You are on page 1of 8

Applied Nursing Research 26 (2013) 210217

Contents lists available at ScienceDirect

Applied Nursing Research


journal homepage: www.elsevier.com/locate/apnr

Effects of back massage on chemotherapy-related fatigue and anxiety: Supportive


care and therapeutic touch in cancer nursing
Serife Karagozoglu, BSc, MSc, PhD, RN a,, Emine Kahve, BSc, MSc, RN b
a
Cumhuriyet University Faculty of Health Science, Division of Nursing, Department of Fundamentals of Nursing, 58140, Sivas, Turkey
b
Cumhuriyet University Research and Application Hospital, Sivas, Turkey

a r t i c l e i n f o a b s t r a c t

Article history: This quasi-experimental and cross-sectional study was carried out to determine the efcacy of back massage,
Received 9 August 2012 a nursing intervention, on the process of acute fatigue developing due to chemotherapy and on the anxiety
Revised 12 July 2013 level emerging in cancer patients receiving chemotherapy during this process. The study was conducted on 40
Accepted 23 July 2013
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.
Keywords:
Chemotherapy
In our study, it was determined that mean anxiety scores decreased in the intervention group patients after
Side effects of chemotherapy chemotherapy. The level of fatigue in the intervention group decreased statistically signicantly on the next
Anxiety day after chemotherapy (p = .020; effect size = 0.84). At the same time, the mean anxiety scores of the
Fatigue patients in the intervention group decreased right after the massage provided during chemotherapy (p =
Massage .109; effect size = 0.37) and after chemotherapy. In line with our study ndings, it can be said that back
Cancer (oncology) nursing massage given during chemotherapy affects anxiety and fatigue suffered during the chemotherapy process
and that it signicantly 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.
2013 Elsevier Inc. All rights reserved.

1. Introduction Acute and chronic fatigue should be distinguished from each other.
Although acute fatigue is experienced by everyone, chronic fatigue is a
Chemotherapy is a long-term treatment and leads to many side serious condition which accompanies a disease or treatment, is not
effects in individuals receiving it (Can, Erol, Aydiner, & Topuz, 2011; relieved by rest and affects a person's quality of life and ability to do
Cleeland et al., 2000; Kearney et al., 2008; Turgay, Khorshid, & Eser, activities (Ahlberg et al., 2003; Trendall, 2000; Yurtsever, 2000).
2008). One of the most common side effects of chemotherapy is Fatigue is a universal, chronic problem suffered by cancer patients,
fatigue (Ahlberg, Ekman, Gaston-Johansson, & Mock, 2003; Barsevick and the severity of its symptoms often varies from time to time during
et al., 2010; Breitbart & Alici, 2010; Gerber et al., 2011; Mitchell, 2010; the course of the disease (Finnegan-John, Molassiotis, Richardson, &
Rotonda, Guillemin, Bonnetain, & Conroy, 2011; Schulmeister & Gobel, Ream, 2013; Mitchell, 2010; Oh & Seo, 2011; Werner, 2009). Of the
2008; Wu & McSweeney, 2004; Wu & McSweeney, 2007). The term patients receiving chemotherapy, 8096% suffer fatigue which in-
fatigue used as the synonym of weakness, exhaustion, tiredness, creases over time (Cheville, 2009; Iop et al., 2004; Kearney et al., 2008;
weariness can also be dened as a state of mental and physical Kwekkeboom, Cherwin, Lee, & Wanta, 2010; Rotonda et al., 2011;
exhaustion which covers all these concepts (Ahlberg et al., 2003; Sood, Barton, Bauer, & Loprinzi, 2007; Stasi, Abriani, Beccaglia, Terzoli,
Cheville, 2009; Iop, Manfredi, & Bonura, 2004; Mitchell, 2010; Wu & & Amadori, 2003). Fatigue can be caused by either the disease itself, or
McSweeney, 2007; Yurtsever, 2007). Fatigue is a multi-dimensional by anemia, a decrease in hematocrit values, the accumulation of waste
problem arising from the combination of physical, psychological and products resulting from the destruction of cells, interruptions in sleep,
situational factors. Fatigue adversely affects not only a patient's sense pain, anxiety, depression, immobility, anorexia, nausea and vomiting
of wellbeing but also his/her daily performance, activities, profes- and malnutrition due to chemotherapy (Barsevick et al., 2010; Can,
sional life, relationships with his/her family and friends, sexual life Durna, & Aydiner, 2004; Franklin & Packel, 2006; Harper & Littlewood,
and tolerance to the treatment (Curt et al., 2000; Jean-Pierre et al., 2005; Lane, 2005; Mitchell, 2010; Mock et al., 2001; Oh & Seo, 2011;
2007; Kearney et al., 2008; Lee, Tsai, Lai, & Tsai, 2008; Oh & Seo, 2011). Rabbetts, 2010; Yavuzen & Kmrc, 2008).
Cancer treatment, which takes a long time and has a great many
Corresponding author. Tel.: +90 1 532 7427059; fax: +90 1 346 2191261.
side effects, shatters an individual's family, work and social life and
E-mail addresses: serifekaragozoglu@gmail.com (S. Karagozoglu), thus leads to the loss of role and status, hopelessness, helplessness,
emine_kahvecioglu@hotmail.com (E. Kahve). anxiety about the future, social isolation and exhaustion. Therefore,

0897-1897/$ see front matter 2013 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.apnr.2013.07.002
S. Karagozoglu, E. Kahve / Applied Nursing Research 26 (2013) 210217 211

