Massage is one of the oldest healing arts. Chinese records dating back 3,000 years document its use. The ancient Hindus, Persians and Egyptians applied forms of massage for many ailments. Hippocrates wrote papers recommending the use of rubbing and friction for joint and circulatory problems.
Today, massage therapy is part of many physical rehabilitation programs. It has also proven beneficial for many chronic conditions, including low back pain, arthritis, bursitis, fatigue, high blood pressure, diabetes, immunity suppression, infertility, smoking cessation, depression, and more. And, as many millions will attest, massage helps relieve the stress and tension of everyday living.
Massage, bodywork and somatic therapies are defined as the application of various techniques to the muscular structure and soft tissues of the human body.
- Massage: The application of soft-tissue manipulation techniques to the body, generally intended to reduce stress and fatigue while improving circulation. The many variations of massage account for several different techniques.
- Bodywork: Various forms of touch therapies that may use manipulation, movement, and/or repatterning to affect structural changes to the body.
- Somatic: Meaning “of the body.” This term is often used to denote a body/mind or whole-body approach, as distinguished from a physiology-only or environmental perspective.
There are more than 250 different types of massage, bodywork, and somatic therapies. Depending on the type of therapy, techniques may include stroking, kneading, tapping, compression, vibration, rocking, friction, pressure to the muscles and other soft tissues, passive or active movement, and/or techniques intended to affect the energetic systems of the body. Oils, lotions, or powders may be used to reduce friction on the skin.
Massage, bodywork and somatic therapies specifically exclude diagnosis, prescription, manipulation or adjustments of the human skeletal structure, or any other service, procedure or therapy which requires a license to practice orthopedics, physical therapy, podiatry, chiropractic, osteopathy, psychotherapy, acupuncture, or any other profession or branch of medicine.
Massage therapy in combination with traditional medical treatment has the potential to influence the body to heal in many ways. Massage is much more than just a “feel good” service. Massage relieves muscle tension and soreness and causes the body to release its natural painkillers. Additionally, massage aides in the elimination of toxic substances from the body, thus reducing stress. Although massage does not cure disease, it can help a patient enter into a deeply relaxed state, allowing for a reduction of stress, pain, anxiety and other symptoms related to illness and treatment.
Research indicates that cancer patients who integrate massage therapy into their treatment regimen report improvements with anxiety, pain and fatigue, a reduction in swelling, improvement of lymphatic drainage, in addition to feeling more relaxed and comfortable. There is also evidence that massage can help boost the cancer patient’s immune system as well as support individuals experiencing post-operative discomfort.
There are a multitude of other benefits of therapeutic massage including: improved circulation, improved flexibility and range of motion, increased blood supply and nutrition to muscles and organs, improved breathing, and speedier recovery from injuries and surgery. Massage therapy can ease the side effects of treatment by reducing pain and fever, restoring sensation by stimulating nerve endings to reduce neuropathy, slowing the rate of scar formation, and preventing atrophy from forced inactivity. In addition, there are many mental health benefits to massage: stimulation of endorphin release, increased mental relaxation, better sleep, reduced anxiety and stress, and uplifted spirit. Massage soothes the body, calms the mind, and revives the spirit.
Oncology massage is designed to meet the unique needs of someone in treatment for cancer or with a history of cancer treatment. An individually tailored session with an oncology-trained massage therapist can yield benefits for nearly all persons affected by cancer. Its benefits include:
- Reduced pain
- Decreased anxiety and stress
- Relief from nausea
- Diminished peripheral neuropathy
- Less swelling
- Increased energy, less fatigue
- Improved quality of life and sense of well-being
The Benefits of Oncology Massage
By Sat-Siri Sumler and Lorenzo Cohen, Ph.D.
Oncology massage is an approach to massage therapy based in both compassion and specialized massage treatments to help people manage their experience with cancer. Review of the scientific literature indicates oncology massage helps improve quality of life, improved relaxation, sleep, and immune function as well as relieving anxiety, pain, fatigue and nausea.
Oncology massage therapists are trained to meet people where they are in their experience with cancer and apply a highly individualized massage treatment to comfort, nurture and support them in their process.
