Massage Therapy for Patients With Cancer


According to the American Cancer Society, an expected 1,735,350 people will have been diagnosed with cancer in 2018—and approximately two-thirds of those diagnosed will survive. Traditional treatments like surgery, radiation and chemotherapy have had great success, but sometimes with crippling side effects that make the disease even more physically and emotionally taxing.

Today, more research is helping health care professionals and patients alike understand the role massage therapy plays in an integrative care plan. From providing stress relief to helping patients better handle symptoms such as pain and side effects like nausea, massage therapy can benefit cancer patients in a variety of ways.

As Heather Greenlee, ND, Ph.D., medical director of Integrative Medicine at Seattle Cancer Care Alliance, puts it: “We have really good data now showing that a lot of these integrative therapies can be used to manage symptoms or side effects. We still need to do more research to understand how these therapies affect survival.”

Massage therapy has shown promising results in helping the following symptoms of cancer and cancer treatment.


Massage + Fatigue

When you are tired, you aren’t the same person. Fatigue can make some people short-tempered, or simply limit how engaged they feel in the activities they may have enjoyed at one time. Oncology patients already have the mental strain of fighting a life-threatening disease, so helping them find ways to alleviate this symptom can improve their ability to continue participating in the things they value. According to some new research, massage therapy can play the vital role of mitigating fatigue in oncology patients.

A 2018 study1 by the Emory University School of Medicine compared the effects of six weeks of once-weekly Swedish massage therapy on cancer-related fatigue in breast cancer survivors against an active control condition (light touch) and wait-list control. This randomized, single-masked, three-arm study comprised 66 breast cancer survivors who had received surgery plus radiation and/or chemotherapy/ chemoprevention who also had cancer-related fatigue. Fatigue levels were compared by measuring the Multidimensional Fatigue Inventory (MFI) and National Institutes of Health PROMIS Fatigue scale at baseline and after the six-week intervention.

Results showed there was a statistically significant six-week reduction in MFI total scores for both the Swedish massage and light touch participants, and a significant increase in MFI scores with the wait-list control group. “This finding suggests that six weeks of a safe, widely accepted manual intervention causes a significant reduction in fatigue, a debilitating sequela for cancer survivors,” researchers explain.

Similar results were found in a 2018 study2 on cancer-related fatigue in 40 gynecologic cancer survivors. Participants were randomized to either the active treatment group or control. The active treatment group received one 40-minute massage once per week for eight weeks. The control group did not receive massage therapy.

After eight weeks of receiving one 40-minute session of massage therapy, gynecologic survivors’ scores on fatigue and insomnia showed significant improvement compared to those who did not receive massage therapy. The study also showed health-related quality of life improved in study participants who received massage.

There is also research that indicates integrative therapies can be helpful midtreatment, too. One 2018 study3 took 72 women with breast cancer (stages 1-3) scheduled for radiation therapy and split them into two groups: one that received reflexology once a week and the other a control group. Findings illustrated that after five weeks of radiation therapy, those who received reflexology had statistically lower levels of fatigue; quality of sleep post-10 weeks of radiation was also improved.

“The results of the present study indicate that reflexology may have a positive effect on fatigue, quality of sleep, pain and quality of life in breast cancer patients during radiation therapy,” researchers explain. “Reflexology prevented the decline in quality of life and significantly ameliorated the fatigue and quality of sleep of these patients.”

Sonia Tatninov, a massage therapist at Tulena Wellness in Brooklyn, New York, says her own experience is similar to what the research is finding. “Massage has a very direct effect in, at least temporarily, reducing fatigue, anxiety and often pain in cancer patients,” she says. “It is one of the few interventions that can provide some relief from the discomfort of peripheral neuropathy that can accompany chemotherapy treatments and still continue after treatment is completed.”


Cancer + Massage Therapy CE: Learn how massage can relieve symptoms, reduce fatigue and empower cancer patients. Earn 2.5 CE credits.  


Massage + Lymphedema

Lymphedema is one of the most common conditions developed because of cancer treatment, causing swelling in the arms and legs that can be painful. For cancer patients dealing with this condition, lymphatic drainage has shown some promise. “When a massage therapist is trained in manual lymphatic drainage, they can play a huge role in helping to identify and treat lymphedema of the arm,” explains Tatninov.

“If the nodes have been removed, it is important for individuals to have the upper extremity drained from time to time to keep the lymphatic vessels open and working,” says Cynthia Oberdier, a licensed massage therapist and certified lymphatic therapist from Columbus, Ohio. “If no massage has been performed, an injury or insult to the extremity can cause the area to swell and become increasingly painful.”

The effects of lymphedema are long lasting and don’t fade easily. For that reason, Tatninov also emphasized the need for awareness and constant communication with clients who have lymphedema when administering any type of massage. “If they have had axillary lymph nodes removed, you want to use light pressure at the arm,” says Tatninov. “If they have had inguinal lymph nodes removed, light pressure to the leg. Likewise, if they have had cervical lymph nodes dissected, you’d only use light pressure at the neck.”


Massage Therapy + Depression

Depression is not an uncommon occurrence when dealing with cancer, or even after surviving the disease. At a time when a patient is dealing with a lot of unknowns or worrying about possible outcomes, changes in mood can be expected, but that doesn’t make depression any less troublesome.

There is some research, however, that massage therapy may help with depression and mood disorders in cancer patients. For example, meta-analysis indicated a significant association between massage therapy and alleviated symptoms of depression.4 Researchers also found that massage therapy helped significantly reduce depression in HIV patients when compared to light touch or no intervention.5

More recently, the Society for Integrative Oncology created evidence-based guidelines regarding the use of integrative therapies for breast cancer patients, both during and after treatment. After examining randomized trials from 1990 to 2015, researchers were able to identify major benefits of the different integrative therapies for breast cancer patients. “Meditation, relaxation, yoga, massage and music therapy are recommended for depression/ mood disorders,” they explain.