the disease, treatment and uncertainties about the future can lead to many studies demonstrating the benets of massage applications in
anxiety and depression (Arslan & Blkba, 2003; Beer & z, 2003; cancer patients. However, there are no studies demonstrating the
Nagel, 2004; enler, 2001). In cancer patients, there is a strong effects of back massage provided during chemotherapy on acute
association between depression and fatigue (Dimeo et al., 2004; chemotherapy-induced fatigue and the level of anxiety developing
Kwekkeboom et al., 2010; Winell & Roth, 2004) and between anxiety during this process. In our country too, the number of experimental
and fatigue (Brown & Kroenke, 2009; Li & Yuan, 2011; Mansky & studies specic to complementary treatment approaches aiming to
Wallerstedt, 2006; Oh & Seo, 2011; Reddick, Nanda, Campbell, Ryman, control the side effects occurring in patients receiving chemotherapy
& Gaston-Johansson, 2005; Redeker, Lev, & Ruggiero, 2000). Although is quite inadequate.
it is common in patients with cancer, fatigue, which is often neglected,
imposes psychological stress on the patient and is assumed to be the 1.1. Purpose and hypothesis
most important cause of non-compliance to treatment (Glaus, Crow, &
Hammond, 1996). Nursing interventions aiming to reduce distress This quasi-experimental and cross-sectional study was carried out
and anxiety in cancer patients are of great importance in ensuring the to determine the efcacy of back massage, a nursing intervention, on
patient's compliance to treatment and enhancing the quality of life the process of acute fatigue developing due to chemotherapy and on
(Schreier & Williams, 2004; Smith, Gomm, & Dickens, 2003). the anxiety level emerging during this process in cancer patients
Nurses who directly observe the inconveniences due to unwanted receiving the third and fourth day chemotherapy cycles of one-day
effects of chemotherapy in patients receiving chemotherapy are the chemotherapy.
professionals who have a key role in dealing with problems The hypotheses to be tested in the study are as follows:
experienced in patient care (Aghabati, Mohammadi, & Pour Esmaiel,
2010; Aslan, Vural, & Kmrc, 2006; Berger, 2001). Nursing H1: Back massage provided during chemotherapy decreases
interventions performed to control symptoms in cancer patients chemotherapy-related fatigue.
receiving chemotherapy help them relieve and regain their con- H2: Back massage provided during chemotherapy reduces chemo-
dence. Today, given the fact that providing cancer treatment and care therapy-related anxiety.
in outpatient care centers is becoming widespread, it is obvious that
nurses' increasingly expanding roles will come to the fore even more. 1.2. Ethical considerations
Complementary therapies, palliative and supportive care have an
important place in the control of fatigue and anxiety suffered by During the planning stage of the study, written permission was
patients receiving chemotherapy (Ernst, 2001; Fontaine, 2004; received from the chief physician and the Presidency of the Radiation
Henricson, Berglungd, Matta, & Segesten, 2006; Kwekkeboom et Oncology Department of the hospital where the study was carried out.
al., 2010; Mitchell, Beck, Hood, Moore, & Tanner, 2007; Parkman, Then, Ethics Committee Decision (decision no. 2007/10-03) was
2001; Walters, 2010). Complementary therapies are not curative obtained from the Presidency of the Ethics Committee of Cumhuriyet
applications, but they aim to alleviate the symptoms of the disease University Faculty of Medicine. The study was conducted in
or to reduce the adverse effects of traditional therapy, and improve accordance with the principles of the Helsinki Declaration.
the individual's general well-being and quality of life (Ernst, Filshie, All patients were informed about the study and provided time
& Hardy, 2003; Finnegan-John et al., 2013; Fox et al., 2013; to ask questions, prior to providing their oral-written consent to
Harrington, Baker, & Hoffman, 2012; Henricson et al., 2006). Back participate. All the participants of this study gave their verbal and
massage, a nursing intervention, is one of the complementary written informed consents. The patients were assured that the data
treatment approaches. to be obtained in the study would be used only in the scope of the
Massage is a way of communication performed not by using study and would not be shared with any other person, institution
words but by touching the individual (Currin & Meister, 2008; or organization.
Fontaine, 2004; Gleeson & Timmins, 2005; Henricson et al., 2006;
Jane, Wilkie, Gallucci, & Beaton, 2008; Toth et al., 2013). Massage is a 2. Methods
cheap and easy-to-perform application with no side effects and,
unlike stress response, leads to relaxation in the muscles by reducing 2.1. Setting and sample
tension (Field, 1998; Jane et al., 2008; Menefee & Monti, 2005; Mok
& Woo, 2004; Myers, Walton, & Small, 2008; Smith, Yamashita, The study was carried out at the Chemotherapy Unit of the
Bryant, Hemphill, & Kutner, 2009). Massage can be dened as the Radiation Oncology Center of a university hospital. In this unit which
systemic stimulation of the body's soft tissues manually or started to offer service in March 2007, patients having lung, breast,
mechanically for therapeutic purposes in order to maintain blood stomach, rectum, and colon, ovarian or cervical cancer receive
and lymph circulation, relax muscles, relieve pain, reduce fatigue and outpatient chemotherapy service. The unit has two separate sections
ensure sleep (Ernst, 2009; Fontaine, 2004; Menefee & Monti, 2005; furnished with recliners in which patients comfortably sit during
Monti & Yang, 2005; Thompson, Sherman, Dixon, & Cherkin, 2006; chemotherapy. In each section, three patients can receive chemo-
Wolsko, Eisenberg, Davis, & Phillips, 2004). The application area of therapy at the same time. In the unit, approximately 110 patients per
classical massage is the skin and the muscles under the skin. The day receive chemotherapy between 8 a.m. and 5 p.m.
effects of massage applied can be seen either locally or in the other The chemotherapy nurse admits patients presenting to the unit to
parts of the body as a result of stimuli transmitted through the have chemotherapy, and then prepares and implements the treat-
nervous system. Manual massage techniques provide both physical ment according to the chemotherapy cure protocol determined
and mental relaxation (Beck, 2006; Collinge, Macdonald, & Walton, previously. The chemotherapy nurse provides education for patients
2012; Ernst, 2009; Fernndez-Lao et al., 2012; Jane et al., 2008; on chemotherapy and side effects of chemotherapy. In addition,
O'Mathna, 2009; Quattrin et al., 2006; Thompson et al., 2006; patients having undergone chemotherapy are given an appointment
Timby, 2009; Werner, 2009). by the chemotherapy nurse for the subsequent cycle of chemother-
Massage is used as a supportive treatment method in cancer apy. Within the rst 30 minutes after the patient's admittance to the
patients (Cassileth & Vickers, 2004; Collinge et al., 2012; Finnegan- chemotherapy unit, chemotherapeutic medicines are prepared for
John et al., 2013; Fontaine, 2004; Gross, Cromwell, Fonteyn, administration in a special pharmaceutical preparation cabin. For the
Matulonis, & Hayman, 2013; Sagar, Dryden, & Wong, 2007; Walters, preparation of antineoplastic drugs, class II biological safety cabin,
2010; Wilkinson, Barnes, & Storey, 2008). In the literature, there are which is placed in the unit where entering is limited, only drug
212 S. Karagozoglu, E. Kahve / Applied Nursing Research 26 (2013) 210217

