Title : THE EFFECT OF SWEDISH MASSAGE THERAPY AGAINST PAIN INTENSITY IN CHILDREN WITH

LEUKIMIA IN CHILDREN'S LOVE HOME BANDUNG CANCER

Stikes Jenderal Achmad Yani, Email: dewiumukulsum81.stikay@gmail.com

Dewi Umu Kulsum

Abstract

Background, Acute Lymphoblastic Leukemia (ALL) in Indonesia ranks highest in cancer in children that cause death.
ALL is a type of cancer that often occurs in children around 68.9%. Regimen therapy for ALL generally causes pain,
causes disturbing side effects and takes a long time. The phenomenon at the Children's Love House Cancer in Bandung
also illustrates the incidence of cancer in children around 20-30 children in 1 month most sufferers of ALL. Objectives
: this study was to identify the effect of Swedish massage therapy on pain intensity in children with leukemia at Rumah
Cinta Anak Cancer Bandung. The research method uses a pre-experimental approach to "pre test post test one group
design" (before and after). The sample in this study were children who had been diagnosed with ALL and were
undergoing chemotherapy and were not under the influence of analgesic drugs, amounting to 16 people using
accidental sampling. The research instrument uses face, leg, activity, cry, consolability (FLACC). The procedure used
in this study is the Swedish massage therapy action carried out directly by the researcher. Analysis of the data used is
univariate analysis and bivariate analysis. The results illustrate that there are differences in the level of pain intensity
before and after Swedish massage therapy (p = 0,000 at α = 5). The results of the study recommend that Swedish
massage therapy can be used as an alternative method in reducing the intensity of pain in children with leukemia who
are undergoing chemotherapy.
Keywords: pain intensity, leukemia, chemotherapy, Swedish massage therapy

INTRODUCTION

The term "childhood cancer" is the most commonly used to designate cancer that occurs in children before the
age of 15 years (WHO, 2009). According to the National Cancer Institude (2009), ALL is a cancer that attacks white
blood cells which often occurs in children around 68.9% of all cases of leukemia in children. In Indonesia ALL ranks
highest in cancer in children which causes death in children. Acute Lymphoblastic Leukemia (ALL) is one type of
leukemia characterized by the proliferation and accumulation of pathological cells of the lymphopoietic system that
results in organomegaly and organ failure (Nurarif & Kusuma, 2015) pediatric cancer patients often experience adverse
symptoms, and generally not easily easy known early because it develops slowly until an advanced stage (Corwin,
2009; Landolt & Vollrath, 2006).
ALL type of NSAID cancer therapy regimens and chemotherapy generally cause side effects that cause pain.
In addition, cancer treatment requires a long time, not least causing the patient to become frustrated. Besides the price
of drugs which are generally expensive, there is dissatisfaction with conventional medicine so that many people use
complementary therapy as an alternative treatment (Kemper et al., 2008). Management of ALL is conservative therapy
which means a treatment that is carried out to avoid operating procedures and is also supportive care which means care
is given to improve the quality of life of patients suffering from serious or life-threatening illnesses. Supportive care is
sometimes called palliative care and symptom management, which aims to prevent or treat disease symptoms, side
effects caused by the treatment of serious diseases such as cancer. One of the supportive care interventions is
complementary therapy that has been used by oncology nurses to date. (Somantri et al., 2014). Support from the
Complementary / Alternative Academy of Pediatrics Association by The American Academy of Pediatrics, established
in 2005, is part of the care system in the world (Kemper et al., 2008). Swedish massage is a massage method used for
therapy and improving health in the sick. (Clavert, 2002; Beck, 2010).
Previous studies conducted by Haun et al. (2009) aims to determine the feasibility of Swedish Massage
Therapy techniques. In this study a randomized (non-blinded prospective study) was carried out in patients with
leukemia, and stated that there was a significant decrease in discomfort, reduced muscle pain and respiratory rate in
physiological function, whereas in psychological function it reduced anxiety and emotional levels, in addition to
psychophysiologic function. can improve the function of the immune system, and minimize the risk of infection.
Explanation of the results of the study above shows complementary therapy with Swedish Massage Therapy is
a viable option for children with cancer, especially ALL as a companion treatment to overcome the symptoms of cancer
and symptoms of side effects due to chemotherapy, thereby strengthening the main therapeutic work of cancer
treatment. Researchers conducted a preliminary study at Rumah Cinta Anak Cancer Bandung and obtained data that
around 20-30 children in 1 month had cancer, most of whom had Acute Lymphoblastic Leukemia. In general, often
complained of nausea, vomiting, headache, weakness and weakness, joint pain, muscle and body aches that can not
walk.
 The general purpose of this study was to identify the effect of Swedish massage therapy on pain intensity in
children with leukemia at Rumah Cinta Anak Cancer Bandung.

