What do we need to know when we see a check mark in front of cancer on an intake form? Given the increasing rates of cancer and cancer survivorship, all massage therapists will come in contact with a client who has undergone or is currently living with cancer.
These clients will show up in all locations in which massage is offered—a spa, sports clinic, hospital, or home-based clinic.
Massage is an in-demand integrative health practice for many people living with cancer. Treatment for this disease impacts every aspect of a person’s life from the physical to the emotional. It can have an impact on finances, family situations and ability to work, and creates enormous stress.
Biomedical cancer treatments such as surgery, chemotherapy, radiation, immunotherapy, and hormone therapy can create side effects that along with many life stresses are all brought into the massage treatment room.
Listening to a client talk about all of the effects of their cancer treatment can be overwhelming. However, with some basic information and clear parameters on what we can offer, safe massage is well within the scope of practice of all massage therapists. By adapting already learned massage techniques and approaches, as well as considering factors such as pressure, site, position and duration, all therapists can offer safe treatment to someone living with cancer.
The Oncology Massage Intake
All massage therapy treatments start with intake. It is an opportunity to get to know our client and their treatment goals, identify signs and symptoms and evaluate whether the symptoms can be treated by massage.
During intake:
• Assess and respect all contraindications.
• Assess and respect all restrictions to pressure, site, position and duration
• Ensure that client’s treatment goals are consistent with the massage therapist’s knowledge of providing safe and effective treatment.
Once the massage starts:
• Proceed with caution.
• Maintain close communication with your client.
• Monitor client’s reactions throughout the treatment.
• Follow up afterwards to track client’s reaction to treatment.
Risk of Lymphedema
Cancer treatments impact the lymphatic system in a number of ways. Two of the most common are:
- Surgical removal of lymph nodes.
- Radiation treatment that causes lymphatic vessels to become dense.
These interventions increase the risk of developing lymphedema, forever. Massage therapy offered to someone at risk for lymphedema requires very careful adaptation of the site treated and pressure used during the massage.
Thermotherapy and Cryotherapy: The Use of Heat and Cold
The local effects of cancer treatment render all tissues from blood to bone fragile. Any type of heat (hot stones, heating pad, etc.) and the application of cold require careful consideration; their use can contribute to deeply damaging outcomes for the client.
Special attention is required for:
• Radiation-induced tissue damage that extends beyond visible skin changes and extends deep into the body’s tissues.
• Lymphedema risk* is elevated for anyone who has had lymph nodes surgically removed or who has undergone radiation and/or chemotherapy.
• Decreased sensation caused by surgery, chemotherapy or radiation that make it difficult for a client to assess if heat or cold is tolerable.
*For anyone at risk of developing lymphedema, the use of heat and cold is contraindicated because of fluid fluctuations that may be beyond the capacity of the tissues.
Lotion, Oil and Gel
Cancer treatments can have a profound effect on the skin causing it to become dry, itchy, fragile and sensitive to sunlight. Massage lotions, oils and gels must be carefully chosen to avoid exacerbating skin problems. Radiation therapy in particular has a very damaging effect on the skin. Most radiation departments have their own recommendations for lotions; ask your client what has been recommended to them.
For massage, the lubricant should be:
• Easy to apply with light pressure.
• Unscented (smell sensitivity can increase during chemotherapy).
• Made of high-quality ingredients to maximize nourishment of the skin.
Medical Devices
Depending on the type of cancer and treatment intervention, medical devices can be short or long-term guests in our client’s body. Some common medical devices include:
• A Portacath (See Figure 1) or PICC (peripherally inserted central catheter) line used to administer chemotherapy.
• A stoma (artificial opening to the outside of the body) can be placed in organs such as the colon or bladder, as well as in the trachea during a tracheostomy.
• Surgical drains, stents or shunts.
During massage treatment it is important to ensure that medical devices are not compressed or moved by pulling on surrounding tissues.
Common Medications
Massage treatments may require adaptation and consideration for the drugs being taken by their clients.
Pharmaceuticals are an integral part of biomedical cancer treatments and can bring a host of side effects. A few of the most common medications prescribed while undergoing cancer treatment include:
• Blood thinners that cause easy bruising and thinning skin.
• Steroids to combat inflammation can contribute to feelings of anxiety.
• Opioid pain medication can create a sense of confusion.
• Bone-stimulating drugs that cause deep bone pain.
Phases of Wound Healing
Cancer treatment can have an enormous impact on soft tissues. Surgical intervention may be nearly invisible (“keyhole” laparoscopic surgeries), small (lymph node removal, drain insertion) or large (mastectomy, liver resection). Radiation damage is also evident on the skin and in the deeper tissues, possibly contributing to palpable density, reduced mobility and pain.
Damaged tissue heals in predictable, overlapping stages. With no prescription protocol for working with damaged tissue, treatment practices are best guided by cautious progression, with careful observation of the dual outcomes of tissue change and client reaction. The possible occurrence of adverse events, for example increased pain, also needs to be monitored.
| Phase | Description | Physiological Changes |
| Hemostasis | Within minutes of injury | Fibrin clot formation stops bleeding. |
| Inflammation | Up to 6 days post-injury | Controls blood loss. Defends against bacteria. Wound has no tensile strength and a poor response to mechanical stress. |
| Proliferation | Lasts up to several weeks | New tissue formed to close wound. Slow increase in tensile strength with fibroblasts and collagen aligning along lines of stress. |
| Maturation or remodeling | Day 21 to several years | Scar tissue is organized along lines of stress until maximum strength and function are achieved. |
Massage therapy treatments are safe at any phase of healing from surgical and radiation procedures, providing there is:
• Adherence to the considerations for each phase of healing.
• The massage therapist has adequate training.
Cancer treatments are highly complex and each individual’s reactions are also complicated. Massage therapists don’t have to know everything about working with people with cancer. However, by increasing their knowledge they will be better able to address their client’s needs and improve treatment outcomes.
This article was excerpted from “Oncology Massage: An Integrative Approach to Cancer Care.” Copyright © Handspring Publishing 2021; reproduced with permission.
About the Authors
Janet Penny, RMT, calls Ottawa, Ontario, her home. Janet developed a treatment approach that addresses the multi-faceted needs of oncology massage clients; she is forever amazed at the resiliency of the human body and all it goes through, and she has extensive experience working with people living with cancer. Janet can be reached at info@focusmassagetherapy.ca. She offers online courses on safe practices in oncology massage.
Rebecca Sturgeon calls Louisville, Kentucky, her home. Rebecca has worked in clinical and community environments and is currently the education director for Healwell. Rebecca can be reached at education@healwell.org.
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