preparation process is conducted and there is no in-room air alpha coefcient was found to be between 0.83 and 0.92 and was
turbulence, is used. In the cabin, there is downward airow and stated that the scale had high validity. In our study, Cronbach's alpha
HEPA (high-efciency particulate air) lter is available in the cabin. coefcient of the scale was found to be 0.78 for pre-chemotherapy and
While the applications in the cabin are performed, gloves are worn. 0.80 for post-chemotherapy.
While preparing antineoplastic drugs, the nurses wear chemotherapy State-Trait Anxiety Inventory includes two 20-item scales. It is a
gloves, gown, mask, and goggles as personal protective equipment. psychological assessment tool used to determine the levels of state
Of the patients who underwent one-day chemotherapy, those who anxiety and trait anxiety. The former perceived by individuals as a
received the third and fourth chemotherapy treatments in this unit result of stresses they face in their daily lives reects transitory,
comprised the population of the study. The data were collected by the situational circumstances. The latter is independent of conditions, and
researchers between August 1, 2007 and May 30, 2008, until the reects personality characteristics. It was especially developed for use
number of the patients reached 40. In this study, it was decided to in research (ner & Le Compte, 1998). State Anxiety Inventory was
include 20 people in each group when = 0.05, = 0.20 and 1 congured to measure what is felt at the time of measurement. On
= 0.80, and the power of the test was determined as p = .80482. Of this scale, the answer options are as follows: (1) not at all, (2)
the patients included in the study, 20 were in the intervention group somewhat, (3) moderately so and (4) very much so. Theoretically,
and the other 20 were in the control group. The rst three patients scores obtained from the inventory range between 20 and 80. The
were assigned to the intervention group and the second three patients higher the score is, the greater the anxiety is (ner & Le Compte, 1998.
to the control group and so on until the number of the patients
reached 40. 2.3.3. Brief Fatigue Inventory/BFI
In the study, in order to assess fatigue levels of patients who
2.2. Eligibility criteria received chemotherapy, the Brief Fatigue Inventory, consisting of 10
questions, was used. nar, Sezerli, Sarsmaz and Mente (2000)
The following patients were included in the study: (1) those who performed the validity and reliability study of the Turkish version of
had no speech and hearing problem so that the data collection forms Brief Fatigue Inventory/BFI, which was developed by Mendoza et al.
could be clearly lled in through face to face talks with the patient or (1999) at MD Anderson Cancer Center, and the internal consistency of
on the telephone, (2) those who received the third and fourth the scale was determined to be 0.98. In our study, the Cronbach alpha
chemotherapy cycles because during these cycles, the side effects of reliability coefcient of the scale was determined to be 0.93 for pre-
chemotherapy are heavily observed, (3) those who had one-day chemotherapy and 0.96 for post-chemotherapy. BFI includes items
chemotherapy so that all the patients could get back massage on the assessing general fatigue levels of individuals (fatigue felt at the time
same day for the same length of time, (4) those who had of the interview, fatigue in general and the worst fatigue suffered in
chemotherapy for less than 8 hours in order that all the patients the past 24 hours) and the interference of fatigue with daily activities
could have back massage for the same length of time, (5) those who (general activity, mood, walking ability, work life, relationships with
did not have open wounds, fractures and/or luxation in the back, neck, other people, the joy of life) in the past 24 hours. Scoring ranges
shoulders and arms likely to cause them to suffer problems in addition between 0 and 10, 0 indicating no impact at all and 10
to the problems caused by the disease itself and chemotherapy. indicating the highest level of impact. In the assessment of fatigue
During the chemotherapy process, none of the patients who levels, 0 referred to no fatigue at all, 12 to the very low level of
participated in the study had an active working life which might fatigue, 34 to the low level of fatigue, 56 to the moderate level of
cause fatigue and insomnia. fatigue, 78 to the high of level fatigue and 910 to the very high
level of fatigue. Each item in the BFI can be evaluated singly, or the
2.3. Instruments overall fatigue level and the level of interference on activities can be
determined by calculating the total score. The point value of each item
To collect the data, the Personal Information Form, the State is no more than 10, the overall fatigue level (containing 10 items) is
Anxiety part of Spielberger State-Trait Anxiety Inventory/STAI and the maximum 100, and the level of impact on activities (including 6
Brief Fatigue Inventory/BFI were used. items) is maximum 60 points.

2.3.1. Personal information form 2.4. Procedures


The Personal Information Form based on the literature included nine
questions: patient's age, gender, diagnosis, starting date of chemother- During the implementation process of the research, one researcher
apy, chemotherapeutic and other medicines taken, feelings and stayed in the unit full time and applied the back massage exactly as
thoughts about the disease and treatment, support resources, chemo- planned. In order to maintain the integrity of the data collection
therapy, thoughts and feelings about the environment where chemo- process and massage treatment, no more than one patient a day was
therapy is provided, how satised with nursing services and the factors included in the sample. In order to create a study mechanism, six
likely to affect the level of chemotherapy-related fatigue and anxiety. patients (three from the intervention group and three from the
The list of chemotherapeutic or other drugs administered to the patients control group) having chemotherapy in the unit underwent a pre-
was obtained from the medical records. In the Personal Information implementation process after verbal or written permissions were
Form, patients were asked an open-ended question whether they were received. After the pre-intervention process, the study process was
satised with nursing care, and the answers received were evaluated in initiated. Before chemotherapy was started, Personal Information
two groups: (a) satised and (b) not satised. Form, STAI and BFI were lled in through face-to-face interviews with
all the patients participating in the study. During the chemotherapy
2.3.2. Spielberger State-Trait Anxiety Inventory/STAI process, the patients in the intervention group had repetitive back
In the study, State-Trait Anxiety Inventory/STAI was used to massage for 15 minutes before the infusion, between 25th and 40th
measure the level of anxiety before and after chemotherapy. STAI, minutes of each 1-hour period during the treatment and for
which was developed by Spielberger et al. in 1964 in order to 15 minutes at the end of the treatment in accordance with the
determine the state and trait anxiety levels separately, is a self-report duration of chemotherapy. Chemotherapy cycles administered to the
questionnaire consisting of short statements. It was adapted into patients included in the study were minimum 2-hour and maximum
Turkish by ner and Le Compte (1998) and its validityreliability 3-hour cycles. Thus, patients had a 60-minute back massage during
studies were conducted by them as well. In several studies, Cronbach's the 2-hour cycle (Table 1) and a 75-minute back massage during the
S. Karagozoglu, E. Kahve / Applied Nursing Research 26 (2013) 210217 213

