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Effects of Massage Therapy on Preoperative Anxiety and Postoperative Pain in Cancer Patients Undergoing Port Implantation Jennifer E. Rosen, MD FACS (Principal Investigator) This work was supported by a grant from

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Effects of Massage Therapy on Preoperative Anxiety and Postoperative Pain in Cancer Patients Undergoing Port Implantatio

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Effects of Massage Therapy on Preoperative Anxiety and Postoperative Pain in Cancer Patients Undergoing Port Implantation

Jennifer E. Rosen, MD FACS

(Principal Investigator)

this work was supported by a grant from
This work was supported by a grant from

Massage Therapy Foundation500 Davis Street, Suite 900Evanston, IL 60201Phone: (847)869-5019Fax: (847)864-1178

  • At Boston Medical Center, cancer patients often enter care with significantly larger tumors than patients at other nearby Boston hospitals.
  • Experience debilitating side effects and lower quality of life (QOL) 1
  • Exacerbated for racial/ethnic minorities
  • Treatment often proves unaffordable or is inaccessible to our low-income patients

1. Garcia, S.F., et al., Standardizing patient-reported outcomes assessment in cancer clinical trials: a patient-reported outcomes measurement information system initiative. J Clin Oncol, 2007. 25(32): p. 5106-12.

2. McNeill, J.A., J. Reynolds, and M.L. Ney, Unequal quality of cancer pain management: disparity in perceived control and proposed solutions. Oncol Nurs Forum, 2007. 34(6): p. 1121-8.

cancer chemotherapy treatment options
Cancer chemotherapy treatment options
  • Peripheral IV’s
  • PICC lines
  • port
implantable venous access device aka port
Implantable venous access device (aka port)
  • Permanent intravenous device (IV)
    • Delivers chemotherapy
    • Allows repeated withdrawal of blood samples
In 2006 and 2007, there were approximately 225 and 250 cancer patients who received port implantation at BMCPorts…
boston medical center moakley building preoperative suite entry into the operating room
Boston Medical Center: Moakley Building Preoperative SuiteEntry into the operating room

Outpatient surgical procedure

boston medical center moakley building operative suite15
Boston Medical Center: Moakley Building Operative Suite
  • Patients remain conscious, keep their head rotated 90 degrees to one side and remain very still during this delicate procedure, which takes approximately 60 min
outcomes of procedure
Outcomes of Procedure
  • Headaches, muscle stiffness and neck and shoulder pain
  • Often the first surgical procedure for cancer patients at the beginning of their treatment, they often have significant levels of pre-procedure anxiety
  • Need for safe, efficacious, and cost-effective interventions to reduce anxiety and pain related to port placement
cam survey descriptive data
CAM Survey: Descriptive Data

CancerDiagnosis (N = 45)

N = 54

  • Male: 43%/Female 57%
  • Have a PCP: 94%
  • Diabetic: 16%
  • High BP: 39%
  • High Cholesterol: 34%




patient health ratings









Patient Health Ratings


One person rated themselves both of Good and Fair health

why are you here today
Why Are You Here Today?

33% other

55% getting treated

8% done with treatment

4% about to get treatment


cam facts
CAM Facts
  • Used at least one CAM ever: 80%

- 36% Male

- 64% Female

  • Used CAM in past 12 months: 41%
cams used
Multivitamins: 27 people

Prayer: 18 people

Herbal Tea: 17 people

Chiropraxy/Massage: 14 people

Herbal supplements or chinese herbs: 11 people

Spiritual or religious healing: 10 people

Cod liver oil: 9 people

Garlic: 7 people

Home/ fold remedies, poultices: 7 people

Wore something: 6 people

Ate a special diet: 6 people

Homeopathic meds: 5 people

Aloe: 5 people

Acupuncture: 4 people

Hypnosis, meditation, or yoga: 4 people

Other types of special diets: 3 people

Valerian (all heal), Ginseng, and Cascara: 2 people for each

CAMs Used

Only one person used each of the following:Ayurveda, Chelation therapy,

Coral calcium, Ephedra (ma huang), Flax seed oil, Ginger, Gogi,

Nutrition drinks, Pinea rice, Primrose oil, and Wheat grass

cams used in last 12 months
CAMs used in last 12 months
  • Used CAM in past 12 months: 41%

