Massage with or without aromatherapy for symptom relief in people with cancer

71 Pages·2016·0.58 MB·English

CochraneDatabaseofSystematicReviews
Massage with or without aromatherapy for symptom relief in
people with cancer (Review)
ShinES,SeoKH,LeeSH,JangJE,JungYM,KimMJ,YeonJY
ShinES,SeoKH,LeeSH,JangJE,JungYM,KimMJ,YeonJY.
Massagewithorwithoutaromatherapyforsymptomreliefinpeoplewithcancer.
CochraneDatabaseofSystematicReviews2016,Issue6.Art.No.:CD009873.
DOI:10.1002/14651858.CD009873.pub3.
www.cochranelibrary.com
Massagewithorwithoutaromatherapyforsymptomreliefinpeoplewithcancer(Review)
Copyright©2016TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
TABLE OF CONTENTS
HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
PLAINLANGUAGESUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
SUMMARYOFFINDINGSFORTHEMAINCOMPARISON . . . . . . . . . . . . . . . . . . . 4
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Figure1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Figure2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Figure3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Figure4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
ADDITIONALSUMMARYOFFINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . 19
DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
AUTHORS’CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
CHARACTERISTICSOFSTUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
DATAANDANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Analysis1.1.Comparison1Massageversusnomassage,Outcome1Anxiety(STAI-state). . . . . . . . . . 58
Analysis2.1.Comparison2Massageversusnomassage:subgroupanalysis,Outcome1Anxiety(STAI-state). . . . 59
Analysis2.2.Comparison2Massageversusnomassage:subgroupanalysis,Outcome2Anxiety(STAI-state). . . . 60
Analysis3.1.Comparison3Aromatherapywithmassageversusnomassage,Outcome1Anxiety(STAI-state). . . . 61
Analysis4.1.Comparison4Aromatherapywithmassageversusnomassage:subgroupanalysis,Outcome1Anxiety(STAI-
state). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
ADDITIONALTABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
WHAT’SNEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
CONTRIBUTIONSOFAUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
DECLARATIONSOFINTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
SOURCESOFSUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
DIFFERENCESBETWEENPROTOCOLANDREVIEW . . . . . . . . . . . . . . . . . . . . . 68
NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
INDEXTERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Massagewithorwithoutaromatherapyforsymptomreliefinpeoplewithcancer(Review) i
Copyright©2016TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
[InterventionReview]
Massage with or without aromatherapy for symptom relief in
people with cancer
Ein-SoonShin1,Kyung-HwaSeo2,3,Sun-HeeLee4,Ji-EunJang1,Yu-MinJung4,Min-JiKim4,Ji-YunYeon1
1KAMSResearchCenter,ResearchAgencyforClinicalPracticeGuidelines,KoreanAcademyofMedicalSciences(KAMS),Yongsan-
gu,Korea,South.2DepartmentofResearch,ResearchInstituteforHealthcarePolicy,KoreanMedicalAssociation,Seoul,Korea,South.
3Department of Medical Sciences, Ewha Woman’s University, Seoul, Korea, South. 4Department of Preventive Medicine, EWHA
Woman’sUniversitySchoolofMedicine,Seoul,Korea,South
Contactaddress:Ein-SoonShin,KAMSResearchCenter,ResearchAgencyforClinicalPracticeGuidelines,KoreanAcademyofMedical
Sciences(KAMS),44-3Hangang-ro,2(i),Yongsan-gu,Seoul,140-706,Korea,[email protected]@gmail.com.
Editorialgroup:CochranePain,PalliativeandSupportiveCareGroup.
Publicationstatusanddate:Stable(noupdateexpectedforreasonsgivenin’What’snew’),publishedinIssue6,2016.
Reviewcontentassessedasup-to-date: 5August2015.
Citation: Shin ES, Seo KH, Lee SH, Jang JE, Jung YM, Kim MJ, Yeon JY. Massage with or without aromatherapy for
symptom relief in people with cancer. Cochrane Database of Systematic Reviews 2016, Issue 6. Art. No.: CD009873. DOI:
10.1002/14651858.CD009873.pub3.
Copyright©2016TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
ABSTRACT
Background
Massageandaromatherapymassageareusedtorelievecancer-relatedsymptoms.Anumberofclaimshavebeenmadeforthesetreatments
includingreductionofpain,anxiety,depression,andstress.Otherstudieshavenotshownthesebenefits.
Objectives
Toevaluatetheeffectsofmassagewithorwithoutaromatherapyonpainandothersymptomsassociatedwithcancer.
