Skip to main content
SpringerLink
Log in

Massage therapy significantly improves cancer-related fatigue in cancer patients: a meta-analysis of randomized controlled trials

  • Review
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

This study was designed to investigate the effectiveness and safety of massage therapy in cancer-related fatigue (CRF) and to provide a reference for the future management of CRF.

Methods

Eight databases (PubMed, Embase, Cochrane Library, CINAHL, Sinomed, Chinese Scientific Journal database (VIP), Wanfang, and China National Knowledge Infrastructure (CNKI)) were systematically reviewed from inception to May 2022 for randomized controlled trials. Two reviewers critically and independently assessed the risk of bias using Cochrane Collaboration criteria and extracted correlated data using the designed form. The meta-analysis was performed using RevMan 5.3 to calculate the pooled effect sizes and 95% confidence intervals (CIs). Sensitivity analysis was performed to find the source of the heterogeneity. Publication bias was assessed via funnel plot analysis and the Egger test.

Result

A total of 11 qualified studies that included 789 patients (massage therapy group: 389; control group: 400) were included in the meta-analysis. Massage therapy had a marked effect on fatigue in cancer patients [standardized mean difference (SMD) =  − 1.69, 95% CI (− 2.46, − 0.93), P < 0.01], especially in breast cancer [SMD =  − 1.62, 95% CI (− 2.18, − 1.05), P < 0.01]. Reflexology [SMD =  − 2.71, 95% CI (− 4.65, − 0.77), P < 0.01] and Chinese massage [SMD =  − 1.14, 95% CI (− 1.95, − 0.33), P < 0.01] can have a more significant effect on fatigue. Massage time is 20 to 40 min [SMD =  − 2.39, 95% CI (− 4.13, − 0.66), P < 0.01], twice a week [SMD =  − 3.46, 95% CI (− 5.47, − 1.45), P < 0.01] for 3–5 weeks [SMD =  − 2.36, 95% CI (− 3.53, − 1.19), P < 0.01], which is more effective in relieving fatigue in cancer patients. Five studies described the occurrence of adverse events and only two studies had adverse events.

Conclusion

Massage therapy can be effective in relieving fatigue in cancer patients. Current evidence suggests that reflexology is the most effective approach to relieve fatigue, particularly in the breast cancer patients. The optimal intervention frequency and cycle for massage therapy is twice a week for 3–5 weeks, and the optimal duration is 20–40 min.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data Availability

Data that were used for analysis in this review were all extracted from the original studies. All data relevant to the study are included in the article.

References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F (2021) Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 71(3):209–249. https://doi.org/10.3322/caac.21660

    Article  PubMed  Google Scholar 

  2. Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR (2007) Cancer-related fatigue: the scale of the problem. Oncologist 12(Suppl 1):4–10. https://doi.org/10.1634/theoncologist.12-S1-4

    Article  PubMed  Google Scholar 

  3. Fabi A, Bhargava R, Fatigoni S, Guglielmo M, Horneber M, Roila F, Weis J, Jordan K, Ripamonti CI (2020) Cancer-related fatigue: ESMO Clinical Practice Guidelines for diagnosis and treatment. Ann Oncol 31(6):713–723. https://doi.org/10.1016/j.annonc.2020.02.016

    Article  CAS  PubMed  Google Scholar 

  4. Fabi A, Falcicchio C, Giannarelli D, Maggi G, Cognetti F, Pugliese P (2017) The course of cancer related fatigue up to ten years in early breast cancer patients: what impact in clinical practice? Breast 34:44–52. https://doi.org/10.1016/j.breast.2017.04.012

    Article  PubMed  Google Scholar 

  5. Curt GA, Breitbart W, Cella D, Groopman JE, Horning SJ, Itri LM, Johnson DH, Miaskowski C, Scherr SL, Portenoy RK, Vogelzang NJ (2000) Impact of cancer-related fatigue on the lives of patients: new findings from the Fatigue Coalition. Oncologist 5(5):353–360. https://doi.org/10.1634/theoncologist.5-5-353

