An oncology massage is a client-specific, customized massage session designed to meet the unique and changing needs of someone in treatment for cancer or with a history of cancer treatment. A safe massage plan generally revolves around the side effects (both short- and long-term) of chemotherapy, radiation and surgery.
Oncology massage can only be provided by a massage therapist who has received training in the specifics of cancer and cancer treatment. This training is more about cancer and less about massage. When you are receiving an oncology massage, you are receiving traditional, established massage therapy techniques that have been adapted to account for your unique health situation. The changes that might be made to a massage that make it an "oncology massage" can fall under any number of categories, but typically they will be related to session length, pressure, positioning and areas of specific compromise or concern like mediports, bone metastases or skin reactions to treatment.
The short answer is, "Yes." Even without knowing your patient's specific situation, we can tell you that a massage therapist who has received appropriate oncology massage training can provide safe and effective massage for any person at any stage of his or her cancer journey: during and after treatment, in remission, cure or at the end of life.
Part of a complete understanding of oncology massage involves a shift in how we define "massage". Many people think of massage as something that "has to hurt to be effective" or as something they have received, with some discomfort, after an injury or surgery. Others think of some of the more vigorous forms of massage that get the most visiblity in popular media.
When we are talking about massage in the oncology community it can mean anything from a very "normal" massage equally involving all of the client's body to very light, simple touch intended to help a person reconnect with his or her body in a kind and healing way. When we broaden the definition of massage in this way we can easily say, "Yes, oncology massage is safe for your patients when provided by a massage therapist trained in oncology massage".
Oncology massage is now available in many of the world’s leading cancer hospitals. Oncology massage training addresses the full spectrum of cancer-related issues: the physical consequences of cancer, the side effects of various treatments, and the psycho-social and emotional considerations. An oncology massage therapist will adapt his/her massage therapy techniques to the specific needs of your patient.
There are clear medical thought processes by which physicians authorize participation in school athletics, approve return to work after surgery, prescribe physical therapy and many others. Massage therapy is practiced in many different ways by therapists with many different levels of training.
A growing number of physicians welcome massage therapy for their patients, but it is not realistic to expect them to be aware of all the variations. Ultimately, the responsibility lies with the therapist to practice ethically and within his/her training and experience. A doctor's order is not a replacement for sound judgment on the part of a massage therapist. Even with a doctor's order it is best for the client/patient to see a trained oncology massage therapist who will know the appropriate questions to ask to make safe adjustments to the massage and who will often include the physician in the massage care plan conversation if needed.
Patients and their caregivers report many and varied changes after massage. A therapist trained in oncology massage can provide a variety of positive effects from relaxation to scar tissue moblization to pain reduction, but the anecdotal evidence suggests that there are many benefits beyond even these that are enjoyed by people at all stages of the cancer journey.
● deep relaxation
● reduced stress
● improved sleep
● eased constipation
● increased alertness and mental clarity
● reduced anxiety
● less nausea
● reduced pain
● reduced anxiety in advance of surgery
● easier recovery from anesthesia
● reduced post-surgical pain
● improved moblity and appearance of surgical scars
● reduced swelling
● improved range of motion
● easier adaptation to implants and expanders
Following Radiation or Chemotherapy
● reduced anxiety in advance of and during treatment
● reduced post-treatment fatigue
● improved appetite
● improved peripheral neuropathy
● decreased anxiety
● decreased depression
● increased feelings of well-being
● being pleasantly distracted
● improved body self-image
● restored hope
● satisfaction in participating actively in a part of the healing process
"Knowing what to do, when to do it and why." Each of the following common cancer-related conditions (and others) require important adjustments be made for the client's comfort and/or safety. The massage therapist must know what particular information to gather from the client and then know how to make the corresponding adjustments.
The specific appliances, conditions and complications listed below are not things thare are covered in typical massage therapy training in the United States. Many massage therapists are taught "It's only massage. It can't hurt." Few things could be further from the truth, but many massage therapists don't understand the realities of just how wrong that statement can be.
Every country is different, however. Some countries require comprehensive training for massage therapists such that they approach massage therapy with a knowledge base not unlike that of nurses. The United States is not one of those countries.
