Massage and the Cancer Patient – The Courage of Touch

Like most attorneys, Jo Anne Adlerstein is a fiend for the kind of research that can make or break a case. So when she was diagnosed with breast cancer in the summer of 1998, she used her research skills to find out all she could about how to fight the disease that invaded her body.

“What I found is that despite the fact that I live near New York City and have been to the top doctors throughout, each doctor — the surgeon, the hematologist, oncologist and the radiation therapist — is concerned with getting rid of your cancer cells,” Adlerstein said. “The other parts of your body and the other parts of healing are not necessarily part of their agenda.”

Adlerstein’s research led her to massage therapist Cheryl Chapman — someone who did have holistic healing in her agenda. What research didn’t tell Adlerstein was that many bodyworkers, even as recently as a decade ago, would have turned her away. For years, massage and bodywork was contraindicated for cancer patients. Massage schools, mostly fearing that bodywork could spread cancer, largely taught their students to avoid working with cancer patients. The notion is still pervasive in the bodywork community.

“I think it’s very common to hear this idea that it’s absolutely contraindicated,” said Christopher Quinn, D.C., president of the Boulder College of Massage Therapy in Colorado. “There is such a variety in the levels of massage therapy training in the country that we’re a long way off from not only the information being standardized, but the competence and the level of training being standardized as well.”

Quinn likens the misinformation over contraindication to the old days of sports coaches, who not only advised athletes not to drink water during activity, but also gave them salt tablets. It’s similar with massage therapists. “Unless it’s something therapists do or specialize in, they may not retain that knowledge base,” he said.

But as the field of massage therapy matures, its knowledge base expands. And thanks to schools such as Quinn’s and therapists/teachers such as Chapman and others, the notion that massage is contraindicated for cancer patients is changing. There are still hurdles to overcome. How massage therapy fits into traditional insurance or managed care coverage is a gray area. And old attitudes about contraindication die hard.

But massage and bodywork are increasingly important weapons in the fight against one of the most prevalent diseases in America today. Therapists seeing clients with cancer tout the many benefits. It reduces stress and relaxes patients. It bolsters the immune system and helps remove toxins from the body. It helps with circulation and restores energy. It reduces pain and minimizes the effects of radiation and chemotherapy treatments. It enhances a patient’s body awareness and allows them to direct energy toward healing. And in cancer patients who will die from the disease, it can help ease their final days and hours. Massage therapy is becoming an important arrow in the quiver of those treating cancer patients. The evidence covers a wide spectrum of massage therapists and bodyworkers.

Hospitals are integrating massage therapists into teams of doctors and health professionals. Therapists in private practice are getting the training they need to be able to see patients recovering from cancer or in treatment. In hospice settings, bodyworkers are providing comfort to terminally ill patients and their families. Schools are rethinking the blanket statement that massage is contraindicated for cancer patients and are developing programs to give bodyworkers the specialized training they need.

Researchers are beginning to explore the relationship between massage and cancer patients. And books such as Gayle MacDonald’s Medicine Hands: Massage Therapy for People with Cancer are helping guide bodyworkers into previously uncharted territory.

These are positive trends, both for cancer patients and the bodywork community, for the need is great. Cancer is the second most prevalent killer of Americans, behind heart disease. The American Cancer Society estimates that 563,100 Americans are expected to die of cancer this year, more than 1,500 per day. Nearly 5 million Americans have died from cancer this decade. The statistics are grim, but there is a silver lining. An increase in early detection and improved treatment means that cancer is no longer a death sentence. More people are surviving and living with cancer, about 8 million in the United States today, which means a greater role for bodyworkers.

That role is getting the approval of organizations such as the American Cancer Society, which now views massage therapy as an important complementary therapy for cancer patients, although not one to specifically treat the cancer, said Terri Ades, RN, the society’s director of health content.

“We know that massage therapy makes everyone feel better, whether they’re ill or whether they’re healthy,” Ades said. “It is becoming more prevalent in the health professional community.

“There are more people surviving cancer than ever before. I see the complementary therapies as an important component of helping the person improve their quality of life. Oncologists are becoming much more aware of the importance of complementary therapies.”

Despite the evolution in knowledge and attitudes, the blanket contraindication is deep-seated among bodyworkers. No one is quite sure from where it came. Most guess it had to do with the mistaken idea that massage could either cause cells to break off from tumors and migrate to other parts of the body, or that increased lymphatic activity – resulting from bodywork – promotes the spread of cancer cells. Bodyworkers are cautioned against working the sites of tumors, but as MacDonald writes in Medicine Hands, “The more the medical profession understands how cancer spreads, the more apparent it is that previous fears about massaging people with cancer are unfounded.”

Although researchers are still looking at how cancer occurs, most evidence points to a combination of genetics and environmental factors. These same factors heavily influence how cancer cells spread. Malignant cells spread in two ways — they migrate directly to the adjoining site of tumors or metastasize and spread to distant sites. The potential for metastasis in any individual is similar to how cancer occurs in the first place — it is driven by genetic factors that are inherited or environmental factors that are acquired.

While cancer cells do travel via the lymphatic system, MacDonald writes that “many oncologists fail to see how comfort-oriented massage would contribute to the spread of cancer.” Massage does not increase lymphatic circulation any more than any of a number of day-to-day activities. If increased circulation led to increased spread of cancer cells, doctors would warn patients against any activity at all, which they clearly do not.

The pendulum that is swinging away from contraindication toward working with cancer patients travels with a variety of cautionary notes. It is not a simple matter of what was once discouraged is now fine. The process of metastasis, or how cancer cells travel through the lymph or blood vessels, is not completely understood. As with any foray into relatively uncharted territory, it is wise for bodyworkers to learn from those who came before.

TO READ THE REST OF THE ARTICLE VISIT  Massage & Bodywork magazine, December/January 2000.