RESEARCH METHODS
This study used a pre-experimental approach to "pre test post test one group design" (before and after) by
conducting experiments on one group twice, before the experiment and after the experiment. The selection of
respondents was based on inclusion criteria, namely respondents who were undergoing treatment at the induction stage,
who experienced treatment relapses and were not affected by anacetic drugs at least 4 hours before the intervention. The
population in this study are children suffering from leukemia at Rumah Cinta Anak Cancer Bandung, totaling 20-30
children each month. The large number of samples in this study were 16 respondents.
The sampling technique in this study was carried out not randomly using the accidental sampling method,
selecting samples by taking cases or respondents who happened to be there. At the time of direct sampling, a pre-test
using FLACC is used to determine the initial situation. After the pre-test, respondents were given Swedish massage
therapy intervention for 20 minutes, then half an hour after the therapy was assessed post FLACC. Each respondent
received 12 SMT interventions. Swedish massage therapy is carried out directly by researchers with an average duration
of treatment of 30 minutes.

RESEARCH RESULT
Pain Intensity
The researcher assessed the intensity of the respondent's pain before and after the Swedish massage therapy.

Table 1: The distribution of the average of pain intensity in children with leukemia before intervention Rumah Cinta
Anak Anak Cancer Bandung in 2016
Variable
Domain The
N Mean SD 95% CI
Intensity of maximum
Pain
Before 16 7,0208 0,24056 6,58-7,33 6,8926-7,1490
Based on table 1 shows that the results of the analysis of the average pain intensity of the respondents before the
intervention is with a standard deviation of 0.2406. It can be concluded that 95% believed the average pain intensity of
the respondents before the intervention was 6.8926 to 7.1490

Table 2: The distribution of the average pain intensity in children with leukemia after the intervention at Rumah Cinta
Anak Anak Cancer Bandung in 2016
Variable
Domain The
N Mean SD 95% CI
Intensity of maximum
Pain
After 16 3,4531 1,59 1,25-6,50 2,6048-4,3014
Based on table 2 shows that the results of the analysis of the average pain intensity of respondents after the intervention
was 3.4531 with a standard deviation of 1.59. It can be concluded that 95% believed the average pain intensity of the
respondents after the intervention was 2.6048 to 4.3014.

Table 3 : Difference in average pain intensity in children with leukemia before and after the intervention at Rumah
Cinta Anak Anak Cancer Bandung in 2016
Variable Variable
Domain Domain
N Mean SD SE P Value
Intensity of Intensitas
Pain Nyeri
After Sesusah 16 3,568 1,604 0,401 0,000
Based on table 3 shows that the results of statistical tests before and after intervention with the T-dependent test
obtained p value = 0,000, with the provisions of alpa 5%, it can be concluded that in the two measurements there are
differences in the level of pain intensity before and after the intervention which means that there is an influence
significant to the decrease in pain intensity after the Swedish massage therapy.
DISCUSSION

