WITHDRAWN: Aromatherapy and massage for symptom relief in patients with cancer.

BACKGROUND: Aromatherapy massage is a commonly used complementary therapy, and is employed in cancer and palliative care largely to improve quality of life and reduce psychological distress. OBJECTIVES: To investigate whether aromatherapy or massage, or both, decreases psychological morbidity, lessens symptom distress and/or improves the quality of life in patients with a diagnosis of cancer. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library, Issue 1, 2002), MEDLINE (1966 to May week 3 2002), CINAHL (1982 to April 2002), British Nursing Index (1994 to April 2002), EMBASE (1980 to Week 25 2002), AMED (1985 to April 2002), PsycINFO (1887 to April week 4 2002), SIGLE (1980 to March 2002), CancerLit (1975 to April 2002) and Dissertation Abstracts International (1861 to March 2002). Reference lists of relevant articles were searched for additional studies. SELECTION CRITERIA: We sought randomised controlled trials (RCTs); controlled before and after studies; and interrupted time series studies of aromatherapy or massage, or both, for patients with cancer, that measured changes in patient-reported levels of physical or psychological distress or quality of life using reliable and valid tools. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion in the review, assessed study quality and extracted data. Study authors were contacted where information was unclear. MAIN RESULTS: The search strategy retrieved 1322 studies. Ten studies met the inclusion criteria and these represented eight RCTs (357 participants). The most consistently found effect of massage or aromatherapy massage was on anxiety. Four trials (207 participants) measuring anxiety detected a reduction post intervention, with benefits of 19 to 32% reported. Contradictory evidence exists as to any additional benefit on anxiety conferred by the addition of aromatherapy. The evidence for the impact of massage/aromatherapy on depression was variable. Of the three trials (120 participants) that assessed depression in cancer patients, only one found any significant differences in this symptom. Three studies (117 participants) found a reduction in pain following intervention, and two (71 participants) found a reduction in nausea. Although several of the trials measured changes in other symptoms such as fatigue, anger, hostility, communication and digestive problems, none of these assessments was replicated. AUTHORS' CONCLUSIONS: Massage and aromatherapy massage confer short term benefits on psychological well being, with the effect on anxiety supported by limited evidence. Effects on physical symptoms may also occur. Evidence is mixed as to whether aromatherapy enhances the effects of massage. Replication, longer follow up, and larger trials are need to accrue the necessary evidence.

District nurses' referrals to home-based palliative nursing services.

This study investigated district nurses' considerations of the Marie Curie Nursing Service. Most saw the primary service as respite care and referred patients to it during late stages of illness rather than palliative phases. The MCNS is valued, but confusion exists about appropriate referral times and the services provided. Improvement in communication and education is needed. The provision of this home palliative nursing service helps to promote the principle of palliative care in optimising the quality of life of patients who have life-limiting diseases and their families.