Massage Safe in Cancer, Self-Acupressure Reduces Ovarian Cancer Fatigue

Two new studies published in JAMA Network Open and PLoS One provide evidence on the use of complementary therapies in cancer care. One randomized clinical trial found that self-acupressure decreased cancer-related fatigue (CRF) and improved quality of life compared with usual care for women with ovarian cancer. A systematic review and meta-analysis found no evidence of a higher risk of adverse events related to light to moderate intensity massage compared with usual care in people living with or receiving treatment for cancer.

The phase 3 trial (NCT03763838) evaluated the use of self-acupressure, taught through a mobile app, to decrease CRF and sleep disturbance, and improve quality of life. The trial included women aged 21 years or older with ovarian cancer of any stage or histotype who had started cancer treatment at least 4 weeks before study enrollment. Researchers randomized the women to either 6 weeks of once-daily true self-acupressure, sham self-acupressure, or usual care. Patients in the true self-acupressure arm received instructions to perform acupressure on 5 specific acupoints for 3 minutes each for a total of 27 minutes each day. A total of 171 women were randomly assigned to intervention (n=58), sham acupressure (n=58), or usual care (n=55).

At week 6, patients in the true self-acupressure arm had a significant reduction in CRF compared with usual care, with a mean difference of −1.23 (95% CI, −2.17 to −0.29; P=.005). The benefit persisted at 24 weeks (−1.38; 95% CI, −2.36 to −0.41). No significant differences were observed between the 3 arms for sleep quality. However, true self-acupressure provided a clinically meaningful and statistically significant improvement in quality of life compared with the usual care arm: 57.5% reported improved quality of life at week 6, compared with 37.8% in the sham arm and 30.0% in the usual care arm (P=.02). At 24 weeks, 56.8% in the intervention arm reported improved quality of life compared with 50.0% in the sham arm and 33.3% in the usual care arm (P=.04). Adherence to the acupressure protocol was high (84% mean adherence in the true arm, 78% in the sham arm), and no study-related adverse events were reported. The researchers concluded that self-acupressure, taught by an app, was an inexpensive, safe, and effective therapy for improving CRF to normal fatigue levels in approximately 60% of women with ovarian cancer.

The systematic review and meta-analysis, published in PLoS One, assessed harms related to massage in people with and/or receiving treatment for cancer. The review included 63 intervention studies, of which 53% (n=34) did not report adverse events. Ten databases and trials registries were searched up to 22 October 2024. Twenty-nine studies (n=2699) reported adverse events explicitly and/or as study discontinuation. Meta-analyses indicated no evidence of a higher risk of adverse events related to massage compared to usual care/attention control. Three cohort studies (n=1406) were included, two of which (both with critical risk of bias) found significant associations between massage over tumor site and negative survival outcomes in patients with osteosarcoma. Overall, the quality of adverse events reporting was poor, and certainty of evidence considered very low. The authors concluded that light to moderate intensity massage in people living with and/or receiving treatment for cancer can be performed without increased risk of harms, with contraindications applied as per the general population. Due to uncertainty as to whether massage over tumor in osteosarcoma constitutes an increased risk of negative survival outcomes, massage directly on tumor is discouraged, though definitive evidence is lacking.