Massage Therapy & Cancer

Massage Therapy, as a field, is far broader than most people would think.

What I find comes to most people’s minds when I tell them I work as a massage therapist is the concept of a spa massage; lighter pressure, hot towels, steam treatments, tinkley chime music. Mileage may vary, but luckily the general cultural consciousness is starting to shift from only viewing massage as a luxury wealthy people get to something that truly belongs as part of an overarching health plan for any given person.

Massage therapy is a highly regulated field, with almost every state in America requiring 500-1200 hours of study (1-2 year intensive programs). Massage therapists themselves work in a great variety of settings, from health and wellness centers, to hospitals, to alongside physical therapists and chiropractors, to individually or with studios and smaller clinics.

What’s important for now is that thanks to the breadth of options and the many levels and focuses of different massage therapists, there’s a modality or ten for just about everybody; and across the board, the majority of healthcare professionals, including physicians and physical therapists, recommend their patients towards massage therapy (AMTA, 2023).

Source: AMTA, 2023. From their Massage Therapy Industry Fact Sheet.

Nearly everyone can benefit from massage; in the field, we consider indications and contraindications - the former being things that suggest strong benefit from massage therapy, while the latter either cautions extra care or outright recommends against massage therapy. The most common contraindications are things like open wounds, broken bones, blood clots, active fevers, burns, or severe dizziness or nausea.

Beyond that, a great many conditions and daily plights can be helped by massage therapy. From the aches and pains of working at a desk all day (or standing all day), to mental health ailments such as anxiety, depression, and stress, to managing pain from the general to specific conditions like fibromyalgia, to providing great benefits for tackling heart health or joint pain, and to helping manage the side effects of cancer. Overall, the affective touch of therapeutic massage influences cell physiology, stimulates the nervous system in positive ways, and provides a sense of a personalized health practice that assists in positive health outcomes (Lebert, 2023).

The last of these populations is the focus of this page - how do massage therapy and cancer intersect? What about those old myths about massage therapy being at odds with cancer treatment? What biological, physiological effects does cancer have on the body, and how can massage therapy help?

As a massage therapist, this strongly affects my day-to-day and how I communicate with clients and the world at large about my profession. While I anecdotally have a great amount of experience and hearsay about the many benefits my clients experience (I consider myself lucky enough to be the kind of specialist and skilled therapist to be booked 8-12 weeks out, solid), I also prefer to have research and base scientific understanding to both provide better care and help educate my clients.

What Are the Biological Effects of Massage Therapy?

What is massage therapy? Well, if you look up most articles whether in a pop culture magazine or a health website, you’ll find some definition not far from what is offered by the Mayo Clinic (2021): that massage is “a general term for pressing, rubbing, and manipulating your skin, muscles, tendons, and ligaments,” and that it “has been used for thousands of years in many cultures to heal, soothe, and relieve physical and emotional pain.”

Not bad as far as definitions go, but broad, to say the least! As a massage therapist who has studied widely and worked with a great variety of specialists - and acts as a specialist in a particular modality, myself - I always follow up with the variety of massage therapies there are to try. As in part explained by Dorwart (2023), some of the most popular types include:

• Swedish massage - the type most people think of, involving effleurage, compression, and kneading techniques, and more, and the one most often practiced in spa and other clinic settings.
• Manual lymphatic drainage (MLD) massage - featuring lighter pressure, it focuses almost solely on the lymphatic system, moving the fluid from where it might have collected in the body and reducing lymphedema as well as related swelling, stiffness, and the pain associated with it.
• Deep tissue massage - while often compared or perceived as simply Swedish massage with deeper pressure, deep tissue massage particularly targets deeper layers of tissue and is often referred to as more therapeutic.
• Sports Massage - dialed in towards athletes, active and passive stretching techniques are often used in sports massage, and the specific purpose is to prevent or treat athletic injuries.
• Shiatsu - a Japanese modality that developed from methods of traditional Chinese medicine, focusing on acupressure techniques - that is, using the same points acupuncture uses, but applying pressure instead of using needles.
• Prenatal Massage - a subcategory of Swedish massage in many aspects, massage therapists trained in prenatal massage work in the lighter end of the pressure spectrum and focus on pain management, improved circulation, and the general mood improvements that come with massage therapies.
• Thai Massage - one of the oldest forms of massage, traceable to 2000 years ago, if not more, it effectively combines stretching and massage, as well as acupressure techniques. This is one of the fewer forms of massage that usually keeps clients clothed, and often works on the ground on a mat as the therapist puts the client into passive yoga poses and uses range of motion techniques coupled with massage work to release muscle tension and improve your mobility. (Can you tell that this one is my specialty?)
• Other specific forms of massage - myofascial release, craniosacral release, barefoot massage (aka ashiatsu), hot stone massage, reflexology, TMJ release therapy, Tok Sen, Tui Na…

… and that is to say nothing of just how specialized an individual massage therapist can be within any or multiple of those fields!

The field has been around for thousands of years, indeed, but in particular the last two decades have seen an explosion of popularity and gained recognition for it as an important and highly beneficial aspect of body care, in line with increased understanding at large of the benefits of clinical care that includes physical therapy, more targeted and varied exercise, and the importance of preventative care that is far more holistic.

Source; Lebert, 2023; from Massage Therapy: An Evidence Based Framework.

All in all, massage therapies across the board share the goal of a cultivating a therapeutic response in the body's physiology, and through the mental and emotional benefits of positive, therapeutic touch.

What is Cancer, and How Does It Work?

