Feasibility and Efficacy of Reiki Versus Massage for Cancer-Related Fatigue in Patients with Breast and Prostate Cancer Receiving Hormone Therapy

Background

Cancer-related fatigue (CRF) is persistent exhaustion caused by cancer or its treatment. Unlike normal tiredness, CRF is not alleviated by rest, and impairs daily functioning.^1,2 CRF may worsen with treatment and can persist for years after treatment. Unaddressed CRF may impair treatment adherence and quality of life, increase morbidity, and potentially compromise survival outcomes.^3–5 CRF is particularly prevalent and challenging among patients with breast and prostate cancer undergoing hormonal therapy. Patients with breast cancer receiving endocrine therapy experience CRF rates of approximately 60%, with >55% of those on aromatase inhibitors (AIs) reporting moderate to severe fatigue.^6,7 Similarly, patients with prostate cancer receiving long-term androgen deprivation therapy (ADT) demonstrate a CRF prevalence of 43%, with fatigue often persisting for years after treatment completion.⁸ These populations face barriers related to treatment side effects and impaired physical function. Adherence to therapy and interventions is frequently compromised by these side effects and physical limitations.⁹ Targeted interventions that address multidimensional aspects of fatigue while considering treatment-related barriers are essential for optimizing quality of life in these patient populations.

CRF varies by individual and treatment.¹⁰ Given the complexity of CRF, novel integrative oncology approaches are being explored.¹¹ Current ASCO guidelines for managing CRF recommend interventions such as exercise, Tai Chi, Qigong, mindfulness-based stress reduction, and cognitive behavioral therapy.^2,12 These approaches typically require active participation, but some patients may prefer passive therapies such as massage and Reiki, which may expand treatment options and enhance accessibility for a wider patient population.¹³ Emerging evidence supports the potential benefits of massage therapy. Meta-analysis supports its use, and NCCN recognizes massage therapy as a supportive care option.^14,15 Pilot trials suggest that Reiki may reduce fatigue and improve quality of life.^16–19 Limitations include small sample sizes, insufficient controls, and inconsistent outcomes. Meta-analyses highlight the need for larger randomized studies with robust methodological controls.^18–20 Our study addresses prior design gaps by enrolling a larger sample of patients with breast and prostate cancer receiving hormonal therapy and directly comparing Reiki with both massage and a dose–response schedule. By specifically addressing limitations of prior work, such as session frequency, heterogeneity in design, and lack of comparator arms, this research provides more definitive evidence on the feasibility and efficacy of Reiki for reducing CRF, helping to inform future guidelines.

For this study, we compared Reiki directly with massage therapy, as both are used as complementary therapies with differing mechanisms—massage providing tactile relief and Reiki offering non-touch comfort as an option for patients unable to tolerate physical manipulation. Limited comparative research informs this direct comparison for personalized CRF management in these populations. The massage therapy dose was selected based on evidence demonstrating fatigue reduction with 2 sessions.²¹ Higher doses of Reiki in frequency and duration have been shown to enhance quality of life and fatigue outcomes; however, shorter regimens have also shown benefit.¹⁹

To investigate the potential role of Reiki in supportive cancer care and how it compares to massage therapy, we conducted a randomized, 3-arm pilot study in which patients received either 2 massage sessions, 2 Reiki sessions, or 4 Reiki sessions to assess the feasibility and efficacy of these interventions for mitigating CRF. Our primary hypothesis was that Reiki, with its purported energy-balancing effects, would be both feasible and efficacious in reducing CRF and would perform as well as, or better than, massage therapy. This research may help inform future CRF management guidelines.

Patients and Methods

Study Design

After providing informed consent, participants completed baseline questionnaires, including demographics and the Brief Fatigue Inventory (BFI). Participants were randomized in a blinded manner using a computer-generated block randomization (block size of 6), stratified by cancer type, into 1 of 3 arms: (1) 2 massage treatments (2 weeks apart), (2) 2 Reiki treatments (2 weeks apart), or (3) 4 Reiki treatments (1 week apart). Weekly questionnaires were administered from week 1 through week 6. This pilot study aimed to assess the feasibility of delivering Reiki and massage interventions for fatigue by evaluating recruitment, retention, and adherence. Secondary objectives included estimating effect sizes to inform future sample size calculations. Formal a priori power calculations were not conducted, as this was a feasibility study rather than a definitive efficacy trial.

