According to the National Cancer Institute, the lifetime risk of developing cancer is approximately 43 percent in men and 38 percent in women. Pain is a common complaint with cancer patients due to the disease, the treatments, and the recovery, and it is experienced by 40–90 percent of cancer patients. One treatment that may improve the symptoms of cancer pain is massage therapy.

A recent meta-analysis focused on massage therapy for cancer pain.1 The authors searched nine research databases and included articles if they were randomized or nonrandomized clinical trials with any type of massage intervention group, as well as a control group for treatment of cancer-related pain. Studies including all types of cancer were allowed in this review. Once the articles were found, they were evaluated for methodological quality as “excellent,” “good,” “fair,” or “poor.”
Twelve clinical trials met all of the inclusion criteria and were used to determine the overall effectiveness of massage for cancer pain. Massage techniques included body massage, foot reflexology, and aromatherapy massage with an average treatment time of 29.5 minutes (ranging from 10–50 minutes), an average of 4.5 treatment sessions (a range of 1–12 sessions), and an average treatment duration of 23.6 days (ranging from one day to 20 weeks). Within the 12 trials, there were a total of 559 subjects from the United States, South Korea, Taiwan, and the United Kingdom. Nine of the studies were high quality and three were low quality.
The overall results of the meta-analysis demonstrated a significant improvement in cancer pain with massage treatment compared to conventional care or no massage. After further analysis regarding the specific cause of cancer pain, the researchers found massage therapy significantly improved cancer pain after surgery, after chemotherapy, due to metastases, and due to a combination of these symptoms. In other words, all types of pain during the process of cancer treatment were improved by massage therapy.
Different types of cancer were included in this review and the researchers discovered that all types of cancer demonstrated significant improvement in pain due to massage therapy, with the majority of studies being specific for breast and digestive cancers. When the results were subdivided by massage type, significant effects occurred with body massage, foot reflexology, and aroma massage, with foot reflexology being the most effective treatment.
As in all review articles, there are limitations to these results. First, a variety of cancer types were included in this meta-analysis, making it difficult to discern the effect of massage on each specific type or stage of cancer. Second, differences were noticed based on the type of massage, possibly also due to the practitioner’s qualifications, experience, or clinical expertise. Third, some subjects were not able to be blinded to their treatment group allocation, possibly leading to biased reports of improvement in the massage treatment group compared to subject reports in the control groups. Finally, not all studies were performed in the United States, possibly leading to outcomes that may not be generalizable to American patients due to differences in health care, social/economic environment, or other related factors.

Massage for Breast Cancer
A second recent meta-analysis in the literature focused on massage therapy for treatment-related side effects in patients with breast cancer.2 In this article, the researchers focused not only on cancer pain but also anxiety, depression, upper limb lymphedema, cortisol levels, and health-related quality of life.
Four research databases were searched for relevant articles. Studies were included if the subjects were female, aged 18 years or older, had a history of breast cancer, and received active breast cancer treatments. Studies also had to be randomized controlled trials focused on the effects of massage for treatment-related symptoms.
Eighteen clinical trials involving a total of 3,889 subjects were included in the meta-analysis. The majority of studies occurred in Europe and North America, with one study from Israel. No study achieved perfect methodological quality, with the main issues including: no report of how random sequence generation occurred, no description of blinding of assessors and/or subjects, and no report of incomplete data.
Participants in the studies ranged from 48 to 78 years old, had various stages of breast cancer (stage 0 to IV), and had various forms of treatment (chemotherapy, hormone therapy, radiation, surgery, or a combination of therapies). The type of massage therapy varied by clinical trial and included foot reflexology, lymphatic drainage techniques, myofascial release, scalp massage, self-massage, and Swedish massage. Control groups received no treatment, usual care, health education classes, health-care visits, modified massage treatments without energy-balancing features, compression bandages, or self-administered treatment.
The results of the meta-analysis demonstrate that massage therapy significantly improved breast cancer patients’ symptoms of anger (based on four studies) and fatigue (based on five studies). However, no significant improvements were demonstrated for anxiety, cortisol levels, depression, health-related quality of life, upper limb lymphedema or pain.
As with the previous meta-analysis, the main limitations of this study include the type and stage of cancer; the massage form, duration, number of sessions, and therapists’ qualifications; lack of blinding within the studies leading to expectation bias; other methodological problems within the studies; and the international nature of the studies possibly leading to differences in outcomes. For this review, no articles included all of the outcomes of interest, leading to a very small amount of data to analyze for each outcome measure.

Conclusions
1.    When data from all types of cancer are combined, massage therapy appears to be beneficial for cancer pain related to chemotherapy, metastases, and surgery.
2.    Massage therapy may also improve anger and fatigue in subjects with breast cancer.
3.    Very little is known about the beneficial effects of massage therapy for specific types and stages of cancer. Because each patient is unique, you should work very closely with your client and her health-care team to determine what type of massage therapy is the best for her condition as well as the amount and duration of care.
4.    Larger, more rigorous trials on massage therapy for
cancer-related pain are needed.

Notes
1. S. H. Lee et al., “Meta-Analysis of Massage Therapy on Cancer Pain,” Integrative Cancer Therapies March 17 (2015).  
2.    Y. Q. Pan et al., “Massage Interventions and Treatment-Related Side Effects of Breast Cancer: A Systematic Review and Meta-Analysis,” International Journal of Clinical Oncology 19, no. 5 (October 2014): 829–41.

Jerrilyn Cambron, DC, PhD, MPH, LMT, is an educator at the National University of Health Sciences and president of the Massage Therapy Foundation. Contact her at jcambron@nuhs.edu.