Effectiveness of aroma massage on advanced cancer patients with constipation: A pilot study

The Role of Rehabilitation in the Treatment of Constipation in Oncological Patients

BACKGROUND

Chemotherapy, as well as opioid and antiemetic drugs, can contribute to constipation in oncological patients. This systematic review aims to analyse the potential of specific rehabilitation strategies and alternative strategies for improving constipation symptoms, with the goal of incorporating these strategies into a dedicated protocol for managing cancer-related constipation. This could potentially reduce the dosages of or eliminate the need for constipation medications.

METHODS

A systematic search was conducted on PubMed, Scopus and Web of Science. The review included studies analysing constipation complaints in cancer patients treated with rehabilitation, acupuncture and osteopathy.

RESULTS

The review included 16 studies in line with PRISMA and PICOS criteria. Most studies showed that physical exercise, abdominal massage, TENS, acupuncture and education on the correct defecation position positively impacted the management of constipation and quality of life in oncological patients. A physiotherapy program involving massages as well as aerobic and resistance training improved constipation in oncological women, regardless of age, sex and frailty. A combination of abdominal massage, abdominal muscle stretching and education on proper defecation position alleviated the severity of constipation and related depression. However, the outcomes regarding TENS were yet inconsistent. Another technique, becoming increasingly common for constipation, and demonstrating positive results, involved stimulating trigger points through acupressure and acupuncture. Conversely, osteopathic and superficial manipulations more frequently required constipation medications than did the other alternative approaches. However, no existing studies have proposed a specific protocol to manage cancer-related constipation.

CONCLUSIONS

The results of the studies confirm the positive influences of rehabilitation, osteopathy and acupuncture on constipation and pain in oncological patients. Nevertheless, further studies are required to establish the best type, timing and duration of treatment, as well as how the stage and location of the cancer and the cause of constipation (drug-induced or functional) impact the results.

Essential Oils from Mediterranean Plants Inhibit In Vitro Monocyte Adhesion to Endothelial Cells from Umbilical Cords of Females with Gestational Diabetes Mellitus

Essential oils (EOs) are mixtures of volatile compounds belonging to several chemical classes derived from aromatic plants using different distillation techniques. Recent studies suggest that the consumption of Mediterranean plants, such as anise and laurel, contributes to improving the lipid and glycemic profile of patients with diabetes mellitus (DM). Hence, the aim of the present study was to investigate the potential anti-inflammatory effect of anise and laurel EOs (AEO and LEO) on endothelial cells isolated from the umbilical cord vein of females with gestational diabetes mellitus (GDM-HUVEC), which is a suitable in vitro model to reproduce the pro-inflammatory phenotype of a diabetic endothelium. For this purpose, the Gas Chromatographic/Mass Spectrometric (GC-MS) chemical profiles of AEO and LEO were first analyzed. Thus, GDM-HUVEC and related controls (C-HUVEC) were pre-treated for 24 h with AEO and LEO at 0.025% v/v, a concentration chosen among others (cell viability by MTT assay), and then stimulated with TNF-α (1 ng/mL). From the GC-MS analysis, trans-anethole (88.5%) and 1,8-cineole (53.9%) resulted as the major components of AEO and LEO, respectively. The results in C- and GDM-HUVEC showed that the treatment with both EOs significantly reduced: (i) the adhesion of the U937 monocyte to HUVEC; (ii) vascular adhesion molecule-1 (VCAM-1) protein and gene expression; (iii) Nuclear Factor-kappa B (NF-κB) p65 nuclear translocation. Taken together, these data suggest the anti-inflammatory efficacy of AEO and LEO in our in vitro model and lay the groundwork for further preclinical and clinical studies to study their potential use as supplements to mitigate vascular endothelial dysfunction associated with DM.

Citrus Essential Oils in Aromatherapy: Therapeutic Effects and Mechanisms

Citrus is one of the main fruit crops cultivated in tropical and subtropical regions worldwide. Approximately half (40-47%) of the fruit mass is inedible and discarded as waste after processing, which causes pollution to the environment. Essential oils (EOs) are aromatic compounds found in significant quantities in oil sacs or oil glands present in the leaves, flowers, and fruit peels (mainly the flavedo part). Citrus EO is a complex mixture of ~400 compounds and has been found to be useful in aromatic infusions for personal health care, perfumes, pharmaceuticals, color enhancers in foods and beverages, and aromatherapy. The citrus EOs possess a pleasant scent, and impart relaxing, calming, mood-uplifting, and cheer-enhancing effects. In aromatherapy, it is applied either in message oils or in diffusion sprays for homes and vehicle sittings. The diffusion creates a fresh feeling and enhances relaxation from stress and anxiety and helps uplifting mood and boosting emotional and physical energy. This review presents a comprehensive outlook on the composition, properties, characterization, and mechanism of action of the citrus EOs in various health-related issues, with a focus on its antioxidant properties.

