Massage Therapy

Key Points

  • Massage is the manipulation of muscles and other soft tissues in the body and may range from light stroking to deep pressure.
  • Clinical practice guidelines cite use of massage for managing anxiety, mood disturbance, pain, and peripheral neuropathy.
  • Massage may also help to improve sleep disruption, nausea, feelings of hopelessness and other negative emotions, physical complaints and markers of stress, quality of life, fatigue, and breast symptoms.
  • Massage therapy administered by a trained massage therapist is generally safe, with few adverse outcomes.
  • Massage therapy delivered by an oncology-trained massage therapist is recommended.

Author

Nancy Hepp, MS, BCCT Project Manager

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Reviewer

Laura Pole, RN, MSN, OCNS, BCCT Senior Researcher

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Contributor

Maria Williams, BCCT Research & Communications Consultant

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Last updated September 17, 2021.

Massage is the manipulation of muscles and other soft tissues in the body. Massage may range from light stroking to deep pressure, with a goal to release tension or stress in the tissues. Studies of the benefits of massage find it an effective treatment for reducing anxiety, pain and muscle tension. It may help with other symptoms and conditions such as insomnia.1 Massage may be accompanied by aromatherapy.

Clinical Practice Guidelines

The Society for Integrative Oncology evidence-based clinical practice guidelines cite massage to manage these symptoms. The guidelines recommend massage as useful in integrative plans combining two or more therapies (multimodality treatment):2

Breast Cancer Guideline

Clinical practice guidelines for use of massage therapy with breast cancer:3

  • Can be considered for reducing anxiety
  • Recommended for improving mood disturbance

Chronic Pain Guideline

The 2016 American Society of Clinical Oncology clinical practice guideline for managing chronic pain in survivors of adult cancers makes a weak recommendation for using massage.4

Peripheral Neuropathy Guideline

The patient-education resource from the American Society for Clinical Oncology (ASCO) advises an integrative approach including massage to manage peripheral neuropathy.5

Managing Side Effects and Promoting Wellness

Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being

Stronger Evidence

The clinical practice guidelines described above reviewed all the evidence available at the time and concluded that massage therapy is effective for these symptoms (further research in footnotes since those guidelines were published affirms these findings):

  • Anxiety or depression
    • Modest improvement in anxiety among people with cancer in a meta-analysis of RCTs of both high and low quality6
    • Less anxiety among women with breast cancer with massage in a meta-analysis of RCTs78
    • No difference in anxiety among people with cancer with massage in a9 meta-analysis of RCTs of very low quality10
    • Substantially lower scores on stress among people with moderate baseline stress scores and not using using anxiolytics or antidepressants with massage compared to no treatment, and even higher scores when reiki was added after massage in a small RCT11
    • Less anxiety among critically ill adults with either aromatherapy or massage in a review of RCTs12
    • Lower measures of both stress and anxiety among people receiving massage either with or without Reiki compared to standard of care in a mid-sized RCT13
    • Lower anxiety among adult burn patients with massage from a trained massage therapist in a meta-analysis of RCTs14
    • Less anxiety among people with cancer receiving therapeutic massage compared to presence alone or standard care in a mid-sized RCT15
    • Less anxiety, depression, or mood disturbance among adults with cancer with massage in a review of RCTs16
  • Fatigue:
    • Improvement in fatigue among people with cancer in a meta-analysis of RCTs of both high and low quality17
    • Substantially less cancer-related fatigue during cancer treatment with relaxation exercise compared to usual care in a meta-analysis of RCTs18
  • Mood disturbance or depression,19 although one meta-analysis found no difference with massage20
    • Less mood disturbance among people with cancer compared to presence alone or standard care in a mid-sized RCT21
  • Pain,22 although one meta-analysis found greater reported pain with massage23
    • Improvement in pain among people with cancer in a meta-analysis of RCTs of both high and low quality24
    • Substantially less pain following surgery with single dosage massage therapy in a meta-analysis of RCTs of low quality25
    • The presence of depression or higher baseline psychological symptom frequency impacts the effect of massage therapy on pain, interference of pain, quality of life, 60-second heart and respiratory rates, and physical distress among people with advanced cancer26
    • Less pain and nonsteroidal antiinflammatory drug use among people with cancer receiving therapeutic massage compared to presence alone or standard care in a mid-sized RCT27
    • No significant impact on cancer-related procedural pain among children with cancer compared to standard care in a meta-analysis of controlled trials28
    • Lower pain levels among adults with cancer with massage in a review of RCTs29
  • Peripheral neuropathy30
  • Quality of life:
    • Better quality of life among people with metastatic cancer compared to a non-touch control or usual care in a small RCT31
    • No improvement in health-related quality of life among people with cancer with massage compared to controls in a meta-analysis of RCTs of low quality32
  • Sleep disruption: massage, whether with or without aromatherapy, was associated with better sleep in cancer patients and survivors.3334
  • Better sleep with aromatherapy, and better level of arousal with massage among critically ill adults in a review of RCTs3536
  • Lowered blood pressure, respiratory rate, and heart rate among people with cancer receiving therapeutic massage compared to presence alone or standard care in a mid-sized RCT373839

