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Massage and Cancer
Big question! Massage and Cancer? I hear pros and cons about when and what kind of massage you can do on a client with cancer. Power of touch in the safe zone, what is Safe? I just had a client who completed the client information form but neglected to state they were undergoing chemotherapy until half way through the massage. Thank you, Rick Romine
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Replies to This Discussion
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Permalink Reply by Susan G. Salvo on
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Hey Richard,
I just agreed to speak about Cancer and Massage on Massage Therapy Radio on June 6-7 if you'd care to listen in to learn more.
http://massagetherapyradio.com/
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Permalink Reply by Richard G Romine on
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Thank you, neat site!
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Permalink Reply by Ellen Stetson on
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Richard, here's what I've discovered while working with a prospective client undergoing treatment. First, she was a career nurse (43 years) and was reluctant to disclose that she was undergoing chemo. She requested a series of deep tissue treatments from me, and I let her know on her first visit that light touch or energy work was indicated at this stage. Also, she declined giving me her doctors' contact numbers (red flag) because in her words, "they don't know anything about massage therapy," etc. Her resistance to a comprehensive treatment plan and reluctance to disclose as in your case, could have been her own desire to maintain some degree of control in what might seem a condition "out of her control." It came down to her safety, and mine too! According to a Physiology Instructor of mine, chemo drugs aren't fat soluable, staying in the system for as much as 6+ months. My nurse/prospective client insisted I was wrong on this, and that one week was plenty of time for all chemo drugs to have "passed through" her system. I have also read that chemo drugs can be passed from client to massage therapist through the skin. Please do correct me if you have contrary information, but having read this was also sobering. The American Cancer Society web site does recommend massage therapy as part of an overall treatment plan, but they are non-specific about when and what type of treatment. In the end, when she refused Healing Touch and palliative care ("doesn't do anything for me") I politely declined treatment, letting her know that I would be happy to support her when she signed a release form and gave me permission to contact her doctor, at which point she hung up during our last conversation. Lots of contrary info out there, but when in doubt I will always ere on the side of safety and efficacy. I hear from mutual friends that she remains furious about "that woman" who wouldn't help her, meaning me, so be it! Lots of good lessons learned here, and I trust for you as well.
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Thank you Susan, I've copied this for reference as SOP, standard operating procedure!
Susan G. Salvo said:Hey Richard,
Here's what I have...
General Guidelines for Massage Therapy and Cancer:
1) Obtain clearance from the client’s physician or oncologist before massage begins (he or she will be under medical supervision).
2) Conduct a thorough intake and ask about the type of cancer and any cancer treatments your client is undergoing. Find out about medications your client is taking. Also ask about any symptoms he or she may be experiencing.
3) Because fatigue is a symptom not only of cancer, but also of most cancer treatments, your client will likely experience fatigue. In these cases a slower, shorter massage (30 minutes or less) with lighter-than-normal pressure is indicated. A longer more vigorous massage would further fatigue and overtire your client.
4) Be attentive about pressure. Use moderate, firm (not deep) pressure during the massage. Proper pressure is critical because light stroking or feathering is generally aversive and irritating (very similar to tickling). In some cases, methods that utilize touching rather than massage (e.g., therapeutic touch, polarity, Reiki, craniosacral therapy) may be appropriate if your client cannot tolerate pressure.
5) Avoid known tumor sites, cancerous lesions (e.g., skin cancers), enlarged lymph nodes, areas subjected to radiation (both entrance and exit sites) up to two weeks after treatment is complete, and ports used to administer chemotherapy.
6) Metastatic cancer must also be considered. For example, if cancer has spread to the bones, bone integrity may be affected. In these cases, deep pressure, traction, and joint mobilizations are contraindicated. Also, note and avoid areas of inflammation (such as redness and heat) not previously mentioned during the intake. Bring these areas to the attention of the client or caregiver.
7) Document the session.
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Ellen, Thanks for sharing your story.
While doing the research for a pathology book, I did find that with certain types of chemotherapy (Thiotepa, Cyclophosphamide), you need to wear gloves if the client has received the medication within 24 hours of the scheduled session. These medications can come through the client’s skin and are potentially harmful for the therapist unless gloves are worn to reduce exposure.
However, the chemotherapeutic agents circulating in the blood may cause your client with cancer to feel ill after the treatment. So I HIGHLY recommend postponing massage until the day AFTER your client receives chemotherapy.