Participants/Eligibility

Eligible participants were: (1) adults (age ≥21 years) diagnosed with breast cancer receiving an AI or with prostate cancer receiving ADT for at least 8 weeks, with no planned changes in hormone therapy; (2) experiencing moderate or greater CRF, defined as a score of ≥4 on an 11-point scale (0 = no CRF, 10 = worst possible CRF); (3) fluent in English; and (4) at least 2 months post-completion of any other cancer treatment. Exclusion criteria were: (1) plans to undergo cancer treatments other than hormone therapy within the next 10 weeks; (2) current use of erythropoietin or darbepoetin for anemia; (3) receipt of professional massage or energy therapy within the previous 4 weeks; or (4) any medical condition that would contraindicate participation in the study interventions. Following approval from the University of Rochester Institutional Review Board, participants were screened after their outpatient visits at Wilmot Cancer institute, University of Rochester Medical Center, and its affiliates. Eligible patients were referred by their treating oncologists during routinely scheduled clinic visits, after completion of a preliminary eligibility screening based on medical record review and study protocol criteria. Once referred, eligibility was verified using medical record data, and informed consent in accordance with Institutional Review Board guidelines. This approach allowed for efficient identification and enrollment of patients actively managed by oncology providers, facilitating timely recruitment and minimizing disruption to routine care.

Interventions

Reiki Treatments

Three Reiki Masters (15–21 years’ experience, New York State [NYS] massage license) delivered up to 75-minute sessions on a massage table. Treatments were individualized but excluded Swedish massage techniques (the comparison condition) and minimized conversation to avoid effects related to talk therapy effects.

Massage Treatments

Two NYS-licensed massage therapists (>7 years’ experience) provided Swedish massage, focusing on tissue manipulation without energy healing. Sessions lasted up to 75 minutes. Energy techniques were excluded, and conversation was limited to essential communication.

All treatments occurred in a quiet, softly lit private room. Participants remained fully clothed for Reiki and were appropriately draped for massage. Providers documented session details and participated in monthly team meetings to ensure protocol adherence.

Study Measures

Demographics

Demographic data—including age, sex, race, education, marital status, and cancer type—were collected at baseline using a standardized, self-report questionnaire completed by participants during the enrollment process.

Feasibility: Recruitment Retention and Adherence

Recruitment rate was calculated as the proportion of eligible individuals who consented and were randomized. Retention rate was defined as the proportion of randomized participants who completed the study. Adherence rate was calculated as the proportion of scheduled intervention sessions attended by each participant, with full, partial, and nonadherence categorized according to the number of sessions attended relative to the protocol.

Cancer-Related Fatigue

The primary outcome measure for this study was CRF, assessed at baseline and Week 6 using the BFI, a 9-item, 11-point rating scale questionnaire to assess the severity and impact of CRF.²² Total CRF was calculated as the mean of all 9 BFI items, each rated from 0 to 10. CRF interference was calculated as the mean of items 4 through 9, which assess the degree to which CRF interferes with daily functioning. Worst CRF was defined as the score for item 3, which asks participants to rate their worst level of CRF over the past 24 hours.

Statistical Analyses

Statisticians were blinded until the analysis was finalized. Descriptive statistics were generated for all variables of interest, including means and SDs. Statistical power was limited by the small sample size in each treatment arm; however, the data will be used to generate effect size estimates for power calculations for an anticipated future larger trial. Reasons for any missing data were documented.

Sociodemographic variables were evaluated with 2-sided (P=.05) t tests for continuous variables and chi-square tests for categorical variables. ANCOVA was conducted for the primary BFI fatigue outcomes at Week 6, adjusting for baseline (Week 1), to evaluate between-group differences in intervention effects. Cohen d was used to estimate the effect size of within-group differences by measuring the standardized difference between preintervention and postintervention scores within the same group, calculated as the mean change divided by the SD of the change (or baseline variability). A d of 0.2 indicates a small effect, 0.5 a medium effect, and 0.8 a large effect, reflecting the magnitude of improvement or decline relative to natural variability in the sample.