Emerging Evidence

Evidence shows further benefits of massage therapy for these symptoms, but study designs or methods are not always strong and conclusions are weak:

Primarily physical symptoms

  • Breast symptoms: reduced long-term symptoms relating to the breast in people with breast cancer40
  • Fatigue: reduced fatigue41 compared to other active therapies for cancer patients also experiencing pain,42 for patients in cancer treatment compared with usual care,43 or patients with breast cancer44 although one meta-analysis found no difference with massage45
  • Nausea: alleviated nausea46 although one meta-analysis found no difference with massage47 and another systematic review found weak evidence of effect48
  • No difference in anti-emetic use among women with ovarian cancer undergoing chemotherapy with an intervention combining healing touch, hypnosis, and massage compared to no intervention in a small RCT49
  • Physical complaints and markers of stress: reduced severity of subjective physical complaints and reduced markers of stress in survivors of gynecologic cancers (uterine, cervical, endometrial, ovarian, fallopian tubal, or peritoneal cancer) following Anma therapy (Japanese massage)50 and of physical and psychological symptoms in breast cancer patients with aromatherapy massage,51 although one meta-analysis found no overall difference with massage5253
  • No difference in re-hospitalization rates, treatment delays, and infection rates among women with ovarian cancer undergoing chemotherapy with an intervention combining healing touch, hypnosis, and massage compared to no intervention in a small RCT5455

Primarily mental or emotional symptoms

  • Hopelessness: reduced feelings of hopelessness in patients undergoing treatment56
  • Negative emotions, including anger: reduced anger and negative emotions in cancer patients57
  • Stress: alleviated stress in patients with cancer58

Other symptoms

  • Quality of life:
    • Improved quality of life score with aromatherapy massage59 or massage60 compared to no massage, although one meta-analysis found no difference with massage alone61
    • Moderately better scores on quality of life among people with moderate baseline stress scores and not using using anxiolytics or antidepressants with massage with or without reiki compared to no intervention in a small RCT62
    • No difference in quality of life among women with ovarian cancer undergoing chemotherapy with an intervention combining healing touch, hypnosis, and massage compared to no intervention in a small RCT63
  • Symptoms in children with cancer: massage alleviated pain, nausea, stress and anxiety64

Optimizing Your Terrain

Creating an environment within your body that does not support cancer development, growth or spread

Massage increased white blood cells and neutrophils in children with cancer.65

Cautions

Massage therapy administered by a trained massage therapist is generally safe, with few adverse outcomes.66 The National Cancer Institute urges massage therapists to take precautions with all cancer patients and avoid massaging specific vulnerable areas of the body. In addition, certain patients with multiple bone metastases may be at risk for fracture during deep massage.67

Massage therapy delivered by an oncology-trained massage therapist is recommended.68 Oncology massage therapists are keenly aware of any cautions and how to adapt massage for individual needs.69 See below for a website to locate an oncology massage therapist in North America.

Access

Massage therapists are widely available, including within many cancer centers. The Society for Oncology Massage has a search page to locate therapists in North America.

Some insurance plans pay for medically indicated massage therapy.

Integrative Programs, Protocols and Medical Systems

For more information about programs and protocols, see our Integrative Programs and Protocols page.

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