Results Summary
What was the research about?
Pain is one of the most common symptoms for patients living with advanced cancer. Pain can disrupt sleep, lead to fatigue, and decrease quality of life. Medicine can help ease pain, but it may have side effects. Treatments without medicine can be used to reduce pain and improve quality of life in patients with cancer.
In this study, the research team compared two approaches to treat pain without medicine in adults with advanced cancer:
- Acupuncture, which involves inserting thin needles into different parts of the body
- Massage, which involves using the hands to work muscles and other soft tissues
Patients received up to ten 30-minute treatments for 10 weeks. After that, they received treatments once a month for up to 26 weeks. The research team looked at how well each treatment worked to reduce severe pain.
What were the results?
After 10 weeks, patients using either approach had less pain and fatigue and had improved sleep and quality of life. These changes were maintained through the end of the study with the monthly sessions. Patients also used less pain medicine over time.
At the end of study, patients who received acupuncture and patients who received massage did not differ in:
- Decreases in severe pain
- Problems sleeping
- Symptoms of depression and anxiety
- Fatigue
- Quality of life
Who was in the study?
The study included 298 adults with advanced cancer, including breast, blood, lung, and stomach cancers. All patients reported moderate to severe pain from their cancer or cancer treatment. Patients were receiving care at cancer centers in New York, New Jersey, or Florida.
Of these patients, 74 percent were White, 11 percent were Black, 6 percent were Asian, and 8 percent were multiple races; 15 percent were Hispanic. The average age was 59, and 67 percent were women.
What did the research team do?
The research team assigned patients by chance to receive acupuncture or massage. Patients completed surveys online or by phone on their pain and other health outcomes. They filled out surveys at the start of the study and again after 4, 10, 14, 18, 22, and 26 weeks.
Patients with advanced cancer, doctors, and patient advocates helped to plan and conduct the study.
What were the limits of the study?
The therapists provided acupuncture and massage treatment in a clinical setting. The research team trained and monitored therapists regularly to make sure they applied the therapy in a standard way each time. Results may differ in community settings where care delivery may vary.
Future research could look at these treatments in community settings.
How can people use the results?
Patients with advanced cancer and their doctors can use these results when considering ways to treat pain.
PCORI identified relief of symptoms that patients with advanced illness often experience as an important research topic. Patients, clinicians, and others wanted to learn how different treatment strategies affect pain, fatigue, insomnia, nausea, depression, and other common symptoms. To address this issue, PCORI launched an initiative in 2017 on Symptom Management for Patients with Advanced Illness. The initiative funded this research project. |
Professional Abstract
Objective
To compare the effectiveness of acupuncture versus massage in reducing pain for patients with advanced cancer
Study Design
Design Element | Description |
---|---|
Design | Randomized controlled trial |
Population | 298 adults receiving treatment for advanced cancer, including blood, breast, lung, and stomach cancers |
Interventions/ Comparators |
|
Outcomes | Primary: reduction in worst pain Secondary: insomnia, depression, anxiety, fatigue, quality of life |
Timeframe | 26-week follow-up for primary outcome |
This randomized controlled trial compared the effectiveness of acupuncture versus massage in reducing pain and other patient-reported outcomes among patients receiving treatment for advanced cancer.
Researchers randomly assigned patients to receive either acupuncture or massage therapy. Patients received the assigned treatment for 30 minutes, up to 10 times over 10 weeks, followed by monthly sessions for up to 26 weeks.
The study included 298 adults with advanced cancer who reported experiencing moderate to severe musculoskeletal pain. Patients were receiving care at cancer centers in New York, New Jersey, or Florida. Of these patients, 74% were White, 11% were Black, 6% were Asian, and 8% were multiple races; 15% were Hispanic. The average age was 59, and 67% were female.
Patients completed surveys on study outcomes online or by phone at the start of the study and again 4, 10, 14, 18, 22, and 26 weeks later.
Patients with advanced cancer, patient advocates, clinicians, and representatives from patient advocacy groups helped to plan and conduct the study.
Results
At 26 weeks, patients receiving acupuncture and patients receiving massage did not differ significantly in reductions in worst pain. At 26 weeks, patients in both groups reported reductions in worst pain relative to baseline using a 10-point scale: 2.53 points for those receiving acupuncture (95% confidence interval [CI]: 2.15, 2.92) and 3.01 points for those receiving massage (95% CI: 2.63, 3.38). Across both groups, the use of pain medication at 26 weeks declined relative to baseline.
The two groups did not differ significantly in secondary outcomes. At 26 weeks, patients in both groups had improved fatigue, insomnia, and quality of life scores.
Limitations
To control for treatment consistency and fidelity, researchers provided rigorous training to and regularly monitored the treatments provided by acupuncture and massage therapists. Results may differ in nonclinical, community care settings where care delivery may be more variable.
Conclusions and Relevance
In this study, both massage therapy and acupuncture resulted in clinically meaningful reductions in worst pain and improved other patient-reported outcomes among patients with advanced cancer.
Future Research Needs
Future research could focus on examining outcomes for these treatments in smaller clinics or community care settings.
PCORI identified relief of symptoms that patients with advanced illness often experience as an important research topic. Patients, clinicians, and others wanted to learn how different treatment strategies affect pain, fatigue, insomnia, nausea, depression, and other common symptoms. To address this issue, PCORI launched an initiative in 2017 on Symptom Management for Patients with Advanced Illness. The initiative funded this research project. |
Final Research Report
This project's final research report is expected to be available by December 2024.
Journal Citations
Results of This Project
Related Journal Citations
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The report indicated that the therapists were study personnel, the participant inclusion criteria were somewhat narrow, and the research data were collected separately from regular clinic visits. As such, the reviewers questioned whether this study was really pragmatic. The researchers explained that the therapists conducting the study interventions saw patients regularly outside of the research project and that the inclusion criteria were actually broader than a typical efficacy study. They felt the diversity of sources for pain among participants justified calling this study pragmatic.
- The reviewers asked the researchers to revise their primary conclusions, which stated that both acupuncture and massage reduced pain in participants. The reviewers noted that because the change in level of pain was assessed without a usual care comparator, it was not possible to know whether the interventions improved pain or whether the changes would happen over time without intervention. The researchers removed causal language indicating that massage and acupuncture were responsible for the improvement in pain symptoms throughout the report.
- The reviewers noted that the primary aim of this study was to test whether one of the interventions was better than the other at reducing pain. The fact that there was no measurable difference between the two interventions should be the first result reported in the abstract and in the main text rather than the change in pain level. The researchers made this change.
- The reviewers asked the researchers to expand their presentation of results of the heterogeneity of treatment effects (HTE) analyses, noting that this was the second aim of the study and should be mentioned in the abstract and discussion. The researchers initially disagreed because the study was not powered for the HTE analyses so these analyses should not be given any prominence. However, they did eventually add information about these analyses to the abstract and discussion of the report to follow PCORI guidelines for final report content.