Massage in der Versorgung von Brustkrebspatientinnen - Eine systematische Analyse der aktuellen Studienlage

Zusammenfassung

Das Mammakarzinom ist das häufigste Malignom der Frau. Obwohl die Therapie während der letzten Jahrzehnte stark verbessert wurde, leiden die Patientinnen oftmals an erheblichen psychischen Beeinträchtigungen wie Depressionen und Angststörungen. Mit steigender Tendenz werden daher in Europa und den Vereinigten Staaten zusätzlich zur Standardbehandlung komplementäre Therapien eingesetzt. Unter diesen ist die Massage eine der ältesten und meist angewandten Therapieformen. Verschiedene Massagetechniken von der klassischen Massage bis zur Fußreflexzonentherapie werden vorgestellt. Vierzehn Studien über Massage bei Tumorpatienten, vorwiegend Brustkrebspatientinnen, wurden in PubMed identifiziert und ausgewertet. Dreizehn Studien erfolgten nach kontrolliert randomisiertem Design und wurden in den Jahren 1990 bis 2006 publiziert. Die Massagetherapie bewirkte in den meisten Studien eine signifikante Reduktion der Schmerzwahrnehmung und Ängstlichkeit. Eine Verringerung des subjektiven Stresserlebens und ein entspannender Effekt konnte in fünf Studien in der Massagegruppe gezeigt werden. Zusätzlich zeigte sich in jeweils drei Studien eine signifikante Reduktion von Übelkeit und Fatigue. Keine konsistenten Ergebnisse wurden dagegen für den Einfluss der Massage auf die Depressivität der Patienten gefunden. Die vorliegenden Studien weisen einige methodische Schwächen auf. Die Zahl der kontrolliert randomisierten Studien ist immer noch sehr gering. Aus diesem Grunde besteht ein großer Forschungsbedarf auf diesem Gebiet an methodisch hochwertigen Studien nach den Kriterien der evidence-based medicine. Insgesamt wirkte sich die Massagetherapie positiv auf die Lebensqualität der Tumorpatienten aus. Es finden sich in der Literatur keine Hinweise für eine Streuung von Tumorzellen durch die Massage. Daher kann eine ergänzende Massagetherapie zusätzlich zur konventionellen Behandlung bei Brustkrebspatientinnen empfohlen werden.

Abstract

Treatment of breast cancer, the most frequently occurring malignancy in women, has become more effective in the past decades. Nevertheless, many patients suffer from attendant psychological disturbances such as depression and anxiety. Therefore, the number of patients using additional complementary medicine is increasing in Europe and the United States. One of the most frequently applied traditional therapies is massage therapy. Several massage techniques from Swedish massage to foot reflexology are described here. Fourteen studies dealing with massage therapy for cancer patients, most of them breast cancer patients, were identified by a PubMed research and reviewed. All studies except one were randomized and controlled, and were published between 1990 and 2006. In most of the studies there was evidence for the efficacy of massage in providing a significant reduction of pain and anxiety. In five studies relaxation and reduction of stress in the massage group was also observed. In three trials nausea and fatigue were found to be significantly reduced. Inconsistent results were found with regard to the influence of massage on depression. The reviewed studies had some methodological weaknesses. The number of randomized controlled trials is still small. There is a need for further studies with strong standards to investigate the efficacy of massage in cancer patients. In summary, positive effects on the quality of life of cancer patients were found in most of the studies. No risk of tumor cell spread was reported. Therefore, the use of massage therapy in addition to conventional treatments is recommended for patients suffering from breast cancer.

