Written by Sam Mishra, Medical Massage
Aromatherapist, accredited course tutor, oncology practitioner, trauma practitioner and breathwork facilitator.
Having spent a reasonable amount of my nursing career around oncology patients, I am aware of how those basic care measures, such as touch, can make such a difference. Yet when I trained as a massage therapist back in 1996, we were told that cancer was an absolute contraindication to massage, and it seems many schools are still teaching this today.
Certainly, having been a dual-trained medical professional, I have questioned the insufficient anatomy, physiology, and pathology content, which is part of the reason why I also now offer massage training courses from a more medical viewpoint.
It is perfectly reasonable for a therapist to refuse to treat a cancer client due to not knowing how to modify a technique or not feeling confident in their ability to offer a safe and effective treatment. What I can’t perceive to be acceptable is that in a time when massage is no longer simply a luxurious bit of pampering but a natural healthcare solution for dealing with injuries, health issues, and their symptoms, massage therapists are not gaining any understanding of the pathophysiology involved with common conditions. This means that some of the clients who could benefit the most from such therapy are not able to access it, or in some instances, are seeking therapy from untrained individuals who do not have sufficient knowledge to adapt techniques in order to take a safe, effective, client-centred approach.
This lack of knowledge has created various myths regarding oncology massage, a common one being that it will spread cancer. Unfortunately, I’ve had clients who have really wanted to access my service, but due to their GP having outdated information about the uses of complementary therapies, they have been persuaded not to. Don’t get me wrong, there are some great GPs out there who are really embracing natural therapies, but there is still a long way to go.
When I was nursing, to hear a patient say they had looked on the internet would often fill us with dread, because so often they would have looked at information that did not come from a reliable or evidence-based source, or what they had read may have been outdated. This also applies to oncology massage, where there is a lot of out of date information about massage for a cancer patient being contraindicated. It is always important, with any decision about your health, to look at the research, seek a few opinions, and follow your intuition, because nobody knows your body better than you.
It used to be that receiving massage therapy while having medical treatment for cancer was met with disapproval, mainly because there was very little qualitative research undertaken in the complementary therapy field. Conventional treatments such as chemotherapy and radiotherapy were pretty much what were offered, and of course this is still the case, but we are now more aware of the effects of therapies, such as massage, on the body, so we are able to offer additional natural solutions to relieve some of the symptoms, whether physical, mental, or spiritual.
Gone are the days where we didn’t have evidence-based studies to show that massage wouldn’t spread cancer through improved circulation or pressure applied, so why does this myth (that massage will spread cancer) still exist?
What myths exist about massage for clients with cancer?
There are a few myths that have discouraged those with cancer from booking in for massage therapy. An example of this is the idea that oncology massage therapists offer their services according to their own beliefs as opposed to working in line with current research. Although research has been limited in previous years, there are more studies being done to evaluate the efficacy of massage and other complementary therapies on cancer patients. Research is ongoing in any medical field, and all healthcare professionals continuously develop their understanding in line with the current evidence. We can only ever work with the information we have, but this is why anyone seeking an oncology massage should consult with a reputable and experienced therapist who has undergone specific oncology training and looked at the research.
The biggest myth regarding massage for those with cancer is the idea that massage will spread the cancer due to its effect on both the lymphatic and blood circulation. Given that cancer can develop in the blood and lymph nodes, I suppose it is understandable why some people may have thought that massage should be avoided. In reality, the impact of massage on the circulation is less than with exercise, and one of the first things doctors will tell a cancer patient is to stay as active as possible. So, if a doctor is advising an activity that will increase circulation, it makes no sense to say that massage is not appropriate. Of course, some might argue that cancer patients can be inactive for lengthy periods, during treatment cycles, or following surgery, potentially supporting the view that increased circulation has a negative impact on the cancer, but in that case, those with cancer shouldn’t move at all! And for how long? Until they finish a treatment cycle? Until their scans come back clear? Until they have been in remission for five years? There is no logic to this argument, and it would lead to further health problems and a reduced quality of life.
The truth is, cancer spreads due to mutations at a cellular level which mean that the usual mechanism to prevent continuous proliferation of damaged cells doesn’t work. Also metastatic cancer cells can replicate in liquid and change shape, enabling them to move through membranes and into other organs. These factors, combined with the fact that cancer cells are also self sufficient, ie. they don’t require growth factor, mean that the cells will spread of their own free will, and massage is not going to be responsible for that.
Certainly, therapists won’t work directly over a tumour, but we can still work around the area, and even offering a simple hand and foot massage can be very effective in easing symptoms during a chemotherapy cycle or in palliative cases. This is why hospices often have therapists volunteer their time to give massages, and why charities such as Cancer Research and Macmillan support the use of massage to ease the symptoms of cancer and related treatments.