Searchmethods
We searched the following databases and trials registries up to August 2015: the Cochrane Central Register of Controlled Trials
(CENTRAL,2015,Issue7),MEDLINE(Ovid),EMBASE(Ovid),PsycINFO(Ovid),CINAHL(EBSCO),PubMedCancerSubset,
SADCCT,andtheWorldHealthOrganization(WHO)ICTRP.Wealsosearchedclinicaltrialregistriesforongoingstudies.
Selectioncriteria
Randomised controlledstudies(RCTs) reportingtheeffectsofaromatherapyormassage therapy,orboth,inpeoplewithcancerof
any age. We applied no language restrictions. Comparators were massage (using carrier oil only) versus no massage, massage with
aromatherapy(usingcarrieroilplusessentialoils)versusnomassage,andmassagewitharomatherapy(usingcarrieroilplusessential
oils)versusmassagewithoutaromatherapy(usingcarrieroilonly).
Datacollectionandanalysis
Atleasttworeviewauthorsselectedstudies,assessedtheriskofbias,andextracteddatarelatingtopainandothersymptomsassociated
withcancer,usingstandardisedforms.WeassessedtheevidenceusingGRADE(GradingofRecommendationsAssessment,Develop-
mentandEvaluation)andcreatedtwo’Summaryoffindings’tables.
Massagewithorwithoutaromatherapyforsymptomreliefinpeoplewithcancer(Review) 1
Copyright©2016TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
Mainresults
Weincluded19studies(21reports)ofverylowqualityevidencewithatotalof1274participants.Weincluded14studies(16reports)
inaqualitative synthesisandfivestudiesinaquantitative synthesis(meta-analysis). Thirteenstudies(14reports,596 participants)
comparedmassagewithnomassage.Sixstudies(sevenreports,561participants)comparedaromatherapymassagewithnomassage.
Twostudies(117participants)comparedmassagewitharomatherapyandmassagewithoutaromatherapy.Fourteenstudieshadahigh
riskofbiasrelatedtosamplesizeand15studieshadalowriskofbiasforblindingtheoutcomeassessment.Wejudgedthestudiesto
beatunclearriskofbiasoverall.Ourprimaryoutcomeswerepainandpsychologicalsymptoms.Twostudiesreportedphysicaldistress,
rash,and general malaise asadverse events.Theremaining 17 studies didnotreportadverse events.We downgraded the GRADE
quality ofevidence foralloutcomestoverylowbecause ofobserved imprecision, indirectness, imbalance betweengroups inmany
studies,andlimitationsofstudydesign.
Massageversusno-massagegroups
Weanalysedresultsforpainandanxietybutthequalityofevidencewasverylowasmoststudiesweresmallandconsideredatanunclear
orhighriskofbiasduetopoorreporting.Short-termpain(PresentPainIntensity-VisualAnalogueScale)wasgreaterforthemassage
groupcomparedwiththeno-massagegroup(oneRCT,n=72,meandifference(MD)-1.60,95%confidenceinterval(CI)-2.67to-
0.53).Dataforanxiety(State-TraitAnxietyInventory-state)reliefshowednosignificantdifferenceinanxietybetweenthegroups(three
RCTs,n=98,combinedMD-5.36,95%CI-16.06to5.34).Thesubgroupanalysisforanxietyrevealedthattheanxietyrelieffor
childrenwasgreaterforthemassagegroupcomparedwiththeno-massagegroup(oneRCT,n=30,MD-14.70,95%CI-19.33to
-10.07),butthesizeofthiseffectwasconsiderednotclinicallysignificant. Furthermore,thisreviewdemonstratednodifferencesin
effectsofmassageondepression,mooddisturbance,psychologicaldistress,nausea,fatigue,physicalsymptomdistress,orqualityoflife
whencomparedwithnomassage.
Massagewitharomatherapyversusno-massagegroups
Weanalysedresultsforpain,anxiety,symptomsrelatingtothebreast,andqualityoflifebutthequalityofevidencewasverylowas
studiesweregenerallyatahighriskofbias.Therewassomeindicationofbenefitinthearomatherapy-massagegroupbutthisbenefitis
unlikelytotranslateintoclinicalbenefit.Thereliefofmedium-andlong-termpain(medium-term:oneRCT,n=86,MD5.30,95%
CI1.52to9.08;long-term:oneRCT,n=86,MD3.80,95%CI0.19to7.41),anxiety(twoRCTs,n=253,combinedMD-4.50,
95%CI-7.70to-1.30),andlong-termsymptomsrelatingtothebreastinpeoplewithbreastcancer(oneRCT,n=86,MD-9.80,
95%CI-19.13to-0.47)wasgreaterforthearomatherapy-massagegroup,buttheresultswereconsiderednotclinicallysignificant.
