Effects of an 8-week Swedish massage program on quality of life, sleep, stress, fatigue, cortisol, c-reactive protein and cytokines in breast cancer survivors
Date
2020-12-01
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
ORCID
0000-0001-7759-8459
Type
Thesis
Degree Level
Doctoral
Abstract
Background: Many women who have received treatment for breast cancer have a high risk of developing late side effects or persistent cancer-related symptoms (CRS). Although massage therapy (MT) showed to provide positive results in the management of CRS, only a few studies have been conducted to examine persistent CRS in breast cancer survivors (BCS). Additionally, more robust examinations of the biological effects of most integrative therapies, including MT, remains needed. Objective: To investigate the effects of an 8-week Swedish massage program on quality of life (QoL), sleep, stress, fatigue, cortisol, c-reactive protein (CRP) and pro-inflammatory cytokines in BCS. Methodology: Females over 18 years who were diagnosed with breast cancer - stages I to III and have completed the treatment in the last six months were recruited. Participants underwent a one-hour session of MT once a week. Subjects were assessed for QoL, fatigue, stress, sleep and inflammatory markers before the beginning of the study (baseline), every two weeks during intervention period (assessment 1 and 2) and one week after the program (endpoint). The Functional Assessment of Cancer Therapy Fatigue was chosen to measure QoL and fatigue, and the Perceived Stress Scale was used to measure stress. Circadian sleep-wake rhythms were measured noninvasively through Actigraphy. Saliva was collected to detect the following markers: cortisol, CRP, IL-1β, IL-6, TNF-α and IFN-𝛾. Oximetry, heart rate and blood pressure were measured pre and post every MT session. Results: A total of 24 participants completed the study. The average age of participants was 56.9 (±9.3). QoL improvements were significantly associated with time after cancer treatment completion and cancer stage. Changes in fatigue scores were significantly associated with sleep aids in use and comorbidities. Stress levels significantly improved at endpoint in comparison to baseline, regardless of any covariates tested. Wake after sleep onset showed improvement at endpoint. Sleep onset latency improvement was only significant for Stage III patients. Sleep duration did not show any significant improvement. Subjects showed superior sleep efficiency at the end of the program, however, changes did not attain statistical significance. Overall, all the biomarkers decreased at endpoint in comparison to baseline; however, only cortisol, IL-1β and TNF-α reached significant changes, with IL-1β showing important associations with cancer stage and hormone therapy. Heart rate and oxygen levels improved right after sessions, and blood pressure slightly increased. Conclusion: This study reveals evidence of a positive effect of MT in QoL, fatigue, stress, some sleep parameters, oxygen levels, heart rate, cortisol, IL-1β and TNF-α.
Description
Keywords
breast cancer survivors, integrative medicine, salivary markers, patient-reported outcomes, sleep
Citation
Degree
Doctor of Philosophy (Ph.D.)
Department
Medicine
Program
Health Sciences