Interventions
diaphragmatic breathing exercise, pain
Licensed and oncology-experienced acupuncturists and massage therapists delivered the treatments. All therapists received a manual with the treatment protocols for acupuncture and massage and were trained by the principal investigator (J.J.M.), lead acupuncturist, and/or lead massage therapist. The lead therapists audited at least 2 records for each therapist per week to ensure treatment fidelity. If treatments needed to be modified for medical reasons, therapists were instructed to document the details of the modifications with an accompanying rationale. The interventions have been described in detail previously.Acupuncturists placed 10 to 20 needles at a minimum of 4 local points around the body area with the most pain, as well as supplementary points at other locations, depending on the presence of comorbid symptoms. The acupuncture needles were inserted to appropriate depths based on the body type and point location.Massage therapists started with a 5-minute protocol that included guided diaphragmatic breathing exercise, rib mobilizations, and occipital release designed to increase parasympathetic tone. Depending on the primary area of pain, the therapist focused 20 minutes of massage on that specific body area followed by effleurage toward the heart. Massage techniques were applied with light to moderate pressure and included compression, muscle stripping, active/passive range of motion, postisometric stretching, effleurage, myofascial release, positional release, and trigger point release for a total treatment time of 30 minutes.