Themedium-termqualityoflifescorewaslower(better)forthearomatherapy-massagegroupcomparedwiththeno-massagegroup
(oneRCT,n=30,MD-2.00,95%CI-3.46to-0.54).
Massagewitharomatherapyversusmassagewithoutaromatherapygroups
From the limited evidence available, we were unable to assess the effect of adding aromatherapy to massage on the relief of pain,
psychologicalsymptomsincludinganxietyanddepression,physicalsymptomdistress,orqualityoflife.
Authors’conclusions
Therewasalackofevidenceontheclinicaleffectivenessofmassageforsymptomreliefinpeoplewithcancer.Moststudiesweretoo
smalltobereliableandkeyoutcomeswerenotreported.Anyfurtherstudiesofaromatherapyandmassagewillneedtoaddressthese
concerns.
PLAIN LANGUAGE SUMMARY
Aromatherapyandmassageforsymptomreliefinpeoplewithcancer
Background
Peoplewithcancermayexperiencesymptomssuchaspain,anxiety,ordistress.Massagewithorwithoutaromatherapy(usingessential
oils,whicharenaturaloilsthatmayhavetheodouroftheplantfromwhichitwasextracted)mayhelprelievethesesymptoms.Massage
involvesworkingandactingonthebodywithpressure.Massageisgivenusingacarrieroil(baseoilorvegetableoil)withorwithout
essentialoils.Massagewithessentialoilssuchasroseorlavenderoilisknownasaromatherapymassage.
Keyresultsandqualityofevidence
Massagewithorwithoutaromatherapyforsymptomreliefinpeoplewithcancer(Review) 2
Copyright©2016TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
InAugust2015,wesearchedforclinicaltrialslookingatmassagewithorwithoutaromatherapyforsymptomreliefinpeoplewithcancer.
Wefound19smallstudies(1274participants)ofverylowquality.Somesmallstudiessuggestedthatmassagewithoutaromatherapy
mayhelprelieveshort-termpainandanxiety inpeoplewith cancer.Othersmallstudiessuggestedthataromatherapymassage may
provide medium- or long-term relief for these symptoms. However, the quality of evidence was very low and the results were not
consistent.Wecannotbesurethatthesetreatmentswillbringanybenefit.
Massagewithorwithoutaromatherapyforsymptomreliefinpeoplewithcancer(Review) 3
Copyright©2016TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
CoMa SUMMARY OF FINDINGS FOR THE MAIN COMPARISON [Explanation]
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Johnpeop Pain(PPI-VAS) The mean pain (PPI- The mean pain (PPI- Continuousdata 72 ⊕(cid:13)(cid:13)(cid:13) Lower score indicates
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across control groups ventiongroupswas model
from30.0to37.7points 5.36lower
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Anxiety(STAI-state) The mean anxiety The mean anxiety Continuousdata 30 ⊕(cid:13)(cid:13)(cid:13) Lower score indicates
subgroup 1: children (STAI-state) for chil- (STAI-state) for chil- (1study) Verylow1,2,3 lessseverityinanxiety
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CI:confidenceinterval;PPI-VAS:PresentPainIntensity-VisualAnalogueScale;STAI:State-TraitAnxietyInventory.
GRADEWorkingGroupgradesof evidence
Highquality:Furtherresearchisveryunlikelytochangeourconfidenceintheestimateof effect.
Moderatequality:Furtherresearchislikelytohaveanimportantimpactonourconfidenceintheestimateof effectandmaychangetheestimate.
Lowquality:Furtherresearchisverylikelytohaveanimportantimpactonourconfidenceintheestimateof effectandislikelytochangetheestimate.
