Original ArticleEffects of back massage on chemotherapy-related fatigue and anxiety: Supportive care and therapeutic touch in cancer nursing
Introduction
Chemotherapy is a long-term treatment and leads to many side effects in individuals receiving it (Can et al., 2011, Cleeland et al., 2000, Kearney et al., 2008, Turgay et al., 2008). One of the most common side effects of chemotherapy is fatigue (Ahlberg et al., 2003, Barsevick et al., 2010, Breitbart and Alici, 2010, Gerber et al., 2011, Mitchell, 2010, Rotonda et al., 2011, Schulmeister and Gobel, 2008, Wu and McSweeney, 2004, Wu and McSweeney, 2007). The term fatigue used as the synonym of weakness, exhaustion, tiredness, weariness can also be defined as a state of mental and physical exhaustion which covers all these concepts (Ahlberg et al., 2003, Cheville, 2009, Iop et al., 2004, Mitchell, 2010, Wu and McSweeney, 2007, Yurtsever, 2007). Fatigue is a multi-dimensional problem arising from the combination of physical, psychological and situational factors. Fatigue adversely affects not only a patient's sense of wellbeing but also his/her daily performance, activities, professional life, relationships with his/her family and friends, sexual life and tolerance to the treatment (Curt et al., 2000, Jean-Pierre et al., 2007, Kearney et al., 2008, Lee et al., 2008, Oh and Seo, 2011). Acute and chronic fatigue should be distinguished from each other. Although acute fatigue is experienced by everyone, chronic fatigue is a serious condition which accompanies a disease or treatment, is not relieved by rest and affects a person's quality of life and ability to do activities (Ahlberg et al., 2003, Trendall, 2000, Yurtsever, 2000).
Fatigue is a universal, chronic problem suffered by cancer patients, and the severity of its symptoms often varies from time to time during the course of the disease (Finnegan-John et al., 2013, Mitchell, 2010, Oh and Seo, 2011, Werner, 2009). Of the patients receiving chemotherapy, 80–96% suffer fatigue which increases over time (Cheville, 2009, Iop et al., 2004, Kearney et al., 2008, Kwekkeboom et al., 2010, Rotonda et al., 2011, Sood et al., 2007, Stasi et al., 2003). Fatigue can be caused by either the disease itself, or by anemia, a decrease in hematocrit values, the accumulation of waste products resulting from the destruction of cells, interruptions in sleep, pain, anxiety, depression, immobility, anorexia, nausea and vomiting and malnutrition due to chemotherapy (Barsevick et al., 2010, Can et al., 2004, Franklin and Packel, 2006, Harper and Littlewood, 2005, Lane, 2005, Mitchell, 2010, Mock et al., 2001, Oh and Seo, 2011, Rabbetts, 2010, Yavuzşen and Kömürcü, 2008).
Cancer treatment, which takes a long time and has a great many side effects, shatters an individual's family, work and social life and thus leads to the loss of role and status, hopelessness, helplessness, anxiety about the future, social isolation and exhaustion. Therefore, the disease, treatment and uncertainties about the future can lead to anxiety and depression (Arslan and Bölükbaş, 2003, Beşer and Öz, 2003, Nagel, 2004, Şenler, 2001). In cancer patients, there is a strong association between depression and fatigue (Dimeo et al., 2004, Kwekkeboom et al., 2010, Winell and Roth, 2004) and between anxiety and fatigue (Brown and Kroenke, 2009, Li and Yuan, 2011, Mansky and Wallerstedt, 2006, Oh and Seo, 2011, Reddick et al., 2005, Redeker et al., 2000). Although it is common in patients with cancer, fatigue, which is often neglected, imposes psychological stress on the patient and is assumed to be the most important cause of non-compliance to treatment (Glaus, Crow, & Hammond, 1996). Nursing interventions aiming to reduce distress and anxiety in cancer patients are of great importance in ensuring the patient's compliance to treatment and enhancing the quality of life (Schreier and Williams, 2004, Smith et al., 2003).
Nurses who directly observe the inconveniences due to unwanted effects of chemotherapy in patients receiving chemotherapy are the professionals who have a key role in dealing with problems experienced in patient care (Aghabati et al., 2010, Aslan et al., 2006, Berger, 2001). Nursing interventions performed to control symptoms in cancer patients receiving chemotherapy help them relieve and regain their confidence. Today, given the fact that providing cancer treatment and care in outpatient care centers is becoming widespread, it is obvious that nurses' increasingly expanding roles will come to the fore even more.
Complementary therapies, palliative and supportive care have an important place in the control of fatigue and anxiety suffered by patients receiving chemotherapy (Ernst, 2001, Fontaine, 2004, Henricson et al., 2006, Kwekkeboom et al., 2010, Mitchell et al., 2007, Parkman, 2001, Walters, 2010). Complementary therapies are not curative applications, but they aim to alleviate the symptoms of the disease or to reduce the adverse effects of traditional therapy, and improve the individual's general well-being and quality of life (Ernst et al., 2003, Finnegan-John et al., 2013, Fox et al., 2013, Harrington et al., 2012, Henricson et al., 2006). Back massage, a nursing intervention, is one of the complementary treatment approaches.
