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Abstract

Background

Massage therapy is an effective non-pharmacological intervention in treating pain and anxiety of patients with cancer. Prior studies have reviewed the benefits of massage therapy in patients with breast cancer undergoing chemotherapy, radiation, and other patient-specific cancer treatments. What has yet to be examined is the effects of massage therapy on the pain and anxiety of patients with breast cancer after surgery.

Objective

: The purpose of this systematic review and meta-analysis was to examine the effect of massage therapy on post-surgical pain and anxiety in patients with breast cancer.

Methods

Systematic searches were performed using databases PubMed, CINAHL, and Medline (EBSCO), with no date constraint through September 30, 2023, to identify randomized control trials, randomized pilot, and quasi-experimental studies. The database searches retrieved 1205 titles, and after screening, 7 studies were chosen for full analysis using Cohen’s d, 95% Confidence Interval (CI), and effect size. The heterogeneity of the studies was calculated in the meta-analysis using Cochran’s Q equation.

Results

Massage therapy techniques reported were massage therapy, classic massage, reflexology, myofascial release, and myofascial therapy, and were performed at day 0 up to 16 weeks post-surgery. Massage therapy decreased pain and anxiety for patients in the massage group. Analyses showed a positive effect size using massage therapy as an intervention for pain and anxiety in women with breast cancer post-surgery. Overall effect size for pain was 1.057 with a P-value of <.0001, and overall effect size for anxiety was .673 with a P-value of <.0001.

Conclusion

The current evidence in this study reflects that massage therapy is effective as a non-pharmacological tool in decreasing post-surgical pain and anxiety in women with breast cancer.

Keywords

massage therapy manual therapy breast cancer pain anxiety

Introduction

Women with breast cancer experience persistent post-surgical pain and anxiety at a rate of 42% and 49%, respectively.^1,2 While the main goal of clinical treatment is to eradicate cancer, little focus is placed on addressing other symptom management² and therefore pain and anxiety in women with breast cancer often gets under-, un- or misdiagnosed.³ Additionally, women experiencing increased levels of anxiety before breast cancer surgery, frequently receive more aggressive procedures than surgically recommended.⁴ Health care providers most likely know that their patients are dealing with persistent pain and anxiety post-surgery, yet may not have the time or knowledge of effective treatments to offer help and support.³

The use of pharmaceuticals and opioids for symptom management in patients with cancer does not always yield the desired analgesic outcomes and can lead to unwanted side-effects.⁵ In addition, there remains concern for addiction, even though the risk for dependency is low.⁶ A patient’s ability to recover from breast cancer after surgery includes access to tools that address pain and anxiety as well as stress.⁷ High levels of pain and anxiety in women with breast cancer can lead to prolonged recovery and a decreased quality of life.^8,9 Therefore, there is a need for non-pharmacological interventions to treat pain and anxiety in patients with breast cancer after surgery.

Massage therapy has been shown to be a viable non-pharmacological intervention for symptom management of pain and anxiety in patients with cancer.^10-12 In women with breast cancer, massage is effective in reducing pain in patients acute care, pre- and post-operative. Massage therapy is also beneficial in treating generalized anxiety disorder and anxiety in the hospital setting.^13,14 In patients with breast cancer, quality of life increases with massage therapy interventions.^15-17 However, effectiveness and efficacy of massage therapy for the reduction of pain and anxiety,^18,19 in patients with breast cancer after surgery specifically, has yet to be determined. The objective of this systematic review and meta-analysis is to examine massage therapy’s effects as a non-pharmacological intervention on post-surgical pain and anxiety in women with breast cancer.

Methods

This systematic review and meta-analyses followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA-P),²⁰ but was not registered.

Criteria for Considering Studies for this Review

Evaluation of articles reviewed included patients with breast cancer, with no previous diagnosis of breast cancer, ages 18-75 years, who received either a mastectomy, lumpectomy, and/or breast reconstruction, 0-5 years post-operative. Further adjuvant treatment of chemotherapy and radiation was included, as these treatments often accompany surgical strategies to eradicate breast cancer and often cause pain and anxiety. The eligibility of the articles was identified by 2 authors (JSC, ADO) using specific inclusion and exclusion criteria for the systematic search.

Randomized control trials (RCTs), quasi-experimental studies, and randomized pilot studies were included in the search strategy and eligibility criteria and had to be published in a peer-reviewed journal. Studies were excluded if they were not in English, case studies, systematic reviews, or meta-analysis, below a Level of Evidence of 3, or if they included patients with cancer other than breast cancer.

Search Strategy

Using databases PubMed, CINAHL, and Medline (EBSCO), a systematic search was performed with no date constraint through September 30, 2023. MESH terms of “massage therapy, manual therapy, breast cancer, anxiety, pain” were accompanied by the Boolean term of “and” to reconcile the search and eligibility criteria. Further filters of the terms “full text” and “clinical trials” and “randomized control trials” were used (Addendum 1).

