Aromatherapy and massage for symptom relief in patients with cancer

This study is the summary of a systematic review performed by the Cochrane Collaboration, a volunteer group of health professionals. Cochrane reviews are periodically updated as new studies are conducted; this review was performed in 2004. The goal of the study was to examine whether massage or massage combined with aromatherapy reduces symptom distress and/or enhances quality of life for patients with a cancer diagnosis. Databases searched included MEDLINE, die Cumulative Index to Nursing and Allied Health Literature (CINAIIL), the British Nursing Index, EMBASE (a European biomedical index), PsycINFO (an index of psychology journals), CancerLit and Dissertation Abstracts International (summaries of doctoral students’ dissertations). The reference section of relevant articles located also was searched for additional studies.

The selection criteria for articles to be included in the review were randomized controlled trials (RGTs), and controlled before and after studies. Studies had to measure patient-reported levels of physical or psychological distress, or quality of life, using reliable and valid tools. A tool, which can be a device or a question¬naire, is reliable if it measures an outcome consistently, and valid if it really measures what it says it measures. Two reviewers independently assessed the quality of the 1,322 references that were retrieved. Only 10 studies met inclusion criteria; 8 of these were RGTs.

The most consistent effect found across the studies was a reduction in anxiety, ranging from 19 percent to 32 percent. It was not clear whether aromatherapy added any additional benefit. Evidence for the effect of massage on depression,
pain and nausea was mixed, with only some, but not all, of the included studies reporting positive effects. The conclusion of this systematic review is that massage confers short-term benefits on psychological well-being, with some limited support for reducing anxiety. The final conclusion is the classic “more research is needed.” Specifically, to answer the question posed by the Cochrane reviewers will require replication of existing studies, with more patients/larger trials and with longer follow-up to see how long any effects may last. Because the study has not been updated since 2004, it does not include the Gassileth and Yickers study discussed previously. An important consideration in evaluating this systematic review is that while the search to retrieve relevant articles was quite thorough* the number of articles that met the authors’ inclusion criteria for quality was small—only 10 out of 1,322 references. Here we can see the problem of small sample size. Massage may actually be very effective in reducing the symptoms of cancer and side effects of treatment, but at the time this review was conducted there were not enough high-quality studies to conclusively answer the research question posed. There is a well-known saying in epidemiology that “absence of evidence is not evidence of absence.” It will be interesting to see what happens when this systematic review is next updated.

Conclusion
Massage therapy is becoming more popular with consumers as a method to reduce the symptoms of cancer and the side effects of treatment, despite a lack of hard evidence to support its use. More rigorous research will be necessary to sup¬port the routine use of massage as a component in the integrative treatment of cancer. However, early results are promising, and if larger controlled studies show consistently positive results, massage will secure a place in integrative oncology as a relatively low-risk and beneficial method for improving the quality of care for people living with cancer.