This “day of rest” for your client also puts massage therapy after the 24 hour window. So glove use should not be a concern.
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Permalink Reply by Daniel Cohen on
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I work on Cancer at various stages and various forms. There are many modalities today that are suited to cancer work. Also I find Oncologists more willing to have their patients get massage. Know your modalities and how they affect the body. Even some hospitals have both bodywork and energywork available to patients. "Times they are a changing!"
For your professional protection, do get a Doctor's authorization for massage when a client is being treated by a Physician.
As for your client it was unfortunate that they did not give full disclosure. But that is their neglect not yours unless they stated they recently had cancer surgery and you did not question further. It is a tangled web. During Chemo it more for your own protection as Chemo releases through the skin. Some Therapists prefer not to work or wear gloves.
Susan G. Salvo gives a good checklist above.
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I understand where you are coming from. Keeping the "Best intrest in mine" for the client and yourself. I did not know Cemo would pass through the skin to the MT. Very interesting!, Thank you.
Ellen Stetson said:Richard, here's what I've discovered while working with a prospective client undergoing treatment. First, she was a nurse (43 years) and was reluctant to disclose that she was undergoing chemo. She requested a series of deep tissue treatments from me, and I let her know on her first visit that light touch or energy work was indicated at this stage. Also, she declined giving me her doctors' contact numbers (red flag) because in her words, "they don't know anything about massage therapy," etc. Her resistance to a comprehensive treatment plan and reluctance to disclose as in your case, could have been her own desire to maintain some of control in what might seem a condition "out of her control." It came down to her safety, and mine too! According to a Physiology Instructor of mine, chemo drugs aren't fat soluable, staying in the system for as much as 6+ months. My nurse/prospective client insisted I was wrong on this, and that one week was plenty of time for all chemo drugs to have "passed through" her system. I have also read that chemo drugs can be passed from client to massage therapist through the skin. Please do correct me if you have contrary information, but having read this was also sobering. The American Cancer Society web site does recommend massage therapy as part of an overall treatment plan, but they are non-specific about when and what type of treatment. In the end, when she refused Healing Touch and palliative care ("doesn't do anything for me") I politely declined treatment, letting her know that I would be happy to support her when she signed a release form and gave me permission to contact her doctor, at which point she hung up during our last conversation. Lots of contrary info out there, but when in doubt I will always ere on the side of safety and efficacy. I hear from mutual friends that she remains furious about "that woman" who wouldn't help her, meaning me, so be it! Lots of good lessons learned here, and I trust for you as well.
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Permalink Reply by Jean Van Etten on
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I've been working as a massage therapist in a cancer treatment center for over six years. I cannot stress enough the importance of receiving training in this field; I completed 300 hours in oncology massage from the Peregrine Institute. There is so much misinformation out there about cancer and massage that it is important to get training so that you can provide your client with a safe and effective massage. It is indeed possible and enormously helpful to provide massage to people in treatment and recovery from cancer treatment. The notion that massage can cause cancer cells to migrate and flourish in a distant site is erroneous and has hindered therapists for many years from working with people who really need bodywork. Trained therapists learn to work with people diagnosed with bone and other metastases, at risk or having lymphedema, as well as those who have various medical devices (like chemo ports) inserted in their bodies.
Please google Gayle MacDonald, Tracy Walton and Cheryl Chapmen, three outstanding instructors! And visit www.s4om.org (Society for Oncology Massage) for information on the upcoming Summit in St. Paul.
This is a great, rewarding modality, but only if you know what you are doing.
Richard G Romine said:Thank you
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My hat off to massgeprofrofesstionals.com for providing this avenue to ask and learn.
A simple question about massage and cancer has provided some very informative answers and personal thoughts. I think all those who responded and encourage everyone to these.
Just a few of the comments from this discussion:
The American Cancer Society web site does recommend massage therapy as part of an overall treatment plan, but they are non-specific about when and what type of treatment.
Conduct a thorough intake to learn what type of cancer and any cancer treatments including medication your client is undergoing.
For your professional protection, do get a Doctor's authorization for massage when a client is being treated by a Physician.
Chemo drugs aren't fat soluble and can stay in the system for as much as 6+ months.
Certain types of chemotherapy like Thiotepa and Cyclophosphamide), you need to wear gloves if the client has received the medication within 24 hours of the scheduled session. These medications can come through the client’s skin and are potentially harmful for the therapist unless gloves are worn to reduce exposure. Postpone massage until the day AFTER your client receives chemotherapy.
