Pain symptom was examined in five of the six included studies [12, 13, 16-18]. The analgesic effect of massage therapy in cancer patients receiving palliative care could be demonstrated in four of these five studies [12, 13, 16, 18]. In four studies, the amount of pain reduction reached a statistically significant value (see Table 3) [12, 13, 16, 18]. The results also showed that massage therapy produced a significantly better effect in patients with strong pain perception (VAS> 4) [12, 13, 18]. However, Downey et al.  was unable to demonstrate the efficacy of massage therapy in terminal cancer patients through the results of their study (see Table 3).
Three of the six studies looked at the long-term effects of massage therapy [13, 16, 18]. In particular, the results turned out to be very divergent. Jane et al.  provided the longest follow-up of all studies analyzed with a period ranging from 16 to 18 hours. However, Jane et al.  found that massage therapy did not produce a statistically significant effect on pain perception after this period (see Table 3). Kutner et al.  and Wilkie et al.  also analyzed the long-term effect of massage therapy and these authors found that the immediate effects were greater and the long-term less.
In addition to the lasting effect of massage therapy, Wilkie et al.  also looked at the change in pain. Wilkie et al.  found a transformation from perception of constant pain to perception of intermittent or episodic pain in 14% of participating patients. In summary, it can be said that massage therapy can achieve a reduction in pain lasting up to 18 hours [13, 16, 18].
Massage therapy shows a favorable effect in both immediate and continuous analysis of the results. To further support this effect, Kutner et al.  and Wilkie et al.  studied the patients’ analgesic consumption after massage therapy and compared it with the previous dose. Although the decrease in analgesic consumption was not statistically significant, the dose of analgesics was subject to minor fluctuations .
5.4. The effect of massage therapy in reducing anxiety and depression
The presence of pain can cause anxiety and depression to develop or become more pronounced . For this reason, the effect of massage therapy in consideration of these two symptoms of the disease was evaluated in four of the six studies [12, 13, 18, 19].
The anxiety symptom was examined in three of the six studies; however, the authors did not provide a definition of anxiety [12, 18, 19].
The authors found that physiological relaxation is closely related to immediate anxiety reduction and they also found that it is important for a lasting effect [12, 18, 19]. Monitoring of the heart and respiratory rate after the respective massage therapy can indicate relaxation. While Jane et al.  were able to note a reduction in rates, the results were not statistically significant. However, patients’ perception of anxiety immediately after surgery was statistically significantly decreased (see Table 3) .
The Osaka et al.  was limited to administering a hand massage. Despite the short duration of only five minutes, a statistically significant reduction in anxiety perception was achieved (see Table 3). Cassileth and Vickers  provided evidence of a significantly greater reduction in both pain perception and feelings of anxiety in those patients who had higher underlying anxiety (VAS> 4) prior to surgery.