Methodological reflections on body–mind intervention studies with cancer patients
Introduction
Cancer patients (CPs) are confronted with several emotional, social, and spiritual problems [1], [2], [3]. To raise their quality of life, CPs are often turning to the use of complementary and alternative medicine (CAM). Worldwide, 29–70% of the general population [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], and 42–50% of CPs and palliative care patients use yearly at least one form of CAM [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26]. Massage and relaxation techniques are the forms of healthcare most commonly used [4], [5], [6], [9], [10], [11], [12], [15], [16], [19], [20], [27].
By means of massage and touches, patients are learned to connect with their feelings, how to deal with their illness, with themselves, and with the world around them, leading to reduction in symptoms and improvement in quality of life [28], [29], [30], [31]. This approach is a part of the mind–body medicine, defined as focusing on the interaction among the brain, mind, body, and behavior, and the powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health [32]. We will use the term body–mind approaches, because the studied interventions are mainly focusing on bodily interventions.
In this article we reflect on six methodological themes, giving insight in the effects of three body–mind interventions studies for CPs. First we present in Box 1 the conclusions from several studies and reviews about the effects of massage, guided imagery, and relaxation training on the well-being of CPs. The conclusion is that a number of these studies show significantly positive effects on the well-being of CPs. However, in the reviews and in the studies, several methodological issues and limitations are discussed, which undermine firm conclusions about the benefits of the interventions for CPs. Some studies show negative effects [47], [69], [76], [96], [100], [101], [33]. Only few studies are measuring the body perception by the patients [2], [3].
A lot of methodological factors may influence the results of body–mind interventions for CPs [90]. It is out-of discussion that these studies would require a firm design, by preference a randomized controlled study [33], [37], [91], [92], [93]. In practice it is not always easy to realize due to e.g. failing or impossible blinding, randomization problems, finding an adequate control group, and small samples [33], [90], [94], [95]. Further, we analyzed the following six methodological themes, as presented in Box 2.
We did three experimental studies on body–mind interventions for CPs: one study about haptotherapy [105], [106], and two studies about relaxing face massage [98], [99]. In this article we discuss the following six methodological themes: (1) the extent of the drop-out; (2) the characteristics of the participating patients, (3) the control on the participation in other complementary interventions; (4) the satisfaction of the participant; (5) the differential effects of the three interventions, and (6) the role of response shift.
Section snippets
Haptotherapy at a day clinic for chemotherapeutical treated CPs
The purpose of this study was to evaluate a haptotherapeutic treatment on the well-being and satisfaction of CPs treated with chemotherapy during day care. Haptotherapy can be seen as a form of complementary care to which touch is central, contributing to the quality of life of patients [31], [107].
Participation and drop out
The three studies contained in total 267 CPs. From them 40% did drop-out of the studies. Based at the data in Table 2 the dropout is higher in the experimental groups than in the control groups, except for the third study. This last study was the most controlled study, strictly guided by the trial office and supervised by the researcher. Based on the drop-out, patients seem more willing to fill in a questionnaire than accepting the offered intervention.
The main reason for the drop-out in the
Discussion and conclusion
We will discuss the six presented methodological reflections, and conclude on a more general level, and discuss the implications and recommendations for the practice of conducting studies with similar intervention in hospitals.
Conflict of interest
We confirm that all patient/personal identifiers have been removed or disguised to ensure anonymity of all patients/persons described. The authors indicated no potential conflict of interest.
Role of the funding source
None.
Acknowledgements
We would like to thank all cooperating patients and staff members who took the time to participate in this study. Especially we thank Dr. Lia van Zuylen (Erasmus MC) for her supporting supervision. Dr. Melanie Neumann was very helpful to complete the manuscript.
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- 1
During the studies at the Helen Dowling Institute: Center for Psycho-oncology, Utrecht, The Netherlands.
- 2
During the study Erasmus MC, Rotterdam, the Netherlands.
- 3
During the study Leiden University Medical Center, Leiden, the Netherlands.