Monitoring Adverse Events

Adverse events (AEs) and serious AEs (SAEs) related to the intervention were monitored from enrollment through study completion in accordance with University of Rochester Research Subjects Review Board requirements. SAEs included fatal, life-threatening, disabling, or hospitalization-requiring events; new cancer diagnoses; or overdose. All AEs were graded using the NCI CTCAE. The study was considered minimal risk, with ongoing safety monitoring by investigators and annual Data and Safety Monitoring Committee (DSMC) review. Unexpected or possibly related toxicities were reported immediately to the Safety Officer or DSMC Chair, and the study was subject to audit.

Results

Demographics

Baseline demographic characteristics by study arm are shown in Table 1. Mean ages were 65 years in the massage arm, 63 years in the 2-session Reiki arm, and 62 years in the 4-session Reiki arm (P=.49). Groups were similar with regard to race (>93% White in each arm), cancer type (approximately two-thirds breast cancer and one-third prostate cancer), and marital status. However, the education level differed significantly: 73.3% of the massage group had a college degree, compared with 42.9% in the 2-session Reiki group and 41.4% in the 4-session Reiki group (P=.02). When education was added to the model assessing between-group differences, it was found to be nonsignificant at the 0.15 alpha level. Additionally, inclusion of education contributed negligible explanatory value, as indicated by a <2% change in the adjusted R². Importantly, this adjustment did not alter the clinical interpretation or overall conclusions of our findings. All other baseline characteristics were well balanced between groups.

Table 1.

Baseline Characteristics of Participants by Intervention Group

Characteristic	2 Massage Sessions n (%)	2 Reiki Sessions n (%)	4 Reiki Sessions n (%)	P Value (Chi-Square)
Total, N	30	28	29
Education				.02
College degree	22 (73.3)	12 (42.9)	12 (41.4)
No college degree	8 (26.7)	16 (57.1)	17 (58.6)
Mean age, y	65	63	62	.49
Marital status				.67
Married	23 (76.7)	6 (21.4)	20 (69.0)
Not married	7 (23.3)	22 (78.6)	9 (31.0)
Race				1.00
Black/African American or othera	2 (6.7)	2 (7.1)	2 (6.9)
White	28 (93.3)	26 (92.9)	27 (93.1)
Cancer type				.98
Breast	19 (63.3)	18 (64.3)	19 (65.5)
Prostate	11 (36.7)	10 (35.7)	10 (34.5)

^aOther: Asian (n=1).

Retention, and Adherence

A total of 87 eligible participants (breast cancer, n=57; prostate cancer, n=30) were randomized to 1 of 3 treatment arms. Five participants withdrew (2 for medical reasons, 2 due to lack of interest, 1 lost to follow-up), leaving 82 who completed the study and provided evaluable data. Of 167 screened participants, 91% (n=152) were eligible and 51% (n=87) were included; retention among those included was 94% (n=82). Overall adherence was 85%. In the massage arm (n=28), 96.4% fully complied and 3.6% were noncompliant. In the 2-session Reiki arm (n=26), 96.4% fully complied and 3.6% partially complied. In the 4-session Reiki arm (n=28), 92.3% fully complied and 7.7% partially complied. No participants in the Reiki arms were completely noncompliant (Figure 1). No AEs related to the study interventions were reported, supporting the feasibility and safety of both massage and Reiki therapies for individuals with CRF.

Figure 1.

CONSORT diagram.

Abbreviations: BFI, Brief Fatigue Inventory; CRF, cancer-related fatigue.

Citation: Journal of the National Comprehensive Cancer Network 2026; 10.6004/jnccn.2026.7010