Efeitos de Abordagens não Farmacológicas nos Sintomas Físicos de Indivíduos com Câncer Avançado: Revisão Sistemática

Introdução: O câncer e um problema de saúde publica que, em estágios avançados, pode ocasionar desconfortos físicos, psicossociais e espirituais. Assim, abordagens fisioterapêuticas e as Práticas Integrativas e Complementares em Saúde (PICS) surgem como ferramentas importantes para o controle e melhora de sintomas físicos nesses indivíduos. Objetivo: Descrever os efeitos de abordagens não farmacológicas, envolvendo técnicas fisioterapêuticas e PICS, nos sintomas físicos de indivíduos com câncer avançado. Método: Revisão sistemática da literatura composta por ensaios clínicos randomizados que abordassem os efeitos de abordagens fisioterapêuticas ou PICS nos sintomas físicos de indivíduos diagnosticados com câncer avançado. Foram selecionadas as bases de dados PubMed, LILACS, PEDro, Cochrane, SciELO, e a última busca ocorreu em abril de 2021. A avaliação da qualidade metodológica dos estudos foi realizada por meio da escala PEDro. Resultados: Vinte e dois estudos foram incluídos, e demonstraram que ambas as abordagens tem efeitos positivos para os sintomas físicos, como fadiga e dor, na população estudada. Conclusão: A fisioterapia e as PICS tem efeitos positivos nos sintomas físicos em indivíduos com diagnostico de câncer avançado. No entanto, existem poucos estudos com qualidade metodológica suficiente para confirmar a eficácia das duas abordagens nos desfechos estudados para essa população.

Comparative Study of the Effect of Acupressure and Abdominal Massage on Constipation in Elderly Women: A Clinical Trial Study

Constipation is a common complaint and challenge in the elderly. Methods such as acupressure and abdominal massage can be considered for the treatment of constipation in the elderly. This study aimed to compare the effect of abdominal massage and acupressure on constipation in healthy elderly women. In this study, 60 elderly women with constipation participated in two groups. The first group underwent acupressure for 3 minutes every day for 5 days, and the other group underwent classical abdominal massage for 15-20 minutes every day for 5 days. The two groups were followed for a month. Data collection tools included a demographic characteristics questionnaire, Rome III criteria, and constipation assessment scale. The data were analyzed by SPSS18 software. Following the intervention, there was no significant difference between the two groups (p > .05). But in the first month, the mean scores of constipation in the abdominal massage and acupressure groups were 6.30 ± 3.47 and 9.03 ± 3.84, respectively, which showed a significant difference between the two groups for that time period (p = .005). Although there was no significant difference between the two methods during the intervention, the severity of constipation did decrease in each group. Also, in the first month after individual intervention, a significant difference was observed between the two groups. We conclude that abdominal massage can be suggested as an applicable and simple method in the treatment of constipation for elderly women.

Effect of Abdominal Massage with and without Salvia officinalis on Nausea and Vomiting in Patients with Cancer Undergoing Chemotherapy: A Randomized Clinical Trial

Objective

The aim of this study was to determine the effect of abdominal massage with and without Salvia officinalis on nausea and vomiting in patients with cancer undergoing chemotherapy.

Methods

In this randomized clinical trial, 60 patients undergoing chemotherapy were placed in one of two intervention groups or in a control group. Abdominal massage with and without Salvia officinalis was performed for 15 minutes twice a day for 3 consecutive days by the patient's companion. The rate of nausea and vomiting was measured with a Visual Analog Scale.

Results

Findings showed that immediately after the intervention, the mean score of nausea in abdominal massage with Salvia officinalis group was lower than that of the control group. The mean score of nausea was not different between abdominal massage and control groups. One week after the intervention, the mean score of nausea was not different among the three groups. In addition, the frequency of vomiting was not different among the three groups.

Conclusion

Abdominal massage with/without Salvia officinalis as a complementary medicine has not considerable effect on reducing nausea and vomiting in patient with cancer undergoing chemotherapy. More studies are needed to achieve better and more accurate results.

The Effect of Abdominal Massage with Extra-Virgin Olive Oil on Constipation among Elderly Individuals: A Randomized Controlled Clinical Trial

Background:

Constipation is one of the most prevalent problems during old age. Abdominal massage is a complementary method in controlling constipation. This study is conducted with the aim of determining the effect of abdominal massage with extra-virgin olive oil on constipation among the elderly.

Methods:

In this single-blind randomized controlled clinical trial, 54 old individuals in Shiraz nursing homes during November 2018-March 2019 were selected randomly and then allocated to three groups of 18, based on block randomization. The first group underwent abdominal massage with olive oil for five consecutive days (each day one time for 15 minutes). The second group underwent abdominal massage with water similar to the first group. No specific intervention was applied to the control group. All three groups received their medical treatment. The constipation scores were examined using constipation assessment scale (CAS) before the intervention and on the sixth day. Data analysis was done through SPSS 22 using Chi-square, paired t-test, and ANOVA. P<0.05 was considered as the level of statistical significance.

Results:

There were no statistically significant differences among the three groups before the intervention. The results demonstrated that the mean score of constipation further decreased in the olive oil group (5.62±1.89 to 2.06±0.99) (P≤0.001) than the massage with water (5.05±1.25 to 3.11±0.99) (P=0.02), and the control group (4.44±1.38 to 5.22±1.35) (P=0.006).

Conclusion:

Due to the greater effectiveness of abdominal massage with extra-virgin olive oil, the use of this method is recommended in treatment of constipation among the elderly.

Trial Registration Number:

IRCT20180923041101N

Aromatherapy Plus Music Therapy Improve Pain Intensity and Anxiety Scores in Patients With Breast Cancer During Perioperative Periods: A Randomized Controlled Trial

INTRODUCTION

To investigate the effect of perioperative aromatherapy (AT) or/plus music therapy (MT) on pain and anxiety level, and the potential mechanism in women experiencing breast cancer surgery.

METHODS

A total of 160 patients with breast cancer were randomly assigned in a 1:1:1:1 ratio to receive usual care (UC), AT, MT, or combination therapy (CT) during perioperative periods. Pain intensity and anxiety scores were measured by visual analog scale. Interleukin (IL)-6 and high mobility group box 1 (HMGB-1) were measured by enzyme-linked immunosorbent assay.