The treatments are modified according to the full spectrum of cancer-related issues: the physical, psycho-social and emotional consequences of cancer. In addition, the person’s individual goals are considered and aspects of the disease and cancer treatment side effects.
Personal goals for receiving oncology massage can include the desire for a respite — a relaxing pleasurable experience in the midst of everything that is going on — relieving nausea or other symptoms such as pain or peripheral neuropathy and helping them get though the remainder of their cancer treatments.
In the past, therapists thought massage would increase circulation and therefore cause cancer to spread. The process of metastasis is very complicated and poorly understood; however increased circulation is not considered a significant part of that process by itself.
However, it’s true that cancer and cancer treatments can put people at risk for complications from massage, so it is important to take some precautions. Because of the different contraindications for massage in this population, it is very important for the massage therapist who is treating a person with a history of cancer – either currently or in the past – to have specialized training in oncology massage, in addition to being a licensed massage therapist.
Helpful questions to ask of your massage therapist
Massage can make your cancer journey easier … but not just any massage; an oncology massage. Many of the body’s responses to cancer and cancer treatment require changes to massage therapy. A properly trained therapist should be able to tell you why and how.
If you are currently receiving treatment or have ever received treatment for cancer in your life, the safest way for you to get massage is to find a massage therapist who has had appropriate training in the specifics of cancer and cancer treatment and how to use a knowledge of those specifics to provide safely adapted massage therapy for people at all stages of the cancer journey.
Below you will find a few questions that will help you to decide if a massage therapist has enough training to work with you and your unique medical history as it relates to cancer.
Ask if she/he has special training covering contraindications, modifications, and benefits of massage for people with a cancer history.
If not, keep looking. Providing massage therapy for a person affected by cancer is not something that should be done without training. Any therapist who tells you that they have not had training, but “it shouldn’t be a problem” or “It’ll be ok. I’ll just work lightly” simply doesn’t understand what kind of risks he/she is taking with your health and safety.
If so, was the training on the internet, a one-day course or a Society for Oncology Massage recognized course of 24 hours or more including lectures and hands-on experience?
The Society for Oncology Massage has agreed upon a standard core of elements that should be contained within any course that claims to be preparing massage therapists to work with people affected by cancer. We believe that competency in these elements and skills is essential to safe oncology massage. Typically, these compentencies are best achieved over a course of multiple days with an opportunity to receive hands-on instruction from an experienced instructor in a live setting and, ideally, including a directly supervised opportunity to work with an actual client affected by cancer. Most therapists are not able to safely learn and apply the information necessary when that information is provided online or through a course of one or less days. There are always exceptions, so you will have to use your intuition to decide how or if a therapist’s answer to this and other questions is satisfactory for you and your needs.
Ask about her/his experience working with people with a cancer history. How many and when?
As with any discipline, someone who has worked with many people over many years is going to feel preferable to most clients over someone who is just starting out. Keep in mind, however, that oncology massage is a relatively new discipline so many of the therapists you will encounter may be relatively new. There is so much to know about cancer and about the thousands of different treatment options and variations. No massage therapist will know it all, but the more training and experience a therapist has the more likely he/she is to know things pertinent to you and your situation.
Briefly describe your cancer treatment history and/or plan (include surgery, chemotherapy and radiation history) and ask what kind of modifications she/he might make from standard massage based on this information. Listen for things like changes in treatment time, pressure, positioning and joint movement, to name a few.
A properly trained oncology massage therapist should be able to tell you some basic adjustments he/she might make to your session based on a brief description of your treatment plan and/or history. It is a good sign if the information you share leads your therapist to ask you additional questions. Nothing is black and white with oncology massage. Many details of your history will lead your therapist to seek further clarification. “Oh, you’re receiving radiation? Is it external beam or brachytherapy?” “You mentioned you had a mastectomy. Did you have reconstruction? If so, what kind?” An oncology massage therapist’s curiosity may surprise you at first, but a curious therapist is a good therapist.
Ask how being immune-compromised changes things.
Oncology massage therapists know how important the immune system is and they know that cancer treatment poses a big challenge to the immune system. If you are immune-compromised your therapist should be taking hygiene-related precautions to keep you safe.
If you have had surgery or radiation, ask how she/he approaches the risk of lymphedema.