Outcome Measures

Across studies, researchers used a variety of outcome measures. Pain data were assessed using the, Short-Form McGill Pain Questionnaire (SF-MPQ), the Self-Leeds Assessment of Neuropathic Symptoms and signs (S-LANNS) and the Visual Analog Scale (VAS).^21,22 Data on anxiety were assessed using the VAS and the Quality-of-Life Form (QOL).²³

Data Collection

Data collection process for the studies selected in the systematic review was adopted from Pinheiro de Silva, et al²⁴ and is represented in Tables 2 and 3. Table 2 includes data collected from each study and the instruments used to measure the outcomes to assess pain of patients with breast cancer, post-surgery. Table 3, assessing anxiety in post-surgical breast cancer patients, includes the author/year, sample size, interventions used by both the experimental and control groups, and the protocols performed. The constructed Boolean phrase, systematic search, and hand search were conducted by 1 investigator (JSC) and an academic medical center librarian.

Analysis Plan

Data on pain and anxiety were collected for each article, pre/post massage therapy intervention, and placed in a spreadsheet for meta-analysis. Effect size was calculated using Cohen’s d, 95% Confidence Interval (CI), mean, sample size, and standard deviation of the massage group and control group for each study (Tables 2 and 3; Figures 2 and 3). Analysis and forest plots were generated by the software Comprehensive Meta-Analysis Version 3. A random-effects method meta-analysis was implemented on all 7 studies identified from this search, using standard deviation of the means, standard error, variance, upper and lower limits, z/P-values, and a 95% confidence interval. The heterogeneity of the studies was measured in the meta-analysis using Cochran’s Q.

Quality Assessment

Of the 7 articles chosen for review there were 4 RCTs, 2 randomized pilot studies, and 1 quasi-experimental study. Each article was assessed for quality using the PEDro scale,²⁵ the CONSORT scale,²⁶ and the Downs and Black Scale,²⁷ as appropriate and reported in Table 4. Each critical appraisal tool checked for bias, randomization, blinding of assessors and subjects, criteria eligibility, and concealment of allocation. Two reviewers (JSC, ADO) completed independent reviews of the data including study design, inclusion/exclusion criteria, study quality, participant characteristics, intervention procedures, clinician information, statistical analysis techniques, outcomes, and appropriate methodological limitations. Any discrepancies of interpretation were resolved by discussion until consensus was reached. If consensus could not be reached, a third reviewer (EED) was planned, but not needed.

Results

Study Selection and Characteristics

From the database searches, 1204 titles were retrieved. Once duplicates were removed, and screening eligibility was completed by title and abstract, 21 full text articles were fully read and assessed, and 10 articles were eliminated because the outcomes did not meet our inclusion criteria. Overall, 4 studies examined post-surgical patients with breast cancer in the outpatient setting and 3 studies examined post-surgical patients with breast cancer in the inpatient setting.^28-34 The massage therapy interventions used in the 7 studies, included myofascial release,^28,32 massage therapy,^29,30,34 reflexology,³³ classic massage³¹ and myofascial therapy.³²

Ultimately, 7 studies were included in this systematic review and meta-analysis (see Figure 1 for the Prisma Flow Diagram). Combined, this resulted in a sample size of 235 women who received massage therapy in the massage group, and 191 women who did not receive massage therapy in the control group. The most common form of surgery for the women in the 7 studies was mastectomy, followed by lumpectomy and reconstruction. The range of time from surgery to the massage therapy intervention ranged from zero hours to 16 weeks (Table 1). Using the Strength of Recommendation Taxonomy (SORT)³⁵ model, a Level 1 Study Quality was determined in all 4 RCTs, and a Level 2 study quality was determined in both the randomized pilot and quasi-experimental studies (Table 1). The Downs and Black checklist was used for the quasi-experimental study, which scored the lowest level of evidence with a total of 17/26 possible points due to lack of randomization and blinding.²⁷ Overall, all studies had some degree of bias ranging from low to high bias.

Figure 1.

Prisma flow diagram for study eligibility.

Table 1.

Summary of Studies.