RESULTS

There was a significant group effect on pain, anxiety, and IL-6 and HMGB-1 levels, with the greatest improvement occurring in the CT group (P < .001). Compared with the UC group, the AT and MT groups had lower mean changes of pain intensity and IL-6 and HMGB-1 levels, and greater anxiety reduction (P < .001). However, the differences between the AT and MT groups did not reach significance (P > .05).

CONCLUSION

In patients with breast cancer, perioperative CT achieves greater pain improvement and anxiety reduction and less marked increase in IL-6 and HMGB-1 levels. These results suggest that CT is an acceptable complementary and alternative medicine for breast cancer patients.

Exploring the Potential of Aromatherapy as an Adjuvant Therapy in Cancer and its Complications: A Comprehensive Update

BACKGROUND

Aromatherapy is a traditional practice of employing essential oils for the therapeutic purposes, currently headed under the category of complementary and adjuvant medicine.

OBJECTIVE

The aim of this review article is to summarize the potential health benefits of aromatic essential oil from traditional times till the present. It also proposed some mechanisms which can be utilized as basis for using aromatherapy in cancer and cancer linked complications.

METHODS

To find out the relevant and authentic data, several search engines like Science direct, Pubmed, research gate, etc. were thoroughly checked by inserting key words like aromatherapy, complementary, adjuvant therapy etc. to collect the relevant material in context of article. Also, the chemical components of essential oil were classified based on the presence of functional groups, which are further explored for their cytotoxic potential.

RESULTS

The result depicted the anti-cancer potential of chemical constituents of essential oil against different types of cancer. Moreover, the essential oils show promising anti-inflammatory, anti-microbial, anti-oxidant and anti-mutagenic potential in several studies, which collectively can form the basis for initiation of its anti-cancer utility.

CONCLUSION

Aromatherapy can serve as adjuvant economic therapy in cancer after the standardization of protocol.

Complementary therapy in palliative care: A synthesis of qualitative and quantitative systematic reviews

BACKGROUND

Interventions delivered in palliative care are complex and their evaluation through qualitative and quantitative research can lead to contrasting results. In a systematic review of trials, the effectiveness results of complementary therapies in palliative care were inconclusive; however, our qualitative synthesis showed participants perceived them to be beneficial.

AIM

Use a novel methodology to synthesise evidence from qualitative and quantitative systematic reviews on complementary therapy in palliative care to explore the following: (1) If interventions delivered in trials reflect how participants in qualitative studies report they are delivered in real-life settings and (2) whether quality of life measures used in trials capture perceived benefits that are reported in qualitative studies.

METHODS

Two matrix tables were formulated. In one, key components in delivery of the complementary therapy from the qualitative synthesis which are as follows: (1) relationship with therapist, (2) comfortable environment, (3) choices (e.g. area of massage) and (4) frequent sessions, were plotted against intervention description, to explore matches and mismatches. In the other, items included in quality of life scales were compared with perceived benefits of complementary therapy.

RESULTS

None of the trials included all four key delivery components. The five quality of life scales used in the trials failed to capture the range of perceived benefits from the complementary therapies and many included inappropriate or redundant items.

CONCLUSIONS

By integrating qualitative and quantitative review data, we determined the reasons trials may be inconclusive. This methodological exemplar provides a framework for understanding complexity in outcomes across trials and a direction for future research.

GASTROINTESTINAL CHANGES DURING NUTRITIONAL FOLLOW-UP OF CANCER PATIENTS UNDERGOING OUTPATIENT CHEMOTHERAPY

BACKGROUND

Cancer patients may have gastrointestinal changes that influence nutritional status.

OBJECTIVE

To investigate the occurrence of gastrointestinal changes resulting from outpatient chemotherapy treatment in cancer patients.

METHODS

In a retrospective longitudinal study, the nutritional status and chemotherapy gastrointestinal changes (nausea, vomit, diarrhea, constipation, mucositis, dysphagia, xerostomia, inappetence, dysgeusia and heartburn) in cancer patients (n=187) were investigated in an outpatient follow-up. For the study of the parameters over time, the generalized estimating equation (GEE) method was used. Kruskal-Wallis, Mann-Whitney tests and Spearman coefficient, at a significance level of 5% were also used.

RESULTS

The majority of the patients were female (63.64%) and the mean age was 57.5±12.1 years. The most frequent symptoms were nausea (18.54%); inappetence (18.31%); intestinal constipation (11.58%); diarrhea (7.98%); xerostomia (7.59%) and vomiting (7.43%). The nutritional status did not exhibit any relevant changes (P=0.7594). However, a higher prevalence of eutrophy was observed, followed by overweight; vomiting exhibited a significant difference (P=0.0211). The nausea symptom exhibited a significant difference with a higher prevalence of colorectal neoplasia when compared to breast neoplasia (P=0.0062); as well as vomiting in lung and colorectal neoplasias (P=0.0022), and dysphagia, in head and neck neoplasia, when compared to other neoplasms (P<0.001). There was a statistically significant difference between the number of medical appointments and gender (P=0.0102) and between dysphagia and gender (P<0.0001).

CONCLUSION

The study findings enhance the need for signs and symptoms follow up, as well as nutritional status follow up of patients undergoing outpatient chemotherapy.

Short and long-term efficacy of massage for functional constipation: A protocol for systematic review and meta analysis

BACKGROUND

Functional constipation (FC) is one of the most common diseases throughout the world, which brings a bad influence on life quality as well as mental health. Massage has been widely used in the treatment of functional constipation in china. In several randomized controlled trials indicate that massage has a positive effect on FC. However, there remain exist controversy towards its effectiveness and safety. What's more, how about the short and long-term efficacy? We, therefore, design this systematic review to assess the short and long-term effects of massage for FC.