Lymphedema is a serious condition. If you are at risk, you have likely been told just how serious that risk is and what you need to do to prevent yourself from developing lymphedema. If you are at risk for lymphedema and the massage therapist you are about to see has never heard of lymphedema or doesn’t have a clear plan to keep your risk from developing into an acute condition, you need to keep looking.
Will you need your physician’s consent?
It is always a good idea, but it does not replace a properly trained therapist.
Will you need to give a complete medical and cancer history?
This is essential. If the therapist does not plan to take a complete medical and cancer history, keep looking. A complete history is essential to safe oncology massage. Many therapists feel that a thorough health history is an “inconvenience” for clients and many therapists practice in settings where the scheduling of appointments is such that there simply isn’t time to conduct a thorough health history and still offer a 50-60-minute session. Be that as it may, it simply isn’t possible to provide a safe massage session (oncology or otherwise) without a thorough health history.
All of these questions will help you to get a feel for how well-trained and prepared a given massage therapist is to support you safely and effectively. The many situations we have mentioned above do require changes to typical massage protocol. Some of the changes will be small and virtually imperceptible to you as someone getting a massage, but the making of these adjustments can mean the difference between healing support and acute complication. Listen for detailed, thoughtful answers. You want a massage that is effective and safe. It’s not “just massage”.
Source: Society for Oncology Massage
Massage Therapy for Patients with Cancer
According to the American Cancer Society, an expected 1,735,350 people will have been diagnosed with cancer in 2018—and approximately two-thirds of those diagnosed will survive. Traditional treatments like surgery, radiation and chemotherapy have had great success, but sometimes with crippling side effects that make the disease even more physically and emotionally taxing.
Today, more research is helping health care professionals and patients alike understand the role massage therapy plays in an integrative care plan. From providing stress relief to helping patients better handle symptoms such as pain and side effects like nausea, massage therapy can benefit cancer patients in a variety of ways.
As Heather Greenlee, ND, Ph.D.,
Medical Director of Integrative Medicine
at Seattle Cancer Care Alliance, puts it:
We have really good data now
showing that a lot of these integrative therapies can be used
to manage symptoms or side effects.
We still need to do more research
to understand how these therapies affect survival.
Massage therapy has shown promising results in helping the following symptoms of cancer and cancer treatment.
Source: Keith Borher
May 15, 2019
AMTA (American Massage Therapy Association)
Massage Therapy + Fatigue
When you are tired, you are not the same person. Fatigue can make some people short-tempered or simply limit how engaged they feel in the activities they may have enjoyed at one time. Oncology patients already have the mental strain of fighting a life-threatening disease, so helping them find ways to alleviate this symptom can improve their ability to continue participating in the things they value. According to some new research, massage therapy can play the vital role of mitigating fatigue in oncology patients.
A 2018 study1 by the Emory University School of Medicine compared the effects of six weeks of once-weekly Swedish massage therapy on cancer-related fatigue in breast cancer survivors against an active control condition (light touch) and wait-list control. This randomized, single-masked, three-arm study comprised 66 breast cancer survivors who had received surgery plus radiation and/or chemotherapy/ chemoprevention who also had cancer-related fatigue. Fatigue levels were compared by measuring the Multidimensional Fatigue Inventory (MFI) and National Institutes of Health PROMIS Fatigue scale at baseline and after the six-week intervention.
Results showed there was a statistically significant six-week reduction in MFI total scores for both the Swedish massage and light touch participants and a significant increase in MFI scores with the wait-list control group. “This finding suggests that six weeks of a safe, widely-accepted manual intervention causes a significant reduction in fatigue, a debilitating sequela for cancer survivors,” researchers explain.
Similar results were found in a 2018 study2 on cancer-related fatigue in 40 gynecologic cancer survivors. Participants were randomized to either the active treatment group or control. The active treatment group received one 40-minute massage once per week for eight weeks. The control group did not receive massage therapy.
After eight weeks of receiving one 40-minute session of massage therapy, gynecologic survivors’ scores on fatigue and insomnia showed significant improvement compared to those who did not receive massage therapy. The study also showed health-related quality of life improved in study participants who received massage.
There is also research that indicates integrative therapies can be helpful midtreatment, too. One 2018 study3 took 72 women with breast cancer (stages 1-3) scheduled for radiation therapy and split them into two groups: one that received reflexology once a week and the other a control group. Findings illustrated that after five weeks of radiation therapy, those who received reflexology had statistically lower levels of fatigue; quality of sleep post-10 weeks of radiation was also improved.
“The results of the present study indicate that reflexology may have a positive effect on fatigue, quality of sleep, pain and quality of life in breast cancer patients during radiation therapy,” researchers explain. “Reflexology prevented the decline in quality of life and significantly ameliorated the fatigue and quality of sleep of these patients.”
Sonia Tatninov, a massage therapist at Tulena Wellness in Brooklyn, New York, says her own experience is similar to what the research is finding. “Massage has a very direct effect in, at least temporarily, reducing fatigue, anxiety and often pain in cancer patients,” she says. “It is one of the few interventions that can provide some relief from the discomfort of peripheral neuropathy that can accompany chemotherapy treatments and still continue after treatment is completed.”
Massage Therapy + Lymphedema
Lymphedema is one of the most common conditions developed because of cancer treatment, causing swelling in the arms and legs that can be painful. For cancer patients dealing with this condition, lymphatic drainage has shown some promise. “When a massage therapist is trained in manual lymphatic drainage, they can play a huge role in helping to identify and treat lymphedema of the arm,” explains Tatninov.
“If the nodes have been removed, it is important for individuals to have the upper extremity drained from time to time to keep the lymphatic vessels open and working,” says Cynthia Oberdier, a licensed massage therapist and certified lymphatic therapist from Columbus, Ohio. “If no massage has been performed, an injury or insult to the extremity can cause the area to swell and become increasingly painful.”
The effects of lymphedema are long lasting and don’t fade easily. For that reason, Tatninov also emphasized the need for awareness and constant communication with clients who have lymphedema when administering any type of massage. “If they have had axillary lymph nodes removed, you want to use light pressure at the arm,” says Tatninov. “If they have had inguinal lymph nodes removed, light pressure to the leg. Likewise, if they have had cervical lymph nodes dissected, you’d only use light pressure at the neck.”
Massage Therapy + Depression
Depression is not an uncommon occurrence when dealing with cancer or even after surviving the disease. At a time when a patient is dealing with a lot of unknowns or worrying about possible outcomes, changes in mood can be expected but that doesn’t make depression any less troublesome.
There is some research, however, that massage therapy may help with depression and mood disorders in cancer patients. For example, meta-analysis indicated a significant association between massage therapy and alleviated symptoms of depression.4 Researchers also found that massage therapy helped significantly reduce depression in HIV patients when compared to light touch or no intervention.5
More recently, the Society for Integrative Oncology created evidence-based guidelines regarding the use of integrative therapies for breast cancer patients, both during and after treatment. After examining randomized trials from 1990 to 2015, researchers were able to identify major benefits of the different integrative therapies for breast cancer patients. “Meditation, relaxation, yoga, massage and music therapy are recommended for depression/ mood disorders,” they explain.
Massage Therapy + Nausea
Chemotherapy is typically an aggressive treatment that can have a variety of side effects, with nausea and vomiting being among the most common. While anti-nausea medication is often used for severe symptoms, new research indicates massage can play a role in helping patients find some relief from these symptoms.
A 2018 quasi-randomized controlled pilot study6 looked at the feasibility and preliminary effects of massage and inhalation aromatherapies on chemotherapy-induced acute nausea and vomiting. The 75 breast cancer patients were split into three groups: massage, inhalation and control. The massage group received 20-minute aromatherapy foot massages before their second, third and fourth chemotherapy cycles, while the inhalation group received three-minute inhalation aromatherapy on the same schedule. The control group received routine treatment.
Results showed that the incidence of nausea and vomiting were significantly higher in the control group than in either of the two active groups in the third and fourth chemotherapy cycles. “Furthermore, in these two cycles, the incidence of nausea and vomiting was significantly lower in the massage group than the inhalation group,” researchers note.