Author, Year & Study Design	Sample Size	Participant Characteristics (Age, Race, Surgery Type)	Massage GroupProtocol	Control GroupProtocol
De Groef, et al, 2018 Randomized control trial	MG = 25 CG = 25	Female, no prior breast cancer dx, mastectomy/lumpectomy intervention, mean age, 54.2 0-5 yrs. post-op; surgeries to remove breast cancer and reconstruction; chemo/radiation; no available data on race	MG = 12 weeks PT + 12 weeks of MFR	CG = 12 weeks PT + 12 weeks placebo MFR-light hand holds
Dilaveri, et al, 2020 Randomized pilot study	MG = 21 CG = 19	Female, no prior breast cancer dx Reconstruction immediate or delayed post mastectomy/lumpectomy, mean age 50.15, white = 34, black = 1, American Indian = 1, Asian Korean = 1, did not disclose = 1	MG = 20 minutes massage, 0-3 days post-op	CG = 20 minutes of massage & acupuncture, 0-3 days post-op
Dion, et al, 2016 Randomized pilot study	MG = 19 CG = 19	Female, no prior breast cancer dx Reconstruction immediate or delayed post mastectomy/lumpectomy, mean age 47.7, no available data on race	MG = 20 minutes massage, 0-3 days post-op	CG = 20 minutes of massage & meditation, 0-3 days post-op
Izgu, et al, 2019 Randomized control trial	MG = 20 CG = 20	Female, no prior breast cancer dx, mastectomy/lumpectomy, mean age Intervention = 44.5+-10.7 Control = 47.0+-9.6, no available data on race	MG = 20 minutes of weekly massage, 16 weeks post-op	CG = standard of care, no massage
Serra-Ano, et al, 2019 Randomized control trial	MG = 13 CG = 11	Female, no prior breast cancer dx, mastectomy/lumpectomy mean age 53.71, no available data on race	MG = 10 minutes MFR, 4 weeks	CG = 10 minutes of placebo MFR, light holds, 4 weeks
Sharp, et al, 2010 Randomized control trial	MG1 = 60 MG2 = 61 CG = 62	Female, no prior breast cancer dx, CIPN Wide local incision = 144 Quadrantectomy = 1 Mastectomy = 26 Mast = reconstruction = 12 mean age 58.8, white = 183	MG1 = reflexology, 1 hour/week/8 weeks MG2 = massage 1-hour week/8 weeks	CG = standard of care, no massage therapy
Ucuzal & Kanan, 2012 Quasi-experimental	MG = 35 CG = 35	Female, no prior breast cancer dx, mastectomy/lumpectomy sentinel lymph node biopsy mean age 52.4, no available data on race	MG = 20-minute foot massage, immediately post-op	CG = Analgesics only, immediately post-op

Abbreviations: CG, control group; CIPN, chemotherapy-induced peripheral neuropathy; MG, massage group; MFR, myofascial release/myofascial therapy; MT, classic massage therapy.

Summary of Findings for Pain Outcomes

Of the 7 articles reviewed, 3 included pain as well as anxiety as outcomes,^28-30 with one study assessing anxiety only.³³ Six studies showed a decrease in pain, post-massage in the massage group, in comparison to the control group (Table 2). Pain data were represented by forest plots and massage therapy showed a positive effect for decreasing pain (effect size of 1.057, Figure 2) with all studies favoring massage. The Q-statistic examining the heterogeneity among the studies was 36.125 (P = .000) for pain, indicating variability in effect size.

Table 2.

Summary of Findings for Pain Outcomes.

Author/Year	Outcome Measure	MG Result (Mean (SD))	CG Result (Mean (SD))
De Groef, et al, 2018	Pain (VAS 0-100)	Baseline: 67 (15) 3 months: 23 (30) 6 months: 31 (31) 12 months: 33 (30)	Baseline: 64 (16) 3 months: 40 (36) 6 months: 34 (30) 12 months:43 (28)
Dilaveri, et al, 2020	Pain (VAS 0-10)	Primary Baseline Pre:4.14 (3.14) Visit 1 Pre: −1.24 (3.49) Visit 2 Pre: −1.33 (2.99) Visits 3 Pre: −1.60 (3.23) Baseline Post:4.14 (3.14) Visit 1 Post: −3.29 (3.15) Visit 2 Post: −3.19 (3.04) Visit 3 Post: −2.50 (2.98) Secondary Baseline Pre:1.71 (2.39) Visit 1 Pre: +3.09 (2.46) Visit 2 Pre: +2.43 (3.20) Visits 3 Pre: +1.75 (2.22) Baseline Post:1.71 (2.39) Visit 1 Post: +1.14 (2.29) Visit 2 Post: +.81 (3.52) Visits 3 Post: +.90 (2.59)	Primary Baseline Pre:3.74 (2.49) Visit 1 Pre-1.74 (2.56) Visit 2 Pre: −2.06 (2.53) Visits 3 Pre: −2.28 (2.47) Baseline Post: 3.74 (2.49) Visit 1 Post: −1.74 (2.56) Visit 2 Post: −2.06 (2.53) Visit 3 Post Secondary Baseline Pre:1.00 (1.33) Visit 1 Pre: +3.95 (1.68) Visit 2 Pre: +2.74 (2.13) Visits 3 Pre: +1.56 (2.04) Baseline Post:1.00 (1.33) Visit 1 Post: +1.63 (2.11) Visit 2 Post: +.72 (1.84) Visits 3 Post: +.06 (1.51)
Dion, et al, 2016	Pain (VAS 0-100)	Day 1 Pre:53.4 (17.67) Day 2 Pre:45.95 (10.52) Day 3 Pre:43.37 (5.11) Week 3 Pre:29.82 (10.23) Day 1 Post:35.06 (17.43) Day 2 Post:32.84 (11.83) Day 3 Post:30.26 (9.90) Week 3 Post: N/A	Day 1 Pre: 48.31 (11.07) Day 2 Pre:47.95 (10.22) Day 3 Pre:45.21 (9.25) Week 3 Pre:30.32 (10.17) Day 1 Post:33.07 (9.74) Day 2 Post:33.94 (10.88) Day 3 Post:30.84 (9.75) Week 3 Post: N/A
Izgu, et al, 2019	CIPN Pain (S-LANSS 0-10)	Baseline: 2.15 (5.12) Week 4: 1.94 (3.87) Week 8: 4.73 (4.44) Week 12:5.68 (6.41) Week 16: 4.33 (4.61)	Baseline:1.42 (3.09) Week 4: 4.38 (5.25) Week 8:8.45 (5.77) Week 12: 10.83 (7.51) Week 16: 7.00 (6.65)
Serra-Ano, et al, 2019	Pain (VAS 0-10)	Week 1: 6.48 (1.52) Week 2: 2.87 (1.99) Week 3: 3.62 (3.07)	Week 1:4.95 (2.09) Week 2: 3.77 (2.49) Week 3: 4.68 (1.61)
Ucuzal & Kanan, 2012	Pain (SF-MPQ 0-10)	Follow-up time 0 minutes:7.31 (1.60) 5 minutes: 4.26 (1.92) 30 minutes: 3.74 (1.58) 60 minutes: 3.03 (1.79) 90 minutes: 2.17 (1.79) 120 minutes: 1.71 (1.62)	Follow-up time 0 minutes: 6.69 (1.25) 5 minutes: 6.46 (1.38) 30 minutes: 6.09 (1.90) 60 minutes: 5.57 (1.96) 90 minutes: 5.03 (2.05) 120 minutes: 4.60 (2.20)