Average pain intensity in children with leukemia before intervention at Rumah Cinta Anak Anak Cancer
Bandung in 2016
Based on table 1, the results of the study at RCAK illustrate that prior to intervention the average pain intensity
experienced by respondents was at a fluctuating level and most experienced pain, and the results of the measurement of
pain scale were described at moderate to severe pain levels. The average value before intervention was 7.0208 with a
standard deviation of 0.2406. Pain perception in children according to Collins, Stevens, & Berde (2008) is complex, and
often the symptoms of pain in children with cancer are generally difficult to assess. Most cancer pain in children is due
to treatment and is more common in children with metastatic solid tumors to the spinal cord, spinal cord roots, or large
peripheral nerves. Where cancer pain in children is usually acute on average 74 days before definitive treatment begins,
it feels great with a short duration of time in patients with the disease. Pain in children with hematologic malignancies
has a shorter duration after treatment.
Characteristics of pain arising in pediatric oncology patients can originate from tumor invasion, medical
procedures, surgery, radiation, chemotherapy which are referred to as nociceptive pain for pediatric cancer patients
which can be caused by trauma, surgery, and inflammation. There are also those who experience neuropathic pain that
comes from nerve damage, such as tumor infiltration, surgery, or even injury from radiation and chemotherapy.
Chemotherapy can also affect nerves causing peripheral neuropathy and radiation is a common cause of muscle
stiffness and muscle pain, inflammation especially in joints, skin aches, or more serious and painful side effects. These
side effects are osteoradionecrosis (Christo & Mazloomdoost, 2008 in McConnell, 2013).
Based on the observations of researchers during the RCAK study, all children during the study were still
undergoing chemotherapy treatment and treatment at the induction to remission stage and there was even a relapse
condition where the patient's prognosis worsened was also very influential, the children experienced a decrease in
physical function. Physical problems mean a decrease in pain and injury problems, nausea caused by disease symptoms
and side effects of chemotherapy including peripheral neurotoxicity including sensory and motor, accompanied by pain,
nausea and vomiting, decreased appetite and weight loss, mucosal ulceration, stomatitis.
The average intensity of pain in children with leukemia after intervention at Rumah Cinta Anak Cancer
Bandung in 2016
Based on table 2 the results of research in RCAK illustrate that after being given an intervention - the average
pain intensity experienced by respondents experienced a decrease with the results of the measurement of pain scale
depicted at the level of mild pain. The average value before intervention was 3.4531 with a standard deviation of 1.59.
The concept of the pain theory model, the Gate Control theory, postulates the spinal cord of the control mechanism in
the dorsal horn that receives the rising and falling impulses of the integration of the neural channels and balancing them.
Pain perception is ultimately determined by the biological evaluation of this input. The importance of the Gate Control
theory to the treatment of patients with cancer pain is that decreased cortical input affecting pain perception includes
psychological and psychosocial variables such as beliefs about pain, emotions, reactions to stress, and cognition.
Therefore, interventions that target modification of these factors can change the perception and experience of pain.
Pain is always a subjective experience. This is the body's natural reaction to external or internal stimuli and is
transmitted to the brain pain treatment center, cerebral cortex. Acute or chronic pain is felt continuously by children
during medical procedures in the treatment of cancer.
Some factors that can affect the value of the level of pain intensity and determine the success of therapy
include internal factors including the stage of cancer malignancy, the prognosis of leukemia, the level of compliance