Schlüsselwörter

Lebensqualität - Angst - Depression - Schmerz - Alternativmedizin

Key words

quality of life - anxiety - depression - pain - complementary medicine

Literatur

• 1 Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. in Zusammenarbeit mit dem RKI (Hrsg) .Krebs in Deutschland. 5. überarbeitete, aktualisierte Auflage. Saarbrücken; 2006
• 2 http://www.rki.de/cln_011/nn_226040/DE/Content/GBE/Gesundheitsberichterstattung/Publikation/Themenhefte/brustkrebs__inhalt.html am 12.10.06 am 12.10.06. 
• 3 Kreienberg (Hrsg) R. Interdisziplinäre S‐3-Leitlinie für die Diagnostik und Therapie des Mammakarzinoms der Frau. Wien, New York; Zuckschwerdt 2004
• 4 Faller H, Olshausen B, Flentje M. Emotional distress and needs for psychosocial support among breast cancer patients at start of radiotherapy.  Psychother Psychosom Med Psychol. 2003;  53 229-235
• 5 Hartl K, Janni W, Kastner R, Sommer H, Stauber M. Long-term quality of life, body image and anxiety in women after breast cancer.  Geburtsh Frauenheilk. 2003;  63 446-452
• 6 Yen J Y, Ko C H, Yen C F, Yang M J, Wu C Y, Juan C H, Hou M F. Quality of life, depression, and stress in breast cancer women outpatients receiving active therapy in Taiwan.  Psychiatry Clin Neurosci. 2006;  60 147-153
• 7 Grimm A, Voigt B, Schneider A, Winzer K J, Reisshauer A, Klapp B F, Rauchfuß M. Psychosocial results in psychooncological care for patients with breast cancer.  Geburtsh Frauenheilk. 2006;  66 51-58
• 8 Lu W, Cui Y, Zheng Y, Gu K, Cai H, Li Q, Zheng W, Shu X O. Impact of newly diagnosed breast cancer on quality of life among Chinese women.  Breast Cancer Res Treat. 2007;  102 201-210
• 9 Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study.  BMJ. 2005;  330 702
• 10 Rauchfuss M, Blohmer J U, Neises M, Danzer G, Klapp B F. Psycho-oncological care in a breast cancer center.  Geburtsh Frauenheilk. 2004;  64 1158-1166
• 11 Alderete E, Juarbe T C, Kaplan C P, Pasick R, Perez-Stable E J. Depressive symptoms among women with an abnormal mammogram.  Psychooncology. 2006;  15 66-78
• 12 Okamura M, Yamawaki S, Akechi T, Taniguchi K, Uchitomi Y. Psychiatric disorders following first breast cancer recurrence: prevalence, associated factors and relationship to quality of life.  Jpn J Clin Oncol. 2005;  35 302-309
• 13 Love A W, Grabsch B, Clarke D M, Bloch S, Kissane D W. Screening for depression in women with metastatic breast cancer: a comparison of the Beck Depression Inventory Short Form and the Hospital Anxiety and Depression Scale.  Aust N Z J Psychiatry. 2004;  38 526-531
• 14 Stark D P, House A. Anxiety in cancer patients.  Br J Cancer. 2000;  83 1261-1267
• 15 Mehnert A, Koch U. Prevalence of acute and post-traumatic stress disorder and comorbid mental disorders in breast cancer patients during primary cancer care: a prospective study.  Psychooncology. 2007;  16 181-188
• 16 Grabsch B, Clarke D M, Love A, McKenzie D P, Snyder R D, Bloch S. et al . Psychological morbidity and quality of life in women with advanced breast cancer: a cross-sectional survey.  Palliat Support Care. 2006;  4 47-56
• 17 Hartmann U, Kluge A, Ring C, Reuss-Borst M. Improvement of anxiety and depression in women with breast cancer during inpatient oncological rehabilitation - results of a prospective study.  Rehabilitation (Stuttg). 2006;  45 88-94
• 18 Weis J, Domann U. Interventions in the rehabilitation of breast cancer patients - a critical literature review of the state of the art.  Rehabilitation (Stuttg). 2006;  45 129-145
• 19 Gutenbrunner C, Glaesener J-J. Rehabilitation, Physikalische Medizin und Naturheilverfahren. Heidelberg; Springer Medizin Verlag 2007