Abbreviations: CG, control group; CIPN, chemotherapy-induced peripheral neuropathy; MG, massage group; QOL, quality of life; SD, standard deviation, SF-MPQ, Short-Form McGill Pain Questionnaire; S-LANNS, Self-Leeds Assessment of Neuropathic Symptoms and Signs; VAS, Visual Analog Scale.

Figure 2.

Forest plots for pain with massage therapy intervention for patients with breast cancer.

Summary of Findings for Anxiety Outcomes

Performance from the massage therapy data for anxiety were represented by forest plots (Figure 3). There were four studies that assessed anxiety in post-surgical patients with breast cancer.^31,32,34 One study in particular, revealed a significant decrease, post treatment, in comparison to control. Specifically, anxiety was significantly decreased with massage (effect size of .673, Figure 3, Table 3), with 3 out of the 4 studies favoring massage. The Q-statistic examining the heterogeneity among the studies was 33.276 (P = .000) for anxiety, indicating variability in effect size.

Figure 3.

Forest plots for anxiety with massage therapy intervention for patients with breast cancer.

Table 3.

Summary of Findings for Anxiety Outcomes.

Author/Year	Outcome Measure	MG Result (Mean (SD))	CG Result (Mean (SD))
De Groef, et al, 2018	Anxiety QOL (0-100)	Baseline: 67 (15) 3 months: 23(30) 6 months:31 (31) 12 months: 33 (30)	Baseline: 64 (16) 3 months: 40 (36) 6 months:34 (30) 12 months:43 (28)
Dilaveri, et al, 2020	Anxiety (VAS 0-10)	Primary Baseline Pre:4.14 (3.14) Visit 1 Pre: −1.24 (3.49) Visit 2 Pre: −1.33 (2.99) Visits 3 Pre: −1.60 (3.23) Baseline Post:4.14 (3.14) Visit 1 Post: −3.29 (3.15) Visit 2 Post: −3.19 (3.04) Visit 3 Post: −2.50 (2.98) Secondary Baseline Pre:1.71 (2.39) Visit 1 Pre: +3.09 (2.46) Visit 2 Pre: +2.43 (3.20) Visits 3 Pre: +1.75 (2.22) Baseline Post:1.71 (2.39) Visit 1 Post: +1.14 (2.29) Visit 2 Post: +.81 (3.52) Visits 3 Post: +.90 (2.59)	Primary Baseline Pre:3.74 (2.49) Visit 1 Pre-1.74 (2.56) Visit 2 Pre: −2.06 (2.53) Visits 3 Pre: −2.28 (2.47) Baseline Post: 3.74 (2.49) Visit 1 Post: −1.74 (2.56) Visit 2 Post: −2.06 (2.53) Visit 3 Post Secondary Baseline Pre:1.00 (1.33) Visit 1 Pre: +3.95 (1.68) Visit 2 Pre: +2.74 (2.13) Visits 3 Pre: +1.56 (2.04) Baseline Post:1.00 (1.33) Visit 1 Post: +1.63 (2.11) Visit 2 Post: +.72 (1.84) Visits 3 Post: +.06 (1.51)
Dion, et al, 2016	Anxiety (VAS 0-100)	Day 1 Pre:53.4 (17.67) Day 2 Pre:45.95 (10.52) Day 3 Pre:43.37 (5.11) Week 3 Pre:29.82 (10.23) Day 1 Post:35.06 (17.43) Day 2 Post:32.84 (11.83) Day 3 Post:30.26 (9.90) Week 3 Post: N/A	Day 1 Pre: 48.31 (11.07) Day 2 Pre:47.95 (10.22) Day 3 Pre:45.21 (9.25) Week 3 Pre:30.32 (10.17) Day 1 Post:33.07 (9.74) Day 2 Post:33.94 (10.88) Day 3 Post:30.84 (9.75) Week 3 Post: N/A
Sharp, et al, 2010	Anxiety (VAS 0-10)	MG 1 Week 18: 2.24 (2.11-2.38, 95% CI) Week 24:2.14(1.98-2.30, 95% CI) MG 2 Week 18: 2.22 (2.09-2.35, 95% CI) Week 24: 2.2(2.05-2.36, 95% CI)	Week 18:2.39 (2.25-2.52, 95% CI) Week 24: 2.36(2.20-2.52, 95% CI)

