Introduction

Massage therapy is the scientific, systematic, manual, or mechanical manipulation of the soft tissues of the body for the purpose of normalizing those tissues. It employs manual techniques that include applying fixed or movable pressure, holding, and/or causing movement of, or, to the body. Movements such as rubbing, kneading, pressing, rolling, stroking, and tapping, for therapeutic purposes, promote circulation of the blood and lymph, relaxation of muscles, relief from pain, restoration of metabolic balance, and other benefits both physically and mentally.

Touch is the foundation and cornerstone of massage therapy and has a long history of use as a healing tool. Both Eastern and Western civilizations found that touch can aid in the natural healing process, relieve pain, and prevent and cure symptoms of different illnesses. In addition, the touch of the massage therapist reduces stress and produces deep relaxation. While massage can be described in terms of the type of techniques performed, touch is not used only in a mechanistic way in massage therapy. This is especially important when performing an oncology massage. An oncology massage is a form of touch that causes no pain. Oncology massage therapy (OMT) is individualized to the unique needs and circumstances of the person with cancer. It takes into account the location of the cancer as well as its treatment to ensure the safety of the person being treated.

OMT should only be provided by a massage therapist who has received specialized training in the specifics of cancer and cancer treatment. This specialized training is more about cancer, cancer treatment and their impact on the body, and less about massage. During an oncology massage, the patient receives traditional, established massage therapy techniques that have been adapted to account for one’s unique health situation. The changes that might be made to massage that make it an “oncology massage” can fall under any number of categories, but typically, they will be related to primarily the pressure used, (i.e., a noninvasive, compassionate touch); the direction of the strokes (always toward the heart, never away from it); the length of the session; and positioning of the body, including areas of specific concern.

History

Massage is one of the earliest remedial practices of humankind, dating back thousands of years in ancient cultures that believed in its medical benefits. As one of the oldest health-care practices reported in history, it is described as the most natural and instinctive means of relieving pain and discomfort. The first written records of massage therapy are found in treatises from China and Egypt. Hippocrates wrote in the 4th century BCE: “The physician must be acquainted with many things and assuredly with rubbing.” The ancient Greek term for massage was “rubbing.”

While massage therapy began as a sacred system of natural healing, cultural shifts rendered it a disre-putable form of indulgence for extensive periods of history. However, between the period of 1600 and 1800, numerous physicians and scientists observed and documented the benefits of massage. It was not until the 19th century that different techniques in massage were advanced by western practitioners.

Per Henrik Ling was a Swedish physician who developed the Swedish Gymnastic Movement System. This system incorporated medical gymnastics, physiology, and massage. The massage consisted of various manual techniques such as stroking, striking, pressure, and squeezing that will be described later in the chapter. The massage method he created is commonly known as Swedish massage. Today, massage is one of the most popular healing modalities, being used by both conventional and alternative medical practitioners. Some believe that some of the roots of physical therapy are outgrowths of massage and its various techniques.

Complementary Versus Alternative Therapy

The terms “complementary” and “alternative” are often used as though they mean the same thing. And although they are sometimes combined into one phrase—complementary and alternative therapies—they are different. Complementary therapies are used alongside conventional treatments and medicines, usually to manage side effects. Alternative therapies are used instead of conventional treatments. Many complementary therapies are being scientifically researched for use in people with cancer, while alternative therapies are unlikely to have been tested in this way. Massage therapy is a complementary therapy.

OMT is based on the premise that each person is unique and is to be treated as such. It is an art expressed through the hands of a skilled therapist, with an ever so gentle touch, to be able to work with the superficial lymphatic system and the muscular system of the oncology patient.

