therapist, breast cancer patients will report a decrease in
pain on the numerical pain scale compared to their baseline pain
score measured prior to the massage.

Theoretical Framework
The primary goal of Penders Health Promotion Model is to
enhance quality of life and increase longevity. This study seeks to
enhance quality of life by decreasing pain in patients with breast
cancer.

Research Question

DISCUSSION

Breast cancer is one of the leading types of cancer in the United States, and these patients often experience undesirable
symptoms such as pain during their illness and treatment (Billhult, Stener-Victorin, & Bergbom, 2007). Despite
increasing awareness of the benefits of massage therapy, this additional care is not being implemented for breast cancer
patients (Klafe et al., 2015). Limited research exists on the effects of massage specifically on pain, and on this
intervention being carried out specifically in patients with breast cancer. The purpose of this study is to examine the
effects of massage on pain specifically in patients with breast cancer.

The research study will be marketed as a study to measure


perceptions of pain. This single-blinded approach prevents
subjective bias, since the research subjects will not know which
group they are assigned to. This approach does raise ethical
issues, such as veracity and justice, however, it is anticipated that
the subjects will not experience any adverse effects of receiving
or not receiving treatment (Heckerling, 2005). In order to ensure
ethical principles are upheld, the researchers plan to minimize any
risk of harm, obtain informed consent, protect anonymity and
confidentiality, avoid deceptive practices, and provide the right to
withdraw (Lund Research, 2012).

Study Procedures
Sampling: The study will include a convenience sample size of 50 individuals from the Emily Fenton Hunte Breast
Cancer Center at Scripps Green in Torrey Pines. In order to be included in the study, the patients must be between 18 and
65, have a diagnosis of breast cancer, and must be undergoing chemotherapy or biotherapy.
Research Design: A random controlled trial will be implemented to evaluate the effects of massage on pain in patients
with breast cancer compared to patients that do not receive massage. A licensed massage therapist will perform a twenty
minute effleurage massage (which involves stroking, squeezing, rolling, kneading, and applying pressure to trigger
points) twice a week for five weeks in conjunction with chemotherapy. The control group will receive no treatment in
addition to their chemotherapy. All participants will fill out a numerical pain scale card at the beginning and end of each
appointment during the five weeks. A pretest-posttest design of the numerical pain scale will be used to evaluate the
patients perception of pain before and after each massage. The test will be administered by a third party research
professional to prevent bias from being introduced by the oncology staff. The questionnaire will be documented and
coded among the interview results. Participation for the subjects following recruitment is voluntary and includes
biweekly massages for the intervention group and two interview sessions following the intervention.
Expected Results: Patients with breast cancer that receive effleurage massage will report a decreased amount of pain
compared to patients that do not receive massage interventions.

Research Methods
Statistical Method: To evaluate treatment efficacy, the following validated questionnaires were administered at baseline
(T1), at the end of the intervention (T2), and at a follow up at five weeks (T3): the European Organization of Research
and Treatment of Cancer quality of life questionnaire breast model (EORTC QLQ-BR23) and the Short Form-8 Health
(Listing et al., 2009). The assessment of physical pain and discomfort, was evaluated and responses were rated on a
four-point Likert scale in our analysis from these two questionnaires.
Pain was measured using the numeric rating scale (NRS) on two different occasions at each intervention. On a pain scale
of 0 to 10, zero being no pain at all and ten being unbearable pain, participants were asked to rate their pain intensity.
Pearsons chi square test will be used to evaluate how likely it is that any observed difference between massage and pain
arose by chance. Data analyses were conducted using SPSS (14.0) and two sided p-values<0.05 were measured for
statistically significant (Listing et al., 2009).

CLINICAL IMPLICATIONS &


FUTURE RESEARCH
Massage is a simple intervention that can be implemented by
nurses in many inpatient and outpatient settings and may reduce
the costs associated with pain medication and other types of
therapy (Cancer Research UK, 2015). The original intent was to
evaluate the influence on quality of life, which within our
methods is considered a weak outcome measurement, but
according to the Health Promotion Model is the overall motive for
desirable outcomes. Implementing CAM therapies, like massage,
as a pain reduction strategy also has the potential to reduce the
costs associated with pain medications and other types of therapy
(Cancer Research UK, 2015). Additional research be conducted
that no secondary aggravation of side effects or complications
with chemotherapy or biotherapy are associated to the
intervention.

ACKNOWLEDGEMENTS
As a collaborative team, we would like to recognize the institution
of Azusa Pacific University and the Entry-level Masters Program
(ELM) for sponsoring this proposal of this research project and
also our preceptor Diana Amaya Rodriguez, PhD, MS, CNS, RN
for assisting us in the development of this research design.