with the therapeutic regimen associated with recurrence, symptoms of the disease and treatment side effects that can be
treated, good nutritional status of children, and a healthy lifestyle for all family members, while external factors include
a favorable state of environmental health, the love of parents and siblings (Eiser, 2004; Wong et al., 2008).
The management of cancer therapy is carried out with one or a combination of therapies such as surgery, chemotherapy,
radiation, biotherapy and bone marrow transplantation (Ball and Bindler, 2003; R, Mia., Ugrasena., And
Permono, B., 2006; Wong, 2008). The form of intervention to overcome pain with the use of nonpharmacology is one
of the trend issues that are being developed. The type of nonpharmacological intervention used to treat pain in children
will be effective when adjusted for the child's level of development. Distraction techniques are often used by nurses
during the procedure.
Pain management in children is not always optimized in the management of various health services, including
the emergency department. whereas pain is very important to be controlled due to interference or during painful
procedures. However, the perception of pain in children is very diverse and difficult to assess (Srouji, Ratnapalan, and
Schneeweiss, 2010).
Classification of methods of pain control pharmacology in children with physical engineering categories (eg
massage, heat and cold stimulation, electrical nerve stimulation, acupuncture), behavioral categories (eg sports, operant
conditioning, relaxation, biofeedback, modeling, desensitization, art and play therapy ), or cognitive categories (for
example disorders, attention, images, stop thinking, hypnosis, music therapy, psychotherapy).
Difference in average pain intensity in children with leukemia before and after the intervention at Rumah Cinta
Anak Anak Cancer Bandung in 2016
The statistical test results (T-dependent test) showed that there were differences in the average intensity of pain
in children with leukemia before and after the Swedish massage therapy intervention, p = 0,000 was obtained on both
measurements, which means that there was an influence on the administration of Swedish massage therapy.
The results of statistical tests and observations mentioned illustrate that physical function problems, namely pain and
hurt, have decreased pain scale, which means an increase in physical quality of life. This occurs from the effectiveness
of massage therapy which has benefits and positively influences bodily functions.
These changes are due to the treatment of massage therapy can reduce pain in the muscles, increase relaxation,
reduce heart rate, and blood pressure, reduce depression, and improve sleep quality (Salvo, 2016). Reducing pain and
increasing relaxation are associated with increased production of endorphins (natural painkillers) (Haun et al. (2009).
Increases circulation of blood flow (Walton, 2006)
By doing massage therapy, it helps with adequate nutrition intake, reduced physical complaints and the impact
of peripheral neurotoxicity neurological toxicity, thereby reducing problems that can interfere with the growth and
development of children with leukemia.
Kulsum research results (2016) states that massage therapy can affect the quality of life of children with
cancer. Based on observations made by researchers at RCAK, according to the patients' parents most of the children at
RCAK had been treated with massage therapy and Reiki therapy. In this study, respondents had never before received
massage therapy. Responses and reactions from respondents and respondents' parents said that they felt happy in
massage and some were afraid of having an impact on cancer metastases because they did not know the therapeutic
information.
Overall discussion above according to researchers the success of SMT interventions is influenced by the
patient's prognosis and how children perceive pain. The most important virtue of this study is that it illustrates the
positive effect of "Swedish Massage" massage therapy on reducing the intensity of pain in children with leukemia.