Benefits of Oncology Massage Therapy

The benefits of massage therapy in breast cancer were reviewed in a systematic review from 1990 to 2015 by Greenlee et al. in 2017. Massage therapy was noted to have a beneficial role in reducing anxiety, stress and improving mood disturbance, as well as in reducing pain and promoting relaxation. Aromatherapy massage was found to have a beneficial effect on reducing anxiety in another metaanalysis, although it was unclear if the addition of aromatherapy to the massage therapy added a significant additional benefit. In a large metaanalysis performed on the role of massage therapy in cancer pain, massage therapy was found to significantly reduce cancer pain when compared to no massage therapy or conventional care. It was reported to be especially beneficial for surgery-related pain. Foot reflexology appeared to be more effective when compared to other types of massage. In a large prospective, nonrandomized, observational study, short-term symptom scores for pain, fatigue, stress, anxiety, nausea, and depression are declined by approximately 50% following massage therapy. Swedish and light touch were reported to be better than foot massage. Massage therapy may also be useful for the prevention and treatment of neuropathic pain, chronic localized pain and decreased upper extremity mobility after breast cancer surgery, improvement of quality of life and reduction of physical complaints in survivors of gynecologic cancer, and following autologous tissue reconstruction after mastectomy for breast cancer.

For someone who is receiving treatment for cancer or recovering from it, massage can also provide additional benefits, including improvements in mental clarity, alertness, sleep, and meaningful social interactions.

Contraindications to Massage Therapy

OMT is generally considered to be safe, and complications are rare when treatment is rendered by skilled massage therapists. The contraindications to massage therapy are based on the therapist’s knowledge of the patient, the cancer and its metastatic sites, as well as the treatments used to treat the cancer—chemotherapy, radiation therapy, and surgery. Massage therapy should not be performed (1) directly over a surgical site until the surgical scar is fully healed with no evidence of infection; (2) directly over a mediport access site; (3) directly over skin that is actively treated with radiation therapy and deep pressure therapy; (4) over areas with known lymphedema, lymphatic involvement of cancer, or bone metastasis; (5) in patients with coagulation disorders complicated by hemorrhage, low platelet counts, or on medications such as warfarin or heparin; (6) over skin with infection; and (7) on days when the patient is receiving chemotherapy.

Even though massage therapy is generally safe, patients may experience local bruising, local increase of muscle pain, swelling of massaged muscles or allergic reaction to skin lotions.

It is important to know that massage therapy is not flatly contraindicated for an oncology patient. Massage has not been demonstrated to directly spread cancer. While some types of massage therapy are contraindicated for a patient with cancer, knowledgeable, skilled touch, in some form, is rarely contraindicated. It is true that cancer limits certain massage techniques; however, within those limitations, there are techniques used by trained oncology massage therapists, which will help a patient forget that they are a patient and, psychologically, feel that they are not broken. With their skilled hands, an oncology massage therapist can help a person feel whole again and reduce pain, nausea, and fatigue, all of which enables the patient to regain hope, provide a forum for expressing feelings in an informal setting, reestablish a positive body image, rebuild hope, and enable the patient to receive a moment of pure relaxation that is greatly needed.

Oncology patients need to never be denied compassionate, loving touch. A light, relaxing massage can safely be given to people in all stages of cancer. It goes without saying that a tumor or treatment site should not be massaged. Deep traumatic massage to any part of the body is contraindicated for anyone with active cancer, as the patient can bruise much easier due to chemotherapy, radiation, or medication. Injury to tissues causes the immune response to be activated. Again, while each person is unique and is to be treated as such, the pressure to be used throughout the treatment is an extremely light one, no matter which technique is used.

Massage Techniques

There are five main passive techniques of massage: effleurage, petrissage, friction, tapotement, and vibration. Effleurage refers to the use of long and slow gliding strokes applied with light pressure using the fingers or palm. Petrissage refers to a kneading motion using the thumb and fingers. Friction is a technique in which greater forces are applied using the tips of fingers or thumb to reach deeper muscular tissues to break up areas of local fibrosis. Tapotement utilizes repeated blows utilizing the fingers, fists, or sides of palms of hands. This latter technique should not be applied to the areas of recent inflammation, contusions, or over internal organs such as the kidneys. Vibration is a technique in which the massage therapist uses the hands in a technique that is similar to strumming a guitar string between the fingers.