    Article  CAS  PubMed  Google Scholar 

  6. Mao JJ, Pillai GG, Andrade CJ, Ligibel JA, Basu P, Cohen L, Khan IA, Mustian KM, Puthiyedath R, Dhiman KS, Lao L, Ghelman R, Caceres GP, Lopez G, Gallego-Perez DF, Salicrup LA (2022) Integrative oncology: addressing the global challenges of cancer prevention and treatment. CA Cancer J Clin 72(2):144–164. https://doi.org/10.3322/caac.21706

    Article  PubMed  Google Scholar 

  7. Vapiwala N, Mick R, Hampshire MK, Metz JM, DeNittis AS (2006) Patient initiation of complementary and alternative medical therapies (CAM) following cancer diagnosis. Cancer J 12(6):467–474. https://doi.org/10.1097/00130404-200611000-00006

    Article  PubMed  Google Scholar 

  8. Bower JE (2014) Cancer-related fatigue–mechanisms, risk factors, and treatments. Nat Rev Clin Oncol 11(10):597–609. https://doi.org/10.1038/nrclinonc.2014.127

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Greenlee H, DuPont-Reyes MJ, Balneaves LG, Carlson LE, Cohen MR, Deng G, Johnson JA, Mumber M, Seely D, Zick SM, Boyce LM, Tripathy D (2017) Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin 67(3):194–232. https://doi.org/10.3322/caac.21397

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hilfiker R, Meichtry A, Eicher M, Nilsson BL, Knols RH, Verra ML, Taeymans J (2018) Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis. Br J Sports Med 52(10):651–658. https://doi.org/10.1136/bjsports-2016-096422

    Article  PubMed  Google Scholar 

  11. Cassileth BR, Vickers AJ (2004) Massage therapy for symptom control: outcome study at a major cancer center. J Pain Symptom Manage 28(3):244–249. https://doi.org/10.1016/j.jpainsymman.2003.12.016

    Article  PubMed  Google Scholar 

  12. Smith MC, Yamashita TE, Bryant LL, Hemphill L, Kutner JS (2009) Providing massage therapy for people with advanced cancer: what to expect. J Altern Complement Med 15(4):367–371. https://doi.org/10.1089/acm.2008.0391

    Article  PubMed  PubMed Central  Google Scholar 

  13. Fellowes D, Barnes K, Wilkinson S (2004) Aromatherapy and massage for symptom relief in patients with cancer. Cochrane Database Syst Rev(2) D2287. https://doi.org/10.1002/14651858.CD002287.pub2

  14. Wang T, Zhai J, Liu XL, Yao LQ, Tan JB (2021) Massage therapy for fatigue management in breast cancer survivors: a systematic review and descriptive analysis of randomized controlled trials. Evid Based Complement Alternat Med 9967574 (2021). https://doi.org/10.1155/2021/9967574

  15. Pan YQ, Yang KH, Wang YL, Zhang LP, Liang HQ (2014) Massage interventions and treatment-related side effects of breast cancer: a systematic review and meta-analysis. INT J CLIN ONCOL 19(5):829–841. https://doi.org/10.1007/s10147-013-0635-5

    Article  CAS  PubMed  Google Scholar 

  16. Moher D, Liberati A, Tetzlaff J, Altman DG (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. INT J SURG 8(5):336–341. https://doi.org/10.1016/j.ijsu.2010.02.007

    Article  PubMed  Google Scholar 

  17. Sterne J, Savovic J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, Emberson JR, Hernan MA, Hopewell S, Hrobjartsson A, Junqueira DR, Juni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins J (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898. https://doi.org/10.1136/bmj.l4898