Table 1 may be linear or circular. Over the scapulae, the hands were
Massage treatment schedule in 2-hour chemotherapy protocols. separated from each other and stroking was continued and
Prior to chemotherapy 15 minute massage treatment repeated several times in larger circular movements. Efeurage
The rst hour of chemotherapy was implemented during the rst 5 and last 4 minutes of the
Onset of chemotherapy No massage treatment in the rst 15-minute back massage.
25 minutes
(6) After completing the efeurage phase of the massage, starting
2540 minutes of chemotherapy 15 minutes of massage treatments
4060 minutes of chemotherapy No massage treatment for 20 minutes around the waist, the researcher maintained the back massage
The second hour of chemotherapy with petrissage by grasping the subcutaneous tissues and
6085 minutes of chemotherapy No massage treatment for 25 minutes muscles with the thumb and other ngers. Petrissage is the
85100 minutes of chemotherapy 15 minutes of massage treatments
application of cycles of rhythmic lifting, squeezing, and
100120 minutes of chemotherapy No massage treatment for 20 minutes
After chemotherapy 15 minutes of massage treatments
releasing of tissue, often working parallel to the muscle bers.
Several variations of petrissage are one handed, two hand,
alternate hand, and skin rolling. Kneading movements were
started from the waist and continued to shoulders and arms,
3-hour cycle (Table 2). STAI and BFI were re-applied after chemo- and then back to the waist again and then the petrissage phase
therapy. To determine the effects of back massage on acute fatigue, was over. Petrissage was implemented for 3 minutes between
patients were phoned to determine the level of fatigue experienced at the sixth and ninth minutes of the 15-minute back massage.
home after the rst 24 hours following chemotherapy, and the BFI (7) After petrissage, back massage was continued through friction
was lled in again by the researcher during this interview. Each form movements, another phase of the massage. The thumb tips
was lled in question by question or after the participant provided all were placed one on the other and the massage was started from
of the responses. After the forms were read to the patients, the the sacroiliac junction, and circular friction movements applied
researcher lled in the forms based on the patients' responses. The with ngertips continued along the vertebra to the occipital
patients in the control group underwent all the processes in the same region. Friction movements from the sacroiliac junction to the
way except that they did not receive back massage during occipital region were repeated several times. Friction was
chemotherapy. The control group had no other intervention. Both applied for 3 minutes between the 9th and 12th minutes of the
the intervention group and the control group were treated similarly 15-minute back massage.
during the research, and the communication and interaction with the (8) Before the massage was over, efeurage was applied again for
groups were carried out at the same level. 4 minutes.
Back massage was implemented in nine stages in the intervention (9) Finally, after the back massage was over, the researcher
group by the researchers who previously had training on this topic removed the Vaseline on the back of the patient with a towel
(Clay & Pounds, 2008; Fritz, 2004; Fritz & Grosenbach, 2004; and helped the patient to wear his/her clothes. The application
MacDonald, 2007; Salvo, 2007; Timby, 2009): was nalized after placing the patient in a comfortable position.
(1) The environment where the massage was implemented was
appropriately arranged by checking whether the door and 2.5. Data analysis
windows were closed in order that the ambient temperature in
the chemotherapy unit should be maintained. The data obtained were analyzed using SPSS 14.0 package
(2) The patient was informed about the purpose and duration of program. The data are normally distributed. For the data analysis,
the massage before the massage was started. frequency distribution, chi-square, means, Friedman test, Wilcoxon
(3) The patient's privacy was protected by separating him/her from test and Man-Whitney U test were used.
others with a folding screen, and the patient's back was According to demographic characteristics, the difference between
exposed while he/she was sitting in the recliner. intervention and control groups was evaluated with chi-square test.
(4) After warming his/her hands by rubbing, the researcher put on MannWhitney U test was used to for evaluate BFI and STAI scores
some Vaseline to make them slippery. difference between of the intervention and control group patients.
(5) The massage was started from the waist with long-slow Friedman test was performed to compare the fatigue level of the
efeurage and continued to the neck with circular movements. patients before, right after and on the next day after chemotherapy.
Efeurage is a soothing, stroking movement used at the Wilcoxon test was used to compare anxiety level of the patients
beginning and the end of the body massage. Efeurage is the before and after chemotherapy. Values were considered statistically
application of unbroken gliding movements that are repeated signicant when p b .05. In order to investigate whether the
and follow the contour of the client's body. These movements difference between the mean scores of fatigue and anxiety assessed
before, immediately after and 1 day after chemotherapy in the study
and control groups was signicant not only statistically but also in
Table 2 practice, the effect size was calculated with the Cohen's d method. For
Massage treatment schedule in 3-hour chemotherapy protocols.
Cohen's d, the effect size of 0.20.4 was considered as small, of 0.50.7
Prior to chemotherapy 15-Minute massage treatment as medium and of N 0.8 as large (Cohen, 1988; Cohen, 1992).
The rst hour of chemotherapy
Onset of chemotherapy No massage treatment in the rst
3. Results
25 minutes
2540 minutes of chemotherapy 15 minutes of massage treatments
4060 minutes of chemotherapy No massage treatment for 20 minutes Of the patients, 55.0% (11) in the intervention group and 50.0%
The second hour of chemotherapy (10) in the control group were female. The mean age of the patients in
6085 minutes of chemotherapy No massage treatment for 25 minutes the study was 49.97 11.31. Of them, 75.0% (15) in the intervention
85100 minutes of chemotherapy 15 minutes of massage treatments
100120 minutes of chemotherapy No massage treatment for 20 minutes
group and 60.0% (12) in the control group were in the 4160 age
The third hour of chemotherapy group. In our research, 40.0% (8) of the patients in the intervention
120145 minutes of chemotherapy No massage treatment for 25 minutes group and 50.0% (10) in the control group had breast cancer. Of the
145160 minutes of chemotherapy 15 minutes of massage treatments patients, 55.0% (11) in the intervention group and 50.0% (10) in the
160180 minutes of chemotherapy No massage treatment for 20 minutes
control group underwent the third session of the chemotherapy
After chemotherapy 15 minutes of massage treatments
(Table 3). No statistically signicant difference was determined
214 S. Karagozoglu, E. Kahve / Applied Nursing Research 26 (2013) 210217

Table 3
Distribution of the intervention and control groups according to their personal characteristics (N = 40).

Personal characteristics Intervention group (n = 20) Control group (n = 20) Signicance


test
Number % Number %

Gender
Male 9 45.0 10 50.0 2 = 0.100
Female 11 55.0 10 50.0 p = .752
Age (X = 49.97 11.31)
a
Between 20 and 40 3 15.0 4 20.0
Between 41 and 60 15 75.0 12 60.0
60 and over 2 10.0 4 20.0
Diagnosis
Breast cancer 8 40.0 10 50.0 2 = 1.292
Lung cancer 7 35.0 5 25.0 p = .524
Othersb 5 25.5 5 25.0
Treatment
Cyclophosphamide + doxorubicin + Fluorouracil 7 35.0 11 55.0 2 = 3.917
Paclitaxel + platinol 8 40.0 4 20.0 p = .141
Othersc 5 25.0 5 25.0
The number of chemotherapy treatments received
Three treatments 11 55.0 10 50.0 2 = 0.100
Four treatments 9 45.0 10 50.0 p = .752
a
The chi-square test was not applied because in multi-cell orders, the number of the cells in which the expected frequency was less than 5 was more than 20% of the total number
of the cells.
b
Others (ovarian cancer, rectal cancer, stomach cancer).
c
Other (platinol + etoposide; platinol + docetaxel).

between the participants' gender, diagnosis and treatment, and the were compared, the level of anxiety was higher after chemotherapy in
chemotherapy cycles received by the participants in the study and the control group, but the difference between the groups was not
control groups: (gender: p = .752; diagnosis: p = .524; treatment: statistically signicant (Z = 1.602; p = .109; effect size = 0.37).
p = .141; the number of chemotherapy treatments received: p = However, intra-group comparisons revealed that, though statistically
.752).Thus, the subjects in both groups had similar characteristics. was not signicant (Z = 0.427; p = .670), the mean anxiety scores of
Of the patients, 80.0% (16) in the intervention group and 95.0% the patients in the control group raised up to 29.50 7.68 after
(19) in the control group expressed their satisfaction with the chemotherapy which was 28.80 6.75 before chemotherapy, where-
environment where they received chemotherapy. When the patients as the mean anxiety scores of the patients in the intervention group
were asked about their perception of comfort and discomfort during decreased statistically signicantly (Z = 3.703; p = .000) down to
chemotherapy, 75.0% (15) in the intervention group and 80.0% (16) in 26.70 7.35 after chemotherapy which was 33.35 11.89 before
the control group said that they were comfortable. chemotherapy (Table 5).
When the BFI mean scores of the study and control group patients When the chemotherapy sessions of the patients who participated
were compared, there was a statistically signicant difference in study were compared, anxiety and fatigue levels in the third and
between the two groups in terms of the level of fatigue observed fourth chemotherapy treatments were close to each other, but the
before chemotherapy (Z = 2.516; p = .012; effect size = 0.81) and difference was not statistically signicant (p N .05).
on the next day after chemotherapy (Z = 2.315; p = .020; effect
size = 0.84). It was higher in the control group on the next day after
chemotherapy (48.05 22.90). However, intra-group comparisons 4. Discussion
revealed that, though statistically was not signicant ( 2 = 3.308;
p = .191), the control group patients' fatigue level after chemother- Complementary and alternative approaches are the practices
apy (39.55 17.67) and on the next day after chemotherapy which help individuals to lead a healthy life and to improve their
(48.05 22.90) was higher than that before chemotherapy quality of life, and these approaches are a unique opportunity for
(39.40 18.03) whereas the intervention group patients' fatigue nurses so that they can provide holistic care. In the literature, it is
level after chemotherapy (44.5 23:10) and on the next day after reported that massage, one of the complementary and alternative
chemotherapy (30.15 19.59) was statistically signicantly lower approaches, is effective in relieving overall symptoms and side effects
( 2 = 25.600; p = .000) than that before chemotherapy (55.20 cancer patients suffer due to the disease and treatment. Although
20.85) (Table 4). there are several studies evaluating the efcacy of massage applied to
When the pre- and post-chemotherapy STAI mean scores of both cancer patients on the quality of life (Sturgeon, Wetta-Hall, Hart,
the study and control group patients within the scope of the study Good, & Dakhil, 2009; Toth et al., 2013; Wyatt, Sikorskii, Siddiqi, &

Table 4
Mean BFI scores of the patients before, right after and the next day after chemotherapy.