● Anemia (low red blood count)
● Anticoagulant Therapy
● Ascites (fluid in the abdomen)
● Bone Metastasis (spread of cancer to bones)
● Breast Expander or Implant
● Colostomy / Iliostomy / Jejunostomy / Urostomy
● Deep Vein Thrombosis
● Foley Catheter
● Immunosupression (immune compromised)
● Leukopenia (low white blood count)
● Lymph Node Enlargement
● Lymph Node Removal
● Lymph Node Irradiation
● PEG or PEJ Tube
● PICC line or Port
● Radiation Skin Reaction
● Radioactive Implant
● Radioactive Iodine
● Risk of Lymphedema
● Skin Eruption
● Surgical Adhesions
● Surgical Scarring
● Thrombocytopenia (low platelet count)
● Upcoming Radiation
For many people an oncology massage is their first massage. Whether a person is a seasoned recipient of massage or receiving their first massage as a part of cancer treatment or recovery, the experience is at once unique to that person and shared by so many others. Massage can mean different things to the same person at different times in the cancer journey, but most find that massage provided by a trained therapist provides so much more than they expect.
"My therapist understands the difficult road of cancer and addresses the physical pain associated with the mental anguish."
"All through my diagnosis and treatment, the only time someone touched me and it didn't hurt was on the massage table. It was like an oasis in the desert."
"As soon as I had a surgery date, I started going in tighter and tighter circles. [Massage] was a big help in being relaxed, but ready when the day came."
"[Massage] was a great way to get through the stress of chemotherapy."
"We scheduled a massage a day or two before each chemo. That way my mind and body were looking forward to the massage, not to the chemo."
"I not only felt relief from the taxing effects of chemo and the debilitating muscle/bone ache, I ended up feeling an overwhelming sense of peace."
"It's my oasis. I get bogged down with doctors' appointments ..... all these big things coming at me. I get on the massage table and everything just melts away. For me that is a gift and he is a healer."
"During my sessions I felt completely at peace, a tranquility and serenity of the soul. Euphoria of the mind completely transcended the quiet horror of cancer."
"I was so sick from concurrent chemo and radiation. Massage was the only place where I felt in control and could help myself."
"Massage has created an overall sense of well being. I'm at peace with mastectomy and more at peace with my body image."
"It's like a vacation from cancer."
"After chemotherapy, I started receiving some gentle massage. I found I was able to care for my children rather than having to stay in bed for days."
"My oncologist told me I was in for a year of hell. It has been. But no matter how rotten I feel, it is never more than six days from my next weekly massage."
"Massage helped me to accept the new me. I am alive, I am beautiful, scars and all."
Currently, massage therapy is seen in a wide spectrum of ways ranging from "Sure, can't hurt." and "What's the value in that?" to "Of course I recommend massage for my patients." and "Every person should have massage."
Massage in general has a long way to go and oncology massage has an equally long way to go before it is widely accepted within the medical community as an automatic and understood adjunct to mainstream treatments and interventions. Many cancer centers around the world are now incorporating massage therapy in the typical progression of treatment for their patients, but even some of these centers don't know about the importance of proper training or how and where to get it.
Nevertheless, an understanding of the value of massage is growing within the medical community and is likely to continue to do so as awareness increases among health professionals and training improves for therapists.
"No single therapeutic agent can be compared in efficiency with this familiar but perfect tool... the human hand. If half as much research had been expended on the principles governing manual treatment as upon pharmacology, the hand would be esteemed today on a par with drugs in acceptability and power. - J. Madison Taylor, M.D. 1908
"Memorial Sloan-Kettering Cancer Center in New York City is a national leader in cancer treatment. Researchers recently surveyed patients who had therapeutic massage added to their treatment regimens. Over a three year period, results impressively confirmed the value of massage. Anxiety levels decreased by 52%, pain by 40%, fatigue by 41%, depression by 32%, and nausea by 21%. Researchers concluded that massage is a "markedly effective, uncommonly noninvasive and inexpensive way" to control symptoms for cancer patients."
"Technical advances are important but we need to remember the difference between treating the disease and treating a patient. Massage is an extension of the time honored principle of laying on of hands. Massage therapy can help reduce stress, fears, and pain - all of this without side effects. Whether the mechanism of action of massage is physiologic or psychological matters not to me. The fact that it makes the patients feel better and allows them to better deal with their illness or treatment is good enough for me." - Adapted from "Better Living & Health", Portland (Maine) Press-Herald, Summer, 2006
"Massage therapy is not contraindicated in cancer patients, massaging a tumor is, but there is a great deal more to a person than the tumor." - Roger E. Alberty, MD, Director - Department of Surgery, St. Vincent's Medical Center, Portland, Oregon
"Somehow, this routine with my hands and heart has helped me grow and to heal some of my own wounds. Contact with others requires contact between me and myself. I know myself better than I did before I started this work. My affection—for myself and for everyone else—has grown over the years. And my hands, constantly in contact with the changing waters of clients’ experiences, have learned to trust the sacred rhythm of people moving in and through and out of my life."
