Elsevier

Applied Nursing Research

Volume 26, Issue 4, November 2013, Pages 210-217
Applied Nursing Research

Original Article
Effects of back massage on chemotherapy-related fatigue and anxiety: Supportive care and therapeutic touch in cancer nursing

https://doi.org/10.1016/j.apnr.2013.07.002Get rights and content

Abstract

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 in cancer patients receiving chemotherapy during this process. The study was conducted on 40 patients. To collect the data, the Personal Information Form, the State Anxiety part of Spielberger State-Trait Anxiety Inventory and the Brief Fatigue Inventory were used.

In our study, it was determined that mean anxiety scores decreased in the intervention group patients after chemotherapy. The level of fatigue in the intervention group decreased statistically significantly on the next day after chemotherapy (p = .020; effect size = 0.84). At the same time, the mean anxiety scores of the patients in the intervention group decreased right after the massage provided during chemotherapy (p = .109; effect size = 0.37) and after chemotherapy. In line with our study findings, it can be said that back massage given during chemotherapy affects anxiety and fatigue suffered during the chemotherapy process and that it significantly reduces state anxiety and acute fatigue. Therefore, the effective use of back massage in the process of chemotherapy by oncology nurses who have a key role in cancer treatment and care can make it more modulated.

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)

  • M. Gleeson et al.

    A review of the use and clinical effectiveness of touch as a nursing intervention

    Clinical Effectiveness in Nursing

    (2005)
  • J.E. Harrington et al.

    Effect of an integrated support programme on the concerns and wellbeing of women with breast cancer: A national service evaluation

    Complementary Therapies in Clinical Practice

    (2012)
  • M. Henricson et al.

    A transition from nurse to touch therapist—A study of preparation before giving tactile touch in an intensive care unit

    Intensive & Critical Care Nursing

    (2006)
  • M. Hernandez-Reif et al.

    Breast cancer patients have improved immune and neuroendocrine functions following massage therapy

    Journal of Psychosomatic Research

    (2004)
  • A. Iop et al.

    Fatigue in cancer patients receiving chemotherapy: An analysis of published studies

    Annals of Oncology

    (2004)
  • N. Kearney et al.

    WISECARE +: Results of a European study of a nursing intervention for the management of chemotherapy-related symptoms

    European Journal of Oncology Nursing

    (2008)
  • K.L. Kwekkeboom et al.

    Mind-body treatments for the pain–fatigue–sleep disturbance symptom cluster in persons with cancer

    Journal of Pain and Symptom Management

    (2010)
  • S.A. Mitchell

    Cancer-related fatigue: State of the science

    PM R

    (2010)
  • E. Mok et al.

    The effects of slow-stroke back massage on anxiety and shoulder pain in elderly stroke patients

    Complementary Therapies in Nursing & Midwifery

    (2004)
  • D.A. Monti et al.

    Complementary medicine in chronic cancer care

    Seminar in Oncology

    (2005)
  • C.D. Myers et al.

    The value of massage therapy in cancer care

    Hematology/Oncology Clinics of North America

    (2008)
  • C. Rotonda et al.

    Factors correlated with fatigue in breast cancer patients before, during and after adjuvant chemotherapy: The FATSEIN study

    Contemporary Clinical Trials

    (2011)
  • L. Schulmeister et al.

    Symptom management issues in oncology nursing

    The Nursing Clinics of North America

    (2008)
  • N. Aghabati et al.

    The effect of therapeutic touch on pain and fatigue of cancer patients undergoing chemotherapy

    eCAM

    (2010)
  • S. Arslan et al.

    Evaluation of the life quality of the patients with cancer

    Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi

    (2003)
  • Ö. Aslan et al.

    Effect of education on chemotherapy symptoms in cancer patients receiving chemotherapy

    Cumhuriyet Üniversitesi Hemşirelik Yüksekokulu Dergisi

    (2006)
  • M.F. Beck

    Theory & practice of therapeutic massage

    (2006)
  • A.M. Berger

    Factors influencing cancer-related fatigue in a primary care practice

    Home Health Care Consultant

    (2001)
  • N. Beşer et al.

    Anxiety-depression levels and quality of life of patients with lymphoma who are curing chemotherapy

    Cumhuriyet Üniversitesi Hemşirelik Yüksek Okulu Dergisi

    (2003)
  • A. Billhult et al.

    Massage relieves nausea in women with breast cancer who are undergoing chemotherapy

    Journal of Alternative and Complementary Medicine

    (2007)
  • W. Breitbart et al.

    Psychostimulants for cancer-related fatigue

    Journal of the National Comprehensive Cancer Network

    (2010)
  • M.P. Campeau et al.

    Impact of massage therapy on anxiety levels in patients undergoing radiation therapy: Randomized controlled trial

    Journal of the Society for Integrative Oncology

    (2007)
  • G. Can et al.

    Assessment of fatigue in and care needs of Turkish women with breast cancer

    Cancer Nursing

    (2004)
  • D. Cella et al.

    Cancer-related fatigue: Prevalence of proposed diagnostic criteria united states sample of cancer survivors

    Journal of Clinical Oncology

    (2001)
  • S.Y. Chang

    Effects of aroma hand massage on pain, state anxiety and depression in hospice patients with terminal cancer

    Taehan Kanho Hakhoe Chi

    (2008)
  • S. Çınar et al.

    Hemodialysis may cause acute fatigue syndrome?

    Hemşirelik Forumu Dergisi

    (2000)
  • J.H. Clay et al.

    Basic clinical massage therapy, integrating anatomy and treatment

    (2008)
  • C.S. Cleeland et al.

    Assessing symptom distress in cancer patients: The M.D. Anderson symptom inventory

    Cancer

    (2000)
  • J. Cohen

    Statistical power analysis for the behavioral sciences

    (1988)
  • J. Cohen

    A power primer

    Psychological Bulletin

    (1992)
  • J. Currin et al.

    A hospital-based ıntervention using massage to reduce distress among oncology patients

    Cancer Nursing

    (2008)
  • G.A. Curt et al.

    Impact of cancer-related fatigue on the lives of patients: New findings from the fatigue coalition

    The Oncologist

    (2000)
  • E. Ernst

    Complementary therapies in palliative cancer care

    Cancer

    (2001)
  • E. Ernst

    Massage therapy for cancer palliation and supportive care: A systematic review of randomised clinical trials

    Supportive Care in Cancer

    (2009)
  • E. Ernst et al.

    Evidence-based complementary medicine for palliative cancer care: Does it make sense?

    Palliative Medicine

    (2003)
  • D. Fellowes et al.

    Aromatherapy and massage for symptom relief in patients with cancer

    Cochrane Database of Systematic Reviews

    (2004)
  • C. Fernández-Lao et al.

    Attitudes towards massage modify effects of manual therapy in breast cancer survivors: A randomised clinical trial with crossover design

    Eur J Cancer Care (Engl)

    (2012)
  • A.T. Ferrell-Torry et al.

    The use of therapeutic massage as a nursing intervention to modify anxiety and the perception of cancer pain

    Cancer Nursing

    (1993)
  • T.M. Field

    Massage therapy effects

    The American Psychologist

    (1998)
  • J. Finnegan-John et al.

    A systematic review of complementary and alternative medicine ınterventions for the management of cancer-related fatigue

    Integrative Cancer Therapies

    (2013)
  • Cited by (0)

    View full text