During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that require research and writing. Some of these assignments result in very insightful and well thought out information and decision-making outcomes. I am happy to share some of their assignments for you to enjoy.
Massage Therapy is a form of touch-therapy, aimed at providing relief from physical and psychological ailments. For the purposes of this essay, the massage style I am referring to is generally Swedish Massage.
In researching the statement, "Massage can spread cancer and is always contraindicated," I have found many types of articles that explore concepts and beliefs surrounding massage. These papers include randomised trials (6,8), single case studies (9), literature reviews (2,11), expert opinions (1,3,4,14), surveys (5,10,12,13), and quasi-experimental designs (7). Often, the numbers in the studies are small, reducing the power of the studies. The most valid, or strongest level of evidence, is randomised controlled trials (RCTs). There seems to be a paucity of well-designed and large scale RCTs in this field of study. Researchers have expressed the desire for further research and increasing the power and quality of the study desgins. Better quality research, and positive outcomes supporting the benefits of massage therapy, will increase the standing of massage therapy as a true evidence-based health care treatment in oncology. I have included a range of articles of variable quality, hoping to encompass both the facts about good cancer care and current professional opinion. Most of the articles have been drawn from clinical journals which suggests that they have a reasonable level of validity.
To question if the statement is true or false, one needs an understanding of what cancer is. Cancer is a disease that can take many forms. There are cancers that involve the blood (e.g. leukemias), cancers involving the musculoskeletal system (e.g. osteosarcomas), cancers involving the reproductive system (e.g. breast and prostate), and cancers involving the major organs of the body (e.g. liver, lung, colon), just to name a few. Cancer can strike anyone, of any age, of any gender and of any race. It is a disease that often results in the demise of its victim if treatment is not swift and rigorous. Cancer involves the uncontrolled division of abnormal cells, resulting in tumors within the primary tissue that can spread, or metastasize, though out bodily systems. Cancer treatment is often harsh and leaves the sufferer to deal with sequelae that can linger for years beyond the active phase of cancer treatment. There appears to be much demand for massage therapy in this population, to help relieve some of the suffering. This treatment is often sought during active cancer treatment, long after cancer treatment has ceased, and in the terminal phase of the illness (palliative care).
In researching this statement, I have explored recent articles that have investigated massage therapy given to different groups of cancer patients throughout the world, and also looked at the theories that cover tumor behaviour, and the opinion of massage experts regarding the safety of massage in this special population of massage clients.
I have been unable to find any recent articles that support the notion that cancer can be spread by massage. Corbin (14) reports that there is "no evidence that massage can spread cancer." As stated by MacDonald (1), it is a myth that massage can spread cancer. "The good news is that the contraindication against massage, based on the irrational fear of metastasis, is well on its way out of massage pedagogy." MacDonald goes on to point out the considerations of therapists in planning and conducting massage therapy on people with active cancer, as this condition does often dictate local contraindications to massage therapy.
Even to this day, it is not clear to researchers and practitioners how cancer spreads throughout the body. One theory (2) is that cancer cells appear to move from their primary site via blood and lymph vessels. The implication of this, in terms of massage, would be that it would be prudent to avoid any area that has active cancer tumor activity, to avoid encouraging such movement of cells from the tumor. However, there is no evidence that I have found to support the notion that massage is contraindicated if massage is conducted away from the tumor site.
Several authors have recommended that oncology massage is most safely performed by licensed massage therapists who have specific intensive training in cancer care (1,3,4,5). In terms of massaging a client with active cancer, the therapist must take precautions in providing a safe treatment. Things to consider include: the therapist should involve the client's primary cancer physician in treatment planning; the client should be screened for local contraindications, including increased risk of fractures (bone metastases or primary tumors), bleeding (anemia), infection or increased risk of neutropenia, and pain levels and location. The therapist would also screen for the standard contraindications to treatment. Therapists need a thorough understanding of what clients are dealing with while undergoing active cancer therapy (including chemotherapy and radiotherapy side effects), and what clients can continue to suffer from well after their treatment has ended.
The type of massage given to cancer patients needs to be modified. Walton (4) describes the type of massage she recommends giving during chemotherapy treatment as being gentler in pressure, slower in speed, decreased friction, modified treatment position if required, regular assessment of the client regarding day to day function and well-being, and extra care with infection control and hygiene (immunosuppression). This, along with a trained oncology massage therapist and consultation with the medical physician, will enhance safety and effectiveness of treatment. Other researchers have made similar suggestions in terms of treatment modifications (6,7,8,9).
