What is Oncology massage?

Oncology massage is the modification of existing massage therapy techniques in order to safely work with complications of cancer and cancer treatment. Anyone who has ever received cancer treatment, from those in active treatment to those in recovery or survivorship, as well as those at the end of life, are best served by a massage therapist who has been properly trained in oncology massage.

Essential aspects of an oncology massage therapist's skill set are an informed understanding of the disease itself and the many ways it can affect the human body; the side effects of cancer treatments, such as medications, surgery, chemotherapy and radiation; and the ability to modify massage techniques in order to adapt for these side effects, as well as for the disease.

Oncology Massage Assessments

Clinical assessments and adaptations to the massage session for someone experiencing cancer or with a history of cancer treatment are critical to providing a safe massage. Standard oncology massage intake questions include those pertaining to:

cancer treatment history
tumor site or metastasis
compromised blood cell counts
lymph node involvement
blood clots or blood clot risk
medications (short and long term)
vital organ involvement
fragile or unstable tissue
medical devices
fatigue, neuropathy, or pain
changes in sensation
late effects of treatment

A properly trained massage therapist will ask questions about these issues and more, depending on your unique situation. Many of the changes that will be made to your session will be virtually imperceptible to you as a recipient (and others may be quite obvious), but they are essential to safety and proper support of your well being.

Oncology Massage Guidelines

Clinical assessments and adaptations to the massage session for someone experiencing cancer or with a history of cancer treatment are critical to providing a safe massage.

For people in active treatment, recently into recovery, or at end of life, these clinical considerations can and do regularly change. Massage modifications as a result of positioning, pressure, pace or site considerations related to concerns like medical devices, side effects of drug treatments, surgery or radiation, compromised lymph nodes or blood cell counts, and other concerns, may apply, and are unique for each person and each session.

Certain massage modifications will remain crucial even decades after treatment is complete. When providing massage for someone who has a history of cancer treatment, primary massage considerations include but are not limited to bone integrity, vital organ involvement, and compromised lymph nodes.

Why Oncology Massage Training?

Q: Why is it important that a massage therapist have special training before working with anyone who is being treated or has been treated for cancer?

A: Each of the following common cancer related conditions (and others) require substantial adjustments be made for the client's comfort and/or safety. The massage therapist must know what particulars to elicit from the client and then know the corresponding adjustments.

Anemia (low red blood count) Anticoagulant Therapy Ascites (fluid in the abdomen) Bone Metastasis (spread of cancer to bones) Breast Expander or Implant Chemotherapy Colostomy / Iliostomy / Jejunostomy / Urostomy Constipation Deep Vein Thrombosis Edema Foley Catheter Immunosupression (immune compromised) Incision IV Leukopenia (low white blood count) Lymphedema 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) Tumor Upcoming Radiation

Q: Why isn't the client's physician's approval for massage enough?

A: 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. Not so for massage therapy which 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. It is better for the client/patient to see a trained oncology massage therapist who will automatically adjust the massage for patient safety and will include the physician in the massage care plan conversation if needed.

What are the benefits of massage for someone with cancer?

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.

General Benefits

● deep relaxation ● reduced stress ● improved sleep ● eased constipation ● increased alertness and mental clarity ● reduced anxiety ● less nausea ● reduced pain

Following Surgery

● 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

Emotional Benefits

● 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

What are people living with cancer saying about oncology massage?

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."

What is the medical community saying about oncology massage?

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 psychologic 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