Mean BFI scores

Time Intervention group (n = 20) Control group (n = 20) MannWhitney U Cohen's d


test effect size
X SD X SD

Before chemotherapy 55.20 20.85 39.40 18.03 Z = 2.516 p = .012 ES = 0.81


Right after chemotherapy 44.5 23.10 39.55 17.67 Z = 0.758 p = .449 ES = 0.24
The next day after chemotherapy 30.15 19.59 48.05 22.90 Z = 2.315 p = .020 ES = 0.84
Friedman Test 2 = 25.600 p = .000 2 = 3.308 p = .191
S. Karagozoglu, E. Kahve / Applied Nursing Research 26 (2013) 210217 215

Table 5
The mean STAI scores of patients before and right after chemotherapy.

Mean STAI scores

Patient group Intervention group (n = 20) Control group (n = 20) MannWhitney Cohen's d
U test effect size
X SD X SD

Before chemotherapy 33.35 11.89 28.80 6.75 Z = 1.152 p = .249 ES = 0.47


Right after chemotherapy 26.70 7.35 29.50 7.68 Z = 1.602 p = .109 ES = 0.37
Wilcoxon test Z = 3.703 p = .000 Z = 0.427 p = .670

Given, 2007), pain (Aghabati et al., 2010; Chang, 2008; Ferrell-Torry & after chemotherapy but the mean anxiety scores of the patients in the
Glick, 1993; Gross et al., 2013; Smith et al., 2009; Toth et al., 2013), intervention group decreased after chemotherapy (Table 5). In line
sleep (Smith, Kemp, Hemphill, & Vojir, 2002; Toth et al., 2013), muscle with our ndings, it can be said that hypothesis H2, that the back
tension and anxiety (Campeau et al., 2007; Hernandez-Reif et al., massage during chemotherapy is effective on anxiety suffered during
2004; Post-White, Kinney, & Savik, 2003; Post-White et al., 2009; chemotherapy and that the massage signicantly reduces state
Wilkinson et al., 2007), nausea (Billhult, Bergbom, & Stener-Victorin, anxiety, was supported. During the phone calls made to patients a
2007; Fellowes, Barnes, & Wilkinson, 2004), fatigue (Aghabati et al., day after chemotherapy, the patients stated that they had a
2010; Listing et al., 2009; Monti & Yang, 2005; O'Mathna, 2009; Sood comfortable sleep and they felt more energetic and comfortable,
et al., 2007), and many of these difculties (Cassileth & Vickers, 2004; which supports the ndings of our study. Therefore, it is thought that
Fellowes et al., 2004; Myers, Walton, Bratsman, et al., 2008; Pruthi back massage during chemotherapy, a nursing practice, is an effective
Degnim, Bauer, DePompolo, & Nayar, 2009; Russell, Sumler, Beinhorn, method in reducing the level of anxiety suffered by individuals. In
& Frenkel, 2008; Smith et al., 2002; Wilkinson et al., 2008), we have another study, it is stated that massage applied to control the
not seen any national or international studies investigating the effects symptoms in cancer patients affects anxiety more than it affects all
of back massage implemented during chemotherapy on chemother- other symptoms (Myers, Walton, Bratsman, et al., 2008).
apy-related fatigue and anxiety. Therefore, we consider that our study In this context, one of the strengths of our study is that the study
ndings will provide a signicant contribution to the literature. was conducted with the matched control group in terms of personal
When the patients' BFI scores in our study obtained before, right characteristics such as age, gender, diagnosis and treatment. Another
after and on the next day after chemotherapy were compared, it was strong aspect of this study is that it reveals the importance of the
determined that the control group patients' fatigue levels right after complementary and supportive nursing interventions which help
and on the next day after chemotherapy were higher than those cancer patients cope with the symptoms they experience during the
before chemotherapy, and that their post-chemotherapy fatigue treatment process of the disease. On the other hand, since the study
levels increased gradually. However, the intervention group patients' was conducted on a small sample group, it is hard to generalize the
fatigue levels statistically signicantly decreased on the next day after ndings of the study.
chemotherapy (p = .020; effect size = 0.84) (Table 4). Therefore, it
can be said that the hypothesis H1, that the back massage provided
5. Conclusions
during chemotherapy signicantly reduces fatigue suffered in the
process of chemotherapy was supported. However, in the literature,
In line with the ndings of our study conducted to determine the
there are studies with the results that the fatigue level caused by
effects of back massage, a nursing intervention, on the chemotherapy
chemotherapy increases gradually in the process of chemotherapy
induced acute fatigue and the level of anxiety developing in this
treatment. In studies which evaluated the level of fatigue after
process, it can be suggested that back massage administered during
chemotherapy, it is stated that 70100% of the patients suffer fatigue
chemotherapy is effective on anxiety and fatigue suffered during
(Gerber et al., 2011), that they suffer fatigue even after a year or more
chemotherapy, and decreases state anxiety and acute fatigue
subsequent to chemotherapy (Cella, Davis, Breitbart, & Curt, 2001),
signicantly. Therefore, it can be recommended that the awareness,
that the level of fatigue increases in the further phases of
understanding and sensitivity of professionals, especially of nurses,
chemotherapy, that those who receive chemotherapy for the third
working in oncology centers and chemotherapy application units
time have higher levels of fatigue than do those who receive
regarding this application should be increased and that they should be
chemotherapy for the rst time (Lee et al., 2008) and that the highest
encouraged to implement this intervention.
level of fatigue is observed on the day chemotherapy is received
(Schwartz, 2000). Therefore, if fatigue caused by the chemotherapy
process is to be brought under control, it can be said that back Acknowledgments
massage during chemotherapy is an important and primary nursing
practice. During the interviews conducted with the participants of our The authors express their thanks to Dr. Ziynet iner of the
study on the next day after chemotherapy, those who had massages Department of Statistics of Cumhuriyet University, for help with the
during chemotherapy treatments stated that they were more statistical evaluations in this investigation.
comfortable than they were in previous chemotherapy treatments,
which is a noteworthy feedback in the assessment of the efcacy of
our study. In their study, Cassileth and Vickers (2004) reported that References
the effectiveness of the massage provided for cancer patients to Aghabati, N., Mohammadi, E., & Pour Esmaiel, Z. (2010). The effect of therapeutic touch
reduce the symptoms was more in the rst 25 hours and that the on pain and fatigue of cancer patients undergoing chemotherapy. eCAM, 7(3),
375381.
effects of the massage lasted longer in outpatients. Wilkinson et al.
Ahlberg, K., Ekman, T., Gaston-Johansson, F., & Mock, V. (2003). Assessment and
(2007) stated that the effectiveness of the massage provided for management of cancer-related fatigue in adults. The Lancet, 362, 640650.
cancer patients might last for 26 weeks after the intervention. Arslan, S., & Blkba, N. (2003). Evaluation of the life quality of the patients with
When the state anxiety levels of the patients participating in our cancer. Atatrk niversitesi Hemirelik Yksekokulu Dergisi, 6(3), 3847 [in Turkish].
Aslan, ., Vural, H., & Kmrc, . (2006). Effect of education on chemotherapy
investigation were taken into consideration, it was observed that the symptoms in cancer patients receiving chemotherapy. Cumhuriyet niversitesi
mean anxiety scores of the patients in the control group increased Hemirelik Yksekokulu Dergisi, 10(1), 1528 [in Turkish].
216 S. Karagozoglu, E. Kahve / Applied Nursing Research 26 (2013) 210217