Massage is a way of communication performed not by using words but by touching the individual (Currin and Meister, 2008, Fontaine, 2004, Gleeson and Timmins, 2005, Henricson et al., 2006, Jane et al., 2008, Toth et al., 2013). Massage is a cheap and easy-to-perform application with no side effects and, unlike stress response, leads to relaxation in the muscles by reducing tension (Field, 1998, Jane et al., 2008, Menefee and Monti, 2005, Mok and Woo, 2004, Myers et al., 2008, Smith et al., 2009). Massage can be defined as the systemic stimulation of the body's soft tissues manually or mechanically for therapeutic purposes in order to maintain blood and lymph circulation, relax muscles, relieve pain, reduce fatigue and ensure sleep (Ernst, 2009, Fontaine, 2004, Menefee and Monti, 2005, Monti and Yang, 2005, Thompson et al., 2006, Wolsko et al., 2004). The application area of classical massage is the skin and the muscles under the skin. The effects of massage applied can be seen either locally or in the other parts of the body as a result of stimuli transmitted through the nervous system. Manual massage techniques provide both physical and mental relaxation (Beck, 2006, Collinge et al., 2012, Ernst, 2009, Fernández-Lao et al., 2012, Jane et al., 2008, O'Mathúna, 2009, Quattrin et al., 2006, Thompson et al., 2006, Timby, 2009, Werner, 2009).
Massage is used as a supportive treatment method in cancer patients (Cassileth and Vickers, 2004, Collinge et al., 2012, Finnegan-John et al., 2013, Fontaine, 2004, Gross et al., 2013, Sagar et al., 2007, Walters, 2010, Wilkinson et al., 2008). In the literature, there are many studies demonstrating the benefits of massage applications in cancer patients. However, there are no studies demonstrating the effects of back massage provided during chemotherapy on acute chemotherapy-induced fatigue and the level of anxiety developing during this process. In our country too, the number of experimental studies specific to complementary treatment approaches aiming to control the side effects occurring in patients receiving chemotherapy is quite inadequate.
This quasi-experimental and cross-sectional study was carried out to determine the efficacy of back massage, a nursing intervention, on the process of acute fatigue developing due to chemotherapy and on the anxiety level emerging during this process in cancer patients receiving the third and fourth day chemotherapy cycles of one-day chemotherapy.
The hypotheses to be tested in the study are as follows:
H1: Back massage provided during chemotherapy decreases chemotherapy-related fatigue.
H2: Back massage provided during chemotherapy reduces chemotherapy-related anxiety.
During the planning stage of the study, written permission was received from the chief physician and the Presidency of the Radiation Oncology Department of the hospital where the study was carried out. Then, Ethics Committee Decision (decision no. 2007/10-03) was obtained from the Presidency of the Ethics Committee of Cumhuriyet University Faculty of Medicine. The study was conducted in accordance with the principles of the Helsinki Declaration.
All patients were informed about the study and provided time to ask questions, prior to providing their oral-written consent to participate. All the participants of this study gave their verbal and written informed consents. The patients were assured that the data to be obtained in the study would be used only in the scope of the study and would not be shared with any other person, institution or organization.
Section snippets
Setting and sample
The study was carried out at the Chemotherapy Unit of the Radiation Oncology Center of a university hospital. In this unit which started to offer service in March 2007, patients having lung, breast, stomach, rectum, and colon, ovarian or cervical cancer receive outpatient chemotherapy service. The unit has two separate sections furnished with recliners in which patients comfortably sit during chemotherapy. In each section, three patients can receive chemotherapy at the same time. In the unit,
Results
Of the patients, 55.0% (11) in the intervention group and 50.0% (10) in the control group were female. The mean age of the patients in the study was 49.97 ± 11.31. Of them, 75.0% (15) in the intervention group and 60.0% (12) in the control group were in the 41–60 age group. In our research, 40.0% (8) of the patients in the intervention group and 50.0% (10) in the control group had breast cancer. Of the patients, 55.0% (11) in the intervention group and 50.0% (10) in the control group underwent
Discussion
Complementary and alternative approaches are the practices which help individuals to lead a healthy life and to improve their quality of life, and these approaches are a unique opportunity for nurses so that they can provide holistic care. In the literature, it is reported that massage, one of the complementary and alternative approaches, is effective in relieving overall symptoms and side effects cancer patients suffer due to the disease and treatment. Although there are several studies
Conclusions
In line with the findings of our study conducted to determine the effects of back massage, a nursing intervention, on the chemotherapy induced acute fatigue and the level of anxiety developing in this process, it can be suggested that back massage administered during chemotherapy is effective on anxiety and fatigue suffered during chemotherapy, and decreases state anxiety and acute fatigue significantly. Therefore, it can be recommended that the awareness, understanding and sensitivity of
Acknowledgments
The authors express their thanks to Dr. Ziynet Çiner of the Department of Statistics of Cumhuriyet University, for help with the statistical evaluations in this investigation.
References (111)
- et al.
Assessment and management of cancer-related fatigue in adults
The Lancet
(2003) - et al.
Efficacy of an intervention for fatigue and sleep disturbance during cancer chemotherapy
Journal of Pain and Symptom Management
(2010) - et al.
Cancer-related fatigue and its associations with depression and anxiety: A systematic review
Psychosomatics
(2009) - et al.
Non-pharmacological interventions used by cancer patients during chemotherapy in Turkey
European Journal of Oncology Nursing
(2011) - et al.
Massage therapy for symptom control: Outcome study at a major cancer center
Journal of Pain and Symptom Management
(2004) Cancer-related fatigue
Physical Medicine and Rehabilitation Clinics of North America
(2009)- et al.
Massage in supportive cancer care
Seminars in Oncology Nursing
(2012) - et al.
Physical performance, depression, immune status and fatigue in patients with hematological malignancies after treatment
Annals of Oncology
(2004) - et al.
Using a mixed methods research design to investigate complementary alternative medicine (CAM) use among women with breast cancer in Ireland
European Journal of Oncology Nursing
(2013) - et al.
Cancer-related fatigue
Archives of Physical Medicine and Rehabilitation
(2006)