    Article  PubMed  Google Scholar 

  18. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS MED 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mustian KM, Roscoe JA, Palesh OG, Sprod LK, Heckler CE, Peppone LJ, Usuki KY, Ling MN, Brasacchio RA, Morrow GR (2011) Polarity Therapy for cancer-related fatigue in patients with breast cancer receiving radiation therapy: a randomized controlled pilot study. Integr Cancer Ther 10(1):27–37. https://doi.org/10.1177/1534735410397044

    Article  PubMed  Google Scholar 

  20. Ozdelikara A, Tan M (2017) The effect of reflexology on chemotherapy-induced nausea, vomiting, and fatigue in breast cancer patients. Asia Pac J Oncol Nurs 4(3):241–249. https://doi.org/10.4103/apjon.apjon_15_17

    Article  PubMed  PubMed Central  Google Scholar 

  21. Bahceli PZ, Arslan S, Ilik Y (2022) The effect of slow-stroke back massage on chemotherapy-related fatigue in women with breast cancer: an assessor blinded, parallel group, randomized control trial. Complement Ther Clin Pract 46:101518. https://doi.org/10.1016/j.ctcp.2021.101518

    Article  PubMed  Google Scholar 

  22. Hassan N, Minoo M, Milad B, Asma T, Behrouz S (2019) The effects of reflexology on fatigue severity of patients with cancer. Asian Pac J Cancer Prev 20(2):391–394

    Article  Google Scholar 

  23. Listing M, Krohn M, Liezmann C, Kim I, Reisshauer A, Peters E, Klapp BF, Rauchfuss M (2010) The efficacy of classical massage on stress perception and cortisol following primary treatment of breast cancer. Arch Womens Ment Health 13(2):165–173. https://doi.org/10.1007/s00737-009-0143-9

    Article  PubMed  Google Scholar 

  24. Hu FH, Hu MJ and Zhan ZH, Zhan YC. (2014) Effect of back massage on chemotherapy-related fatigue and anxiety in cancer patients. Chinese Journal of Modern Nursing 4579–4581. https://d.wanfangdata.com.cn/periodical/ChlQZXJpb2RpY2FsQ0hJTmV3UzIwMjMwMTEyEg14ZGhsMjAxNDM2MDE1GghpZHgzYW14Mw%3D%3D

  25. Liang RJ and Qu X. (2016) Influence of back massage on the fatigue and anxiety state related with chemotherapy of the old acute myelogenous leukemia patient. China Modern Medicine 23: 148–151.https://kns.cnki.net/kcms/detail/detail.aspx?dbcode=CJFD&dbname=CJFDLAST2016&filename=ZGUD201614048&uniplatform=NZKPT&v=0sjyyKu_DGZ2IbGP9lMgEKcH-EipVpnJ7oloywQGHilpxK-hEhjLYc4Mtp8mKUp2

  26. Donoyama N, Satoh T, Hamano T, Ohkoshi N, Onuki M (2018) Effects of Anma therapy (Japanese massage) on health-related quality of life in gynecologic cancer survivors: a randomized controlled trial. PLOS ONE 13(5):e196638. https://doi.org/10.1371/journal.pone.0196638

    Article  CAS  Google Scholar 

  27. Rambod M, Pasyar N, Shamsadini M (2019) The effect of foot reflexology on fatigue, pain, and sleep quality in lymphoma patients: a clinical trial. Eur J Oncol Nurs 43:101678. https://doi.org/10.1016/j.ejon.2019.101678

    Article  PubMed  Google Scholar 

  28. LI YL, Zhu F and Hou H. (2011) Effect of tui na on cancer-caused fatigue in patients undergoing neoadjuvant chemotherapy for breast cancer. Chinese Journal of Current Advances in General Surgery 14: 245–247. https://kns.cnki.net/kcms/detail/detail.aspx?dbcode=CJFD&dbname=CJFD2011&filename=PWJZ201103030&uniplatform=NZKPT&v=bC_BxabK0xF0epb9Fyj35ZC44fRTfDoOzqw6058LFLup3EfYAd3USiS8fzqUYlAk