It is indeed possible and enormously helpful to provide massage to people in treatment and recovery from cancer treatment.
Be attentive about pressure. Use moderate, firm (not deep) pressure during the massage.
Susan G Salvo is to speak about Cancer and Massage on Massage Therapy Radio on June 6-7
Gayle MacDonald, Tracy Walton and Cheryl Chapmen, three outstanding instructors! And visit www.s4om.org (Society for Oncology Massage) for more information.
Thank you all for sharing. I hope this discussion continues for a long time.
Jean Van Etten said:I've been working as a massage therapist in a cancer treatment center for over six years. I cannot stress enough the importance of receiving training in this field; I completed 300 hours in oncology massage from the Peregrine Institute. There is so much misinformation out there about cancer and massage that it is important to get training so that you can provide your client with a safe and effective massage. It is indeed possible and enormously helpful to provide massage to people in treatment and recovery from cancer treatment. The notion that massage can cause cancer cells to migrate and flourish in a distant site is erroneous and has hindered therapists for many years from working with people who really need bodywork. Trained therapists learn to work with people diagnosed with bone and other metastases, at risk or having lymphedema, as well as those who have various medical devices (like chemo ports) inserted in their bodies.
Please google Gayle MacDonald, Tracy Walton and Cheryl Chapmen, three outstanding instructors! And visit www.s4om.org (Society for Oncology Massage) for information on the upcoming Summit in St. Paul.
This is a great, rewarding modality, but only if you know what you are doing.
Richard G Romine said:Thank you
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Permalink Reply by Julia Morrow on
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Jean had a great reply. I wanted to add that educating yourself prior to working on this population is extremely important. Chemo drugs and the adjustments the body needs to make after chemo treatments have finished can take up to one year. While receiving treatments, massage should be light/medium Swedish, as you don't want to add a load to the lymph system which is already dealing with more than it normally would what with the chemicals. As for wearing gloves, another drug, Cytoxan possibly can secrete thru the skin but it too dissipates after about 24 hours. If a therapist feels more comfortable wearing gloves, he/she should but there really isn't any large risk. Also, always ask if any nodes have been removed. If so, don't aim strokes toward the area of removal.
As mentioned already, Gayle MacDonald's book is great!!
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Thank you very much Susan~
Susan G. Salvo said:Ellen, Thanks for sharing your story.
While doing the research for a pathology book, I did find that with certain types of chemotherapy (Thiotepa, Cyclophosphamide), you need to wear gloves if the client has received the medication within 24 hours of the scheduled session. These medications can come through the client’s skin and are potentially harmful for the therapist unless gloves are worn to reduce exposure.
However, the chemotherapeutic agents circulating in the blood may cause your client with cancer to feel ill after the treatment. So I HIGHLY recommend postponing massage until the day AFTER your client receives chemotherapy.
This “day of rest” for your client also puts massage therapy after the 24 hour window. So glove use should not be a concern.
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I am a Director of the Society for Oncology Massage - an international organization (English speaking countries). Our members, who provide massage to cancer patients at all stages of the cancer journey, practice in major cancer centers, smaller clinics, and private practices.
Potential members are required to take an intense 24 hour course on the physiological effects of various cancers and their treatments. All of the material covered is important - any particular piece can be crucial to the welfare of the next patient/client.who walks through your door.
Do not let anyone tell you that this check list or that summary prepares you to discharge your primary responsibility, to do no harm. With cancer patients, especially those in treatment, you need to know what not to do and when not to do it based on a thorough understanding of each patient's condition.
It is a wise practice and good manners to ask for the doctor's consent. But, you can not take refuge in the idea that the doctor approved it, so it must be OK. Unless you are following specific and detailed doctors orders, the doctor has no responsibility for any adverse outcome. And, truth be told, many physicians have only the vaguest idea of what massage is all about in general and of the damage that inappropriate massage can do in particular.
We recommend that any massage therapist who wishes to work with cancer patients/survivors take an oncology massage training course first. Numerous weekend continuing education courses, offered regularly across the country, meet S4OM's rigorous standards. A list of instructors can be found on our website at http://www.s4om.org.- click on For Therapists and then Trainings.
With the proper training. working with cancer patients is likely to be the most satisfying work you have ever done.
If you have questions, please email info@s4om.org.
Bruce Hopkins
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