Abbreviations: CG, control group; CI, confidence interval; MG, massage group; QOL, quality of life; SD, standard deviation, VAS, Visual Analog Scale.

Methodological Quality

Of the 121 possible pooled items represented on the critical appraisal tools measured, the reviewers agreed on 114 (see Table 4). From the PEDro checklist, all 4 RCTs received a score of 6 or higher and were considered good quality. The CONSORT checklists also indicated good quality for the randomized pilot studies, scoring a 21 and 22/25.

Table 4.

The Critical Appraisal Table Used to Assess the Quality of Articles.

Study	Study Design	CAT	CAT Results	Level of Evidence
De Groef, et al, 2018	RCT	PEDro	9/11	1b
Dilaveri, et al, 2020	Randomized Pilot study	CONSORT	22/25	2b
Dion, et al, 2016	Randomized Pilot study	CONSORT	22/25	2b
Izgu, et al, 2019	RCT	PEDro	8/11	1b
Serra-Ano, et al, 2019	RCT	PEDro	9/11	1b
Sharp, et al, 2010	RCT	PEDro	8/11	1b
Ucuzal & Kanan, 2012	Quasi-experimental	Downs & Black	17/26	2b

Abbreviations: CAT, critical appraisal tool; CONSORT, Consolidated Standards of Reporting Trials; PEDro, Physiotherapy Evidence Database; RCT, randomize control trials.

Discussion

Results from this systematic review supported our hypothesis that massage therapy is a viable tool as a non-pharmacological intervention in addressing post-surgical pain and anxiety in women with breast cancer. This is particularly of interest since the studies utilized various forms of oncology massage interventions such as foot massage, classic massage, reflexology, myofascial release, and myofascial therapy with the affected limb. Also, all studies focused on the effects of massage therapy during a short-term post-operative time frame and included inpatient as well as outpatient settings. Despite the variability in settings and form of oncology massage administered, positive outcomes of decreased pain and anxiety are evident for patients with breast cancer, post-surgery.

Prior massage therapy research showed a reduction in pain and anxiety following massage therapy in patients with cancer^10,36,37; indeed, massage was shown to decrease pain levels in patients with breast cancer receiving chemotherapy, and improve quality of life and symptom burden.^38,39 Seminal research from Boyd^40,41 thoroughly assessed massage therapy’s efficacy in treating cancer and surgical-related pain. Therefore, systematic reviews dedicated to examining how massage affects pain and quality of life, perception of patients with cancer have contributed to understanding the importance of massage therapy in healthcare.^1,12,42 Our findings are consistent with studies that have examined the effects of massage therapy on pain and anxiety in patients with orthopedic surgeries.^43-45 Patients receiving massage therapy after surgeries of tibial shaft fractures experienced less pain intensity and anxiety. ⁴⁶ The novelty of our current study is that we show in a systemic fashion that patients with breast cancer after surgery experience a reduction of pain and anxiety.

These findings indicate that massage therapy has an important role in the treatment of patients with breast cancer to improve their quality of life. Massage therapy is therefore a very safe and efficacious treatment option.^47-49 The risks involved to the patients receiving massage therapy are very low if an appropriately trained massage therapist is used who understands both the physical, pathophysiology, mental, and emotional considerations of working with patients with breast cancer. While no adverse effects of massage therapy were reported in the previously cited studies, understanding proper dosing of massage therapy, and its role in interdisciplinary cancer care, were concerns of future research in the field. By attenuating the physical and emotional burden that patients with breast cancer often experience after surgery, massage therapy can provide a bridge to healing through the comfort of educated touch.

