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

Ein-Soon Shin, Kyung-Hwa Seo, Sun-Hee Lee, Ji-Eun Jang, Yu-Min Jung, Min-Ji Kim, Ji-Yun Yeon, Ein-Soon Shin, Kyung-Hwa Seo, Sun-Hee Lee, Ji-Eun Jang, Yu-Min Jung, Min-Ji Kim, Ji-Yun Yeon

Abstract

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.

Conflict of interest statement

Shin, Seo, Lee, Jang, Jung, Kim, and Yeon are free of any real or perceived bias introduced by receipt of any benefit in cash or kind, any hospitality, or any subsidy derived from any source that may have or be perceived to have an interest in the outcome of the review. In particular, there are no conflicts of interest that relate to the pharmaceutical industry.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: massage versus no massage, outcome anxiety (State‐Trait Anxiety Inventory (STAI)‐state).
1.1. Analysis
1.1. Analysis
Comparison 1 Massage versus no massage, Outcome 1 Anxiety (STAI‐state).
2.1. Analysis
2.1. Analysis
Comparison 2 Massage versus no massage: subgroup analysis, Outcome 1 Anxiety (STAI‐state).
2.2. Analysis
2.2. Analysis
Comparison 2 Massage versus no massage: subgroup analysis, Outcome 2 Anxiety (STAI‐state).
3.1. Analysis
3.1. Analysis
Comparison 3 Aromatherapy with massage versus no massage, Outcome 1 Anxiety (STAI‐state).
4.1. Analysis
4.1. Analysis
Comparison 4 Aromatherapy with massage versus no massage: subgroup analysis, Outcome 1 Anxiety (STAI‐state).