METHODS

The following electronic databases will be searched from their inception to May 2020, including PubMed, Cochrane Library, EMBASE, Web of Science, WHO International Clinical Trials Registry Platform, Chinese National Knowledge Infrastructure (CNKI), WanFang Database, Chinese Biomedical Literature Database (CBM), the Chongqing VIP Chinese Science, and Technology Periodical Database (VIP).

RESULTS

This systematic review will assess the short and long-term effects of massage in the treatment of FC.

CONCLUSION

This study will provide high-quality current evidence of short and long-term effects of massage for FC.

ETHICS AND DISSEMINATION

Ethical approval is not required, for this review will not involve individuals' information. The results will be published in a peer-reviewed publication or disseminated in relevant conferences.INPLASY Registration number: INPLASY202050001.

The effectiveness of aromatherapy, massage and reflexology in people with palliative care needs: A systematic review

BACKGROUND

Aromatherapy, massage and reflexology are widely used in palliative care. Despite this, there are questions about their suitability for inclusion in clinical guidelines. The need to understand their benefits is a public priority, especially in light of funding pressures.

AIM

To synthesise current evidence on the effectiveness of aromatherapy, massage and reflexology in people with palliative care needs.

DESIGN

A systematic review of randomised controlled trials (PROSPERO CRD42017081409) was undertaken following international standards including Cochrane guidelines. The quality of trials and their pooled evidence were appraised. Primary outcomes on effect were anxiety, pain and quality-of-life.

DATA SOURCES

Eight citation databases and three trial registries were searched to June 2018.

RESULTS

Twenty-two trials, involving 1956 participants were identified. Compared with a control, four evaluated aromatherapy, eight massage and six reflexology. A further four evaluated massage compared with aromatherapy. Trials were at an unclear risk of bias. Many had small samples. Heterogeneity prevented meta-analysis. In comparison with usual care, another therapy or an active control, evidence on the effectiveness of massage and aromatherapy in reducing anxiety, pain and improving quality-of-life was inconclusive. There was some evidence (low quality) that compared to an active control, reflexology reduced pain.

CONCLUSIONS

This review identified a relatively large number of trials, but with poor and heterogeneous evidence. New clinical recommendations cannot be made based on current evidence. To help provide more definitive trial findings, it may be useful first to understand more about the best way to measure the effectiveness of these therapies in palliative care.

A systematic review of complementary and alternative medicine in oncology: Psychological and physical effects of manipulative and body-based practices

Background

Complementary and Alternative Medicines (CAM) are widely used by cancer patients, despite limited evidence of efficacy. Manipulative and body-based practices are some of the most commonly used CAM. This systematic review evaluates their benefits in oncology.

Method

A systematic literature review was carried out with no restriction of language, time, cancer location or type. PubMed, CENTRAL, PsycArticle, PsychInfo, Psychology and Behavioral Sciences Collection and SOCindex were queried. Inclusion criteria were adult cancer patients and randomized controlled trials (RCT) assessing manipulative and body-based complementary practices on psychological and symptom outcomes. Effect size was calculated when applicable.

Results

Of 1624 articles retrieved, 41 articles were included: massage (24), reflexology (11), acupressure (6). Overall, 25 studies showed positive and significant effects on symptom outcomes (versus 9 that did not), especially pain and fatigue. Mixed outcomes were found for quality of life (8 papers finding a significant effect vs. 10 which did not) and mood (14 papers vs. 13). In most studies, there was a high risk of bias with a mean Jadad score of 2, making interpretation of results difficult.

Conclusion

These results seem to indicate that manipulative CAM may be effective on symptom management in cancer. However, more robust methodologies are needed. The methodological requirements of randomized controlled trials are challenging, and more informative results may be provided by more pragmatic study design.

Effect of aromatherapy on cancer complications: A systematic review

PURPOSE

The aim of this study was to determine the effect of aromatherapy on cancer complications.

METHODS

In this systematic review, international (PubMed, Web of Science, Scopus, EMBASE and CENTRAL) and national databases (SID and Magiran) were searched from inception of the databases to April 31, 2019. JBI and Jadad scales were used to assess the quality of the studies included.

RESULTS

of 43 Studies conducted on 3239 cancer patients in 13 countries from 1995 to 2019, entered the final stage. The results showed that the aromatherapy improves the various physical and psychological complications, although few studies have shown that aromatherapy had no effect on skin reactions.

CONCLUSION

Considering the various complications and costs in cancer patients, it seems that the aromatherapy can be used as a proper supplemental treatment to improve complications, although further studies are needed to determine the protocol and the standard dosage.

Chemical profile and in vivo toxicity evaluation of unripe Citrus aurantifolia essential oil

Citrus aurantifolia (Christm.) Swingle (syn. C. MEDICA var. ACIDA Brandis) (family: Rutaceae) essential oil is one of the cheapest oils found in local markets. Although, it is generally accepted as non-toxic to vital organs and cells, majority of people are cynical about it usage. Herein, the present study reports the chemical composition and in vivo oral toxicity study of unripe C. aurantifolia essential oil found in Ghana. The toxicity of C. aurantifolia essential oil extract was investigated via oral administration using two methods: The acute toxicity single dose study (SDS) and the repeated dose method. The oil exhibited no acute toxicity but in the sub-chronic studies, the effects was dose and time-dependent. Chemical profile investigation of the oil showed 9 constituent of phytochemicals (Germacrene isomers (61.2%), Pineen (14%), Linalool dimmer (2.9%), Bornane (11%), Citral (2.9%), Anethole (1.5%), Anisole (1.1%), Safrole (0.3%) and Demitol (0.6%)). Histopathological studies revealed conditions such as necrosis, edema and inflammatory reaction in the liver, spleen and kidneys. Marginal upsurge of biochemical parameters above normal and elevated levels of lymphocytes (35.20–46.40 g/dL) demonstrated mild toxicity among the 100 mg/kg and 500 mg/kg dose groups at the sub-chronic stage. Low levels of hemoglobin (13.60 to 12.70 g/dL), MCV (34.20–24.0 fL), MCH (40.20–36.40 g/dL) along with high levels of liver enzymes confirmed the mild toxicity of the oil at sub-chronic stage. These results demonstrate that, despite consideration of lime essential oil as safe, it can have mild hematotoxic, nephrotoxic and hepatotoxic effects.

