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

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Abstract

Objectives: Women with breast cancer are at risk for elevated depression, anxiety, and decreased natural killer (NK) cell number. Stress has been linked to increased tumor development by decreasing NK cell activity. The objectives of this study included examining massage therapy for women with breast cancer for (1) improving mood and biological measures associated with mood enhancement (serotonin, dopamine), (2) reducing stress and stress hormone levels, and (3) boosting immune measures. Methods: Thirty-four women (M age=53) diagnosed with Stage 1 or 2 breast cancer were randomly assigned postsurgery to a massage therapy group (to receive 30-min massages three times per week for 5 weeks) or a control group. The massage consisted of stroking, squeezing, and stretching techniques to the head, arms, legs/feet, and back. On the first and last day of the study, the women were assessed on (1) immediate effects measures of anxiety, depressed mood, and vigor and (2) longer term effects on depression, anxiety and hostility, functioning, body image, and avoidant versus intrusive coping style, in addition to urinary catecholamines (norepinephrine, epinephrine, and dopamine) and serotonin levels. A subset of 27 women (n=15 massage) had blood drawn to assay immune measures. Results: The immediate massage therapy effects included reduced anxiety, depressed mood, and anger. The longer term massage effects included reduced depression and hostility and increased urinary dopamine, serotonin values, NK cell number, and lymphocytes. Conclusions: Women with Stage 1 and 2 breast cancer may benefit from thrice-weekly massage therapy for reducing depressed mood, anxiety, and anger and for enhancing dopamine, serotonin, and NK cell number and lymphocytes.

Introduction

Breast cancer strikes one in every nine women in the United States [1] and is the leading cause of cancer death for women between the ages of 15 and 54 [2]. Psychological studies on women with breast cancer reveal that they are at risk for depression [3], [4], elevated stress/anxiety levels [5], [6], and anger [6].

Psychological stress has been correlated with lower natural killer (NK) cells and NK cell activity in women with breast cancer [7]. Reduced NK cells may present a significant problem inasmuch as these cells play an important role in anticancer defense by lysing tumor and virus-infected cells, as well as monitoring and combating neoplastic (new and abnormal) growth [8], [9]. In one breast cancer study, higher NK cell activity predicted to lower cancer recurrence at a 5-year follow-up [10]. In another study, 30% of NK activity level variance could be accounted for by psychological stress [7].

Research also reveals that breast cancer patients have reduced NK cell number [8] and that stress increases tumor development by decreasing NK cell activity [8], [11]. Because psychological stress has been shown to negatively impact immune response, reducing stress would be expected to positively impact the immune system (for a review, see Ref. [12]).

Studies on psychological interventions for boosting the immune response of cancer patients reveal positive effects from hypnosis [13], stress-management intervention [14], [15], [16], and cognitive behavioral therapies (for a review, see Ref. [17]). The positive effects from these interventions might relate to reduced cortisol stress hormone level, which would indicate healthier neuroendocrine functioning [18].

Massage therapy may provide another treatment for reducing psychological stress and enhancing immune function for the breast cancer patient in that massage has been shown to (1) increase NK cell number and NK cell activity in men [19] and adolescents with HIV [20] and (2) attenuate psychological stress and neuroendocrine (stress-related) levels in varying conditions (for a review, see Ref. [21]).

One mechanism underlying the enhanced immune function from massage may result from the relaxing effects of massage as evident by decreased stress hormone (cortisol) and catecholamine (norepinephrine, epinephrine) levels reported in other massage therapy studies [22], [23]. Decreased cortisol levels would relate to increased NK cells, as cortisol is noted to destroy NK cells [24]. Massage therapy has also been associated with improved mood and increased serotonin (5-HIAA) and dopamine levels, which would also decrease cortisol levels and thereby increase NK cells [21].

Thus, that massage therapy research reveals positive effects on the immune and the neuroendocrine systems and reduces psychological stress provided the rationale for this study to examine massage effects for women with breast cancer, and inasmuch as that massage therapy effects have not been studied for this group. Although no evidence exists suggesting that an increase in NK cells leads to clinical benefits that can be experienced by the patient, in that massage therapy has been associated with reduced stress and depressed mood would be of clinical importance to the cancer patient. Moreover, in that in our experience with different age groups and medical conditions, no adverse effects have been associated with massage, suggests the potential of massage therapy as a noninvasive, relaxing, and safe treatment for women with cancer.

The specific aim of this study was to assess, via a randomized control design, the effects of 5 weeks of massage therapy (15 massage sessions) on the immune, neuroendocrine, and perceived stress of women with early stages of breast cancer. The hypotheses included that the massage therapy group would report reduced stress and depression levels and show reduced urinary cortisol and increased serotonin, dopamine, and plasma NK cell number and NK activity compared to the control group.

Section snippets

Participants

The HIV men's study demonstrated an effect of massage on NK cytotoxicity with a subset of 17 subjects. A power analysis indicated 80% power to detect a medium to large effect size (.70) for an alpha of .05, two tailed on the immune measure. To accommodate the large number of variables, we intended a sample size of 34 participants (or double the HIV men's sample size). The study was submitted to and approved by the University of Miami's Institutional Review Board.

The inclusion criteria included

Self-report anxiety and mood measures

The analyses revealed for the massage group the following: (1) reduced anxiety on the STAI, F(1,32)=4.49, P<.05, after the first and the last session; (2) reduced depression on the POMS depression score, F(1,32)=6.36, P<.05, after the first and last session and from the first to the last day of the study; and (3) reduced anger on the POMS anger scale, F(1,32)=3.93, P<.05. Means and percent change on the within-groups differences are reported in Table 2.

Self-Reports on mood

The analyses on the SCL-90-R scale

Discussion

In the present breast cancer study, women who received 15 massage treatments over a 5-week period showed an increase in NK cell number and lymphocytes. NK cells spontaneously destroy a wide variety of cancer and virus-infected cells and are involved in eliminating metastases [40]. A boost in NK cell number would be beneficial given that some cancer patients have reduced NK cell numbers [41]. Lymphocytes are precursor cells of immunological function as well as regulators and effectors of

Acknowledgements

We thank the women who participated in this study, Iris Burmam, LMT, for designing the massage therapy procedure, our lead therapists Susan D'Arienzo, LMT, and Carmen Figueroa, LMT, and all of the massage therapists who provided the massage therapy sessions, Patricia Marzol who helped with data collection and Chris Sanders for his assistance with data analyses. This research was supported by USAMRMC DAMD Grant 17-99-1-9292 to Gail Ironson, an award from the Sylvester Comprehensive Cancer Center

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