This study is important for three reasons. First, the review demonstrated that similar effects from massage therapy were observed in women with breast cancer post-surgery as well as those observed in patients with other forms of cancer or orthopedic surgeries.^46,50,51 Second, this review validates the use of massage therapy in a variety of post-operative settings, since patients received different operative care. Third, this study suggests potential clinical applications and significance of massage therapy, as a non-pharmacological treatment of pain and anxiety in women with breast cancer after surgery. The findings provide clinicians with alternative, evidence-based treatment options for patients with breast cancer that experience pain and anxiety after surgery. It is important to have non-pharmacological pain management options available to patients in the hospital setting, as a compliance mandate from the Joint Commission.⁵²

This systematic review is not without limitations, which are important to consider when interpreting the results. The first limitation is the small sample size of the studies, apart from the Sharp study,³³ restricting the effect sizes. Another limitation of the study is selection bias, as many of the participants were randomly selected at a specific cancer center or were picked from a convenience sample. The training and experience level of massage therapists that performed post-surgery massage for patients with breast cancer was not explained in all studies. Massage therapy education, specialization, and experience in the studies reflect varying levels of massage application in the different studies. Lastly, dosing and the variability in the kind of intervention of massage therapy is not the same across studies, which is likely why the effect size was heterogeneous between the studies. To further enhance the efficacy of massage therapy, more research needs to be conducted on dosing, type of massage therapy application, and duration of treatment.

Conclusion

This review sought to systematically evaluate whether massage therapy can be established as a clinical approach to treating pain and anxiety in response to surgical interventions for breast cancer.¹² We showed that a non-pharmacological intervention in the form of massage can be implemented post-operatively, from day zero to 16 weeks post-surgery, to decrease pain and anxiety. This suggests that early massage therapy intervention has an important role for better recovery of pain and anxiety in patients with breast cancer, post-surgery.

Practical Implications

• Massage therapy is a viable non-pharmacological tool to treat postoperative pain and anxiety in patients with breast cancer.

• Massage therapy may be used for application in multiple clinical and non-clinical settings.

Massage therapy intervention provided for patients with breast cancer at day zero up to 16 weeks postoperatively leads to favorable outcomes for those experiencing pain and anxiety.

Addendum 1. The Search Strategy (Pub Med).

“Massage Therapy”

AND

“Massage Therapy”

AND

“Breast Cancer”

AND

“Pain”

AND

“Anxiety”

Supplemental Material

Supplemental Material - The Effects of Massage Therapy in Decreasing Pain and Anxiety in Post-Surgical Patients With Breast Cancer: A Systematic Review and Meta-Analysis

Supplemental Material for The Effects of Massage Therapy in Decreasing Pain and Anxiety in Post-Surgical Patients With Breast Cancer: A Systematic Review and Meta-Analysis by Jill S. Cole, Anne D. Olson, and Esther E. Dupont-Versteegden in Global Advances in Integrative Medicine and Health

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Jill S. Cole

Supplemental Material

Supplemental material for this article is available online.

References

Wang

Yee

Tam

, et al. Prevalence of pain in patients with breast cancer post-treatment: a systematic review. Breast. 2018;42:113-127. doi:10.1016/j.breast.2018.08.105.

Tait

Zoberi

Ferguson

, et al. Persistent post-mastectomy pain: risk factors and current approaches to treatment. J Pain. 2018;19(12):1367-1383. doi:10.1016/j.jpain.2018.06.002.

Maindet

Burnod

Minello

George

Allano

Lemaire

. Strategies of complementary and integrative therapies in cancer-related pain-attaining exhaustive cancer pain management. Support Care Cancer. 2019;27(8):3119-3132. doi:10.1007/s00520-019-04829-7.

LeVasseur

Cheung

, et al. Effects of high anxiety scores on surgical and overall treatment plan in patients with breast cancer treated with neoadjuvant therapy. Oncologist. 2020;25(3):212-217. doi:10.1634/theoncologist.2019-0512.

Corli

Floriani

Roberto

, et al. Are strong opioids equally effective and safe in the treatment of chronic cancer pain? A multicenter randomized phase IV ‘real life’ trial on the variability of response to opioids. Ann Oncol. 2016;27(6):1107-1115. doi:10.1093/annonc/mdw097.

Schmidt-Hansen

Bennett

Arnold

Bromham

Hilgart

. Oxycodone for cancer-related pain. Cochrane Database Syst Rev. 2017;8(8):Cd003870. doi:10.1002/14651858.CD003870.pub6.

Jakovljevic

Kober

Block

, et al. Higher levels of stress are associated with a significant symptom burden in oncology outpatients receiving chemotherapy. J Pain Symptom Manage. 2021;61(1):24-31.e4. doi:10.1016/j.jpainsymman.2020.07.019.

Björkman

Lund

Arnér

Hydén

. The meaning and consequences of amputation and mastectomy from the perspective of pain and suffering. Scand J Pain. 2017;14:100-107. doi:10.1016/j.sjpain.2016.09.012.

Langford

Eaton

Kober

, et al. A high stress profile is associated with severe pain in oncology patients receiving chemotherapy. Eur J Oncol Nurs. 2022;58:102135. doi:10.1016/j.ejon.2022.102135.

10.

Castro-Martín

Ortiz-Comino

Gallart-Aragón

Esteban-Moreno

Arroyo-Morales

Galiano-Castillo

. Myofascial induction effects on neck-shoulder pain in breast cancer survivors: randomized, single-blind, placebo-controlled crossover design. Arch Phys Med Rehabil. 2017;98(5):832-840. doi:10.1016/j.apmr.2016.11.019.