CONCLUSION
1. The average intensity of pain in children with leukemia before the intervention at Rumah Cinta Anak Cancer
Cancer in 2016 is 7.0208
2. The average intensity of pain in children with leukemia after the intervention at Rumah Cinta Anak Cancer
Bandung in 2016 is 3.4531
3. The effect of pain intensity on children with leukemia before and after the intervention at Rumah Cinta Anak
Cancer Bandung in 2016 with the results of statistical tests p value = 0,000

REFERENCES
Ackerman, S. L. et.al. (2011). Massage for Children Undergoing Hematopoietic Cell Transplantation :a
Qualitative Report.
Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine Volume 2012, Article ID
792042, 9 pages.
Adamakidou, T.,& Kalokerinou, A.(2011). Quality of Life and Cancer Patient. Hellenic Journal of Nursing Science4,
289-303.
Allen, T. (2011). Touch Therapy for Liddle Kidz with Cancer Course Manual. Foundation Liddle Kids™.
www.LiddleKidz.com. Diunduh tanggal 15 Mei 2015.
Arikunto, S. (2013). Prosedur Penelitian ; Suatu Pendekatan Praktik. Jakarta : Rineka Cipta
Bakas, T. et.al. (2012). Systematic Review Of Health-Related Quality Of Life Model. Health and Quality of
Life Outcomes, 10:134. BioMed Central.
Ball, J.W., & Bindler, R.C. (2003). Pediatric of Nursing ; Caring for Children 3rd End. New Jersey ; Pearson
Education, Inc.
Batalha, L.M.,& Mota, A.A. (2013). Massage In Children With Cancer:
Effectivveness of A Protocol. Jornal de Pediatria ;89:595---600.
Beider, S., & Moyer, C.A. (2006). Randomized Controlled Trials of Pediatric Massage: A Review. Pediatric Massage
Review ; eCAM ;4 (1) 23–34 doi:10.1093/ecam/nel068
Beck M.F. (2010). Theory & Practice of Therapeutic Massage.Fifth Edition.
Milady, a part of Cengage Learning: USA.
BidYankesra Dinkes Jabar. (2016).
Biondo-Wood, G.L. & Haber, J. (2010). Nursing Research : Methods And Critical Appraisal For Evidence-Based
Practice. 8th Edition. Mosby Elsevier : St. Louis.
Black, J.M., & Hawks, J.H.(2014). Keperawatan Medikal Bedah. Edisi 8. Elsevier. Singapore
Braun, M.B. & Simonson, S.J. (2014). Introduction to MassageTherapy. 3rd edition. Philadelphia : Lippincott Williams
& Wilkins.
Bobak, et al.,(2005). Buku Ajar Keperawatan Maternitas. Jakarta : EGC
Budiman. (2010). Buku Ajar Penelitian Kesehatan jilid ke-1. LPPM STIKES
Buletin Jendela Data dan Informasi Kesehatan. (2012). Penyakit Tidak Menular. ISSN 2008 – 270 X.
Buttle, S.G. et.al. (2011). Massage For Pain Relief In Pediatric Palliative Care: Potential Benefits And Challenges.
Pediatric Pain Letter. Vol. 13 No. 3.
Calvert, R. N. (2002). The History Of Massage : An Illustrated Survey From Around The World. Healing Art Press,
Rochester.
Cassileth, B. et.al. (2008). Integrative Oncology : Complementary Therapies in Cancer Care. Cancer Chemother
Review ;3(4):204-211.
Casanelia, L. & Goldstein, S.(2009). Foundation of Massage; Chapter 16 The Techniques Of Swedish Massage.3rd
Edition. Elsevier
Collins, Stevens, and Berde (2008). Part IV CLINICAL MANAGEMENT OF PAIN IN SPECIAL SITUATIONS :
Pediatric cancer pain. Clinical Pain Management second Edition : cancer pain , volume 3, 2008
Corbin, L. (2005). Safety and Efficacy of Massage Therapy for Patients With Cancer. Vol. 12.No. 3.
Corwin, E.J., (2009). Buku Saku Patofisiologi Edisi 3. Jakarta : EGC.
Castilllo, D.et.al.(2009). Quality Of Life In Children With ALL During Induction Therapy With Pedsql Cancer Module.