"I have learned that the only thing I have to offer sometimes is this deeply cultivated affection. And my companionship. I don’t have to think of anything else more helpful, cleverer or in service of a higher good. My presence honors all that my client is, was and will be. It honors everything that goes on in their bodies. To these, it is simple to offer myself. It is all I have and all I can do. And sometimes, sometimes it is enough." - Tracy Walton, LMT
"While [in oncology massage training] in Arizona, I was assigned to massage a woman who was to receive packed platelets. Her platelet count was so low she was forbidden to brush her teeth because she might bleed out. The only safe massage was to gently move the hair on her skin with a little oil. I found her in a hospital bed in a corner of the infusion room. I could see the anxiety in her face and on her heart rate and blood pressure monitors. After the nurses started the infusion, I pulled the curtain and started to massage her face and scalp, arms and hands, lower legs and feet, and finally, her back. I could feel her become progressively more relaxed and I could see the change in both monitors. By the time I reached the middle of her back, she was sound asleep. What a demonstration of the power of touch and what a demonstration that often less is truly more." - Bruce Hopkins, LMT
"A year after treatment, Pat returned to massage. By then the meaning of the sessions had changed. Before cancer, the massages had been an extension of her fast paced life. When the sessions ended, she immediately stepped back into the high stress, all relaxation quickly forgotten. Now, time spent receiving massage has become sacred and meditative. Pat is in the here and now; she tunes into her body; and touch is an experience that deepens her awareness. These days Pat enjoys the good feelings massage brings to her body and holds on to those sensations as long as possible. Bodywork lets her let go of the tension, anxiety and fear that accumulated over months of treatment. - Gayle MacDonald, LMT
"After finding a lump in my right breast, I had a partial mastectomy with no lymph nodes removed. I was scheduled for 33 days of radiation. The doctors told me that radiation would cause my breast to shrink and become hard. Since I was a practicing massage therapist, I requested permission from my surgeon and radiologist to do self-massage to the breas. Both doctors were supportive. Three days after surgery, I began gentle massage around the incision. When I saw the surgeon two weeks later, he commented on how well I had healed. I reminded him of the massage - he just laughed.
A week later, I began six and a half weeks of radiation. Every day I gently massaged the entire breast without lotion, focusing on the breast being a loved part of my body. After the massage, I sought out the areas that hurt, generally sharp spots of pain at the lower bra line. I set my fingers on the spots and maintained gentle contact - they dissolved in seconds. My massage took two to three minutes, sometimes several times a day.
Each week I saw the radiologist. After three weeks he started commenting on the lack of redness - it finally appeared two weeks later. He suggested a lotion for dryness which I began using.
Two weeks after radiation was done, I saw the surgeon again. He could not believe the condition of my breast. What he saw and palpated was normal, soft tissue with a very light tan. He said this was the best tissue he had seen in twelve years of cancer surgery. I reminded him that I had performed breast massage throughout the process. He did not laugh this time. The oncology radiologist had similar comments.
A month after radiation, to keep the right pectoralis major from binding, I added Myofascial Release for two months. I am now two years cancer-free. I continued the massage for a year and a half before sore and dense tissue stopped appearing - even now I occasionally have to do some touch up. My breast looks and feels completely normal (except for the fact that I am missing pieces/parts). The surgical scar is soft and faint. There is no pain or discomfort and arm motion is completely normal.
My surgeon and radiologist are very impressed and are interested in using massage in treatment." - Susan Shields, LMT
"I worked with a quiet, middle-aged gentleman on the radiation floor where I do gentle shoulder, neck and hand massage. Near the close of our 20 minutes, he was in tears - he was so grateful for relief from the pain of treatment. I was so touched, I was in tears, too. Later one of his family members called me to schedule a full body session for him. She explained that, much to the entire family's surprise, he had no pain that day and told them he felt nourished for the first time in his cancer treatment.
She went on to explain that he is not a man who would do anything like this for himself. They were all surprised he took me up on my offer for shoulder massage. When they asked him why he did, he said, '... because she looked at me, right in the eyes, and I thought maybe I was supposed to be touched today.'" - Meg Robsahm, LMP
Some of these stories have been told before and so are credited here:
Gayle MacDonald , Medicine Hands, Findhorn Press, 2007, p 143
One Man's Massage Journey, Massage and Bodywork Magazine, Feb/Mar - 2007, pp45 - 49
This is an update of an item in Medicine Hands, supra note 1, p117
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