References

References to studies included in this review Ahles 1999 {published data only}

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Batalha 2013 {published data only}
    1. Batalha LM, Mota AA. Massage in children with cancer: effectiveness of a protocol. Journal of Pediatics 2013;89(6):595‐600.
Billhult 2007 {published data only}
    1. Billhult A, Bergbom I, Stener‐Victorin E. Massage relieves nausea in women with breast cancer who are undergoing chemotherapy. Journal of Alternative and Complementary Medicine 2007;13(1):53‐7.
Campeau 2007 {published data only}
    1. Campeau MP, Gaboriault R, Drapeau M, Nguyen TV, Roy I, Fortin B, et al. Impact of massage therapy on anxiety levels in patients undergoing radiation therapy: randomized controlled trial. Journal of the Society for Integrative Oncology 2007;5(4):133‐8.
Fernandez‐Lao 2012 {published data only}
    1. Fernandez‐Lao C, Cantarero‐Villanueva I, Diaz‐Rodriguez L, Cuesta‐Vargas AI, Fernandezdelas‐Penas C, Arroyo‐Morales M. Attitudes towards massage modify effects of manual therapy in breast cancer survivors: a randomised clinical trial with crossover design. European Journal of Cancer care 2012;21(2):233‐41.
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Haun 2009 {published data only}
    1. Haun JN, Graham‐Pole J, Shortley B. Children with cancer and blood diseases experience positive physical and psychological effects from massage therapy. International Journal of Therapeutic Massage and Bodywork 2009;2(2):7‐14.
Hernandez‐Reif 2004 {published data only}
    1. Hernandez‐Reif M, Ironson G, Field T, Hurley J, Katz G, Diego M, et al. Breast cancer patients have improved immune and neuroendocrine functions following massage therapy. Journal of Psychosomatic Research 2004;57(1):45‐52.
Jane 2011 {published data only}
    1. Jane SW, Chen SH, Wilkie DJ, Lin YC, Foreman SW, Beaton RD, et al. Effects of massage on pain, mood status, relaxation, and sleep in Taiwanese patients with metastatic bone pain: a randomized clinical trial. Pain 2011;152(10):2432‐42.
Khiewkhern 2013 {published data only}
    1. Khiewkhern S, Promthet S, Sukprasert A, Eunhpinitpong W, Bradshaw P. Effectiveness of aromatherapy with light Thai massage for cellular immunity improvement in colorectal cancer patients receiving chemotherapy. Asian Pacific Journal of Cancer Prevention 2013;14:3903‐7.
Krohn 2010 {published data only}
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Listing 2009 {published data only}
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Soden 2004 {published data only}
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Sohn 2005 {published data only}
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Toth 2013 {published data only}
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Wang 2015 {published data only}
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Wilkie 2000 {published data only}
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Wilkinson 1999 {published data only}
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Wilkinson 2007 {published data only}
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Calenda 2006 {published data only}
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Cassileth 2004 {published data only}
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Chang 2008 {published data only}
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Chun 2010 {published data only}
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Corner 1995 {published data only}
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Currin 2008 {published data only}
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Dion 2015 {published data only}
    1. Dion LJ, Engen DJ, Lemaine V, Lawson DK, Brock CG, Thomley BS, et al. Massage therapy alone and in combination with meditation for breast cancer patients undergoing autologous tissue reconstruction: a randomized pilot study. Complementary Therapies in Clinical Practice 2015;23:1‐6.
Dyer 2013 {published data only}
    1. Dyer J, Thomas K, Sandsund C, Shaw C. Is reflexology as effective as aromatherapy massage for symptom relief in an adult outpatient oncology population?. Complementary Therapies in Clinical Practice 2013;19:139‐46.
Ernst 2009 {published data only}
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Han 2005 {published data only}
    1. Han JE, Moon YI, Park HR. Effect of hand massage on nausea, vomiting and anxiety in childhood with leukemia on chemotherapy. Korean Journal of Child Health Nursing 2005;11(4):456‐64.
Han 2012 {published data only}
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Hernandez‐Reif 2005 {published data only}
    1. Hernandez‐Reif M, Field T, Ironson G, Beutler J, Vera Y, Hurley J, et al. Natural killer cells and lymphocytes increase in women with breast cancer following massage therapy. International Journal of Neuroscience 2005;115(4):495‐510.
Hughes 2008 {published data only}
    1. Hughes D, Ladas E, Rooney D, Kelly K. Massage therapy as a supportive care intervention for children with cancer. Oncology Nursing Forum 2008;35(3):431‐42.
Imanishi 2009 {published data only}
    1. Imanishi J, Kuriyama H, Shigemori I, Watanabe S, Aihara Y, Kita M, et al. Anxiolytic effect of aromatherapy massage in patients with breast cancer. Evidence‐based Complement and Alternative Medicine 2009;6(1):123‐8.
Jane 2009 {published data only}
    1. Jane S, Wilkie DJ, Gallucci BB, Beaton RD, Huang H. Effects of a full‐body massage on pain intensity, anxiety, and physiological relaxation in Taiwanese patients with metastatic bone pain: a pilot study. Journal of Pain and Symptom Management 2009;37(4):754‐63.
Karagozoglu 2013 {published data only}
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Keir 2011 {published data only}
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Lai 2011 {published data only}
    1. Lai TK, Cheung MC, Lo CK, Ng KL, Fung YH, Tong M, et al. Effectiveness of aroma massage on advanced cancer patients with constipation: a pilot study. Complementary Therapies in Clinical Practice 2011;17(1):37‐43.
Lopez‐Sendin 2012 {published data only}
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Moyer 2004 {published data only}
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Oh 2008 {published data only}
    1. Oh HS. The Effects of Aroma Hand Massage on the Stress, Sleep Satisfaction and Death Anxiety in Terminal Cancer Patients [Master's thesis]. Gyeongsangbuk‐do, South Korea: Catholic University of Daegu, 2008.
Osaka 2009 {published data only}
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PostWhite 2009 {published data only}
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Serfaty 2012 {published data only}
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Smith 2002 {published data only}
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Song 2009 {published data only}
    1. Song BE, Yoo YS, Cho OH. Effects of back massage on immune response, symptom distress and mood state of patients undergoing allogeneic hematopoietic stem cell transplantation. Journal of Korean Academy Adult Nursing 2009;21(3):269‐80.
Stringer 2008 {published data only}
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Sturgeon 2009 {published data only}
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Tarhan 2005 {published data only}
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Wilkinson 2008 {published data only}
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