11.

Miake-Lye

Mak

Lee

, et al. Massage for pain: an evidence map. J Altern Complement Med. 2019;25(5):475-502. doi:10.1089/acm.2018.0282.

12.

Yao

Cheng

Zhu

Kong

Fang

. Clinical evidence for the effects of manual therapy on cancer pain: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2021;6678184. doi:10.1155/2021/6678184

13.

Adams

White

Beckett

. The effects of massage therapy on pain management in the acute care setting. Int J Ther Massage Bodywork. 2010;3(1):4-11.

14.

Rosen

Lawrence

Bouchard

Doros

Gardiner

Saper

. Massage for perioperative pain and anxiety in placement of vascular access devices. Adv Mind Body Med Winter. 2013;27(1):12-23.

15.

Rapaport

Schettler

Larson

, et al. Acute Swedish massage monotherapy successfully remediates symptoms of generalized anxiety disorder: a proof-of-concept, randomized controlled study. J Clin Psychiatry. 2016;77(7):e883-e891. doi:10.4088/JCP.15m10151.

16.

Rapaport

Schettler

Larson

Dunlop

Rakofsky

Kinkead

. Six versus twelve weeks of Swedish massage therapy for generalized anxiety disorder: preliminary findings. Complement Ther Med. 2021;56:102593. doi:10.1016/j.ctim.2020.102593.

17.

Goral Turkcu

Ozkan

. 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. 2021;44:101428. doi:10.1016/j.ctcp.2021.101428.

18.

Feeney

Tormey

Harmon

. Breast cancer and chronic pain: a mixed methods review. Ir J Med Sci. 2018;187(4):877-885. doi:10.1007/s11845-018-1760-y.

19.

Hashemi

Rafiemanesh

Aghamohammadi

, et al. Prevalence of anxiety among breast cancer patients: a systematic review and meta-analysis. Breast Cancer. 2020;27(2):166-178. doi:10.1007/s12282-019-01031-9.

20.

Moher

Shamseer

Clarke

, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. doi:10.1186/2046-4053-4-1.

21.

Sikorskii

Victorson

O’Connor

, et al. PROMIS and legacy measures compared in a supportive care intervention for breast cancer patients and caregivers: experience from a randomized trial. Psycho Oncol. 2018;27(9):2265-2273. doi:10.1002/pon.4825.

22.

Hays

Spritzer

Schalet

Cella

. PROMIS(®)-29 v2.0 profile physical and mental health summary scores. Qual Life Res. 2018;27(7):1885-1891. doi:10.1007/s11136-018-1842-3.

23.

Vaughan

Chase

Hickey

, et al. PROMIS neuropathic and nociceptive pain quality in musculoskeletal pain presentations. Clin J Pain. 2021;37(9):639-647. doi:10.1097/ajp.0000000000000955.

24.

Pinheiro da Silva

Moreira

Zomkowski

Amaral de Noronha

Flores Sperandio

. Manual therapy as treatment for chronic musculoskeletal pain in female breast cancer survivors: a systematic review and meta-analysis. J Manip Physiol Ther. 2019;42(7):503-513. doi:10.1016/j.jmpt.2018.12.007.

25.

Moseley

Elkins

Van der Wees

Pinheiro

. Using research to guide practice: the Physiotherapy evidence database (PEDro). Braz J Phys Ther. 2020;24(5):384-391. doi:10.1016/j.bjpt.2019.11.002.

26.

Moher

Hopewell

Schulz

, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg. 2012;10(1):28-55. doi:10.1016/j.ijsu.2011.10.001.

27.

Downs

Black

. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377-384. doi:10.1136/jech.52.6.377.

28.

De Groef

Van Kampen

Vervloesem

, et al. Effect of myofascial techniques for treatment of persistent arm pain after breast cancer treatment: randomized controlled trial. Clin Rehabil. 2018;32(4):451-461. doi:10.1177/0269215517730863.

29.

Dilaveri

Croghan

Mallory

, et al. Massage compared with massage plus acupuncture for breast cancer patients undergoing reconstructive surgery. J Alternative Compl Med. 2020;36(7):602-609. doi:10.1089/acm.2019.0479.

30.

Dion

Engen

Lemaine

, et al. Massage therapy alone and in combination with meditation for breast cancer patients undergoing autologous tissue reconstruction: a randomized pilot study. Compl Ther Clin Pract. 2016;23:82-87. doi:10.1016/j.ctcp.2015.04.005.

31.

Izgu

Metin

Karadas

Ozdemir

Çetin

Demirci

. Prevention of chemotherapy-induced peripheral neuropathy with classical massage in breast cancer patients receiving paclitaxel: an assessor-blinded randomized controlled trial. Eur J Oncol Nurs. 2019;40:36-43. doi:10.1016/j.ejon.2019.03.002.

32.

Serra-Añó

Inglés

Bou-Catalá

Espí-López

Iraola-Lliso

. Effectiveness of myofascial release after breast cancer surgery in women undergoing conservative surgery and radiotherapy: a randomized controlled trial. Support Care Cancer. 2019;27(7):2633-2641. doi:10.1007/s00520-018-4544-z.