  29. Zengin L, Aylaz R (2019) The effects of sleep hygiene education and reflexology on sleep quality and fatigue in patients receiving chemotherapy. Eur J Cancer Care (Engl) 28(3):e13020. https://doi.org/10.1111/ecc.13020

    Article  PubMed  Google Scholar 

  30. Tao WW, Jiang H, Tao XM, Jiang P, Sha LY, Sun XC (2016) Effects of acupuncture, Tuina, Tai Chi, Qigong, and traditional Chinese medicine five-element music therapy on symptom management and quality of life for cancer patients: a meta-analysis. J Pain Symptom Manage 51(4):728–747. https://doi.org/10.1016/j.jpainsymman.2015.11.027

    Article  PubMed  Google Scholar 

  31. Fernandez-Lao C, Cantarero-Villanueva I, Diaz-Rodriguez L, Cuesta-Vargas AI, Fernandez-Delas-Penas C, Arroyo-Morales M (2012) Attitudes towards massage modify effects of manual therapy in breast cancer survivors: a randomised clinical trial with crossover design. Eur J Cancer Care (Engl) 21(2):233–241. https://doi.org/10.1111/j.1365-2354.2011.01306.x

    Article  CAS  PubMed  Google Scholar 

  32. Moraska A (2007) Therapist education impacts the massage effect on postrace muscle recovery. Med Sci Sport Exer 39(1):34–37. https://doi.org/10.1249/01.mss.0000240320.16029.d2

    Article  Google Scholar 

  33. Weerapong P, Hume PA, Kolt GS (2005) The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Med 35(3):235–256. https://doi.org/10.2165/00007256-200535030-00004

    Article  PubMed  Google Scholar 

  34. Netchanok S, Wendy M, Marie C, Siobhan O (2012) The effectiveness of Swedish massage and traditional Thai massage in treating chronic low back pain: a review of the literature. Complement Ther Clin Pract 18(4):227–234. https://doi.org/10.1016/j.ctcp.2012.07.001

    Article  PubMed  Google Scholar 

  35. McCullough JE, Liddle SD, Sinclair M, Close C, Hughes CM (2014) The physiological and biochemical outcomes associated with a reflexology treatment: a systematic review. Evid Based Complement Alternat Med 2014:502123. https://doi.org/10.1155/2014/502123

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Wilkinson S, Lockhart K, Gambles M, Storey L (2008) Reflexology for symptom relief in patients with cancer. Cancer Nurs 31(5):354-360–361-362. https://doi.org/10.1097/01.NCC.0000305756.58615.81

    Article  Google Scholar 

  37. Stephenson NL, Swanson M, Dalton J, Keefe FJ, Engelke M (2007) Partner-delivered reflexology: effects on cancer pain and anxiety. Oncol Nurs Forum 34(1):127–132. https://doi.org/10.1188/07.ONF.127-132

    Article  PubMed  Google Scholar 

  38. Lee J, Han M, Chung Y, Kim J, Choi J (2011) Effects of foot reflexology on fatigue, sleep and pain: a systematic review and meta-analysis. J Korean Acad Nurs 41(6):821–833. https://doi.org/10.4040/jkan.2011.41.6.821

    Article  PubMed  Google Scholar 

  39. Ozdelikara A, Agcadiken AS (2018) The effects of reflexology on fatigue and anxiety in patients with multiple sclerosis. Altern Ther Health Med 24(4):8–13

    PubMed  Google Scholar 

  40. Gok MZ, Ozdemir L (2016) The effects of aromatherapy massage and reflexology on pain and fatigue in patients with rheumatoid arthritis: a randomized controlled trial. Pain Manag Nurs 17(2):140–149. https://doi.org/10.1016/j.pmn.2016.01.004

    Article  Google Scholar 

  41. Anderson KD, Downey M (2021) Foot reflexology: an intervention for pain and nausea among inpatients with cancer. Clin J Oncol Nurs 25(5):539–545. https://doi.org/10.1188/21.CJON.539-545