“Cancer is a disease in which some of the body’s cells grow uncontrollably and spread to other parts of the body.” - cancer.gov site

As many of us have at the very least known someone close to us with cancer, or perhaps have fought it personally, it feels odd to define it. But it is critical to start from the clarification of the base of the condition. Cancer can occur throughout the human body, can come from genetic mutation or environmental influence, and can result in lumps of tissue known as tumors, which may be benign or malignant (American Cancer Society, 2022). The latter will spread to nearby tissues as well as potentially spread further away in the body, usually via the lymph system; this process is called metastasis.

Cancerous cells have effectively lost the ability to eventually experience cell death, while also quickly losing all specialization and invading the surrounding tissue. Despite this, they are still recognized as “self” cells by the body, making it more difficult for something like the immune system, which normally targets “non-self” cells, to react against it. They also release chemicals that encourage blood vessels to grow towards tumors, providing oxygen and nutrients, further fueling their rapid growth.

While risk of developing cancer can be genetic, roughly 5-10% of cancers are caused by mutations that are passed on from an individual’s parents; “the remaining 90 to 95 percent of cancers are caused by mutations that happen during a person’s lifetime as a natural result of aging and exposure to environmental factors, such as tobacco smoke and radiation,” (National Institutes of Health, 2021).

Most treatments for cancer either target a specific site of cancer, such as via a form of radiation therapy, or use drugs to chemically combat the cancer by targeting specific points in the cell life cycle, such as chemotherapy. Gene therapy and cloning is also being investigated, primarily honing in on the replacement of nucleotides that influence cancer’s development and growth or other risks.

How Do Massage Therapy and Cancer Intersect?

Due to the fact that to the layman, metastasis of a tumor appears to be as straightforward as the tumor “breaking off” and spreading to other parts of the body, there was a long-lived bias against massaging cancer patients. However, there is little to no research with a strong evidential claim to this effect, beyond those that have found direct manual manipulation of tumor sites - and areas affected by bone cancer - to not be recommended. However, this was never the point or goal of oncology massage. Thanks to more research and better education about the topic, however, we now know that gentle massage can be greatly beneficial to cancer patients.

Massage therapy is not used to treat the cancer itself, but rather, the symptoms and effects of cancer as well as the toll treatments can take on an individual.

While massage therapists take care to not massage over a tumor, or indeed over any areas strongly affected by radiation therapy or similar treatments that can leave the body weak in the area, massage in other areas provides many benefits (Eldridge, 2022). The core list of these benefits include:

• Decreased inflammation and swelling
• Improved circulation
• Relief for sore musculature
• Lowered stress hormone levels in the blood
• Emotional benefits, such as relaxation, positive distraction, reduced anxiety, and more

In particular, it cannot be overemphasized how important the aspect of caring touch is. Given the oxytocin, dopamine, and serotonin released by positive physical touch, as well as the reduction of cortisol, alongside the benefits to the circulatory system, the lymphatic system... these in turn cascade to helping everything from digestive function to brain function. The wear and tear of cancer on both overall physical as well as mental health takes a heavy toll, and while efforts to cure or treat it are the most critical, the quality of life of the patient is something that is absolutely worth prioritizing as well, and there are a great deal of studies showing these very benefits to cancer patients, including from the article "Massage therapy decreases cancer-related fatigue: Results from a randomized early phase trial," (2018), as well as "Massage therapy can effectively relieve cancer pain: A meta-analysis," (2023), "The value of massage therapy in cancer care," (2008), and "Therapeutic massage during chemotherapy and/or Biotherapy infusions: Patient perceptions of pain, fatigue, nausea, anxiety, and satisfaction," (2016).

But what are the primary contraindications for massage while getting cancer treatment?

Overall contraindications include (Eldridge, 2022):

• Known blood clots
• Infection
• Severely low white blood cell count
• Severe thrombocytopenia
• Lymphedema (unless in the specific case of Manual Lymphatic Drainage massage)

But more often than not it is mostly recommended to avoid localized contraindications - that is, to avoid work on a specific part of the body, but treat the rest. These include:

• Skin breakdown (particularly at site of radiation therapy)
• Severe bruising, or weakened area that increases your risk of bone fracture
• Site of tumor and immediate surrounding tissue

The benefits of massage continue should the patient go into remission, and as they heal from any aggressive treatments or surgery, over time and with physician and oncologist approval, more variety of massage therapy treatments that can provide additional benefits can be worked in.

And likewise, should palliative care be what is needed instead, the same benefits as mentioned prior that exist during cancer treatments will remain. Palliative massage therapy is a lesser spoken-of niche, but makes a great impact on people’s lives, whether they have support systems in place or face a difficult time relatively alone. It is often cited as a welcome reprieve from the constant cloud of their condition and the stress and emotional fatigue of end-of-life.

I have many clients who have had cancer, and still more who know someone who is going through it. To be able to speak more confidently and share this knowledge with more people is a true gift. I hope to better communicate with my clients, both in a general informative sense, and more specifically with those who are perhaps seeking insight for loved ones on whether or not they should recommend massage therapy while undergoing cancer treatments.

Many massage therapists have "regulars", long-lasting therapist-client relationships that span years. There is often talk on educational aspects of navigating self care in the physical health sense. While the topic of cancer is just one particular branch of this, it is a major one with a devastating and deeply personal impact. To be informed is to better speak with care, professionalism, confidence, and even empathy - all critical things to have in spades in this field.

It may seem obvious that massage therapy is good for you and can, at the least, provide feel-good benefits regardless of the specifics. But knowing the specifics is not only empowering, but improves safety, healthcare, and patient outcomes. As a massage therapist, having a stronger basis in the basic biology of the body and of how cancer occurs, the effects it has, and how it is treated is of significant benefit.