Assessment and management of constipation for patients receiving palliative care in specialist palliative care settings: A systematic review of the literature

BACKGROUND

Constipation is an important issue for patients receiving palliative care within specialist palliative care settings. Questions and ambiguity, however, persist about international best practice and management.

AIM

To synthesise the current evidence base on the assessment and management of constipation for palliative care patients within a specialist palliative care setting.

DESIGN

This is a systematic review.

DATA SOURCES

MEDLINE, Embase, CINAHL, Scopus and Cochrane databases were systematically searched in April 2017 for empirical studies, written in English, on the assessment and management of constipation in specialist palliative care settings, published between 2007 and 2017. Two researchers independently reviewed and critically appraised all studies, conducted data extraction, and undertook a thematic analysis.

RESULTS

In total, 13 studies were included in the review comprising randomised trials ( n = 3), observational ( n = 4) and descriptive studies ( n = 6). Most research was conducted in specialist palliative care units, targeting either healthcare professionals or patients. The analysis highlighted a lack of standard definition of constipation, raising questions on the existence and comparability of baseline prevalence figures, the physical and psychological impact on patients, resource impact on staff and service, the subjective and objective methods of assessing constipation, and key aspects of constipation management, including a lack of focus on non-pharmacological management in this setting.

CONCLUSION

The results of this review are being used to inform the development of an educational intervention targeting healthcare professionals. Gaps in the evidence base include lack of consistent definition of constipation, constipation prevention, non-pharmacological management, and the consideration of the management of constipation for the dying patient.

Does abdominal massage improve gastrointestinal functions of intensive care patients with an endotracheal tube?: A randomized clinical trial

INTRODUCTION

Gastrointestinal dysfunction is one of the most common problems among patients hospitalized in intensive care units. Currently, medicinal and non-medicinal methods are being used to prevent gastrointestinal problems. Among non-medicinal methods, abdominal massage is considered as a relatively acceptable method. The present study aims to examine the effect of abdominal massage on gastrointestinal functions of the intensive care patients with an endotracheal tube.

MATERIALS AND METHODS

In this clinical trial, 70 intensive care patients with an endotracheal tube were chosen by convenience sampling and allocated to an intervention or a control group randomly. In the intervention group, a 15-min abdominal massage was conducted twice a day for three days, while the control group received only routine cares. The abdominal circumference, gastric residual volume, times of defecation, and frequency of constipation were measured.

RESULTS

Gastric residual volume decreased significantly in the intervention group and increased significantly in the control group; however, there was no significant difference between two groups (P = .15). There was a significant difference between two groups regarding abdominal circumference and it was decreased in the intervention group (P < .001). The defecation times significantly increased in the intervention group (P = .002). After the intervention, the prevalence of constipation was significantly decreased in the intervention group (P = .008).

CONCLUSION

The results revealed that abdominal massage could improve gastrointestinal functions in enterally fed patients with an endotracheal tube. It is suggested to use abdominal massage as an adjunct therapy for improving gastrointestinal functions in intensive care patients.

Effects of abdominal massage on constipation in palliative care patients – a pilot study

Introduction: The problem of constipation in Poland concerns 13.4% of the healthy population. In the case of patients treated with opioids, this number increases to 70-90%, which constitutes a serious problem that lowers the patients’ quality of life. The aim of the study was to assess the effects of abdominal massage, which successfully reduces constipation in various diseases, on palliative care patients. Material and methods: The research included 18 patients of a palliative care facility (mean age 78.3 ± 10 years), 11 of whom completed the study. The study participants were randomly divided into two groups, i.e. a pilot group (abdominal massage and kinesiotherapy) and a control group (kinesiotherapy). The therapy lasted 8 weeks and blind evaluation was carried out once per week. The study involved evaluating constipation intensity (The Bowel Function Index), the frequency of defecation (medical documentation) and abdomen circumference (anthropometric tape). The collected data were analysed statistically with the use of Statistica software. Results: The observed differences between the studied groups undergoing different therapies in subsequent weeks were not statistically significant. However, in the group in which abdominal massage was implemented, a decrease in the intensity of constipation, an increase in the frequency of defecation and a reduction in abdomen circumference were noted compared to the control group. The patients also indicated additional positive effects of this form of therapy, i.e. an improvement in breathing, easier urination, release of excessive gas and abdominal pain reduction. Conclusions: The collected data led to the conclusion that abdominal massage may result in a decrease in disorders accompanying opioid-induced constipation. Therefore, it is worth considering the implementation of this form of therapy in the case of patients in an advanced stage of cancer. There is also a need for further research in this field which will include a larger number of patients.

Integrative Oncology

Integrative oncology helps support the health of patients with cancer and their caregivers through an evidence-informed approach to lifestyle and behavior modification and the use of complementary health therapies as part of conventional cancer care. Integrative approaches can provide patients relief from cancer and cancer treatment-related symptoms, leading to improvements in their physical and psychosocial health. An evidence-informed approach is important when recommending an integrative cancer plan. Efforts at enhancing communication between patients and health care providers, as well as between integrative practitioners and conventional health care teams, are critical to achieving optimal health and healing for patients with cancer.