Barsevick, A., Beck, S. L., Dudley, W. N., Wong, B., Berger, A. M., Whitmer, K., et al. Fritz, S. (2004). Mosby's fundamentals of therapeutic massage (3rd ed.)St. Louis: Mosby.
(2010). Efcacy of an intervention for fatigue and sleep disturbance during cancer Fritz, S., & Grosenbach, M. J. (2004). Mosby's essential sciences for therapeutic massage,
chemotherapy. Journal of Pain and Symptom Management, 40(2), 200216. anatomy, physiology, biomechanics and pathology (2nd ed.)St. Louis: Mosby.
Beck, M. F. (2006). Theory & practice of therapeutic massage (4th ed.)United States of Gerber, L. H., Stout, N., McGarvey, C., Soballe, P., Shieh, C. Y., Diao, G., et al. (2011).
America: Thomson Delmar Learning. Factors predicting clinically signicant fatigue in women following treatment for
Berger, A. M. (2001). Factors inuencing cancer-related fatigue in a primary care primary breast cancer. Supportive Care in Cancer, 19(10), 15811591.
practice. Home Health Care Consultant, 8(5), 2836. Glaus, A., Crow, R., & Hammond, S. (1996). A qualitative study to explore the concept of
Beer, N., & z, F. (2003). Anxiety-depression levels and quality of life of patients with fatigue/tiredness in cancer patients and in healthy individuals. Supportive Care in
lymphoma who are curing chemotherapy. Cumhuriyet niversitesi Hemirelik Cancer, 4(2), 8296.
Yksek Okulu Dergisi, 7(1), 4758 [in Turkish]. Gleeson, M., & Timmins, F. (2005). A review of the use and clinical effectiveness of touch
Billhult, A., Bergbom, I., & Stener-Victorin, E. (2007). Massage relieves nausea in women as a nursing intervention. Clinical Effectiveness in Nursing, 9(12), 6977.
with breast cancer who are undergoing chemotherapy. Journal of Alternative and Gross, A. H., Cromwell, J., Fonteyn, M., Matulonis, U. A., & Hayman, L. L. (2013).
Complementary Medicine, 13(1), 5357. Hopelessness and complementary therapy use in patients with ovarian cancer.
Breitbart, W., & Alici, Y. (2010). Psychostimulants for cancer-related fatigue. Journal of Cancer Nursing, 36(4), 256264.
the National Comprehensive Cancer Network, 8(8), 933942. Harper, P., & Littlewood, T. (2005). Anemia of cancer: Impact on patient fatigue and
Brown, L. F., & Kroenke, K. (2009). Cancer-related fatigue and its associations with long-term outcome. Oncology, 69(Suppl 2), 27.
depression and anxiety: A systematic review. Psychosomatics, 50(5), 440447. Harrington, J. E., Baker, B. S., & Hoffman, C. J. (2012). Effect of an integrated support
Campeau, M. P., Gaboriault, R., Drapeau, M., Van Nguyen, T., Roy, I., Fortin, B., et al. programme on the concerns and wellbeing of women with breast cancer: A
(2007). Impact of massage therapy on anxiety levels in patients undergoing national service evaluation. Complementary Therapies in Clinical Practice, 18, 1015.
radiation therapy: Randomized controlled trial. Journal of the Society for Integrative Henricson, M., Berglungd, A. L., Matta, S., & Segesten, K. (2006). A transition from nurse
Oncology, 5(4), 133138. to touch therapistA study of preparation before giving tactile touch in an
Can, G., Durna, Z., & Aydiner, A. (2004). Assessment of fatigue in and care needs of intensive care unit. Intensive & Critical Care Nursing, 22(4), 239245.
Turkish women with breast cancer. Cancer Nursing, 27(2), 153161. Hernandez-Reif, M., Ironson, G., Field, T., Hurley, J., Katz, G., Diego, M., et al. (2004).
Can, G., Erol, O., Aydiner, A., & Topuz, E. (2011). Non-pharmacological interventions Breast cancer patients have improved immune and neuroendocrine functions
used by cancer patients during chemotherapy in Turkey. European Journal of following massage therapy. Journal of Psychosomatic Research, 57(1), 4552.
Oncology Nursing, 15(2), 178184. Iop, A., Manfredi, A. M., & Bonura, S. (2004). Fatigue in cancer patients receiving
Cassileth, B. R., & Vickers, A. J. (2004). Massage therapy for symptom control: Outcome chemotherapy: An analysis of published studies. Annals of Oncology, 15, 712720.
study at a major cancer center. Journal of Pain and Symptom Management, 28(3), Jane, S. W., Wilkie, D. J., Gallucci, B. B., & Beaton, R. D. (2008). Systematic review of
244249. massage intervention for adult patients with cancer. Cancer Nursing, 31(6), 2435.
Cella, D., Davis, K., Breitbart, W., & Curt, G. (2001). Cancer-related fatigue: Prevalence of Jean-Pierre, P., Figeroa-Moseley, C. D., Kohli, S., Fiscella, K., Palesh, O. G., & Morrow, G. R.
proposed diagnostic criteria united states sample of cancer survivors. Journal of (2007). Assessment of cancer-related fatigue: Implications for clinical diagnosis
Clinical Oncology, 19(14), 33853391. and treatment. The Oncologist, 12(Suppl 1), 1121.
Chang, S. Y. (2008). Effects of aroma hand massage on pain, state anxiety and Kearney, N., Miller, M., Maguire, R., Dolan, S., MacDonald, R., McLeod, J., et al. (2008).
depression in hospice patients with terminal cancer. Taehan Kanho Hakhoe Chi, WISECARE+: Results of a European study of a nursing intervention for the
38(4), 493502. management of chemotherapy-related symptoms. European Journal of Oncology
Cheville, A. L. (2009). Cancer-related fatigue. Physical Medicine and Rehabilitation Clinics Nursing, 12(5), 443448.
of North America, 20(2), 405416. Kwekkeboom, K. L., Cherwin, K. H., Lee, J. W., & Wanta, B. (2010). Mind-body
nar, S., Sezerli, M., Sarsmaz, N., & Mente, A.. (2000). Hemodialysis may cause acute treatments for the painfatiguesleep disturbance symptom cluster in persons
fatigue syndrome? Hemirelik Forumu Dergisi, 3, 2833. with cancer. Journal of Pain and Symptom Management, 39(1), 126138.
Clay, J. H., & Pounds, D. M. (2008). Basic clinical massage therapy, integrating anatomy and Lane, I. (2005). Managing cancer-related fatigue in palliative care. Nursing Times,
treatment (2nd ed.) Philadelphia: Wolter Kluwer / Lippincott Williams&Wilkins. 101(18), 3841.
Cleeland, C. S., Mendoza, T. R., Wang, X. S., Chou, C., Harle, M. T., Morrissey, M., et al. Lee, Y. H., Tsai, Y. F., Lai, Y. H., & Tsai, C. M. (2008). Fatigue experience and coping