Read more from Massage Therapy Journal: Massage + Depression.


Massage Therapy + Nausea

Chemotherapy is typically an aggressive treatment that can have a variety of side effects, with nausea and vomiting being among the most common. While anti-nausea medication is often used for severe symptoms, new research indicates massage can play a role in helping patients find some relief from these symptoms.

A 2018 quasi-randomized controlled pilot study6 looked at the feasibility and preliminary effects of massage and inhalation aromatherapies on chemotherapy-induced acute nausea and vomiting. The 75 breast cancer patients were split into three groups: massage, inhalation and control. The massage group received 20-minute aromatherapy foot massages before their second, third and fourth chemotherapy cycles, while the inhalation group received three-minute inhalation aromatherapy on the same schedule. The control group received routine treatment.

Results showed that the incidence of nausea and vomiting were significantly higher in the control group than in either of the two active groups in the third and fourth chemotherapy cycles. “Furthermore, in these two cycles, the incidence of nausea and vomiting was significantly lower in the massage group than the inhalation group,” researchers note.

Another recent study suggests integrative health care can help alleviate chemotherapy-related nausea, as well as provide a wide variety of other benefits to oncology patients, including reducing pain and anxiety and promoting better sleep.7 Similarly, a 2017 study8 looking at integrating massage into chemoinfusion suites found that massage programs can provide symptom relief—including nausea—and can be safely and effectively added to chemoinfusion suites.


Massage Therapy + Pain

Pain is a part of a wide variety of health conditions, and cancer is no different. Whether it’s from the disease or the treatment doesn’t matter to the patient; they just want to find some relief so they can focus on their health and well-being.

Here, too, research has shown the promise of massage therapy. A meta-analysis on the effects of massage therapy found that massage significantly reduced cancer pain compared to no massage control conditions.9 In another quasiexperimental study examining massage therapy’s effect on pain and anxiety in 25 children with cancer undergoing intrathecal therapy or bone marrow aspiration, the experimental group received massage therapy while the control group received standard care. Results showed the children who received massage therapy reported less acute procedural pain from intrathecal therapy or bone marrow aspiration than children who received standard care.


Read the Research: Massage Therapy for Pain & Anxiety in Cancer Patients.


Massage Therapy + Giving Patients Control

The unpredictable nature of cancer can sometimes make patients feel powerless. According to Greenlee, however, that is sometimes where massage therapy really shines—helping oncology patients regain a sense of control.

“I think that being involved in integrative medicine or using integrative medicine can be very empowering to patients,” Greenlee says. “It is something that they can do on their own, and the approach that we take is that we want patients to be as healthy as possible so that they can also receive their treatment.”

Additionally, the relationship cancer patients have with their massage therapist can also be empowering, helping the patient feel more like a whole person than just their diagnosis. Laura Dutton, a massage therapist with the Seattle Cancer Care Alliance, emphasized the importance of this dynamic and how it can truly make a difference. “I think it is that sense of being treated as a whole person,” she explains. “We have an incredible opportunity as massage therapists to spend a concentrated amount of time with patients in a sort of continuous care setting, so you also can help people better manage their own self-care.”


References

1. Kinkead B, Schettler P, Larson E, Carroll D, Sharenko M, Nettles J., Edwards S, Miller A, Torres M, Dunlop B, Rakofsky J, and Rapaport M. "Massage therapy decreases cancer-related fatigue: results from a randomized early phase trial." Cancer. (2018) Feb1:124(3): 546–554.
2. Donoyama N, Satoh T, Hamano T, Ohkoshi N, and Onuki M. "Effects of Anma therapy (Japanese massage) on health-related quality of life in gynecologic cancer survivors: a randomized controlled trial." PLoS One. (2018) 13(5).
3. Tarrasch R, Carmel-Neiderman NN, Ben-Ami S, Kaufman B, Pfeffer R, Ben-David M and Gamus D. "The effect of reflexology on the pain-insomnia-fatigue disturbance cluster of breast cancer patients during adjuvant radiation therapy." J Altern Complement Med. (2018) Jan; 24(1): 62–68.
4. Hou WH, Chiang PT, Hsu TY, Chiu SY, Yen YC. "Treatment effects of massage therapy in depressed people: a meta-analysis." J Clin Psych. (2010) 71:894–901.
5. Poland RE, Gertsik L, Favreau JT, Smith SI, Mirocha JM., Rao U, and Daar ES. "Open label, randomized, parallel-group controlled clinical trial of massage for treatment of depression in HIV-infected subjects." J Altern Complement Med. (2013) 19:334–340.
6. Zorba P, and Ozdemir L. "The preliminary effects of massage and inhalation aromatherapy on chemotherapy-induced acute nausea and vomiting: a quasi-randomized controlled pilot trial." Cancer Nurs. (2018) Sep/Oct; 4(5): 359–366.
7. Armstrong K, Lanni T Jr., Anderson MM, and Patricolo, GE. "Integrative medicine and the oncology patient: options and benefits." Support Care Cancer. (2018) Jul; 26(7): 2267–2273.
8. Mao JJ, Wagner KE, Seluzicki CM, Hugo A, Galindez LK, Sheaffer H, and Fox KR. "Integrating oncology massage into chemoinfusion suites: a program evaluation." (2017) Mar; 13(3).
9. Lee SH, Kim JY, Kim SH et al. "Meta-analysis of massage therapy on cancer pain." Integr Cancer Ther. 2015 Jul; 14(4):297–304.

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