• 20 Werner G, Diehl R, Klimczyk K, Rude J. Checkliste physikalische und rehabilitative Medizin - Naturheilverfahren. Stuttgart, New York; Georg Thieme Verlag 2000
• 21 Cherkin D C, Eisenberg D, Sherman K J, Barlow W, Kaptchuk T J, Street J, Deyo R A. Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain.  Arch Intern Med. 2001;  161 1081-1088
• 22 Preyde M. Effectiveness of massage therapy for subacute low-back pain: a randomized controlled trial.  CMAJ. 2000;  162 1815-1820
• 23 Kalauokalani D, Cherkin D C, Sherman K J, Koepsell T D, Deyo R A. Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects.  Spine. 2001;  26 1418-1424
• 24 Walach H, Guthlin C, Konig M. Efficacy of massage therapy in chronic pain: a pragmatic randomized trial.  J Altern Complement Med. 2003;  9 837-846
• 25 Diego M A, Field T, Hernandez-Reif M, Hart S, Brucker B, Field T, Burman J. Spinal cord patients benefit from massage therapy.  Int J Neurosci. 2002;  112 133-142
• 26 Hernandez-Reif M, Field T, Krasnegor J, Thekston H. Lower back pain is reduced and range of motion increased after massage therapy.  Int J Neurosci. 2001;  106 131-145
• 27 Moyer C A, Rounds J, Hannum J W. A meta-analysis of massage therapy research.  Psychol Bull. 2004;  130 3-18
• 28 Schliack H, Harms E. Bindegewebsmassage nach Dicke. Stuttgart; Hippokrates Verlag GmbH 1996
• 29 Cooke B, Ernst E. Aromatherapy: a systematic review.  Br J Gen Pract. 2000;  50 493-496
• 30 Fellowes D, Barnes K, Wilkinson S. Aromatherapy and massage for symptom relief in patients with cancer.  Cochrane Database Syst Rev. 2004;  (2) CD002287
• 31 Muller-Oerlinghausen B, Berg C, Scherer P, Mackert A, Moestl H P, Wolf J. Effects of slow-stroke massage as complementary treatment of depressed hospitalized patients.  Dtsch Med Wochenschr. 2004;  129 1363-1368
• 32 Furlan A D, Brosseau L, Imamura M, Irvin E. Massage for low back pain.  Cochrane Database Syst Rev. 2002;  (2) CD001929
• 33 Field T. Massage therapy.  Med Clin North Am. 2002;  86 163-171
• 34 Field T, Diego M A, Hernandez-Reif M, Schanberg S, Kuhn C. Massage therapy effects on depressed pregnant women.  J Psychosom Obstet Gynaecol. 2004;  25 115-122
• 35 Fraser J, Kerr J R. Psychophysiological effects of back massage on elderly institutionalized patients.  J Adv Nurs. 1993;  18 238-245
• 36 Imura M, Misao H, Ushijima H. The psychological effects of aromatherapy-massage in healthy postpartum mothers.  J Midwifery Womens Health. 2006;  51 e21-7
• 37 Mok E, Woo C P. The effects of slow-stroke back massage on anxiety and shoulder pain in elderly stroke patients.  Complement Ther Nurs Midwifery. 2004;  10 209-216
• 38 Song R H, Kim D H. The effects of foot reflexion massage on sleep disturbance, depression disorder, and the physiological index of the elderly.  Taehan Kanho Hakhoe Chi. 2006;  36 15-24
• 39 Bost N, Wallis M. The effectiveness of a 15 minute weekly massage in reducing physical and psychological stress in nurses.  Aust J Adv Nurs. 2006;  23 28-33
• 40 Lee Y M. Effect of self-foot reflexology massage on depression, stress responses and immune functions of middle aged women.  Taehan Kanho Hakhoe Chi. 2006;  36 179-188
• 41 Ironson G, Field T, Scafidi F, Hashimoto M, Kumar M, Kumar A, Price A, Goncalves A, Burman I, Tetenman C, Patarca R, Fletcher M A. Massage therapy is associated with enhancement of the immune system's cytotoxic capacity.  Int J Neurosci. 1996;  84 205-217
• 42 McKechnie A A, Wilson F, Watson N, Scott D. Anxiety-States: a preliminary report on the value of connective tissue massage.  J Psychosom Res. 1983;  27 125-129