(2000). Assessing symptom distress in cancer patients: The M.D. Anderson strategies in Taiwanese lung cancer patients receiving chemotherapy. Journal of
symptom inventory. Cancer, 89(7), 16341646. Clinical Nursing, 17(7), 876883.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.)Hillsdale, Li, Y., & Yuan, C. (2011). Levels of fatigue in Chinese women with breast cancer and its
NJ: Lawrence Elbaum Associates. correlates: A cross-sectional questionnaire survey. Journal of the American Academy
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155159. of Nurse Practitioners, 23(3), 153160.
Collinge, W., Macdonald, G., & Walton, T. (2012). Massage in supportive cancer care. Listing, M., ReiXhauer, A., Krohn, M., Voigt, B., Tjahono, G., & Becker, J. (2009). Massage
Seminars in Oncology Nursing, 28(1), 4554. therapy reduces physical discomfort and improves mood disturbances in women
Currin, J., & Meister, E. A. (2008). A hospital-based ntervention using massage to with breast cancer. Psycho-Oncology, 18, 12901299.
reduce distress among oncology patients. Cancer Nursing, 31(3), 214221. MacDonald, G. (2007). Medicine hands, massage therapy for people with cancer. USA:
Curt, G. A., Breitbart, W., Cella, D., Groopman, J. E., Horning, S. J., Itri, L. M., et al. (2000). Findhorn Press.
Impact of cancer-related fatigue on the lives of patients: New ndings from the Mansky, P. J., & Wallerstedt, D. B. (2006). Complementary medicine in palliative care
fatigue coalition. The Oncologist, 5(5), 353360. and cancer symptom management. Cancer Journal, 12(5), 425431.
Dimeo, F., Schmittel, A., Fietz, T., Schwartz, S., Khler, P., Bning, D., et al. (2004). Mendoza, T. R., Wang, X. S., Cleeland, C. S., Morrissey, M., Johnson, B. A., Wendt, J. K.,
Physical performance, depression, immune status and fatigue in patients with et al. (1999). The rapid assessment of fatigue severity in cancer patients: Use of the
hematological malignancies after treatment. Annals of Oncology, 15(8), 12371242. Brief Fatigue Inventory. Cancer, 85(5), 11861196.
Ernst, E. (2001). Complementary therapies in palliative cancer care. Cancer, 91(11), Menefee, L. A., & Monti, D. A. (2005). Nonpharmacologic and complementary
21812185. approaches to cancer pain management. The Journal of the American Osteopathic
Ernst, E. (2009). Massage therapy for cancer palliation and supportive care: A systematic Association, 105(5), 1520.
review of randomised clinical trials. Supportive Care in Cancer, 17(4), 333337. Mitchell, S. A. (2010). Cancer-related fatigue: State of the science. PM R, 2(5), 364383.
Ernst, E., Filshie, J., & Hardy, J. (2003). Evidence-based complementary medicine for Mitchell, S. A., Beck, S. L., Hood, L. E., Moore, K., & Tanner, E. R. (2007). Putting evidence
palliative cancer care: Does it make sense? Palliative Medicine, 17(8), 704707. into practice: Evidence-based interventions for fatigue during and following cancer
Fellowes, D., Barnes, K., & Wilkinson, S. (2004). Aromatherapy and massage for and its treatment. Clinical Journal of Oncology Nursing, 11(1), 99113.
symptom relief in patients with cancer. Cochrane Database of Systematic Reviews, 2, Mock, V., Pickett, M., Ropka, M. E., Muscari Lin, E., Stewart, K. J., Rhodes, V. A., et al.
2287. (2001). Fatigue and quality of life outcomes of exercise during cancer treatment.
Fernndez-Lao, C., Cantarero-Villanueva, I., Daz-Rodrguez, L., Cuesta-Vargas, A. I., Cancer Practice, 9(3), 119127.
Fernndez-Delas-Peas, C., & Arroyo-Morales, M. (2012). Attitudes towards Mok, E., & Woo, C. P. (2004). The effects of slow-stroke back massage on anxiety and
massage modify effects of manual therapy in breast cancer survivors: A randomised shoulder pain in elderly stroke patients. Complementary Therapies in Nursing &
clinical trial with crossover design. Eur J Cancer Care (Engl), 21, 233241. Midwifery, 10(4), 209216.
Ferrell-Torry, A. T., & Glick, O. J. (1993). The use of therapeutic massage as a nursing Monti, D. A., & Yang, J. (2005). Complementary medicine in chronic cancer care. Seminar
intervention to modify anxiety and the perception of cancer pain. Cancer Nursing, in Oncology, 32(2), 225231.
16(2), 93101. Myers, C. D., Walton, T., Bratsman, L., Wilson, J., & Small, B. (2008). Massage modalities
Field, T. M. (1998). Massage therapy effects. The American Psychologist, 53(12), 12701281. and symptoms reported by cancer patients: Narrative review. Journal of the Society
Finnegan-John, J., Molassiotis, A., Richardson, A., & Ream, E. (2013). A systematic review for Integrative Oncology, 6(1), 1928.
of complementary and alternative medicine nterventions for the management of Myers, C. D., Walton, T., & Small, B. J. (2008). The value of massage therapy in cancer
cancer-related fatigue. Integrative Cancer Therapies, 12(4), 276290. care. Hematology/Oncology Clinics of North America, 22(4), 649660.
Fontaine, K. L. (2004). Massage. Complementary & alternative therapies for nursing Nagel, T. (2004). Help patients cope with chemo. RN, 67(10), 2526.
practice (pp. 199220) (2nd ed.). Upper saddle River, NJ: Pearson Education, Inc. Oh, H. S., & Seo, W. S. (2011). Systematic review and meta-analysis of the correlates of
Fox, P., Butler, M., Coughlan, B., Murray, M., Boland, N., Hanan, T., Murphy, H., cancer-related fatigue. Worldviews on Evidence-Based Nursing, 8(4), 191201.
Forrester, P., O' Brien, M., & O'Sullivan, N. (2013). Using a mixed methods research O'Mathna, D. P. (2009). Massage for pain and anxiety in cancer patients. Alternative
design to investigate complementary alternative medicine (CAM) use among Medicine Alert, 1, 911.
women with breast cancer in Ireland. European Journal of Oncology Nursing, 17, ner, N., & Le Compte, A. (1998). Manual of Unsteady State/Trait Anxiety Inventory.
490497. Istanbul: Boazii niversitesi Yaynevi [in Turkish].
Franklin, D. J., & Packel, L. (2006). Cancer-related fatigue. Archives of Physical Medicine Parkman, C. (2001). Alternative therapies are here to stay. Nursing Management, 32(2),
and Rehabilitation, 87(3 Suppl 1), 9193. 3639.
S. Karagozoglu, E. Kahve / Applied Nursing Research 26 (2013) 210217 217