- excluding multivitamin use : 37%

- excluding prayer : 39%

- excluding prayer and multivitamin use: 35%

  • Of those people that had used CAM in past 12 months, 68% (15/22) had used more than one CAM therapy.
massage therapy
Massage therapy
  • Excluding prostatic massage, only 100
  • Excluding treatment for lymphedema, only 70
  • Periprocedural: mostly biopsy, cardiac catheterization
study aims
Study Aims
  • Primary: to determine the feasibility and efficacy of massage therapy for reducing pre-operative anxiety and post-operative pain among predominantly low income minority cancer patients undergoing surgical placement of a port
  • Secondary: assess duration of surgical procedure, amount of anesthetic used, and related costs
  • 9 month randomized clinical trial
  • 60 Patients
  • 2:1 Randomization (Massage Therapy or Control)
  • Data collection blinded to study group, massage therapist blinded to data collection, surgeon blinded to both
study population
Study Population
  • Inclusion
    • 18 years of age and older
    • All languages and ethnicities
    • Within one month of cancer diagnosis
    • Scheduled to undergo, but have not yet received, port implantation by Dr. Jennifer Rosen
    • Have the ability to understand and sign a written informed consent
  • Exclusion
    • Unable or unwilling to provide consent
subject recruitment
Subject Recruitment
  • Boston Medical Center
  • All patients undergoing port insertion by Dr. Jennifer Rosen identified from her operative bookings
  • During time frame that massage therapist was available
  • Copy of consent form and Baseline Questionnaire mailed to patients scheduled for the port-a-cath procedure
  • Contact patients one day prior to surgery to assess interest and to have them come in at least 1 hour prior to scheduled surgery
intervention randomization
Intervention: randomization
  • Massage Therapy
  • Control = Empathic Support Conversation
massage therapy protocol
Massage Therapy Protocol
  • Constituted panel of two licensed massage therapists and an expert in CIM clinical trials along with the principal investigator
  • Systematic review of lay and scientific literature on massage therapy for periprocedural pain and anxiety
  • Panel members reviewed all materials
  • Panel members went into operating room to observe a series of actual port implantations, then met to revise massage therapy protocol based on their experience
  • Panel met twice to draft protocol based upon their experience and the literature
  • Iterative revisions and consensus
massage therapy36
Massage Therapy
  • Licensed Professional Massage Therapist
  • Twenty minute pre-procedure massage, twenty minute post-procedure massage
pre port massage 20 minutes
Pre port massage – 20 minutes
  • Patient is supine in bed or chair. Effleurage strokes from hand to shoulders 3 times. Effleurage shoulder joint 3 times. Gentle compression to shoulders. Slide back down to hand.
  • Hand massage acupressure points LI 4, P6
  • Repeat as above on the other side.
  • Gently rock down body to feet. Foot Massage each foot accessing reflex points spinal, neck, shoulder chest and solar plexus.
  • Finish with hold.
post port massage 20 minutes
Post port massage – 20 minutes
  • Patient is in chair or bed, supine. Begin with Cranial Balance and cradle hold.
  • Gentle finger tip massage whole scalp up to the forehead.
  • Light stroking effleurage over the forehead.
  • Circular light strokes over the temple region, finishing with a slight compression hold.
  • Effleurage down sides of neck with gentle strokes.
  • Gently light downward pressure to shoulders and finish with a cranial hold.
  • Effleurage shoulder to fingertips 3 times
  • Shoulders down the arms through the hands: compression holds 3 times.
  • Hand massage acupressure points LI 4, P 6
  • Repeat on the other side.
  • If time allows hold feet, apply gentle compression.
  • Empathic Support Conversation