• 43 Puustjarvi K, Airaksinen O, Pontinen P J. The effects of massage in patients with chronic tension headache.  Acupunct Electrother Res. 1990;  15 159-162
• 44 Lemstra M, Olszynski W P. The effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia: a randomized controlled trial.  Clin J Pain. 2005;  21 166-174
• 45 Diego M A, Field T, Hernandez-Reif M, Shaw K, Friedman L, Ironson G. HIV aldolescents show improved immune function following massage therapy.  Int J Neurosci. 2001;  106 35-45
• 46 Hernandez-Reif M, Martinez A, Field T, Quintero O, Hart S, Burman I. Premenstrual symptoms are relieved by massage therapy.  J Psychosom Obstet Gynaecol. 2000;  21 9-15
• 47 Field T, Peck M, Hernandez-Reif M, Krugman S, Burman I, Ozment-Schenck L. Postburn itching, pain, and psychological symptoms are reduced with massage therapy.  J Burn Care Rehabil. 2000;  21 189-193
• 48 Diego M A, Field T, Sanders C, Hernandez-Reif M. Massage therapy of moderate and light pressure and vibrator effects on EEG and heart rate.  Int J Neurosci. 2004;  114 31-44
• 49 Chang M Y, Wung S Y, Chen C H. Effects of massage on pain and anxiety during labour: a randomized trial in Taiwan.  J Adv Nurs. 2002;  38 68-73
• 50 Field T, Hernandez-Reif M, Hart S, Theakston H, Schanberg S, Kuhn C. Pregnant women benefit from massage therapy.  J Psychosom Obstet Gynaecol. 1999;  20 31-38
• 51 Field T, Hernandez-Reif M, Taylor S, Quintino O, Burman I. Labor pain is reduced by massage therapy.  J Psychosom Obstet Gynaecol. 1997;  18 286-291
• 52 Glover V, Onozawa K, Hodgkinson A. Benefits of infant massage for mothers with postnatal depression.  Semin Neonatol. 2002;  7 495-500
• 53 Field T, Schanberg S, Kuhn C, Field T, Fierro K, Henteleff T, Mueller C, Yando R, Shaw S, Burman I. Bulimic adolescents benefit from massage therapy.  Adolescence. 1998;  33 555-563
• 54 Field T, Hernandez-Reif M, Diego M, Schanberg S, Kuhn C. Cortisol decreases and serotonin and dopamine increase following massage therapy.  Int J Neurosci. 2005;  115 1397-1413
• 55 Lawler S P, Cameron L D. A randomized, controlled trial of massage therapy as a treatment for migraine.  Ann Behav Med. 2006;  32 50-59
• 56 Olney C M. The effect of therapeutic back massage in hypertensive persons: a preliminary study.  Biol Res Nurs. 2005;  7 98-105
• 57 Diego M A, Field T, Hernandez-Reif M. Vagal activity, gastric motility, and weight gain in massaged preterm neonates.  J Pediatr. 2005;  147 50-55
• 58 Rush A J, Linden M, Zobel A. Vagus nerve stimulation. A potential therapy for chronic/recurrent depression?.  Fortschr Neuron Psychiatr. 2002;  70 297-302
• 59 Dieter J N, Field T, Hernandez-Reif M, Emory E K, Redzepi M. Stable preterm infants gain more weight and sleep less after five days of massage therapy.  J Pediatr Psychol. 2003;  28 403-411
• 60 Vickers A J, Cassileth B R. Unconventional therapies for cancer and cancer-related symptoms.  Lancet Oncol. 2001;  2 226-232
• 61 Cassileth B R, Deng G. Complementary and alternative therapies for cancer.  Oncologist. 2004;  9 80-89
• 62 Buettner C, Kroenke C H, Phillips R S, David R B, Eisenberg D M, Holmes M D. Correlates of use of different types of complementary and alternative medicine by breast cancer survivors in the nurses' health study.  Breast Cancer Res Treat. 2006;  100 219-227
• 63 Ernst E. The safety of massage therapy.  Rheumatology (Oxford). 2003;  42 1101-1106
• 64 Corbin L. Safety and efficacy of massage therapy for patients with cancer.  Cancer Control. 2005;  12 158-164