Cancer-Related Fatigue

The initial evaluation of Reiki's effects involved comparing both the 2- and 4-session regimens to a 2-session massage therapy control. Fatigue was assessed weekly during weeks 1–6 and again at a 1-month postintervention follow-up (week 10). All 3 interventions produced reductions in CRF over the 6-week intervention period, with improvements sustained through 10 weeks (Figure 2A, C, E). There were no statistically significant between-group differences in BFI outcomes between massage and Reiki. However, each treatment group demonstrated statistically significant within-group improvements from baseline to postintervention (6 weeks) in BFI total, worst, and interference scores (P<.001) (Figure 2B, D, F; Table 2). The massage therapy group showed smaller within-group effect sizes compared with those receiving 2 Reiki sessions, while the largest effects were observed in participants receiving 4 Reiki sessions. Specifically, effect sizes were 0.57 (massage), 0.87 (2 Reiki sessions), and 1.16 (4 Reiki sessions) for total CRF; 0.60, 0.89, and 1.49 for worst CRF; and 0.50, 0.81, and 0.99 for CRF interference, respectively. These results suggest that Reiki may be more efficacious than massage, particularly in a larger sample size (Figure 2G, Table 2). Although between-group differences between the 2- and 4-session Reiki groups were not statistically significant for any of the CRF subscales (Supplementary Table S1), the trend suggests a potential dose–response relationship, with greater improvements observed in the 4-session Reiki group.

Figure 2.

BFI scores were assessed at baseline, week 6 (postintervention), and week 10 in participants randomized to 2 sessions of massage therapy (n=28), 2 sessions of Reiki (n=26), or 4 sessions of Reiki (n=28). (A, C, E) Mean BFI total, worst fatigue, and fatigue interference scores over time by group. (B, D, F) Within-group changes from baseline to week 6 (all P<.001). (G) Within-group effect sizes (Cohen d) for CRF outcomes, larger in both Reiki groups than massage. All groups showed sustained fatigue reduction through week 10.

Abbreviations: BFI, Brief Fatigue Inventory; CRF, cancer-related fatigue.

Citation: Journal of the National Comprehensive Cancer Network 2026; 10.6004/jnccn.2026.7010

Table 2.

Fatigue Outcomes

Outcome Measure	2 Massage Sessions (n=28)	2 Reiki Sessions (n=26)	4 Reiki Sessions (n=28)
CRF total score
Baseline, mean [SD]	4.2 [2.1]	4.5 [1.8]	4.4 [1.6]
Postintervention, mean [SD]	3.1 [2.5]	2.7 [2.1]	2.6 [1.5]
Within group difference (adj. baselinea)	−1.32	−1.69	−1.80
Within-group P valueb	<.1	<.01	<.01
Within group effect sizec	0.57	0.87	1.16
Worst CRF score
Baseline, mean [SD]	5.4 [2.2]	5.6 [1.8]	6.0 [1.7]
Postintervention, mean [SD]	4.1 [2.5]	3.8 [2.6]	4.0 [1.6]
Within group difference (adj. baselinea)	−1.78	−2.32	−2.50
Within-group P valueb	<.01	<.01	<.01
Within group effect sizec	0.60	0.89	1.49
CRF interference score
Baseline, mean [SD]	3.7 [2.6]	3.9 [2.0]	3.7 [1.8]
Postintervention, mean [SD]	2.7 [2.6]	2.2 [2.1]	1.9 [1.7]
Within group difference (adj. baselinea)	−1.21	−1.62	−1.81
Within-group P valueb	<.01	<.01	<.01
Within group effect sizec	0.50	0.81	0.99

Abbreviations: adj, adjusted; CRF, cancer-related fatigue.

^aAdjusted mean change from baseline to postintervention within each group.

^bStatistical significance of the within-group change.

^cQuantifies the magnitude of the within-group change.

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Stratified analyses revealed differential responses to massage and Reiki therapies among patients with breast and prostate cancer experiencing CRF. For patients with breast cancer, both 2 massage sessions and 2- and 4-session Reiki regimens led to statistically significant improvements across all subscales of the BFI, indicating that all interventions were efficacious in alleviating CRF in this group (Supplementary Table S2). For patients with prostate cancer, 2 massage therapy sessions resulted in a statistically significant improvement only in the worst CRF subscale (P=.22), with no significant changes observed in other CRF measures. In contrast, both Reiki therapy doses resulted in statistically significant improvements across all BFI subscales, suggesting that Reiki may offer broader or more comprehensive benefits than massage therapy for patients with prostate cancer receiving hormone therapy (Supplementary Table S3).