Experiences of aromatherapy massage among adult female cancer patients: A qualitative study

AIMS AND OBJECTIVES

To explore the experiences towards aromatherapy massage use, and to examine the perceived benefits and adverse effects of aromatherapy massage among adult female cancer patients.

METHOD

A qualitative research design was used. Fifteen women with cancer were recruited for semi-structured interviews. Sample recruitment was undertaken through cancer self-help groups and referrals of a private aromatherapy clinic by convenience sampling. The interview data were analysed by thematic analysis.

RESULTS

All participants had a positive experience towards aromatherapy massage. The perceived benefits of aromatherapy massage included physical and psychological dimensions: overall comfort, relaxation, reduced pain, muscular tension, lymphoedema and numbness, improved sleep, energy level, appetite and mood. Interestingly, a few participants reported that aromatherapy massage helped to enhance self-acceptance and coping with their altered torso. No adverse effects were reported. The findings focused on four main themes that emerged: (i) an immediate effect that brings all-round comfort and reconnection to daily life; (ii) a pleasurable moment to forget the disease with aroma as a booster; (iii) a pampering experience of being cared for with a sense of dignity preserved; and (iv) communicating with the failing body.

CONCLUSIONS

This study contributed by providing a better understanding in aromatherapy massage from female cancer patients' perspective which adds to the existing body of knowledge. The implications for nursing practice, education and future research were suggested.

RELEVANCE TO CLINICAL PRACTICE

Aromatherapy massage seems to have both physical and psychological benefits for women with cancer. The findings elucidated a wide range of benefits that are perceived in such complex intervention, and the contextual factors that may influence these perceived benefits. This will inform future nurse-led quantitative research in the clinical setting. The study highlights the importance of touch towards a caring relationship and the provision of cancer care with a gender-specific approach. Exploring of the lived experience of aromatherapy massage and its meaning enables the healthcare professionals to gain insights into the needs, preferences and values for cancer care among female cancer population. While nurses play a crucial role in collaborating with cancer patients in the choice of CAM therapies, nurses should advise them to attend practising aromatherapists with recognised training and competency who should be members of aromatherapy professional associations. As aromatherapy is an unregulated profession, nurses may also advise oncology patients on the international guideline and institutional policies for aromatherapy massage use in the hospital setting. Nurses may broaden the caring repertoire by expanding their knowledge and skills in aromatherapy massage such as understanding the basic essential oils pharmacology, massage skills and therapy efficacy for symptoms management in cancer care. Oncology clinicians and nurses should support and guide patients' decision in the use of aromatherapy massage by providing evidence-based and comprehensive advice on the potential benefits, risks and related safety issues.

Randomized trial of aromatherapy versus conventional care for breast cancer patients during perioperative periods

PURPOSE

Several studies focused on the effect of aromatherapy on mood, quality of life (QOL), and physical symptoms in patients with cancer. We compared the effects on QOL, vital signs, and sleep quality between aromatherapy and conventional therapy during perioperative periods of the breast cancer patients in this study.

METHODS

Patients were randomly assigned in a 2:1 ratio to receive aromatherapy or usual care. The primary endpoint was QOL, which was assessed using the quality of life questionnaire QLQ-C30, Version 3.0 of the European Organization for Research and Treatment of Cancer (EORTC) Study Group on quality of life. Secondary endpoints included the necessity of hypnotics, vital signs including blood pressure and heart rate and adverse events. In addition, we also summarized the patients' perception of the experience from a free description-type questionnaire.

RESULTS

A total of 249 patients had breast cancer surgery and 162 patients gave physician consent and were recruited; 110 were randomly assigned to aromatherapy group (eight patients showed incomplete EORTC QLQ-C30) and 52 to control group (one patient showed incomplete EORTC QLQ-C30). There were no statistically significant differences between the aromatherapy group and control group in the EORTC QLQ-C30 at the surgery day. As for the results of the post-operation day 1, trends for differentiations of physical functioning and role functioning were detected between aromatherapy group and control group, but the differences did not reach statistical significance (p = 0.08 and 0.09). There were no significant differences of systolic and diastolic blood pressures between aromatherapy group and control group (p = 0.82 and 0.68). There was no statistically significant difference in heart rates between aromatherapy group (70.6 ± 11.0 bpm) and control group (71.2 ± 9.8 bpm) (p = 0.73). Likewise, the rate of hypnotic use was not statistically significant (p = 0.10). No adverse events were reported after aromatherapy and all impressions from aromatherapy group were positive with descriptors such as relaxed, comfortable, and enjoyable being common.

CONCLUSION

The results showed no effects of aromatherapy on QOL, sleep quality, and vital sign. However, there was not any harm or adverse event for using aromatherapy. All impressions from self-reporting were positive such as relaxed, comfortable, and enjoyable by the aromatherapy group. Therefore, we can use aromatherapy during perioperative periods in order to meet the expectations of the patients.

Effects of Auricular Acupressure on Constipation in Patients With Breast Cancer Receiving Chemotherapy: A Randomized Control Trial

The purpose was to examine the effects of auricular acupressure to relieve constipation in patients with breast cancer who were undergoing chemotherapy. Participants were 52 patients with breast cancer receiving chemotherapy at E University Hospital, Seoul, Korea, randomized into two groups of equal size. For the experimental group, auricular acupressure was applied to seven auricular acupoints for 6 weeks using vaccaria seeds, whereas the control group received the usual care. Constipation-assessment scores of the experimental group were significantly lower compared with the control group ( p < .001). Stool-form scores of the experimental group were significantly higher compared with the control group ( p = .003). Patient Assessment of Constipation-Quality of Life scores of the experimental group were significantly lower compared with the control group ( p < .001). Auricular acupressure was effective at relieving constipation in patients with breast cancer receiving chemotherapy. Auricular acupressure was also a safe and acceptable nursing intervention.

