Methodological reflections on body–mind intervention studies with cancer patients

https://doi.org/10.1016/j.pec.2010.12.003Get rights and content

Abstract

Objective

Methodological reflection on the content, results and limitations of three body–mind intervention studies with cancer patients (CPs) in order to improve the quality of studies on body–mind interventions and to raise the potential value for CPs.

Methods

A secondary analysis of a study on haptotherapy and two studies applying relaxing face massage, using a variety of well-being effect measures. Six methodological themes are discussed: (1) drop-out; (2) characteristics of participating patients, (3) participation of patients in other complementary interventions; (4) satisfaction of participants; (5) effects of the three interventions, and (6) role of response shift.

Results

The three interventions showed limited effects after controlling for relevant confounding factors. They are mainly the small sample sizes, the low intensity of the intervention, the possible inadequate measure moments and the use of other CAM that may be responsible for the absence of effects.

Conclusions

Body–mind interventions require more methodological reflections to develop attractive and effective interventions for CPs. Attention needs to be paid to measuring short term effects, practically fitting research designs, and response shift.

Practice implications

Interventions should be intensive, repeated and not too short. The implementation of interventions requires attention to several organizational factors in the health care.

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.

References (126)

  • R.W. Petersen et al.

    Preventing anxiety and depression in gynaecological cancer: a randomised controlled trial

    Brit J Obs Gyn

    (2002)
  • M. Hernandez-Reif et al.

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

    Psychosom Res

    (2004)
  • C.D. Myers et al.

    The value of massage therapy In cancer care

    Hematol Oncol Clin North Am

    (2008)
  • T.A. Ahles et al.

    Massage therapy for patients undergoing autologous bone marrow transplantation

    J Pain Sympt Manage

    (1999)
  • B.R. Cassileth et al.

    Massage therapy for symptom control: outcome study at a major cancer centre

    J Pain Symp Contr

    (2004)
  • L. Baider et al.

    Psychological intervention in cancer patients: a randomized study

    Gen Hosp Psychiatry

    (2001)
  • S. Graffam et al.

    A comparison of two relaxation strategies for the relief of pain and its distress

    J Pain Symp Manage

    (1987)
  • E.F. Targ et al.

    The efficacy of a mind–body–spirit group for women with breast cancer: a randomized controlled trial

    Gen Hosp Psychiatry

    (2002)
  • M. Remie et al.

    Ruimte voor jezelf. Evaluatie groepsbegeleiding voor mensen met kanker door het Helen Dowling Instituut

    (2000)
  • J.C. Holland

    Psycho-oncology

    (1998)
  • J.C.J.M. Haes et al.

    Psychologische patiëntenzorg in de oncologie [Psychological patient care in the oncology]

    (2001)
  • A.P. Visser et al.

    Pleidooi voor implementatie, opleiding, voorlichting en onderzoek op het terrein van complementaire zorg, (Plea for complementary care in the Netherlands)

    Tijdschr Gezondh Wetensch

    (2005)
  • H. Ni et al.

    Utilization of complementary and alternative medicine by United States adults: results from the 1999 national health interview survey

    Med Care

    (2002)
  • P.M. Barnes et al.

    Complementary and alternative medicine use among adults: United States

    Adv Data

    (2004)
  • V. Singh et al.

    The prevalence, patterns of usage and people's attitude towards complementary and alternative medicine (CAM) among the Indian community in Chatsworth, South Africa

    BMC Complement Altern Med

    (2004)
  • M. Tan et al.

    Trends in complementary and alternative medicine in eastern Turkey

    J Altern Complement Med

    (2004)
  • C.M. Gray et al.

    Complementary and alternative medicine use among health plan members. A cross-sectional survey

    Eff Clin Pract

    (2002)
  • R. Crommentuyn

    Het reguliere bolwerk onder druk (The regular care under pressue)

    Medisch Contact

    (2000)
  • D.M. Eisenberg et al.

    Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up National Survey

    J Am Med Assoc

    (1998)
  • T.J. Tijmstra et al.

    Keuzen in de zorg, meningen van publiek en professie vergeleken (choices in the care)

    Med Cont

    (1993)
  • World Health Organization

    Traditional medicine: growing needs and potential. WHO Policy Perspectives and Medicines, no. 2

    (2002)
  • M.L. Jordan et al.

    Quality of life and patterns of nontraditional therapy use by patients with cancer

    Oncol Nurs Forum

    (2001)
  • E. Ernst et al.

    The prevalence of complementary/alternative medicine in cancer: a systematic review

    Cancer

    (1998)
  • F.S.A.M. van Dam

    Houtsmuller is in, Moerman is uit: een onderzoek naar het gebruik van alternatieve diëten en andere alternatieve behandelingen door kankerpatiënten in 1999. (Use of diet and other alternative care by Dutch cancer patients)

    Nederl Tijdschr Geneesk

    (1999)
  • S.C. Tough et al.

    Complementary and alternative medicine use among colorectal cancer patients in Alberta, Canada

    Altern Ther Health Med

    (2002)
  • Wilkes, E. 1992. Complementary therapies in hospice and palliative care. Unpublished study available from: Trent...
  • N. Zouwe et al.

    Alternatieve geneeswijzen bij kanker: omvang en achtergronden van het gebruik

    Nederl Tijdschr Geneesk

    (1994)
  • N. Zouwe et al.

    De betekenis van alternatieve behandelwijzen voor patiënten met kanker

  • 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)
  • P Turton

    Touch me, feel me, heal me

    Nurs Times

    (1989)
  • K. Barnett

    A theoretical construct of the concepts of touch as they relate to nursing

    Nurs Res

    (1972)
  • S. Wilkinson et al.

    An evaluation of aromatherapy massage in palliative care

    Pall Med

    (1999)
  • W. Pollman-Wardenier et al.

    Verkenningen in de haptonomie (Exploration in haptonomy)

    (1993)
  • National Institute of Health, Report mind-body medicine, Washington USA;...
  • M.E.H. Busch et al.

    Richtlijn complementaire zorg [Guideline complementary care]. Utrecht: IKMN

    Complement Med

    (2010)
  • A. Bardia et al.

    Efficacy of complementary and alternative medicine therapies in relieving cancer pa systematic review

    J Clin Oncol

    (2006)
  • G. Deng et al.

    Integrative oncology: complementary therapies for pain, anxiety and mood disturbance

    CA Cancer J Clin

    (2005)
  • E. Ernst

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

    Support Care Cancer

    (2009)
  • D. Fellowes et al.

    Aromatherapy and massage for symptom relief in patients with cancer

    Cochrane Database

    (2004)
  • P.B. Jacobsen et al.

    Efficacy and costs of two forms of stress management training for cancer patients undergoing chemotherapy

    J Clin Oncol

    (2002)
  • 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.

    View full text