Aromatherapy and massage for symptom relief in patients with cancer.
BACKGROUND
Aromatherapy massage is a commonly used complementary therapy, and is employed in cancer and palliative care largely to improve quality of life and reduce psychological distress.


OBJECTIVE
To investigate whether aromatherapy and/or massage decreases psychological morbidity, lessens symptom distress and/or improves the quality of life in patients with a diagnosis of cancer.


METHODS
We searched CENTRAL (Cochrane Library Issue 1 2002), MEDLINE (1966 to May week 3 2002), CINAHL (1982 to April 2002), British Nursing Index (1994 to April 2002), EMBASE (1980 to Week 25 2002), AMED (1985 to April 2002), PsycINFO (1887 to April week 4 2002), SIGLE (1980 to March 2002), CancerLit (1975 to April 2002) and Dissertation Abstracts International (1861 to March 2002). Reference lists of relevant articles were searched for additional studies.


METHODS
We sought randomised controlled trials; controlled before and after studies; and interrupted time series studies of aromatherapy and/or massage for patients with cancer, that measured changes in patient-reported levels of physical or psychological distress or quality of life using reliable and valid tools.


METHODS
Two reviewers independently assessed trials for inclusion in the review, assessed study quality and extracted data. Study authors were contacted where information was unclear.


RESULTS
The search strategy retrieved 1322 references. Ten reports met the inclusion criteria and these represented eight RCTs (357 patients). The most consistently found effect of massage or aromatherapy massage was on anxiety. Four trials (207 patients) measuring anxiety detected a reduction post intervention, with benefits of 19-32% reported. Contradictory evidence exists as to any additional benefit on anxiety conferred by the addition of aromatherapy. The evidence for the impact of massage/aromatherapy on depression was variable. Of the three trials (120 patients) that assessed depression in cancer patients, only one found any significant differences in this symptom. Three studies (117 patients) found a reduction in pain following intervention, and two (71 patients) found a reduction in nausea. Although several of the trials measured changes in other symptoms such as fatigue, anger, hostility, communication and digestive problems, none of these assessments was replicated.


CONCLUSIONS
Massage and aromatherapy massage confer short term benefits on psychological wellbeing, with the effect on anxiety supported by limited evidence. Effects on physical symptoms may also occur. Evidence is mixed as to whether aromatherapy enhances the effects of massage. Replication, longer follow up, and larger trials are need to accrue the necessary evidence.
Fellowes
D
D
Marie Curie Palliative Care Research and Development Unit, Marie Curie Cancer Care, Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, Royal Free Campus, Rowland Hill Street, London, London, UK, NW3 2PF.
Barnes
K
K
Wilkinson
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S
D001007:Anxiety / Q000628:therapy*; D019341:Aromatherapy; D003131:Combined Modality Therapy; D003863:Depression / Q000628:therapy*; D006801:Humans; D008405:Massage; D009369:Neoplasms / Q000523:psychology*; D059408:Pain Management; D010166:Palliative Care; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic