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Massage and cancer: practice guidelines.


The purpose of this article is to examine the use of massage in cancer through recently published evidence. This article also aims to develop an awareness of the contraindications when applying massage to cancer patients.


The use of massage treatment by patients with cancer is common. A survey published in 2008 of 367 Australian women with breast cancer revealed 87.5% used complementary medicine, and of these, 41.4% used massage(1). In Canada, 80% of women with breast cancer used complementary medicine including massage(2). A survey in the USA of 189 women with lung cancer lung cancer, cancer that originates in the tissues of the lungs. Lung cancer is the leading cause of cancer death in the United States in both men and women. Like other cancers, lung cancer occurs after repeated insults to the genetic material of the cell.  showed 44% used complementary or alternative medicine and 6.9% used massage to control symptoms--particularly difficulty with breathing and pain.

It is important for therapists to understand the evidence validating the application of massage for cancer. This article is based on recent research data and intends to guide massage therapists towards appropriate treatment plans that incorporate an awareness of contraindications.

Method And Results

The data was obtained by performing a Medline search using the words 'massage' and 'cancer' but not 'prostatic'. The search included only papers published in the past five years. From the articles retrieved, titles and abstracts were read and irrelevant or insignificant papers were excluded at this author's discretion. A total of 87 articles were considered and information was either extracted from the abstracts or from the retrieved papers.


The therapeutic application of massage for cancer relates to the management of pain, depression and anxiety, lymphedema, nausea and vomiting Nausea and Vomiting Definition

Nausea is the sensation of being about to vomit. Vomiting, or emesis, is the expelling of undigested food through the mouth.
 during chemotherapy, and carer support.


Pain is a common feature in the latter stages of terminal cancer. Gorman et al.(4) put it succinctly: 'Pain, or its anticipation, remains one of the most feared symptoms of the dying process.' In a study comparing massage to simple touch, both massage and touch produced sustained improvements in cancer pain, but massage therapy Massage Therapy Definition

Massage therapy is the scientific manipulation of the soft tissues of the body for the purpose of normalizing those tissues and consists of manual techniques that include applying fixed or movable pressure, holding, and/or
 was significantly more effective at improving pain than touch alone immediately after application (P<0.0001)(5).

In advanced cancer, bone involvement is a significant problem and, '... results in intolerable pain, substantial morbidity, and impaired quality of life in 34%-45% of cancer patients.' (6). Massage was shown to have an effective immediate, short-term (20-30 minutes), intermediate (1-2.5 hours) and long-term (16-18 hours) benefits on the pain and anxiety associated with bone cancer (6). Based on current research, it is reasonable to conclude that massage and reflexology Reflexology Definition

Reflexology is a therapeutic method of relieving pain by stimulating predefined pressure points on the feet and hands. This controlled pressure alleviates the source of the discomfort.
 (7) are valid applications for cancer pain.


The most consistent symptom reduction reported for massage therapy in numerous studies is anxiety (8, 9). For example, reflexology has a powerful anxiety-reducing effect (10) and has been shown to help cancer patients receiving chemotherapy feel better and also cope better with their disease (11).

In a study by Campeau et al., pre and post massage anxiety was measured in patients undergoing radiation therapy (12).Though there was no major impact on intermediate-term anxiety in patients undergoing radiation therapy, there was a significant immediate decrease in anxiety after massage treatment.

Anxiety and depression and immunologic state was improved with aromatherapy massage in a trial with twelve breast cancer patients (13). Although aromatherapy massage does not confer benefits in the long term, the immediate effects on depression and anxiety for up to two weeks were clinically significant.

In a study of mothers of children with cancer, tension and anxiety levels were significantly higher than in mothers of children suffering from other types of diseases or with healthy children (15). Because massage has a favourable effect on stressed mothers, it may serve as a useful support tool. Furthermore, massage for children with cancer appears to decrease anxiety in both parents and children (16).


Fluid accumulation due to obstruction of lymphatic vessels is termed lymphedema and manifests as swelling in the subcutaneous tissues--it is a possible development for patients with cancer. The cause of fluid accumulation can vary and therapists must make a reasonable diagnosis. Table 1 summarises the diagnostic features of fluid swelling.

Lymphedema in cancer is mainly associated with patients undergoing treatment of malignancy; for example, women being treated for breast cancer. The arm on the affected side may become swollen after a mastectomy mastectomy (măstĕk`təmē), surgical removal of breast tissue, usually done as treatment for breast cancer. There are many types of mastectomy. In general, the farther the cancer has spread, the more tissue is taken. , lymph node lymph node

Small, rounded mass of lymphoid tissue contained in connective tissue. They occur all along lymphatic vessels, with clusters in certain areas (e.g., neck, groin, armpits).
 resection, and radiotherapy. Patients presenting with swelling of an extremity should be assessed and the risk factors for oedema oedema

see edema.
 should be identified. These risk factors include prior surgery, radiotherapy, infections, or other forms of trauma to the affected limb. It is important to differentiate lymphedema from other causes of limb swelling(17). Knowledge of cancer and appropriate training should be considered by students aiming for a specialised niche in lymphatic drainage.

Nausea And Vomiting

Nausea and vomiting are a significant problem for people with cancer, especially patients undergoing cancer treatment. There is some evidence that massage(18 22) and acupressure acupressure
 or shiatsu

Alternative-medicine practice in which pressure is applied to points on the body aligned along 12 main meridians (pathways), usually for a short time, to improve the flow of vital force (qi).
(23 27) assists in managing this problem.

Practice Guidelines For Applying Massage To Cancer Patients

Massage practitioners should be able to offer assistance to patients seeking massage as a therapy for cancer. However, it would be unethical and deceptive to offer a prognosis of a cure because no evidence exists to support this claim.

Conversely, the practitioner can have confidence that massage therapy has the potential to assist with pain, nausea and vomiting, anxiety and depression, lymphedema and provide benefits for carers of patients with cancer. Practitioners should be aware that massage therapy is a complement and adjunct to other treatments. Therefore, complementary medicine should not be offered as an alternative to medical treatment.

Furthermore, Sagar Sagar (sä`gər), city (1991 pop. 257,119), Madhya Pradesh state, central India. Sagar is a regional market for wheat, cotton, and oilseed. Such industries as sawmilling, oil, and flour milling are important. , Dryden and Wong(28) have highlighted some cautions for patients with cancer:

* Coagulation disorders, complicated by bruising and internal hemorrhage due to:

--low platelet count

--medications: coumadin, acetylsalicylic acid, heparin

* Metastases Metastasis (plural, metastases)
A tumor growth or deposit that has spread via lymph or blood to an area of the body remote from the primary tumor.

Mentioned in: Malignant Melanoma
 to bone, complicated by fracture/s

* Open wounds or radiation dermatitis, complicated by pain and infection.

Does Massage Spread Cancer?

There is no evidence that massage causes or contributes to metastatic Metastatic
The term used to describe a secondary cancer, or one that has spread from one area of the body to another.

Mentioned in: Coagulation Disorders


pertaining to or of the nature of a metastasis.
 disease. However, some studies have shown that breast epithelial cells may transfer to sentinel lymph nodes as a result of massage (29, 30). Therefore, it may be prudent to avoid applying direct pressure on a tumor location, and breast cancer should be excluded before complementary medicine treatment of any breast condition.


It is important that massage therapists draw evidence from the available literature and design treatment plans that set achievable therapeutic goals. This article has attempted to evaluate recently published research and reviews that considered the use of massage for cancer and to summarise this evidence in the form of practice guidelines.

The use of massage for cancer pain, anxiety, nausea and vomiting, lymphedema, and carer support represents a valid complementary therapy in the management of cancer. Massage practitioners can offer patients their support with some confidence.


(1) Kremser T, Evans A, Moore A, Luxford K, Begbie S, Bensoussan A, et al. Use of complementary therapies by Australian women with breast cancer. Breast. 2008;17(4):387-94.

(2) Boon HS, Olatunde F, Zick SM. Trends in complementary/alternative medicine use by breast cancer survivors: comparing survey data from 1998 and 2005. BMC (BMC Software, Inc., Houston, TX, A leading supplier of software that supports and improves the availability, performance, and recovery of applications in complex computing environments.  Womens Health. 2007;7:4.

(3) Wells M, Sarna L, Cooley ME, Brown JK, Chernecky C, Williams RD, et al. Use of complementary and alternative medicine therapies to control symptoms in women living with lung cancer. Cancer Nurs. 2007;30(1):45-55; quiz 6-7.

(4) Gorman G, Forest J, Stapleton SJ, Hoenig NA, Marschke M, Durham J, et al. Massage for cancer pain: a study with university and hospice collaboration. J Hosp Palliat Nurs. 2008;10(4):191-7.

(5) Kutner JS, Smith MC, Corbin L, Hemphill L, Benton K, Mellis BK, et al. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial. Ann Intern Med. 2008;149(6):369-79.

(6) Jane SW, Wilkie DJ, Gallucci BB, Beaton RD, Huang HY. Effects of a full-body massage on pain intensity, anxiety, and physiological relaxation in Taiwanese patients with metastatic bone pain: a pilot study. J Pain Symptom Manage. 2009;37(4):754-63.

(7) Stephenson NL, Swanson M, Dalton J, Keefe FJ, Engelke M. Partner-delivered reflexology: effects on cancer pain and anxiety. Oncol Nurs Forum. 2007;34(1):127-32.

(8) Myers CD, Walton T, Bratsman L, Wilson J, Small B. Massage modalities and symptoms reported by cancer patients: narrative review. J Soc Integr Oncol. 2008;6(1):19-28.

(9) Cassileth BR, Deng GE, Gomez JE, Johnstone PA, Kumar N, Vickers AJ. Complementary therapies and integrative oncology in lung cancer: ACCP ACCP American College of Chest Physicians
ACCP American College of Clinical Pharmacy
ACCP Army Correspondence Course Program
ACCP Atlantic Climate Change Program
ACCP Association of Caribbean Commissioners of Police
ACCP Assembly of Caribbean Community Parliamentarians
 evidence-based clinical practice guidelines clinical practice guidelines Clinical policies, practice guidelines, practice parameters, practice policies Medtalk Systematically developed statements to assist practitioner and Pt decisions about appropriate health care for specific clinical circumstances. See Psychology.  (2nd edition). Chest. 2007;132(3 Suppl):340S-54S.

(10) McVicar AJ, Greenwood CR, Fewell F, D'Arcy V, Chandrasekharan S, Alldridge LC. Evaluation of anxiety, salivary sal·i·var·y
1. Of, relating to, or producing saliva.

2. Of or relating to a salivary gland.


pertaining to the saliva.
 cortisol cortisol (kôr`tĭsôl') or hydrocortisone, steroid hormone that in humans is the major circulating hormone of the cortex, or outer layer, of the adrenal gland.  and melatonin melatonin: see pineal gland.

Hormone secreted by the pineal gland of most vertebrates. It appears to be important in regulating sleeping cycles; more is produced at night, and test subjects injected with it become sleepy.
 secretion following reflexology treatment: a pilot study in healthy individuals. Complement Ther Clin Pract. 2007;13(3):137-45.

(11) Quattrin R, Zanini A, Buchini S, Turello D, Annunziata MA, Vidotti C, et al. Use of reflexology foot massage to reduce anxiety in hospitalized cancer patients in chemotherapy treatment: methodology and outcomes. J Nurs Manag. 2006;14(2):96-105.

(12) Campeau MP, Gaboriault R, Drapeau M, Van Nguyen T, Roy I, Fortin B, et al. Impact of massage therapy on anxiety levels in patients undergoing radiation therapy: randomized controlled trial A randomized controlled trial (RCT) is a scientific procedure most commonly used in testing medicines or medical procedures. RCTs are considered the most reliable form of scientific evidence because it eliminates all forms of spurious causality. . J Soc Integr Oncol. 2007;5(4):133-8.

(13) Imanishi J, Kuriyama H, Shigemori I, Watanabe S, Aihara Y, Kita M, et al. Anxiolytic anxiolytic /anx·io·lyt·ic/ (ang?ze-o-lit´ik)
1. antianxiety.

2. an antianxiety agent.

A drug that relieves anxiety.
 effect of aromatherapy massage in patients with breast cancer. Evid Based Complement Alternat Med. 2009; 6(1):123-8.

(14) Wilkinson SM, Love SB, Westcombe AM, Gambles MA, Burgess CC, Cargill A, et al. Effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer: a multicenter randomized controlled trial. J Clin Oncol. 2007;25(5):532-9.

(15) Iwasaki M. Interventional study on fatigue relief in mothers caring for hospitalized children: effect of massage incorporating techniques from oriental medicine. Kurume Med J. 2005;52(1-2):19-27.

(16) Post-White J, Fitzgerald M, Savik K, Hooke MC, Hannahan AB, Sencer SF. Massage therapy for children with cancer. J Pediatr Oncol Nurs. 2009 Jan-Feb;26(1):16-28.

(17) Warren AG, Brorson H, Borud LJ, Slavin SA. Lymphedema: a comprehensive review. Ann Plast Surg. 2007;59(4):464-72.

(18) Billhult A, Bergbom I, Stener-Victorin E. Massage relieves nausea in women with breast cancer who are undergoing chemotherapy. J Altern Complement Med. 2007;13(1):53-7.

(19) Cassileth BR, Vickers AJ. Massage therapy for symptom control: outcome study at a major cancer center. J Pain Symptom Manage. 2004;28(3):244-9.

(20) Mehling WE, Jacobs B, Acree M, Wilson L, Bostrom A, West J, et al. Symptom management with massage and acupuncture in postoperative cancer patients: a randomized controlled trial. J Pain Symptom Manage. 2007;33(3):258-66.

(21) Russell NC, Sumler SS, Beinhorn CM, Frenkel MA. Role of massage therapy in cancer care. J Altern Complement Med. 2008; 14(2):209-14.

(22) Wilkinson S, Barnes K, Storey L. Massage for symptom relief in patients with cancer: systematic review. J Adv Nurs. 2008; 63(5):430-9.

(23) Dibble SL, Luce J, Cooper BA, Israel J, Cohen cohen
 or kohen

(Hebrew: “priest”) Jewish priest descended from Zadok (a descendant of Aaron), priest at the First Temple of Jerusalem. The biblical priesthood was hereditary and male.
 M, Nussey B, et al. Acupressure for chemotherapy-induced nausea and vomiting: a randomized clinical trial randomized clinical trial,
n a clinical study where volunteer participants with comparable characteristics are randomly assigned to different test groups to compare the efficacy of therapies.
. Oncol Nurs Forum. 2007;34(4):813-20.

(24) Gardani G, Cerrone R, Biella C, Galbiati G, Proserpio E, Casiraghi M, et al. A progress study of 100 cancer patients treated by acupressure for chemotherapy-induced vomiting after failure with the pharmacological approach. Minerva Med. 2007;98(6):665-8.

(25) Gardani G, Cerrone R, Biella C, Mancini L, Proserpio E, Casiraghi M, et al. Effect of acupressure on nausea and vomiting induced by chemotherapy in cancer patients. Minerva Med. 2006; 97(5):391-4.

(26) Klein J, Griffiths P. Acupressure for nausea and vomiting in cancer patients receiving chemotherapy. Br J Community Nurs. 2004 ;9(9):383-8.

(27) Molassiotis A, Helin AM, Dabbour R, Hummerston S. The effects of P6 acupressure in the prophylaxis of chemotherapy-related nausea and vomiting in breast cancer patients. Complement Ther Med. 2007;15(1):3-12.

(28) Sagar SM, Dryden T, Wong RK. Massage therapy for cancer patients: a reciprocal relationship between body and mind. Curr Oncol. 2007;14(2):45-56.

(29) Diaz NM, Cox CE, Ebert M, Clark JD, Vrcel V, Stowell N, et al. Benign mechanical transport of breast epithelial cells to sentinel lymph nodes. Am J Surg Pathol. 2004;28(12):1641-5.

(30) Diaz NM, Vrcel V, Centeno BA, Muro-Cacho C. Modes of benign mechanical transport of breast epithelial cells to axillary lymph nodes The Axillary lymph nodes are of large size, vary from twenty to thirty in number, and may be arranged in the following groups:
  • brachial lymph nodes (or "lateral")
  • pectoral axillary lymph nodes (or "anterior")
  • subscapular axillary lymph nodes (or "posterior")
. Adv Anat Pathol. 2005;12(1):7-9.

Stephen John Walters, BHSc(Hon.), ND, Dip Massage, Cert Med Tech is a naturopath naturopath

a practitioner of naturopathy.

naturopath A person who practices naturopathy, a drugless system of therapy using physical forces–eg, heat, water, light, air and massage
 with 25 years of clinical experience. He has a special interest in the application of massage in health and disease. Address: 678 Port Road, Beverley SA 5009. Telephone: (08) 8348 0099,
Table 1. Classifications of oedema, causes, features and treatment

                 Cause of         Distinguishing         Treatment
Condition        Condition           Features             Options

Primary      Possibly            Oedema, fibrosis,   Lymphatic
lymphedema   inherited, not      may be present      massage,
             related to cancer   bilaterally,        compression
             or cancer           notably in the      garments, surgery
             treatments          legs

Secondary    Acquired through    Oedema, fibrosis,   Lymphatic
lymphedema   damage or           may be present      massage,
             blockage of the     unilaterally        compression
             lymphatics e.g.,    relative to the     garments
             surgery,            damaged body
             infection,          section, e.g.,
             radiation           one arm post
             treatment, tumors   mastectomy and
             within the          lymphatic
             lymphatics          resection

Peripheral   May be caused by    Fluid               Medical
oedema       conditions such     accumulation at     intervention for
             as heart and/or     the extremities,    failed organs,
             kidney failure      noticeably in the   massage may help
                                 lower legs          manage oedema
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Author:Walters, Stephen John
Publication:Journal of the Australian Traditional-Medicine Society
Geographic Code:8AUST
Date:Sep 1, 2010
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