Another recent study suggests integrative health care can help alleviate chemotherapy-related nausea, as well as provide a wide variety of other benefits to oncology patients, including reducing pain and anxiety and promoting better sleep.7 Similarly, a 2017 study8 looking at integrating massage into chemo-infusion suites found that massage programs can provide symptom relief—including nausea—and can be safely and effectively added to chemo-infusion suites.
Massage Therapy + Pain
Pain is a part of a wide variety of health conditions and cancer is no different. Whether it is from the disease or the treatment does not matter to the patient; they just want to find some relief so they can focus on their health and well-being.
Here, too, research has shown the promise of massage therapy. A meta-analysis on the effects of massage therapy found that massage significantly reduced cancer pain compared to no massage control conditions.9 In another quasiexperimental study examining massage therapy’s effect on pain and anxiety in 25 children with cancer undergoing intrathecal therapy or bone marrow aspiration, the experimental group received massage therapy while the control group received standard care. Results showed the children who received massage therapy reported less acute procedural pain from intrathecal therapy or bone marrow aspiration than children who received standard care.
Massage Therapy + Giving Patients Control
The unpredictable nature of cancer can sometimes make patients feel powerless. According to Greenlee, however, that is sometimes where massage therapy really shines—helping oncology patients regain a sense of control.
“I think that being involved in integrative medicine or using integrative medicine can be very empowering to patients,” Greenlee says. “It is something that they can do on their own, and the approach that we take is that we want patients to be as healthy as possible so that they can also receive their treatment.”
Additionally, the relationship cancer patients have with their massage therapist can also be empowering, helping the patient feel more like a whole person than just their diagnosis. Laura Dutton, a massage therapist with the Seattle Cancer Care Alliance, emphasized the importance of this dynamic and how it can truly make a difference. “I think it is that sense of being treated as a whole person,” she explains. “We have an incredible opportunity as massage therapists to spend a concentrated amount of time with patients in a sort of continuous care setting, so you also can help people better manage their own self-care.”
References
1. Kinkead B, Schettler P, Larson E, Carroll D, Sharenko M, Nettles J., Edwards S, Miller A, Torres M, Dunlop B, Rakofsky J, and Rapaport M. “Massage therapy decreases cancer-related fatigue: results from a randomized early phase trial.” Cancer. (2018) Feb1:124(3): 546–554.
2. Donoyama N, Satoh T, Hamano T, Ohkoshi N, and Onuki M. “Effects of Anma therapy (Japanese massage) on health-related quality of life in gynecologic cancer survivors: a randomized controlled trial.” PLoS One. (2018) 13(5).
3. Tarrasch R, Carmel-Neiderman NN, Ben-Ami S, Kaufman B, Pfeffer R, Ben-David M and Gamus D. “The effect of reflexology on the pain-insomnia-fatigue disturbance cluster of breast cancer patients during adjuvant radiation therapy.” J Altern Complement Med. (2018) Jan; 24(1): 62–68.
4. Hou WH, Chiang PT, Hsu TY, Chiu SY, Yen YC. “Treatment effects of massage therapy in depressed people: a meta-analysis.” J Clin Psych. (2010) 71:894–901.
5. Poland RE, Gertsik L, Favreau JT, Smith SI, Mirocha JM., Rao U, and Daar ES. “Open label, randomized, parallel-group controlled clinical trial of massage for treatment of depression in HIV-infected subjects.” J Altern Complement Med. (2013) 19:334–340.
6. Zorba P, and Ozdemir L. “The preliminary effects of massage and inhalation aromatherapy on chemotherapy-induced acute nausea and vomiting: a quasi-randomized controlled pilot trial.” Cancer Nurs. (2018) Sep/Oct; 4(5): 359–366.
7. Armstrong K, Lanni T Jr., Anderson MM, and Patricolo, GE. “Integrative medicine and the oncology patient: options and benefits.” Support Care Cancer. (2018) Jul; 26(7): 2267–2273.
8. Mao JJ, Wagner KE, Seluzicki CM, Hugo A, Galindez LK, Sheaffer H, and Fox KR. “Integrating oncology massage into chemoinfusion suites: a program evaluation.” (2017) Mar; 13(3).
9. Lee SH, Kim JY, Kim SH et al. “Meta-analysis of massage therapy on cancer pain.” Integr Cancer Ther. 2015 Jul; 14(4):297–304.
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