There are several other different styles of massage and other touch therapies that can be used by an oncology massage therapist, including acupressure, aromatherapy, myofascial release, reflexology, shiatsu, trigger point therapy, and craniosacral therapy.

One fundamental theory of massage therapy is based on the concept that the body functions at its best when arterial, venous, and lymphatic flows are unimpeded. When there is interruption of the flow of these fluids in muscles, changes occur in the muscles and overlying fascia and skin, which can contribute to the development of localized fibrosis, restrictions, and pain. Massage techniques are utilized to reestablish good fluid dynamics in skin, fascia, and muscle.

Patient Assessment

Most people who are coming for an oncology massage session are very open and willing to tell the massage therapist about themselves and their cancer journey. It is imperative for the massage therapist to be completely present and listen very closely to the person receiving the massage about the cancer, its treatment, and the impact of both on their body. That information can subsequently help the therapist guide the treatment session to maximize benefit and minimize harm.

The oncology massage therapist also reviews the medical chart of the person with cancer prior to the treatment session to understand the type of cancer, stage of cancer, and the treatment rendered. In breast and gynecological cancers, this treatment commonly includes surgery, radiation therapy, and chemotherapy.

This is followed by a physical assessment of the patient’s skin to identify any surgical scars and their integrity, wounds and areas of potential skin infection as marked by erythema and access mediports for delivery of chemotherapy, lymphedema, skin bruises, and areas treated by radiation therapy. Muscles are examined for atrophy and bones for deformities. Palpation is an essential component of the assessment and muscles are palpated for tender points and tightness. It is also important to briefly assess for any insensate areas or areas of altered sensation as a result of chemotherapy.

Precautions in Oncology Massage Therapy

Adverse effects can often be prevented with awareness, modification of touch and pressure, and changes to positioning. The Society for Integrative Oncology recommends the use of massage for cancer pain and anxiety but cautions against the use of deep or intense pressure near cancer lesions or enlarged lymph nodes, radiation field sites, intravenous catheters and medical devices, and anatomic distortions, or in patients with a bleeding tendency.

It is 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, as well as being a licensed massage therapist.

Caution should always be used for patients with cancer-related pain. Massage will not resolve pain resulting from pressure of the tumor on surrounding sites, nerve impingement (radiating pain), or bone pain from metastases. Light touch massage can reduce anxiety or distress, whereas deep massage can worsen the pain by increasing inflammation or potentially causing fragile bones to break. No oils or lotions should be used on the field of treatment, during the course of radiation. Rocking motions should be avoided with patients who are experiencing nausea. Practicing diligent handwashing and using clean equipment and linens will reduce the risk of infection. It is also important to use extra caution during a massage session to avoid the carotid artery, suboccipital triangle, supraclavicular fossa, posterior knee, femoral triangle, and abdominal cavity.

Massage Treatment Session

To maximize the benefits of the oncology massage therapy session, it is important to make sure that the patient is comfortable, relaxed, and warm. The ambiance in the massage therapy room should be conducive to a positive experience for the patient. Proper positioning with the use of bolsters and pillows is essential to ensure a comfortable position during the treatment session. Patient may be supine or prone on a massage therapy table or seated on a chair depending on the goals of the treatment session. Areas of the body not being massaged should be covered with blankets or sheets for warmth and modesty.

Conclusion

Oncology massage therapy provides significant benefits to persons with cancer and cancer survivors in both pain and stress reduction. A thorough understanding of the cancer location, metastasis, as well as cancer treatments such as chemotherapy, surgery, and radiation therapy is essential to maximizing the benefits and minimizing the risks. A well-trained, experienced oncology massage therapist can be an integral member of a cancer treatment team.