Discussion

This randomized pilot trial demonstrated high recruitment, retention, and adherence, with no AEs, supporting the feasibility and safety of both Reiki and massage for CRF. All intervention arms showed significant improvements in CRF as measured by the BFI, with the largest effects observed in the 4-session Reiki group. The minimal clinically important difference (MCID) for total BFI is approximately 1.33, with usual and worst fatigue items ranging between 1.5 and 1.76.^23,24 In this study, average score changes met or exceeded these MCID thresholds, indicating both statistically significant and clinically meaningful improvements. Stratified analysis revealed that both therapies benefited patients with breast cancer, whereas Reiki provided greater relief than massage for patients with prostate cancer, suggesting a potential advantage for this population.

Both Reiki and massage improved CRF, but our findings suggest that differential mechanisms and patient-specific responses may help explain why Reiki showed greater effects, especially in patients with prostate cancer. Massage therapy relieves tension through physical manipulation of muscles and soft tissues, particularly benefiting individuals with musculoskeletal discomfort. In contrast, Reiki, an energy field therapy recognized by the National Center for Complementary and Integrative Health (NCCIH), involves light touch or placement of the hands near the body to facilitate bioelectrical field interactions. These interactions may influence the energy field that surrounds and permeates the human body, often referred to as the biofield. Although the exact mechanisms are not fully understood, it has been proposed that Reiki influences the body's bioelectrical signals, which play crucial roles in various physiological processes and the maintenance of homeostasis.^25,26 Cells generate and respond to electric fields through ion channels and membrane potentials, facilitating communication and coordination across tissues. These bioelectrical activities are fundamental to functions such as heart rhythm regulation, neural activity, and immune responses.²⁷ Reiki may serve as a complementary approach to address the multifaceted aspects of CRF, encompassing biologic, social, and psychological dimensions.

We hypothesize that Reiki's reduction of CRF in our study, particularly among patients with prostate cancer, may reflect dual physiological and psychological actions. Clinical studies have linked Reiki to favorable changes in bioelectrical activity, including increased heart rate variability, reduced blood pressure and cortisol levels, elevated salivary immunoglobulin A, and reduced proinflammatory cytokines.^28–31 The calming setting and practitioner attention during Reiki also foster relaxation, reduce anxiety, and create a sense of safety and well-being.²⁰ This multifaceted effect may be important for hormone therapy–related fatigue, in which both inflammation and psychological distress contribute to symptom burden. For patients with prostate cancer, who often experience unique treatment-related side effects, including hormonal changes and fatigue, Reiki's capacity to target both stress-related and inflammatory components may confer advantages over massage's primarily physical effects. Patients with breast cancer, who may experience physical tension related to surgery and radiation, benefited from both modalities, consistent with massage's mechanism. These cancer-type distinctions indicate that tailoring interventions to the specific etiologies of patient fatigue may improve outcomes.

Results are consistent with prior evidence supporting both modalities and extend the literature by offering a direct comparison of massage and Reiki. Massage has a substantial evidence base in oncology supportive care, with meta-analyses demonstrating clinically meaningful reductions in CRF and recognition in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for CRF. The clinically significant results observed with massage in our trial align with these prior findings. The literature on Reiki remails more limited; however, previous large studies have reported reduced pain and anxiety following 4 Reiki sessions in patients undergoing cancer treatment,¹⁷ as well as improved pain control and quality of life when Reiki is added to standard care versus rest.³² Program evaluations and meta-analyses have found that both Reiki and massage provide clinically meaningful relief for CRF,³³ although direct comparisons are rare. A pilot crossover trial in patients with cancer found that fatigue decreased significantly with Reiki (P=.05), with participants experiencing significant improvements in quality of life compared with rest conditions (P<.05), along with daily decreases in tiredness (P<.001).¹⁶ Our findings build on this literature by demonstrating that Reiki may provide differential benefits across cancer types and was associated with similar within-group improvements in CRF compared with massage in this pilot trial. Although massage may be particularly suitable for individuals seeking relief of physical tension, Reiki may offer broader symptom improvement, particularly for populations with complex, multifactorial fatigue.

CRF remains a significant challenge for patients with cancer and survivors, creating demand for passive, low-burden therapies beyond established exercise recommendations. Not all individuals can participate in active interventions due to physical or psychological limitations. Recent research has shown that passive modalities, such as music therapy, provide calming benefits by promoting relaxation and helping patients redirect focus away from distress, whereas active therapies tend to be more stimulating. Passive interventions target symptom control through relaxation and create meditative environments that ease anxiety, making them valuable alternatives for individuals who face barriers to participation.¹³ Both Reiki and massage are accessible passive therapies, and our findings support selecting between them based on cancer type and fatigue characteristics.