33.

Sharp

Walker

Chaturvedi

, et al. A randomised, controlled trial of the psychological effects of reflexology in early breast cancer. Eur J Cancer. 2010;46(2):312-322. doi:10.1016/j.ejca.2009.10.006.

34.

Ucuzal

Kanan

. Foot massage: effectiveness on postoperative pain in breast surgery patients. Pain Manag Nurs. 2014;15(2):458-465. doi:10.1016/j.pmn.2012.03.001

35.

Ebell

Siwek

Weiss

, et al. Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician. 2004;69(3):548-556.

36.

Demirci

Tasci

and Oztunc

. Effect of foot massage on upper extremity pain level and quality of life in women who had a mastectomy operation: a mixed-method study. Article. Eur J Integr Med 2022;54:102160. doi:10.1016/j.eujim.2022.102160

37.

Drackley

Degnim

Jakub

, et al. Effect of massage therapy for postsurgical mastectomy recipients. Clin J Oncol Nurs. 2012;16(2):121-124. doi:10.1188/12.CJON.121-124.

38.

Carreira

Williams

Müller

Harewood

Stanway

Bhaskaran

. Associations between breast cancer survivorship and adverse mental health outcomes: a systematic review. J Natl Cancer Inst. 2018;110(12):1311-1327. doi:10.1093/jnci/djy177.

39.

Duncan

Moschopoulou

Herrington

, et al. Review of systematic reviews of non-pharmacological interventions to improve quality of life in cancer survivors. BMJ Open. 2017;7(11):e015860. doi:10.1136/bmjopen-2017-015860.

40.

Boyd

Crawford

Paat

Price

Xenakis

Zhang

. The impact of massage therapy on function in pain populations-A systematic review and meta-analysis of randomized controlled trials: Part II, cancer pain populations. Pain Med. 2016;17(8):1553-1568. doi:10.1093/pm/pnw100.

41.

Boyd

Crawford

Paat

Price

Xenakis

Zhang

. The impact of massage therapy on function in pain populations-A systematic review and meta-analysis of randomized controlled trials: Part III, surgical pain populations. Pain Med. 2016;17(9):1757-1772. doi:10.1093/pm/pnw101.

42.

Pan

Yang

Wang

Zhang

Liang

. Massage interventions and treatment-related side effects of breast cancer: a systematic review and meta-analysis. Int J Clin Oncol. 2014;19(5):829-841. doi:10.1007/s10147-013-0635-5.

43.

Liu

Chen

. The effect of massage therapy on pain after surgery: a comprehensive meta-analysis. Compl Ther Med. 2022;71:102892. doi:10.1016/j.ctim.2022.102892.

44.

Seyyedrassoli

Ghahramanian

Azizi

Goljarian

Gillespie

Aydinferd

. Comparison of effectiveness of reflexology and abdominal massage on constipation among orthopedic patients: a single-blind randomized controlled trial. Int J Med Res Health Sci. 2016;5(10):33-40.

45.

Bialas

Kreutzer

Bomberg

, et al. Progressive muscle relaxation in postoperative pain therapy. Schmerz. 2020;34(2):148-155. doi:10.1007/s00482-019-00437-w.

46.

Pasyar

Rambod

Kahkhaee

. The effect of foot massage on pain intensity and anxiety in patients having undergone a tibial shaft fracture surgery: a randomized clinical trial. J Orthop Trauma. 2018;32(12):e482-e486. doi:10.1097/bot.0000000000001320.

47.

Ernst

. Massage therapy for cancer palliation and supportive care: a systematic review of randomised clinical trials. Support Care Cancer. 2009;17(4):333-337. doi:10.1007/s00520-008-0569-z.

48.

Cates

Jordan

Munk

Farrand

Kennedy

Groninger

. Massage therapy in palliative care populations: a narrative review of literature from 2012 to 2022. Ann Palliat Med 2023;12:963-975. doi:10.21037/apm-23-126

49.

Qin

Xiao

Chi

, et al. Effectiveness and safety of massage in the treatment of anxiety and depression in patients with cancer: a protocol for systematic review and meta-analysis. Medicine (Baltim). 2020;99(39):e22262. doi:10.1097/md.0000000000022262.

50.

Klein

Tidhar

Kalichman

. Lymphatic treatments after orthopedic surgery or injury: a systematic review. J Bodyw Mov Ther. 2020;24(4):109-117. doi:10.1016/j.jbmt.2020.06.034.

51.

Chen

, et al. An enhanced recovery after surgery program in orthopedic surgery: a systematic review and meta-analysis. J Orthop Surg Res. 2019;14(1):77. doi:10.1186/s13018-019-1116-y.

52.

Martorella

. Characteristics of nonpharmacological interventions for pain management in the ICU: a scoping review. AACN Adv Crit Care. 2019;30(4):388-397. doi:10.4037/aacnacc2019281.

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