Massage with or without aromatherapy for symptom relief in people with cancer

BACKGROUND

Massage and aromatherapy massage are used to relieve cancer-related symptoms. A number of claims have been made for these treatments including reduction of pain, anxiety, depression, and stress. Other studies have not shown these benefits.

OBJECTIVES

To evaluate the effects of massage with or without aromatherapy on pain and other symptoms associated with cancer.

SEARCH METHODS

We searched the following databases and trials registries up to August 2015: the Cochrane Central Register of Controlled Trials (CENTRAL, 2015, Issue 7), MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), PubMed Cancer Subset, SADCCT, and the World Health Organization (WHO) ICTRP. We also searched clinical trial registries for ongoing studies.

SELECTION CRITERIA

Randomised controlled studies (RCTs) reporting the effects of aromatherapy or massage therapy, or both, in people with cancer of any age. We applied no language restrictions. Comparators were massage (using carrier oil only) versus no massage, massage with aromatherapy (using carrier oil plus essential oils) versus no massage, and massage with aromatherapy (using carrier oil plus essential oils) versus massage without aromatherapy (using carrier oil only).

DATA COLLECTION AND ANALYSIS

At least two review authors selected studies, assessed the risk of bias, and extracted data relating to pain and other symptoms associated with cancer, using standardised forms. We assessed the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and created two 'Summary of findings' tables.

MAIN RESULTS

We included 19 studies (21 reports) of very low quality evidence with a total of 1274 participants. We included 14 studies (16 reports) in a qualitative synthesis and five studies in a quantitative synthesis (meta-analysis). Thirteen studies (14 reports, 596 participants) compared massage with no massage. Six studies (seven reports, 561 participants) compared aromatherapy massage with no massage. Two studies (117 participants) compared massage with aromatherapy and massage without aromatherapy. Fourteen studies had a high risk of bias related to sample size and 15 studies had a low risk of bias for blinding the outcome assessment. We judged the studies to be at unclear risk of bias overall. Our primary outcomes were pain and psychological symptoms. Two studies reported physical distress, rash, and general malaise as adverse events. The remaining 17 studies did not report adverse events. We downgraded the GRADE quality of evidence for all outcomes to very low because of observed imprecision, indirectness, imbalance between groups in many studies, and limitations of study design. Massage versus no-massage groupsWe analysed results for pain and anxiety but the quality of evidence was very low as most studies were small and considered at an unclear or high risk of bias due to poor reporting. Short-term pain (Present Pain Intensity-Visual Analogue Scale) was greater for the massage group compared with the no-massage group (one RCT, n = 72, mean difference (MD) -1.60, 95% confidence interval (CI) -2.67 to -0.53). Data for anxiety (State-Trait Anxiety Inventory-state) relief showed no significant difference in anxiety between the groups (three RCTs, n = 98, combined MD -5.36, 95% CI -16.06 to 5.34). The subgroup analysis for anxiety revealed that the anxiety relief for children was greater for the massage group compared with the no-massage group (one RCT, n = 30, MD -14.70, 95% CI -19.33 to -10.07), but the size of this effect was considered not clinically significant. Furthermore, this review demonstrated no differences in effects of massage on depression, mood disturbance, psychological distress, nausea, fatigue, physical symptom distress, or quality of life when compared with no massage. Massage with aromatherapy versus no-massage groupsWe analysed results for pain, anxiety, symptoms relating to the breast, and quality of life but the quality of evidence was very low as studies were generally at a high risk of bias. There was some indication of benefit in the aromatherapy-massage group but this benefit is unlikely to translate into clinical benefit. The relief of medium- and long-term pain (medium-term: one RCT, n = 86, MD 5.30, 95% CI 1.52 to 9.08; long-term: one RCT, n = 86, MD 3.80, 95% CI 0.19 to 7.41), anxiety (two RCTs, n = 253, combined MD -4.50, 95% CI -7.70 to -1.30), and long-term symptoms relating to the breast in people with breast cancer (one RCT, n = 86, MD -9.80, 95% CI -19.13 to -0.47) was greater for the aromatherapy-massage group, but the results were considered not clinically significant. The medium-term quality of life score was lower (better) for the aromatherapy-massage group compared with the no-massage group (one RCT, n = 30, MD -2.00, 95% CI -3.46 to -0.54). Massage with aromatherapy versus massage without aromatherapy groupsFrom the limited evidence available, we were unable to assess the effect of adding aromatherapy to massage on the relief of pain, psychological symptoms including anxiety and depression, physical symptom distress, or quality of life.

AUTHORS' CONCLUSIONS

There was a lack of evidence on the clinical effectiveness of massage for symptom relief in people with cancer. Most studies were too small to be reliable and key outcomes were not reported. Any further studies of aromatherapy and massage will need to address these concerns.