Original Article Departemento De Oncologia, Hospital Infantil De Mexico Federico Gomez.Vol. 67.
Dahlan, M.S., (2011). Statistik Untuk Kedokteran dan Kesehatan, Deskriptif, Bivariat, dan Multivariat Dilengkapi
Aplikasi dengan Menggunakan SPSS Edisi 5. Jakarta: Penerbit Salemba Medika
Daniel., A. (2013). Pengaruh Terapi Massage Terhadap Peningkatan Berat Badan Bayi Premature Di Ruang
Perinatologi RSUD Tasikmalaya.
Dharma, K. (2011). Metodelogi Penelitian Keperawatan : Pedoman Pelaksanaan & Menerapkan Hasil Penelitian.
Jakarta : Trans Info Media.
Eiser, C. (2004). Children The Quality of Life With Cancer.Lawrence Erlbaum Associates, Inc. New Jersey.
Enskar, K.,& Von Essen, L. (2008). Physical Problem And Psychosocial Function In Children With Cancer. Pediatric
Nursing, 23 (3), 37-41.
Ferrans, et.al. (2005).Conceptual Model Of Health-Related Quality Of Life. Journal Nursing Scholarship : Pubmed
Field T, et.al. (2005). Cortisol Decreases And Serotonin And Dopamine Increase Following Massage Therapy.
International Jornal Neurosci;115:1397413.
______(2001). Leukemia Immune Changes Following Massage Therapy. Journal Bodywork Move
Ther ;5:271-274.
Fritz, S. (2009). Mosby’s Fundamentals Of Therapeutic Massage (4th ed).Mosby, St.Louis.
Gunarsa, S.D. (2006). Psikologi Perkembangan Anak Dan Remaja. Jakarta : Gunung Mulia.
Gholami, A.,et al., (2011). Parental Risk Factor of Childhood Acute Leukemia: A Case Control Study. Journal of
Research in Health Sciences. Iran.
Haun, J.N. et.a. (2009). Children with Cancer and Blood Diseases Experience Positive Physical and Psychological
Effects from Massage Therapy. International Journal of Therapeutic
Massage & Bodywork: Research, Education, & Practice, Vol 2, No 2.
Hockenberry, M.J., & Wilson, D. (2007). Wong”S : Nursing Care of Infants And Children. 8th ed). St; Louis : Mosby.
____________________ (2008). Wong”S : Nursing Care of Infants And Children. 8th ed). St; Louis : Mosby.
____________________ (2009). Wong’s Essentials of Pediatric Nursing. 8th ed. St; Louis : Mosby An Affilite Of
Elsevier Inc.
Hodgson, N.A. & Lafferty, D. (2012). Reflexology versus Swedish Massage to Reduce Physiologic Stress and Pain and
Improve Mood in Nursing Home Residents with Cancer : A Pilot Trial. Hindawi Publishing Corporation
Evidence-Based Complementary and Alternative Medicine Volume 2012, Article ID 456897, 5 pages.
Hudak, C.M.,& Gallo, B.M. (2002). Keperawatan Kritis,pendekatan Holistik Vol 2 Edisi VI. Jakarta : EGC
Hughes, D. et.al. (2008). Massage Therapy as a Supportive Care Intervention for Children With Cancer. Oncology
Nursing Forum – vol 35, no.3.
Hull, D., & Johnson, D. (2008). Dasar Dasar Pediatri.Edisi 3. Jakarta: EGC
Hullman., et al. (2011). Measure Of General Pediatric Quality Of Life . Arthritis Care & Research : American College
0f Rheumatology. Vol. 63, No. S11
Hurlock, E.B. (2002). Psikologi Perkembangan : Suatu Pendekatan Sepanjang Rentang Kehidupan. Jakarta :
Airlangga.
http://www.pedsql.org
Kashanini, Z. Et.al. (2011). The Effect of Swedish Massage on Glycohemoglobin in Children with Diabetes Mellitus.
Iranian Rehabilitation Journal, Vol. 9.
Kemper, K.J. et.al. (2008). The Use of Complementary and Alternative Medicine in Pediatrics. Pediatrics Official
Journal Of The American Academy Of Pediatrics ; 122;1374. DOI: 10.1542/peds.2008-2173.
