who had been screened and assigned to the control group
developed lymphodema before starting the trial and had to
be dropped, one woman became pregnant after the screen-
ing, and one woman assigned to the control group stated
that she was not feeling well and did not want to return to
complete the last day’s assessments. The final sample was
comprised of 34 women (M age = 53, S.D. = 10.4) who had
been diagnosed with Stage 1 or 2 breast cancer and were
ethnically distributed, 74% Caucasian and 26% Hispanic,
and middle to upper middle socioeconomic status (M = 2.3
on the Hollingshead two-factor index). The women were
randomly assigned to a massage therapy group (N = 18) or
a standard treatment control group (n = 16) using a flip of a
coin. The groups did not differ on stage of cancer, type of
surgery, treatments received, or demographic variables (see
Table 1). Because participants were assigned using a flip of
a coin at time of screening, no method was used to conceal
allocation. The women assigned to the control group were
informed that they would receive complimentary massages
at the completion of the study. No participant was changed
from one to another group during the 5-week trial.
Of the 34 women comprising the final sample, 27 women
(n = 15 massage and 12 control) provided immune measure
data. Three women in the massage therapy group and four in
the control group did not have their blood drawn due to
missed appointments, phlebotomy scheduling conflicts, or
request not to have blood drawn due to a recent blood draw.
Analyses revealed that the seven women who did not
contribute immune measures data did not differ from the
rest of the women in the study on age, stage of cancer, SES,
treatment, or surgery (all Ps > .10). Their self-report and
urine data were included in the final analyses.
Procedures
The women assigned to the massage therapy group
received 15 massages during the study period (three mas-
sages each week for 5 weeks). Each massage was 30 min
long and the massages were conducted in a quiet and private
room on a massage table by a trained massage therapist.
The standard treatment control group received standard
medical care alone. At the end of the 5-week study period, the
women in the control group were offered massage therapy.
Massage therapy
The participant was asked to undress except for her
undergarments and lie on the massage table, which had
been covered with a soft cotton sheet. A second sheet was
draped over the participant for warmth and security. As the
massage proceeded, the therapist uncovered the body part
to be massaged while keeping the rest of the woman’s
body covered with the top sheet. Female massage thera-
pists were selected for the study as the women informed us
that they felt better having a female therapist. The 30-min
massage routine (designed by Iris Burman, LMT, of the
Educating Hands School of Massage, Miami, FL) con-
sisted of Swedish, trager, and acupressure techniques. The
female massage therapists were trained on the protocol and
delivered the massage on a rotating basis so that the
participants had different massage therapists during the
5-week treatment period. Most massage therapists volun-
teered 1 day a week. The massage sessions followed a
standardized protocol that was similar to the protocol that
had been effective in reducing stress hormones and in-
creasing NK cells in our HIV study [19].
With the participant covered in a supine position and the
therapist standing at the head of the massage table, the
following techniques were applied: head/neck—stretching
of the neck; lateral stroking of the forehead; stroking and
stretching of the muscles along the cheeks and jaw; de-
pressing the shoulders with the flats of the palms; and
pressing on trigger points at midshoulder (2 min). Arms—
progressive intermittent compressions from the axillary
region (armpit) to the chest (6 times); intermittent compres-
sion of the arm, beginning at the shoulder and increasing
4 –6 in. of the arm and returning to shoulder each time
before the addition of another section until the entire arm
from the shoulder to the wrist has been included; broad
circular movements with the flats of the hand to the chest
from the sternum to the shoulder; long strokes (using oil)
from the sternum to the shoulder and from the wrist to the
shoulder; and slow range of motion of the arm including
full arm flexion (overhead), abduction, horizontal adduction
and abduction, and rotation of the humerus (4 min each
arm). Standing at the foot of the massage table, the therapist
delivered the following: legs/feet—pulling (or traction) of
both legs and each leg separately; massage of the feet,
including squeezing of the heel; long gliding strokes up the
leg from ankle to knee; kneading of the thigh muscles; and