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BACKGROUND traditionaltherapyforpainandrelaxation(Denner2009).Berg-
amotisawell-knownessentialoilusedtominimisethesymptoms
ofstress-inducedanxiety,mildmooddisorders, andcancerpain
(Bagetta2010).Ofalltheusesofessentialoilsinaromatherapy,
Descriptionofthecondition
massagefor30minutes(Listing2009;Wilcock2004),bytrained
Cancersignificantly affectsaperson’squalityoflife(Alacacioglu therapists(Listing2009;Wilcock2004;Wilkinson2007),isthe
2010),andisassociatedwithavarietyofpsychologicalsymptoms, mostcommon(Holt2009),followedbyaromaticbaths.Vapouri-
such as anxiety (Jackson 2004) and depression (Akechi 2008), sationisalsoaveryeffectivewayofusingessentialoils,wherebya
andphysiologicalsymptoms,suchaspain(Jackson2007),fatigue smallamountofoilisvaporisedintotheair(Oh2000).Essential
(Bennett2009),constipation(Yu2010),andnauseaandvomit- oilssuchaslavender(Soden2004;Wilcock2004),rose(Listing
ing(Hines2009).Somepalliativecarereportsstatethatbetween 2009),andchamomile(Wilcock2004)wereusedforaromather-
14% and 25% of all people with cancer show signs of anxiety apy-massage intervention for people with cancer. The effectsof
disorders(Mantovan2009),andthat50%ofpeoplewithcancer aromatherapyinterventionsinrelievingcancer-relatedsymptoms
arediagnosedwithapsychiatricdisorder;withthemostcommon havebeenreported(Wilkinson2007).However,theevidencesup-
diagnosisbeingdepressivedisorders(Derogatis1983). portingaclearbenefitofaromatherapyforpeoplewithcancerhas
yettobeestablished.Thereareafewstudiesthatappeartoexhibit
abenefit.Forexample,Wilkinson1999performedarandomised
Descriptionoftheintervention controlledtrial(RCT)thatsuggestedthatmassagewithorwith-
outessentialoilswasaneffectivetherapyforreducinganxietylev-
Thisreviewfocusedonmassageinterventionsusingablendedcar- els.Itisbelievedthattheadditionofanessentialoilcanenhance
rieroilwithessentialoils(aromatherapy)andacarrieroilwithout the effect of massage and improve the psychological symptoms
essentialoils. andoverallqualityoflifeamongpeoplewithcancer.Soden2004
comparedtheeffectsofmassagewithanessentialoil(aromather-
apymassage)tomassagewithoutanessentialoil,andnotedthe
Massageintervention
changesinphysicalandpsychological symptomsinpeoplewith
Massage isdefinedasthemanipulation ofthesofttissuesofthe
advancedcancer.Theresultsappearedtoshowthattheaddition
body,performedbythehands,forthepurposeofproducingeffects
oflavenderessentialoiltothemassagedidnotincreasetheben-
onthevascular,muscular,andnervoussystems(Fellowes2004a).
eficial effectsof massage. Wilcock 2004 reportedthere were no
Massageinterventionsareincreasinglybeingconsideredasameans
seriousadverseeventsexceptarashfollowingaromatherapymas-
ofachievingcancer-relatedsymptomrelief(Ernst2009;Wilkinson
sage. Miller2012 reportedthattopical application of limonene
2008), and are often used to address people with cancer’s need
containingmassageoiltothebreastwaspossiblyorprobablyre-
forhumancontact(Russell2008).Themainreportedeffectsof
latedtoadverseeventssuchasitching,rash,dryskin,lightening
massagetreatment,instudieswithorwithoutrandomisation,in-
skincolour,burningsensation,acne,andheadaches.
clude pain relief (Gorman 2008); improved immune function
(Hernandez-Reif2004);reducedlevelsofanxiety(Campeau2007)
and depression (Krohn 2010); reduced fatigue (Listing 2009),
nausea(Billhult2007),andstress(Listing2010);andanimproved
Howtheinterventionmightwork
qualityoflife(Keir2010).Inmassagetherapy,thepressureshould
not be applied on the affected area and massage should not be Massageisthoughttohaveaneffectbystimulatingtheskin,blood,
given to people with contraindications such as acute thrombo- andlymphaticsystem,whichboostsbloodcirculation,aidsmus-
sis,orinflamedskinintheareaoftherapy(Listing2009;Listing cle relaxation, and soothes nerves (McGilvery 1994). However,
2010).Toth2013andHernandez-Reif2004reportedthatnoad- themechanismsunderlyingtheseeffectsremainunknown. Aro-
verse effectswere associated with massage. However, some peo- matherapymassageusingessentialoilsisconsideredatherapeutic
plereportedexperiencingphysicaldistressandfeelingstressedat treatmentforboth themindandbody, anditworksmainlyon
follow-up(Jane 2011).Ernst2003 alsoconcludedthatmassage thenervous system,butmay alsostimulate theimmune system
therapies are not totally devoid of risk, though the incidence is andaffectemotions.Essentialoilsarecomposedofsmallorganic
rare. moleculesthatpenetratetheouterskin,worktheirwayintothe
body andaccumulateinthefattytissue. Inaddition, thehighly
volatileoilsevaporateandcanalsobeinhaledthroughthenasal
Aromatherapymassageintervention
passages. These olfactory cells send messages straight to higher
Aromatherapymassage involvestheuse of essentialoilsthatare centresofthebrain,includingthelimbicsystem,whichcontrols
combinedwithacarrieroilorcreamtomanipulatethesofttissues thearousalfunctionsofthebodyandemotionalstates.Thus,dur-
ofthebody(Fellowes2004a).Lavenderessentialoilisusedasa inganaromatherapytreatment,essentialoilsmayenhanceboth
Massagewithorwithoutaromatherapyforsymptomreliefinpeoplewithcancer(Review) 7
Copyright©2016TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
physicalandpsychologicalwell-beingatthesametime(McGilvery Massagewasrequiredtoincludetissuemanipulationusingacarrier
1994). oil,therebyexcludingtouchtherapiessuchastherapeutictouch,
acupressure,andreflexology.Wedefinedaromatherapyastheuse
of a blendedcarrier oil with essential oilsand will include only
Whyitisimportanttodothisreview aromatherapyadministeredwithmassage.Thus,weexcludedin-
halationsandhumidificationmethods.