Post-White, J., Fitzgerald, M., Savik, K., Hooke, M. C., Hannahan, A. B., & Sencer, S. F. Stasi, R., Abriani, L., Beccaglia, P., Terzoli, E., & Amadori, S. (2003). Cancer-related
(2009). Massage therapy for children with cancer. Journal of Pediatric Oncology fatigue: Evolving concepts in evaluation and treatment. Cancer, 98(9),
Nursing, 26(1), 1628. 17861801.
Post-White, J., Kinney, M. E., & Savik, K. (2003). Therapeutic massage and healing touch Sturgeon, M., Wetta-Hall, R., Hart, T., Good, M., & Dakhil, S. (2009). Effects of therapeutic
improve symptoms in cancer. Integrative Cancer Therapies, 2(4), 332344. massage on the quality of life among patients with breast cancer during treatment.
Pruthi Degnim, A. C., Bauer, B. A., DePompolo, D. R., & Nayar, V. (2009). Value of massage Journal of Alternative and Complementary Medicine, 15(4), 373380.
therapy for patients in a breast clinic. Clinical Journal of Oncology Nursing, 13(4), Thompson, D., Sherman, K. J., Dixon, M. W., & Cherkin, D. C. (2006). Development of a
422425. taxonomy to describe massage treatments for musculoskeletal pain. BMC
Quattrin, R., Zanini, A., Buchini, S., Turello, D., Annunziata, M. A., Vidotti, C., et al. (2006). Complementary and Alternative Medicine, 23(6), 24.
Use of reexology foot massage to reduce anxiety in hospitalized cancer patients in Timby, B. K. (2009). Giving a back massage. Fundamental nursing skills and concepts
chemotherapy treatment: Methodology and outcomes. Journal of Nursing Manage- (pp. 398402) (9th ed.). Philadelphia: Wolters Kluwer/Lipincott Williams &
ment, 14, 96105. Wilkins.
Rabbetts, L. (2010). Fatigue in patients with advanced cancer. Australian Nursing Toth, M., Marcantonio, E. R., Davis, R. B., Walton, T., Kahn, J. R., & Phillips, R. S.
Journal, 10(17), 7. (2013). Massage therapy for patients with metastatic cancer: A pilot randomized
Reddick, B. K., Nanda, J. P., Campbell, L., Ryman, D. G., & Gaston-Johansson, F. (2005). controlled trial. Journal of Alternative and Complementary Medicine, 19(7),
Examining the inuence of coping with pain on depression, anxiety, and fatigue 650656.
among women with breast cancer. Journal of Psychosocial Oncology, 23(23), 137157. Trendall, J. (2000). Concept analysis: Chronic fatigue. Journal of Advanced Nursing,
Redeker, N. S., Lev, E. L., & Ruggiero, J. (2000). Insomnia, fatigue, anxiety, depression, 32(5), 11261131.
and quality of life of cancer patients undergoing chemotherapy. Scholarly Inquiry for Turgay, A. S., Khorshid, L., & Eser, I. (2008). Effect of the rst chemotherapy course on
Nursing Practice, 14(4), 275290. the quality of life of cancer patients in Turkey. Cancer Nursing, 31(6), E19e23.
Rotonda, C., Guillemin, F., Bonnetain, F., & Conroy, T. (2011). Factors correlated with Walters, S. J. (2010). Massage and cancer: Practice guidelines. Journal of the Australian
fatigue in breast cancer patients before, during and after adjuvant chemotherapy: Traditional-Medicine Society, 16(3), 141143.
The FATSEIN study. Contemporary Clinical Trials, 32(2), 244249. Werner, R. (2009). Principles of cancer. A massage therapist's guide to pathology
Russell, N. C., Sumler, S. S., Beinhorn, C. M., & Frenkel, M. A. (2008). Role of massage therapy (pp. 671682) (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins, a Wolters
in cancer care. Journal of Alternative and Complementary Medicine, 14(2), 209214. Kluwer business.
Sagar, S. M., Dryden, T., & Wong, R. K. (2007). Massage therapy for cancer patients: A Wilkinson, S., Barnes, K., & Storey, L. (2008). Massage for symptom relief in patients
reciprocal relationship between body and mind. Current Oncology, 14(2), 4556. with cancer: Systematic review. Journal of Advanced Nursing, 63(5), 430439.
Salvo, S. G. (2007). Massage therapy principles and practice (3rd ed.)Louisiana: Saunders Wilkinson, S. M., Love, S. B., Westcombe, A. M., Gambles, M. A., Burgess, C. C., Cargill, A.,
Elsevier. et al. (2007). Effectiveness of aromatherapy massage in the management of anxiety
Schreier, A. M., & Williams, S. A. (2004). Anxiety and quality of life of women who and depression in patients with cancer: A multicenter randomized controlled trial.
receive radiation or chemotherapy for breast cancer. Oncology Nursing Forum, Journal of Clinical Oncology, 25, 532539.
31(1), 127130. Winell, J., & Roth, A. J. (2004). Depression in cancer patients. Oncology, 18(12),
Schulmeister, L., & Gobel, B. H. (2008). Symptom management issues in oncology 15541560.
nursing. The Nursing Clinics of North America, 43(2), 205220. Wolsko, P. M., Eisenberg, D. M., Davis, R. B., & Phillips, R. S. (2004). Use of mindbody
Schwartz, A. L. (2000). Daily fatigue patterns and effect of exercise in women with medical therapies. Journal of General Internal Medicine, 19(1), 4350.
breast cancer. Cancer Practice, 8(1), 1624. Wu, H. S., & McSweeney, M. (2004). Assessing fatigue in persons with cancer. Cancer,
enler, . F. (2001). Psychosocial problems and treatment of lung cancer. Solunum, 3(2), 101(7), 16851695.
223225 [in Turkish]. Wu, H. S., & McSweeney, M. (2007). Cancer-related fatigue: It's so much more than just
Smith, E. M., Gomm, S. A., & Dickens, C. M. (2003). Assessing the independent being tired. European Journal of Oncology Nursing, 11(2), 117125.
contribution to quality of life from anxiety and depression in patients with Wyatt, G., Sikorskii, A., Siddiqi, A., & Given, C. W. (2007). Feasibility of a reexology and
advanced cancer. Palliative Medicine, 17(6), 509513. guided imagery intervention during chemotherapy: Results of a quasi-experimen-
Smith, M. C., Kemp, J., Hemphill, L., & Vojir, C. P. (2002). Outcomes of therapeutic massage tal study. Oncology Nursing Forum, 34(3), 635642.
for hospitalized cancer patients. Journal of Nursing Scholarship, 34(3), 257262. Yavuzen, T., & Kmrc, . (2008). Evaluation of the fatigue symptom in patients with
Smith, M., Yamashita, T., Bryant, L., Hemphill, L., & Kutner, J. (2009). Providing massage cancer and associated clinical problems. Glhane Medicine Journal, 50(2), 141146
therapy for people with advanced cancer: What to expect. Journal of Alternative and [in Turkish].
Complementary Medicine, 15(4), 367371. Yurtsever, S. (2000). Fatigue in chronic illness and nursing care. Cumhuriyet niversitesi
Sood, A., Barton, D. L., Bauer, B. A., & Loprinzi, C. L. (2007). Critical review of Hemirelik Yksekokulu Dergisi, 4(1), 1620 [in Turkish].
complementary therapies for cancer-related fatigue. Integrative Cancer Therapies, Yurtsever, S. (2007). The experience of fatigue in Turkish patients receiving
6(1), 813. chemotherapy. Oncology Nursing Forum, 34(3), 721728.

You might also like