• 65 Calenda E. Massage therapy for cancer pain.  Curr Pain Headache Rep. 2006;  10 270-274
• 66 Löffler G, Petrides E P. Biochemie und Pathobiochemie. Berlin, Heidelberg, New York; Springer Verlag 2003
• 67 http://www2.mol-med.uni-freiburg.de/fsp-tumorinvasion/projects.html
• 68 Rozycki B, Lipowsky R, Weikl T R. Adhesion of membranes with active stickers.  Phys Rev Lett. 2006;  96 048101
• 69 Quattrin R, Zanini A, Buchini S, Turello D, Annunziata M A, Vidotti C, Colombatti A, Brusaferro S. Use of reflexology foot massage to reduce anxiety in hospitalized cancer patients in chemotherapy treatment: methodology and outcomes.  J Nurs Manag. 2006;  14 96-105
• 70 Soden K, Vincent K, Craske S, Lucas C, Ashley S. A randomized controlled trial of aromatherapy massage in a hospice setting.  Palliat Med. 2004;  18 87-92
• 71 Cassileth B R, Vickers A J. Massage therapy for symptom control: outcome study at a major cancer center.  J Pain Symptom Manage. 2004;  28 244-249
• 72 Post-White J, Kinney M E, Savik K, Gau J B, Wilcox C, Lerner I. Therapeutic massage and healing touch improve symptoms in cancer.  Integr Cancer Ther. 2003;  2 332-344
• 73 Wilkie D J, Kampbell J, Cutshall S, Halabisky H, Harmon H, Johnson L P, Weinacht L, Rahe-Marona M. Effects of massage on pain intensity, analgesics and quality of life in patients with cancer pain: a pilot study of a randomized clinical trial conducted within hospice care delivery.  Hosp J. 2000;  15 31-53
• 74 Weinrich S P, Weinrich M C. The effect of massage on pain in cancer patients.  Appl Nurs Res. 1990;  3 140-145
• 75 Stephenson N L, Weinrich S P, Tavakoli A S. The effects of foot reflexology on anxiety and pain in patients with breast and lung cancer.  Oncol Nurs Forum. 2000;  27 67-72
• 76 Stephenson N, Dalton J A, Carlson J. The effect of foot reflexology on pain in patients with metastatic cancer.  Appl Nurs Res. 2003;  16 284-286
• 77 Smith M C, Kemp J, Hemphill L, Vojir C P. Outcomes of therapeutic massage for hospitalized cancer patients.  J Nurs Scholarsh. 2002;  34 257-262
• 78 Grealish L, Lomasney A, Whiteman B. Foot massage. A nursing intervention to modify the distressing symptoms of pain and nausea in patients hospitalized with cancer.  Cancer Nurs. 2000;  23 237-243
• 79 Ahles T A, Tope D M, Pinkson B, Walch S, Hann D, Whedon M, Dain B, Weiss J E, Mills L, Silberfarb P M. Massage therapy for patients undergoing autologous bone marrow transplantation.  J Pain Symptom Manage. 1999;  18 157-163
• 80 Corner J, Cawley N, Hildebrand S. An evaluation of the use of massage and essential oils on the wellbeing of cancer patients.  Int J Palliat Nurs. 1995;  1 67-73
• 81 Hernandez-Reif M, Ironson G, Field T, Hurley J, Katz G, Diego M, Weiss S, Fletcher M A, Schanberg S, Kuhn C, Burman I. Breast cancer patients have improved immune and neuroendocrine functions following massage therapy.  J Psychosom Res. 2004;  57 45-52
• 82 Hernandez-Reif M, Field T, Ironson G, Beutler J, Vera Y, Hurley J, Fletcher M A, Schanberg S, Kuhn C, Fraser M. Natural killer cells and lymphocytes increase in women with breast cancer following massage therapy.  Int J Neurosci. 2005;  115 495-510
• 83 Sims S. Slow stroke back massage for cancer patients.  Nurs Times. 1986;  82 47-50
• 84 Lengacher C A, Bennett M P, Kip K E, Keller R, LaVance M S, Smith L S, Cox C E. Frequency of the use of complementary and alternative medicine in women with breast cancer.  Oncol Nurs Forum. 2002;  29 1445-1452
• 85 MacDonald G. Medicine Hands: Massage Therapy for People with Cancer. Florida; Findhorn Press 1999