Kulsum, Dewi U. (2016). Pengaruh Swedish Massage Therapi terhadap Kualitas hidup Penderita Leukemia Di RCAK
Bandung. Tesis
Landolt, M.A. & Vollrath, M. et.al. (2006). Health-Related Quality Of Life In Children With Newly Diagnosed Cancer:
A One Year Follow-Up Study. Biomed Central Ltd.
Mac Donald, G. (2007). Swedish Massage Studies. Medicine Hands: Massage Therapy For People With Cancer. 2nd
edition. Published : Findhorn Press
Martinez, D.C.,(2009). Quality of Life with Acite Lymphoblastic Leukemia During Induction Therapy with PedsQL
Cancer Module. Bio Med Hosp Infant Mex Vol. 67.
Muahimin, T. (2010). Measuring Children’s Quality of Life. Jurnal Kesehatan Masyarakat Nasional Vol. 5, No. 2.
National Cancer Institute.(2009). www.cancer.gov. Diakses tanggal 04 Mei 2015
National Center For Complementary Alternative Medicine. (2007). CAM Use And Children.
www.nccam.niv.gov.health. Diakses 16 januari 2016
Notoadmodjo, S. (2010). Metodologi Penelitian Kesehatan. Jakarta: Rineka Cipta
_____________ (2012). Promosi Kesehatan dan Perilaku Kesehatan. Jakarta: Rineka Cipta
Nurarif, A.H.,& Kusuma, H. (2015). Aplikasi Asuhan Kperawatan Berdasarkan Diagnosa Medis & Nanda Nic-Noc.
Jilid 2. Jogjakarta : Mediaction
Nursalam. (2008). Konsep dan Penerapan Metodologi Penelitian Ilmu Keperawatan. Jakarta : Salemba Medika.
_________ (2013). Metodologi Penelitian Ilmu Keperawatan : Pendekatan Praktis. Edisi 3. Jakarta : Salemba Medika.
Ostrom, K.W. (2000). Massage and the Original Swedish Movements.
Philadelphia: Royal University of Upsala.
Pariani, S. (2001). Pendekatan Praktis Metodologi Riset Keperawatan.
Jakarta : Sagung Seto.
Peterson, J.s., & Bredow, T.S. (2013). Middle Range Theories; Application To Nursing Research. 3rd ed. Philadelphia :
Lippincott Williams & Wilkins.
Polit, D.F., & Hungler, B.P. (2005) Nursing Research: Principle And Methods. Philadelphia. Lippincott
Post-White, J.K. (2003). Therapeutic Massage And Healing Touch Improve Symptoms In Cancer. Integration Cancer
Therapy ;2:33244.
Managing Cancer Pain With Nonpharmacologic and Complementary Therapies
Pujol, Lynette A.M, Monti. (2007) JAm Osteopath Assoc. 2007;107(suppl 7):ES15-ES21 , Downloaded From:
http://jaoa.org/ on 10/13/2016 ,JAOA • Supplement 7 • Vol 107 • No 12 • December 2007
Purba, et.al. (2012). Pengaruh Efek Samping Kemoterapi Terhadap Gangguan Konsep Diri Pasien Kanker Di RSUP H
Adam Malik Medan. www.sari-mutiara.ac.id. Diunduh 15 januari 2016.
Pusat Data Dan Informasi Kemenkes RI. (2013) . Ringkasan Eksekutif Data Dan Informasi Kesehatan Provinsi Jawa
Barat.
Profil Rumah Cinta Anak Kanker Bandung. (2014).
Riskesdas. (2007). Laporan Nasional Riset Kesehatan Dasar.
Riyanto, A. (2011). Pengolahan dan Analisis Data kesehatan ; Dilengkapi Uji validitas dan Reliabilitas serta Aplikasi
Program spss. Yogyakarta : Nuha Medika.
Sajedi, F.,& Kashanini, Z. et.al. (2011). How Effective is Swedish Massage on Blood Glucose Level in Children with
Diabetes Mellitu. Acta Medica Iranica, Vol. 49, No. 9.
Salvo, S.G. (2016). Massage Therapy; Principle and Practice. (5rd ed).
Elsevier. St. Louis.
Sastroasmoro, S & Ismael, S. (2011). Dasar – Dasar Metodologi Penelitian Klinis. Edisi Ke – 4. Jakarta : Sagung Seto
Setiadi, (2007). Konsep Dan Penulisan Riset Keperawatan. Yogyakarta :
Graha Ilmu.’