Effects of a self-management program on antiemetic-induced constipation during chemotherapy among breast cancer patients: a randomized controlled clinical trial

Research on patient-reported outcomes indicates that constipation is a common adverse effect of chemotherapy, and the use of 5-hydroxytryptamine (serotonin; 5HT₃) receptor antagonists aggravates this condition. As cancer patients take multiple drugs as a part of their clinical management, a non-pharmacological self-management (SM) of constipation would be recommended. We aimed to evaluate the effectiveness of a SM program on antiemetic-induced constipation in cancer patients. Thirty patients with breast cancer, receiving 5HT₃ receptor antagonists to prevent emesis during chemotherapy were randomly assigned to the intervention or control group. The SM program consisted of abdominal massage, abdominal muscle stretching, and education on proper defecation position. The intervention group started the program before the first chemotherapy cycle, whereas patients in the wait-list control group received the program on the day before their second chemotherapy cycle. The primary outcome was constipation severity, assessed by the constipation assessment scale (CAS, sum of eight components). The secondary outcome included each CAS component (0–2 points) and mood states. A self-reported assessment of satisfaction with the program was performed. The program produced a statistically and clinically significant alleviation of constipation severity (mean difference in CAS, −3.00; P = 0.02), decrease in the likelihood of a small volume of stool (P = 0.03), and decrease in depression and dejection (P = 0.02). With regards to program satisfaction, 43.6 and 26.4 % patients rated the program as excellent and good, respectively. Our SM program is effective for mitigating the symptoms of antiemetic-induced constipation during chemotherapy.

The measures to evaluate constipation: a review article

The aim of this study was to review current constipation assessment scales and clarify (a) the nature of extant measurements and (b) the criteria contained in the measures. A review of relevant literature from inception to 2011 was extracted from PubMed, CINHAL, Cochrane, and MEDLINE databases by searching for the following key words: constipation, scale, measurement, questionnaire, and assessment. Eight scales were reviewed. The scales under review measured constipation from a subjective viewpoint. All measurement criteria included in 8 of the scales were arranged into 51 items and divided into 5 categories. Categories used to measure the severity of constipation were defecation difficulties, abdominal symptoms, emotional effects of constipation, self-treatment strategies, and individual characteristics. Original and suitable scales for the measurement of the severity of constipation based on the review were the Patient-Assessment of Constipation Symptoms scale and the Constipation Assessment Scale. The Patient-Assessment of Constipation Symptoms scale and the Constipation Assessment Scale are reliable, valid, original, and suitable scales to measure the severity of constipation for subjects.

Complementary and Alternative Therapies for Chronic Constipation

Chronic constipation, an ancient disease, is prevalent, and costly in the general population. Complementary and alternative therapies are frequently used for constipation. This review introduces various methods of complementary and alternative therapies, including acupuncture, moxibustion, massage, and herbal medicine. Efficacy, safety, influence factors, sham control design, and mechanisms of these therapies are discussed and evaluated. Acupuncture or electroacupuncture was found to be most commonly used for constipation among these complementary and alternative therapies, followed by herbal medicine. Although only a small number of clinical studies are flawless, our review of the literature seems to suggest that acupuncture or electroacupuncture and herbal medicine are effective in treating constipation, whereas findings on massage and moxibustion are inconclusive. More well-designed clinical trials are needed to improve and prove the efficacy of the complementary and alternative therapies for constipation; mechanistic studies that would lead to wide spread use and improvement of the methods are also discussed in this review.

Use of complementary and alternative medicine to treat constipation in the elderly

Many modalities of complementary and alternative medicine, such as probiotic bacteria, traditional herbal medicines, biofeedback and massage, have been used to treat constipation in older adults. Virtually all studies in the published literature have been plagued with methodological problems, such as lack of blinding. Chinese herbal medications have been the most frequent subject of studies in controlled trials, but have suffered from methodological insufficiencies, and few have been published in publications other than Chinese language journals. Several therapies, such as yogurt containing probiotic bacteria and massage, are relatively easy to use by the patient, and are likely to cause few adverse reactions. Therefore, complementary and alternative therapies might show the greatest promise for being adopted as adjunctive therapies to conventional treatment.

Effectiveness of aromatherapy with light thai massage for cellular immunity improvement in colorectal cancer patients receiving chemotherapy

BACKGROUND

Patients with colorectal cancer are usually treated with chemotherapy, which reduces the number of blood cells, especially white blood cells, and consequently increases the risk of infections. Some research studies have reported that aromatherapy massage affects the immune system and improves immune function by, for example, increasing the numbers of natural killer cells and peripheral blood lymphocytes. However, there has been no report of any study which provided good evidence as to whether aromatherapy with Thai massage could improve the immune system in patients with colorectal cancer. The objectives of this study were to determine whether the use of aromatherapy with light Thai massage in patients with colorectal cancer, who have received chemotherapy, can result in improvement of the cellular immunity and reduce the severity of the common symptoms of side effects.

MATERIALS AND METHODS

Sixty-six patients with colorectal cancer in Phichit Hospital, Thailand, were enrolled in a single-blind, randomised-controlled trial. The intervention consisted of three massage sessions with ginger and coconut oil over a 1-week period. The control group received standard supportive care only. Assessments were conducted at pre-assessment and at the end of one week of massage or standard care. Changes from pre-assessment to the end of treatment were measured in terms of white blood cells, neutrophils, lymphocytes, CD4 and CD8 cells and the CD4/CD8 ratio and also the severity of self-rated symptom scores.

RESULTS

The main finding was that after adjusting for pre-assessment values the mean lymphocyte count at the post-assessment was significantly higher (P=0.04) in the treatment group than in the controls. The size of this difference suggested that aromatherapy with Thai massage could boost lymphocyte numbers by 11%. The secondary outcomes were that at the post assessment the symptom severity scores for fatigue, presenting symptom, pain and stress were significantly lower in the massage group than in the standard care controls.

CONCLUSIONS

Aromatherapy with light Thai massage can be beneficial for the immune systems of cancer patients who are undergoing chemotherapy by increasing the number of lymphocytes and can help to reduce the severity of common symptoms.