Lang EV et al; Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. The Lancet Vol. 355 April 19 2000 pp 1486-1490.

study instruments
Study instruments
  • Self-reported health
  • Sociodemographics: age, gender, diagnosis, insurance status, income, language spoken, religious preference, country of origin, etc.
  • Expectations regarding massage and control for pain and anxiety
  • STAI (State Trait and Anxiety Inventory)
  • Likert 11 point pain scale
data collection
Data Collection:

Informed Consent and Baseline Questionnaire

Time 1: Preoperative

20 Min Intervention

Time 2: Preoperative

post first intervention

Pain scale and State Trait Anxiety Inventory (STAI)

Surgery: Port Insertion (45-60 min)

Pain scale and State Trait Anxiety Inventory (STAI)

Time 3: Postoperative

pre-second intervention

20 Min Intervention

Time 4: Postoperative

post-second intervention

Pain scale and State Trait Anxiety Inventory (STAI)

Time 5: One day later

Pain scale and State Trait Anxiety Inventory (STAI)

primary outcomes
Primary Outcomes
  • Feasibility Measures
    • Time to recruit 60 subjects
    • Retention
    • % racial/ethnic minorities
  • Pain (0-10) scale
  • Anxiety (STAI scale)
secondary outcomes
Secondary Outcomes
  • Pain Medication Use
  • Adverse Events
covariates measured
Covariates Measured
  • Sociodemographics
  • Expectations surrounding massage and empathic control
participant flow chart

Assessed for eligibility


Excluded (n=18)

Did not meet inclusion criteria (n=13 )

Declined to participate (n=5 )



Massage Therapy

(n=26 )


(n=8 )

Participant Flow Chart

Sample for Analysis:

Baseline (n=34)

Pre-Surgery (n=30)

Post-Surgery 1 (n=33)

Post-Surgery 2 (n=27)

Post-Surgery 3 (n=15)

baseline characteristics
Baseline Characteristics:
  • 17 males, 16 females (N=33)
  • Mean age 54.75 (range 28-84)
baseline characteristics52
Baseline Characteristics:




baseline characteristics54
Baseline characteristics:


Hispanic identification

Language spoken

baseline characteristics55
Baseline characteristics

Experience with massage


Expectations of helpfulness of interventions

Rating of overall health

34 patients randomized

2 patients received postoperative intervention only

4 patients dropped out after first intervention

3 dropped out of intervention but participated in data collection

1 dropped out of both intervention and data collection

study outcomes
No adverse events

Interim analysis currently in progress

No major deviations

Feasibility: anticipate completion of recruitment to 60 patients within 5 months

Study Outcomes:
Change in staff:

Massage Therapist

Research Assistant

Maternity Leave of the principal investigator

IRB approval 

Higher percentage of non-English speaking patients than expected.

short form for IRB consent 

Scheduling and conduct issues

OR efficiency

Late arrivals

OR holding area – precious commodity

Staff/nursing buy-in

Massage Therapist availability, pay by block time

  • Control
  • Small sample size
  • Blinding
  • Use of self-report measures
future research
Future research
  • Adequately powered randomized controlled comparative effectiveness study of massage therapy versus usual care
    • Serum markers/mechanism of action
    • Additional stressors i.e. medicolegal
    • Longer-term study incorporating self-taught or caregiver massage and overall cancer care outcome
  • Extend to additional perioperative settings
    • Thyroid surgery
    • Outpatient procedures i.e. biopsies
thanks to our program project team
Thanks to our program project team:
  • Robert Saper MD MPH (Co-investigator)
  • Michele Bouchard, LMT, NCBTMB (Massage Therapist)
  • Lynne Mullen, LMT (Massage Therapist)
  • Rebecca L. Lawrence, MSW/MPH (Research Assistant)
  • Paula Gardiner MD (CIM researcher)
  • Gheorghe Doros PhD (biostatistician)