Seyedreza, M. Et.Al. (2013). The Effect Of Massage Therapy On Chemotherapy- Induced Nausea And Vomiting In
Pediatric Cancer. Iran Jornal Nurs Midwifery Res. V. 18(4).
Sinaga, J. et.al. (2013). Pengaruh Efek Samping Kemoterapi Terhadap Harga Diri Penderita Kanker Payudara di RSUP.
H. Adam Malik Medan Tahun 2012. Jurnal Mutiara Ners, Vol. 1, No.9.
Sinclair,M. (2005). Pediatric Massage Therapy. 2nd edition. Lippincott Williams & Wilkins : USA.
Sitaresmi, M.N.et.al.(2008). Health-Related Quality of Life Assessment in Indonesia Childhood Acute Lymphoblastic
Leukemia. BioMed Central 6:96. doi:10.1186/1477-75256-96
Scaling And Scoring Of The Pediatric Quality Of Life Inventory™. (2014).
www.PedsQL.org. Diunduh 22 Maret 2015.
Srouji, Ratnapalan, and Schneeweiss (2010). Review Article Pain in Children : Assessment and Non pharmacological
Management. Hindawi Publishing Corporation International Journal of Pediatrics Volume 2010, Article ID
474838, 11 pages doi:10.1155/2010/474838
Snyder,M., & Lindquist,R. (2002). Complementary Alternative Therapies in Nursing. 4th ed. New York: Springer
Publishing Company
_____________(2014).Complementary Alternative Therapies in Nursing. 8th ed. New York: Springer Publishing
Company
Snyder, C.R.,& Lopez, S,J. (2004). Handbook Of Positive Psychology.
Oxford University. Press Inc.
Somani, S. et.al.( 2014). Complementary And Alternative Medicine In Oncology Nursing. British Journal of Nursing,
Vol 23, No1.
Sujarweni, W. (2014). SPSS Untuk Penelitian. Yogyakarta : Pustaka Baru Press.
Sugiyono. (2012). Metode Penelitian Kuantitatif Kualitatif dan R&D. Bandung: Alfabeta
________ (2014) Statistika untuk penelitian. Bandung: Alfabeta
Sulastriana1, Sori Muda2, Jemadi2. (2012). Karakteristik Anak Yang Menderita Leukemia Akut Rawat Inap Di Rsup H.
Adam Malik Medan Tahun 2011-2012. Fkm Usu. Medan
Susilo.,H.W., Alma, H., Suprapti, F. (2014). Biostatistika Lanjut dan Aplikasi Riset. Jakarta : Trans Info Media.
Varni, J.W. et.al. (2001) The Pedsql™ 4.0: Reliability And Validity Of The Pediatric Quality Of Life Inventory™
Version 4.0 Generic Core Scales In Healthy Patient Populations. Med Care 39:800–812.
________ (2002). The PedsQL™ in Pediatric Cancer ; Reliability and Validity of the Pediatric Quality of Life
Inventory™ Generic Core Scales, Multidimensional Fatigue Scale, and Cancer Module. Cancer ;94:2090–106.
________(2003). The PedsQL™ 4.0 as a Pediatric population health measure: feasibility, reliability, and
validity. Ambul Pediatr 3:329–341.
Walton, T. (2006). Cancer Massage Therapy : Essensial Contraindications.
www.Amtamassage.org/mt . Diunduh 21 Februari 2016.
_____(2011). Walton T. “Massage research in massage practice.” Medical conditions and massage therapy: A
decision tree approach. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins,
_____(2016). 5 Myths and Truths about Massage Therapy.
www.info.massagetherapyfoundation.org . Diunduh 26 Februari 2016.
Winoto, H. A. Leukemia. Bag. Ilmu Kesehatan Anak Fk.Universitas Wijaya
Kusuma https://fkuwks2012c.files.wordpress.com/2015/03/kuliahleukemi
ahandout.pdf. Diunduh 6 juni 2016.
Wong et.al. (2008). Buku Ajar Keperawatan Pediatrik. Edisi 6. Jakarta : EGC.
WHO. (2009). World Health Statistics.
www.kemenkopmk.go.id .Diakses 07 Maret 2016.
www.MassageProCE.com . Diakses 16 Mei 2015
www.oncolink.org Diakses 14 Februari 2016
www.who.int/ceh/capacity/cancer.pdf Diakses 21