ThisreviewisanupdateofaCochranereviewfirstpublishedin
2004(Fellowes2004a).Theearlierreviewfoundsomeindication
oftheusefulnessofthisalternativetherapy,yetwithlittleevidence. Typesofoutcomemeasures
Asthisformerreviewwassignificantlyoutofdate,Cochranewith-
drewit.Nevertheless,thistopicneedstobeupdatedduetomore
recentlypublishedRCTsandmethodologicalupdates.Physicians Primaryoutcomes
andpeoplewithcancerneedaccesstothebestavailableandup-to- • Pain(usingvalidatedstandardsubjectivescales(numerical
dateevidencetomakeinformedtreatmentdecisions.Alternative
ratingscale(NRS),verbalratingscale(VRS),orvisualanalogue
therapiescontinuetogeneratesubstantialinterest.
scale(VAS))forpainintensityorpainrelief,orboth).
• Psychologicalsymptoms(includinganxietyanddepression
assessedusingvalidatedscales).
OBJECTIVES
Secondaryoutcomes
Toevaluatetheeffectsofmassagewithorwithoutaromatherapy
• Otherphysicalsymptoms(includingfatigueandnausea,
onpainandothersymptomsassociatedwithcancer.
etc.).
• Qualityoflife(assessedbyavalidandreliableassessment
instrument).
METHODS • Adverseevents.
Criteriaforconsideringstudiesforthisreview
Searchmethodsforidentificationofstudies
Typesofstudies
Electronicsearches
Weincludedrandomisedcontrolledtrials(RCTs)thatevaluated
Wesearchedthefollowingdatabases.
theeffectofmassagewithorwithoutaromatherapy.Weexcluded
• TheCochraneCentralRegisterofControlledTrials
studiesiftheywerequasi-randomisedtrials,non-randomisedtri-
(CENTRAL),2015,Issue7of12.
als,casereports,abstracts,orletters.Weappliednolanguagere-
• MEDLINE(Ovid)1946toweekoneofAugust2015.
strictions.
• EMBASE(Ovid)1974toweekoneofAugust2015.
• PsycINFO(Ovid)1806toweekoneofAugust2015.
Typesofparticipants • CINAHL(EBSCO)toweekoneofAugust2015.
Weincludedadultsandchildrendiagnosed withcancer.Wein- • PubMedCancerSubsettoweekoneofAugust2015.
cludedbothinpatientsandoutpatientswhoreceivedcareinany • SouthAsianDatabaseofControlledClinicalTrials
healthcaresetting(e.g.hospital,hospice,oncologycentre,orcom- (SADCCT)toweekoneofAugust2015.
munity). • WorldHealthOrganization(WHO)ICTRPtoweekone
ofAugust2015.
Typesofinterventions SeeAppendix1;Appendix2;Appendix3;Appendix4;Appendix
Wecomparedthefollowinginterventions: 5;andAppendix6forthesearchstrategiesused.Weappliedno
• massage(usingcarrieroilonly)versusnomassage; dateorlanguagerestrictions.
• massagewitharomatherapy(usingcarrieroilplusessential
oils)versusnomassage;
Searchingotherresources
• massagewitharomatherapy(usingcarrieroilplusessential
oils)versusmassagewithoutaromatherapy(usingcarrieroil Weexpandedthesearchstrategytoincluderegionaldatabasessuch
only). astheKoreandatabases(KISS,KMbase,KoreaMed,andRISS).
Massagewithorwithoutaromatherapyforsymptomreliefinpeoplewithcancer(Review) 8
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