There are so many questions that potential oncology clients can and should ask, for example, “Can I have a safe and effective massage part way through a chemotherapy cycle? ", or “Do I still need an oncology massage if I’ve been in remission for 3 years? “ Not all the questions can be answered in this article, but we can look at the benefits of massage for oncology clients and how to ensure a safe therapeutic experience.
Benefits of oncology massage
When someone has a medical issue which requires numerous hospital visits and invasive treatments, it can start to feel like every time they are touched, it’s because something is being done to them, and it’s often uncomfortable. The beauty of oncology massage is that it truly supports the client, helping them to feel that they are back in control and less isolated, while fulfilling the basic human need of touch, which is so often lacking, because quite often the person is seen as fragile. A massage session can offer a compassionate space where the client can offload feelings that they may not want to burden their loved ones with, helping to reduce anxiety and depression, and promote relaxation and better sleep.
Studies on oncology massage have shown that it helps to increase dopamine levels, which helps to lift the mood, but they have also demonstrated that there are many physical benefits, such as reduced pain and muscle soreness (to the point that there is less need for analgesia, plus the medication tends to be more effective), improved immune function (due to increased white blood cell production), and reduced side effects of chemotherapy and radiotherapy, such as fatigue and nausea.
Massage can also assist clients with cancer following surgical treatment, by promoting deeper respiration, improved digestive function and regulating the nervous system, all of which mean better nutritional uptake, increased oxygenation of the tissues, faster wound healing and faster recovery. By stimulating the lymphatic system, this also means that an oncology client could benefit from less skin problems, reduced oedema and lymphoedema and improved scar elasticity, which will further help to re-establish a positive body image.
I’m often asked by clients who have been in remission for years if they still need to have an oncology massage, and this is really where an in depth consultation is important, because the therapists must establish if there are any long term side effects from radiotherapy or chemotherapy, for example, peripheral neuropathy, or if there is maybe some phantom pain from organ removal. Techniques may still need to be adapted.
Providing a safe treatment
The topic of oncology massage will probably remain a contentious issue for some time, at least until there is further research carried out, but the evidence so far has demonstrated a general improvement in quality of life and that oncology massage promotes relaxation and eases anxiety. There has certainly been no evidence of cancer spreading due to massage, but even so direct massage over lymph nodes and tumour sites will be avoided. If a client has had surgery to remove lymph nodes, care must be taken to position the affected side(for example with mastectomy clients) so that it is well supported, and the area must be massaged gently, unless there is lymphoedema, in which case massage should only be undertaken by a lymphoedema specialist.
Another area of caution is when the client is part way through a treatment cycle. The skin will become very fragile during a course of radiotherapy and may well be irritated by oils, so if any massage is offered in the area it must also be very light and preferably through a blanket, or similar. Markings for the radiotherapy treatment, which will map out the area to be treated, should also be avoided, as it could interfere with the treatment.
While oncology massage is generally only performed at a level that the client’s tissue will allow the therapist to go, particular care must be taken when massaging a client who is having radiotherapy or chemotherapy, as they will be more prone to bruising due to altered blood counts. However, treatment cycles aside, the client may be physically or emotionally more sensitive, and since the massage is intended to be comforting, many of the standard techniques will be modified. Of course surgical treatment may also bring hypersensitivity or the need to avoid to certain areas.
These are all reasons why seeking an oncology certified therapist is crucial, because it is knowledge as well as experience that enables the therapist to make such adaptations. As a nurse I was always taught to be accountable to myself, to the patient and to the profession, and only work within my competency level; that is how standards of care are maintained. Massage therapists are still working with client’s health issues, so they too must be responsible in their practice. This professional responsibility extends to accepting that other members of the multi-disciplinary team will have knowledge in slightly different areas, so the client can only benefit from the therapist liaising with the oncology team. We know that client’s aren’t always forthcoming with all of the relevant information, perhaps because they don’t want to be turned away, they’ve been dealing with a problem so long that it no longer seems significant, or they simply forgot to mention it. By corresponding with the medical team, the therapist may become aware of additional precautions and therefore be able to provide a safer massage.
As with any type of massage, the client’s preferences must be respected by the therapist.
Finding a therapist
When looking for a massage therapist when you have cancer in your medical history, whether past or present, it is perfectly acceptable to ask them about their qualifications and experience. Some areas will have specific requirements, such as 500+ hours of training, having a license to practice, certification etc. Even when seeking a massage in a hospital or hospice, it is still important to make sure that the therapists is adequately qualified and knowledgeable about cancer.
Any massage therapist, regardless of the issue they are working with, should be asking clients to complete a detailed consultation form, but this is essential prior to an oncology massage, enabling the massage session to be truly client centred and customised to their individual needs.
