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. 2019 Oct 17;14(10):e0223564.
doi: 10.1371/journal.pone.0223564. eCollection 2019.

A Systematic Review of Complementary and Alternative Medicine in Oncology: Psychological and Physical Effects of Manipulative and Body-Based Practices

Free PMC article

A Systematic Review of Complementary and Alternative Medicine in Oncology: Psychological and Physical Effects of Manipulative and Body-Based Practices

Nicolas Calcagni et al. PLoS One. .
Free PMC article


Background: Complementary and Alternative Medicines (CAM) are widely used by cancer patients, despite limited evidence of efficacy. Manipulative and body-based practices are some of the most commonly used CAM. This systematic review evaluates their benefits in oncology.

Method: A systematic literature review was carried out with no restriction of language, time, cancer location or type. PubMed, CENTRAL, PsycArticle, PsychInfo, Psychology and Behavioral Sciences Collection and SOCindex were queried. Inclusion criteria were adult cancer patients and randomized controlled trials (RCT) assessing manipulative and body-based complementary practices on psychological and symptom outcomes. Effect size was calculated when applicable.

Results: Of 1624 articles retrieved, 41 articles were included: massage (24), reflexology (11), acupressure (6). Overall, 25 studies showed positive and significant effects on symptom outcomes (versus 9 that did not), especially pain and fatigue. Mixed outcomes were found for quality of life (8 papers finding a significant effect vs. 10 which did not) and mood (14 papers vs. 13). In most studies, there was a high risk of bias with a mean Jadad score of 2, making interpretation of results difficult.

Conclusion: These results seem to indicate that manipulative CAM may be effective on symptom management in cancer. However, more robust methodologies are needed. The methodological requirements of randomized controlled trials are challenging, and more informative results may be provided by more pragmatic study design.

Conflict of interest statement

The authors have declared that no competing interests exist.


Fig 1
Fig 1. Flow diagram of included studies.

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Grant support

This research was funded by the French ‘Site de Recherche Intégrée sur le Cancer - Bordeaux Recherche Intégrée en Oncologie’ (SIRIC – BRIO,, which brings together multidisciplinary research teams working in synergy to produce new knowledge for the benefit of patients. NC received the funding. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.