Many studies have found that massage is beneficial in cancer patients, particularly with helping reduce pain levels (6,11,12,14), depression and anxiety (7,8,13,14), and improving a general sense of well-being and empowerment (5,10). Other benefits of massage therapy include increased relaxation (5,8,9), improved sleep (6,12), and decreased perceived abdominal bloating (7). Studies have looked at massage in both clinical and residential settings. 20% of cancer clients seek massage during and after their treatment phases (12, 13, 14).
The expert opinion of one author (3) referred to the instance where massage therapy is contraindicated in cancer clients (aside from any other contraindications, e.g. systemic illness or inflammation, acute DVT or infection), being where the therapist that has no oncology training. The author then states that massage is indicated in cancer clients in the hands of a trained oncology massage therapist, especially in cancer survivors, in consultation, again, with their medical physician.
In summary, there is no conclusive evidence to support the idea that massage spreads cancer, and there are many researchers, physicians, clients and massage therapists who advocate massage therapy as beneficial during all phases of cancer treatment. Essentially, the research I have referred to contradicts the statement "massage can spread cancer and is always contraindicated." Massage therapy is safest in this client group when provided by therapists trained in oncology massage. Cancer patients can have massage therapy safely, as long as their therapist continues to review their condition at each session, and screens for local and absolute contraindications to treatment, and modifies treatment accordingly.
What implications does this finding have for me and my practice? I am deeply interested in providing care to people with cancer. I want to be able to help relieve their suffering and educate them about the healing and recovery process. I am relieved that the statement appears to be false as I have provided massage therapy to clients in the past (both as a physiotherapist and a lymphedema therapist). In terms of my learning and future practice, I have enrolled myself in an oncology massage therapy course, to give me the tools and confidence to continue treatment for this group of clients in the safest way possible. I feel there will also be the potential for me to participate in educating other massage therapists in the future in oncology massage, and for me to consider participating in researching this area further.
Is research important in the massage profession? I believe it is. I want to have evidence based on research to support the foundations of the therapy I give to clients and to help dispel any myths that are hindering patients from receiving good and necessary care. This will boost the confidence of myself and clients and that of referring professionals. I do not want to provide treatments to clients that will either not benefit them or potentially harm them.
MacDonald, G. "Massage Therapy in Cancer Care: An Overview of the Past, Present and Future." Alternative Therapies 2014 Vol 20 Suppl 2:12-15
Bockhorn, M, Jain R and Munn L. "Active versus passive mechanisms in metastasis: do cancer cells crawl into vessels or are they pushed?" Lancet Oncology 2007 May; 8(5); 444-448.
Handley, W. "Massage for Cancer Patients: Indicated or Contraindicated?" Massage Today 2007 January Vol 7 Issue 1 (www.massagetoday.com)
Walton, T. "Chemotherapy and Massage." Massage and Bodywork Magazine for theVisuallyy Impaired." May/Jun 2011 (found online www.abmp.com)
Furzer B, Petterson A, Wright K, Wallman K, Ackland T and Joske, D. "Positive patient experiences in an Australian integrative oncology centre." BMC Complementary Alternative Medicine 2014; 14:158 (published online 2014 May 14)
Toth M, Marcantonio E, Davis R et al. "Massage Therapy for Patients with Metastatic Cancer; A Pilot randomized controlled trial." Journal of Alternative Complementary Medicine 2013 Jul; 19(7); 650-656
Want T, Wang H, Yang T et al. "The Effect of Abdominal Massage in Reducing Malignant Ascites Symptoms." Research in Nursing and Health 2015, 38:51-59
Taylor A, Snyder A, Anderson J et al. "Gentle Massage Improves Disease-and Treatment-related Symptoms in Patients with Acute Myelogenous Leukemia." Journal of Clinical Trials 2014:4
Lu W, Ott M, Kennedy S et al. "Integrative Tumor Board: A case report and discussion from Dana-Farmer Cancer Institue." Integrated Cancer Therapy 2009 Sep: 8(3):235-241
Dunwoody L, Smyth A and Davidson R. "Cancer patients' experiences and evaluations of aromatherapy massage in palliative care." International Journal of Palliative Nursing 2002,8:10, 497-504
Miladinia M, Baraz S, Zarea K and Nouri E. "Massage Therapy in Patients with Cancer Pain: A review on Palliative Care." 2016. Published online Sept 27. Jundishapur J Chronic Diseases Care.
Dhanoa A, Yong T, Yeap S, Lee I and Singh V. "Complementary and alternative medicine use amongst Malaysian orthopaedic oncology patients." BMC Complementary Alternative Medicine 2014; 14: 404
Cushall S, Cha S, Ness S et al. "Symptom burden and integrative medicine in cancer survivorship." Support Care Cancer 2015 23:2989-2994
Corbin, L. "Safety and efficacy of massage therapy for patients with cancer." Cancer Control 2005 Jul 12:3