    Article  PubMed  PubMed Central  Google Scholar 

  42. Goral TS, Ozkan S (2021) The effects of reflexology on anxiety, depression and quality of life in patients with gynecological cancers with reference to Watson’s theory of human caring. Complement Ther Clin Pract 44:101428. https://doi.org/10.1016/j.ctcp.2021.101428

    Article  Google Scholar 

  43. Crommert ME, Lacourpaille L, Heales LJ, Tucker K, Hug F (2015) Massage induces an immediate, albeit short-term, reduction in muscle stiffness. Scand J Med Sci Spor 25(5):E490–E496. https://doi.org/10.1111/sms.12341

    Article  Google Scholar 

  44. Lopez G, Liu W, Milbury K, Spelman A, Wei Q, Bruera E, Cohen L (2017) The effects of oncology massage on symptom self-report for cancer patients and their caregivers. Supp Care Cancer 25(12):3645–3650. https://doi.org/10.1007/s00520-017-3784-7

    Article  Google Scholar 

  45. Miladinia M, Jahangiri M, Kennedy AB, Fagerstrom C, Tuvesson H, Safavi SS, Maniati M, Javaherforooshzadeh F, Karimpourian H (2022) Determining massage dose-response to improve cancer-related symptom cluster of pain, fatigue, and sleep disturbance: a 7-arm randomized trial in palliative cancer care. Palliat Med 410585030 https://doi.org/10.1177/02692163221129158

  46. Yunhui X, Hao GU, Qing Z, Dejie LI, Ying G, Junxing X, Guofeng S (2022) Efficacy of meridian massage for motor function after a stroke: a systematic review and Meta-analysis. J Tradit Chin Med 42(3):321–331. https://doi.org/10.19852/j.cnki.jtcm.2022.03.001

    Article  PubMed  Google Scholar 

  47. Mustian KM, Alfano CM, Heckler C, Kleckner AS, Kleckner IR, Leach CR, Mohr D, Palesh OG, Peppone LJ, Piper BF, Scarpato J, Smith T, Sprod LK, Miller SM (2017) Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. Jama Oncol 3(7):961–968. https://doi.org/10.1001/jamaoncol.2016.6914

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This study was supported by National Natural Science Foundation of China (Grant No. 81801098) the Key Project of Philosophy and Social Science Research in Colleges and Universities in Jiangsu Province (No. 2023SJZD144).

Author information

Author notes

  1. Shengnan Shan and Lu Lin contributed equally to this work.

Authors and Affiliations

  1. The First Affiliated Hospital of Soochow University, Suzhou, 215006, China

    Shengnan Shan, Lu Lin & Li Tian

  2. School of Nursing, Medical College of Soochow University, Suzhou, 215006, China

    Shengnan Shan, Lu Lin, Qian Fang, Daoxia Guo & Li Tian

  3. The Second Affiliated Hospital of Soochow University, Suzhou, 215000, China

    Fengmei Tian & Yanling Zhou

Authors
  1. Shengnan Shan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lu Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qian Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fengmei Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daoxia Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yanling Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Li Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Shan SN, Lin L, Fang Q, and Tian FM performed the meta-analysis. Shan SN, Lin L, and Tian L wrote the first draft of the manuscript. Tian FM and Guo DX supervised the work. Tian L, Zhou YL, and Lin L revised the final manuscript. All authors reviewed and approved the final manuscript.

Corresponding authors

Correspondence to Yanling Zhou or Li Tian.

Ethics declarations

Ethics approval

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 18 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shan, S., Lin, L., Fang, Q. et al. Massage therapy significantly improves cancer-related fatigue in cancer patients: a meta-analysis of randomized controlled trials. Support Care Cancer 31, 464 (2023). https://doi.org/10.1007/s00520-023-07926-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00520-023-07926-w

Keywords

Search

Navigation