Massage therapy has proven to reduce the subjectively perceived symptom of pain in oncological patients receiving palliative care. Remission of the symptoms of anxiety and depression, examined secondarily, was also achieved. Despite the different characteristics of the population, similar results with respect to reducing pain were achieved in four out of six studies

[13, 16–18]. The qualitative data gained from the analysed studies has shown that interventions such as massage therapy only seem to be effective if the patient is treated with empathy and if a relationship between the massage therapist and the patient had been formed beforehand [13, 16]. This observation may support the hypothesis that desired or undesired effects of a massage are not only dependent on the interventions themselves but also on the time of the day, the setting, the position of the patient, and the type of massage; in addition, the attitude of the therapist plays an important role [13]. The perception of pain in the analysed studies was found to have different initial values, with the highest initial value being the one in the study of Jane et al. [18]. This study was conducted in Taiwan. While all patients were diagnosed with bone metastases, the cultural aspect may influence the subjective assessment of pain. The assumption of Kutner et al. [13] and Wilkie et al. [16] that massage therapy can achieve substantial pain reduction and consequently lower the use of analgesics was not confirmed. Patients require sufficient pharmacological pain treatment; otherwise a state of relaxation before the beginning of the massage treatment cannot be achieved [18]. Only one study [16] found an increase of pain perception as a negative effect. Direct negative effects of massage therapy were not shown in the remaining examined studies. Fellowes et al. [20] note that possible digestive problems might be a negative effect of massage therapy and that patients should therefore be examined for this condition. The assumption that massage therapies are to be considered contraindicated with malign tumours because tumour growth and metastasizing may be accelerated was refuted by several authors [8, 16, 18]. In the analysed studies, both the authors and the patients mainly aimed at a full-body massage [12, 13, 16–18]. It had to be noted that some patients were unable to find a comfortable position or that the position needed to be changed permanently, thereby disturbing the massage and reducing its effect [18]. This suggests the conclusion that the duration of a massage plays a crucial role for achieving the desired effect and enabling the patient to experience relaxation during the massage therapy [22]. Kutner et al. [22] state that seriously ill patients might associate physical contact and touch with painful invasive techniques such as taking a blood sample. For this reason, the patient should be in a relaxed state before the beginning of the message therapy and thoroughly informed about the massage therapy and the kind of physical contact. As a matter of principle, thoroughly informing the patients and their relatives is of utmost importance in treating various symptoms of people who are to be provided with palliative care. Apart from information, direct communication gives the patient trust and a feeling of security, thus additionally increasing the amount of self-determination of the patient with respect to the treatment of potential symptoms [8]. A lack of information provided to the patient by the caregivers concerning the effect of massage entails the risk of the patient refusing massage therapy. In addition, the patients might gain the impression that they are robbed of the time they have left in a senseless way [16]. Massage therapy also enables the caregivers and the patients to deepen their relationship through mutual physical contact and to strengthen mutual trust [22]. The importance of thoroughly counselling and informing the patient cannot be estimated high enough. Offering massage therapy is felt as a relief by hospice and palliative care patients. Patients whose social network is poor especially consider massage therapy a precious offer [25]. Those patients who experience little physical contact, affection and security may be more responsive to massage therapy. Therefore, it should especially be made available for socially isolated patients [9, 26]. Summing up, it can be stated that massage therapy is to be considered a cost-efficient, noninvasive intervention positively influencing and contributing to the reduction of pain, anxiety, and depression in seriously ill cancer patients