Although Reiki has been practiced since the 1800s, rigorous trials remain limited. Physiological research suggests that its benefits may occur through modulation of the autonomic nervous system, as reflected by improved heart rate variability, reduced stress markers, and enhanced immune function. In oncology, clinical studies have reported reductions in pain, anxiety, and fatigue.³⁴ Randomized trials and reviews also indicate that Reiki’s calming environment, and focused attention foster significant relaxation, reduce anxiety, and enhance well-being in patients with cancer.^16,20,35,36 The practitioner's empathetic engagement and supportive relationship may further promote stress reduction and emotional comfort. Researchers have described relaxation as “the most identified experience by participants,” suggesting that this pathway may be one mechanism through which Reiki produces clinically meaningful effects in reducing pain and fatigue.³³

Taken together, these results support massage and Reiki as safe, feasible, and potentially effective integrative therapies for managing CRF, with Reiki showing particular promise for patients with prostate cancer. Our study extends previous work by directly comparing these therapies, exploring dose effects, and examining differential responses by cancer type in a population with hormone therapy–related fatigue. However, further research with larger, adequately powered trials is needed to confirm these findings, elucidate underlying mechanisms through biomarker assessment, incorporate sham controls to clarify comparative efficacy, and prospectively evaluate cancer type–specific matching of intervention modalities. Future studies should also investigate whether baseline inflammatory markers, anxiety levels, or other characteristics predict differential responses to Reiki versus massage.

Key strengths of this study include its randomized, 3-arm design with computer-generated allocation and cancer type stratification, which improved internal validity and enabled direct comparison of intervention type and dose. Standardized eligibility criteria, protocolized interventions delivered by experienced licensed practitioners, regular team meetings, and detailed session documentation helped ensure intervention fidelity and consistency across study arms.

Several limitations warrant consideration. Participant predisposition toward integrative therapies may have introduced expectancy bias. The absence of a placebo or sham control limits causal inference, and future studies should include such controls. Unmeasured concurrent interventions (e.g., sleep aids or supplements affecting fatigue, mood, or sleep) were not systematically captured, limiting adjustment for potential confounders. Clinical details such as cancer stage, comorbidities, time since active treatment, and specific hormonal therapy regimens were also not collected. Future studies should routinely obtain detailed information on clinical variables, including medication and supplement histories, and screen for treatable etiologies (e.g., thyroid dysfunction, anemia) to maximize assessment accuracy and minimize confounding. The 4-session Reiki arm involved twice the amount of therapy as the 2-session massage and Reiki arms, and session intervals varied, with a longer gap in the massage and 2-session Reiki groups than in the 4-session Reiki group. These differences may have impacted CRF outcomes and limited direct comparisons. Future studies should systematically compare session frequency (e.g., weekly vs biweekly) and equal number of sessions for both massage and Reiki, given subgroup and meta-analytic evidence that greater frequency and cumulative dose may enhance fatigue reduction and quality of life. Distinct study arms can elucidate the influence of treatment frequency versus cumulative dose, while inclusion of appropriate controls, such as sham Reiki, will help differentiate true therapeutic effects from placebo or expectancy effects. Subgroup stratification by cancer type and treatment arm reduced statistical power in this 87-participant cohort. Larger studies are needed to validate these findings and clarify Reiki’s role in CRF management for patients receiving hormone therapy.

Conclusions

Reiki and massage are safe and feasible nonpharmacologic interventions that demonstrate preliminary efficacy that is both statistically significant and clinically meaningful in alleviating CRF. Our findings show that Reiki therapy administered in either 2 or 4 sessions was at least as efficacious as, and in some cases more efficacious than, 2 sessions of massage therapy in reducing CRF among patients with breast and prostate cancer receiving hormone therapy. Although between-group differences were not statistically significant, Reiki was associated with larger within-group effect sizes for total CRF reduction (1.16 for 4 Reiki sessions vs 0.57 for 2 massage sessions), suggesting a potentially greater clinical impact. These results support Reiki as a promising integrative therapy for CRF and highlight the need for further investigation in larger, adequately powered trials.