Having a professional registration and a certificate to say that they are qualified in massage does not mean that a therapist is competent or has sufficient knowledge when it comes to an oncology client. Given that fifty percent of people will develop some form of cancer in their lifetime, there is a very good chance that any massage therapist is going to come across clients who have been affected by it. This alone, should be reason enough for basic massage training courses to be including oncology, helping such clients to reconnect with themselves at a time when they can feel disconnected from their body. However, as it stands the techniques used in an oncology massage are performed differently to a standard deep tissue or even Swedish massage, the principal rationale being that minimal stress is placed through the tissues, and these techniques aren’t generally taught in basic training.
Conclusion
No research has shown that massage will promote the spread of cancer, in fact massage therapy can be very beneficial in helping someone with cancer to manage their symptoms or improve their ability to cope. However, there is a potential for harm or interference with treatment cycles if the therapist is not suitably qualified or experienced. It is important to inform your therapist of your diagnosis and symptoms, as well as your current treatment programme. So, do some research and ask for an initial consultation with the therapist to ensure that they are knowledgeable about cancer, and can therefore offer you a safe massage, and also to ensure that you are generally comfortable with them, because, after all, comfort is a large part of why oncology clients seek massage. As long as the therapist is oncology certified massage is a safe therapy for oncology clients, no matter what stage of the cancer journey they are.
While you don’t legally need a doctor’s consent to have an oncology massage, it is recommended to at least discuss it with them, or to give the therapists permission to liaise with your medical team.
It must also be noted that oncology massage is not a treatment for cancer that can replace conventional medicine, but a therapy which can work alongside other treatments to help manage the side effects and symptoms.
I am a dual trained medical professional, with oncology massage certification, as well as MASCED accreditation for the early detection of skin cancers and melanoma, and I am CNHC registered, meaning that I am recognised by and able to accept referrals from doctors and private healthcare insurance.
For oncology massage training, go to website.
To find oncology services in the UK go to website.
Sam Mishra, Medical Massage
Sam Mishra (The Medical Massage Lady), is a multi-award winning massage therapist, aromatherapist, accredited course tutor, oncology practitioner, trauma practitioner and breathwork facilitator. Her medical background as a nurse and a midwife, combined with her own experiences of childhood disability and abuse, have resulted in a diverse and specialised service. She is motivated by the adversity she has faced, using it as a driving force in her charity work and in offering the vulnerable a means of support. Her aim is to educate about medical conditions using easily understood language, to avoid inappropriate treatments being carried out and for health promotion purposes in the general public.
References:
Ashikaga T, Bosompra K, O’Brien P, & Nelson L. (2002) Use of complementary and alternative medicine by breast cancer patients: prevalence, patterns and communication with physicians. Support Care Cancer. 10:542–8.
Bernstein BJ &Grasso T. (2001) Prevalence of complementary and alternative medicine use in cancer patients. Oncology (Williston Park) 15:1267–78. 1283.
Billhult A, Bergbom I, & Stener‐Victorin E. (2007) Massage relieves nausea in women with breast cancer who are undergoing chemotherapy. Journal of Alternative and Complementary Medicine 13(1):53‐7
Cassileth BR & Vickers AJ. (2004) Massage therapy for symptom control: outcome study at a major cancer center. Journal of Pain Symptom Management. 28:244–9.
Fellowes D, Barnes K, & Wilkinson S. (2004) Aromatherapy and massage for symptom relief in patients with cancer Cochrane Database of Systematic Reviews. Issue 3.
Gorman G, Forest J, Stapleton SJ, Hoenig NA, Marschke M, Durham J, Suarez, ML, & Wilkie DJ (2008) Massage for cancer pain: a study with university and hospice collaboration. Journal of Hospice and Palliative Nursing 10(4):191‐7.
Post–White J, Kinney ME, Savik K, Gau JB, Wilcox C, & Lerner I.(2003) Therapeutic massage and healing touch improve symptoms in cancer. Integrative Cancer Therapy. 2:332–44.
Sagar SM, Dryden T, & Wong RK (2007) Massage therapy for cancer patients: a reciprocal relationship between body and mind. Current Oncology Apr; 14(2): 45–56.
Soden K, Vincent K, Craske S, Lucas C, & Ashley S. (2004) A randomized controlled trial of aromatherapy massage in a hospice setting. Palliative Medicine. 18:87–92.
Wilkinson SM, Love SB, Westcombe AM, Gambles MA, Burgess CC, Cargill A, Young T, Maher EJ, & Ramirez AJ (2007) Effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer: a multicenter randomized controlled trial. Journal of Clinical Oncology. 25:532–9.
