Cancer is a consuming, frightening and sometimes fatal condition. It can isolate people in subtle, profound, and often, heartbreaking ways. There is a strong call to massage therapists to provide skilled touch for people with cancer histories.
How do we respond to this call? In recent years, the traditional contraindication to massage therapy for people with cancer has come under scrutiny. I am grateful to authors who have questioned this prohibition with carefully considered arguments and with the use of scientific and medical literature.i
Thoughtful work about massage and cancer has already begun. Because the flat contraindication is being questioned, I hear from many massage therapists that “the contraindication to massage for cancer is over.” This population has called to us for a long time; it is tempting to simply throw off the burden of years of prohibition and begin working. But cancer treatment is extremely medically complex, and delicate handling of each case is necessary to prevent injury. Thoughtful principles and conscious clinical decision-making are needed to replace the “hands-off” rule. Then we can step more firmly forward in our work with this population. Dialogue in the field has begun, but more is needed, and the time is ripe.
We need conversation on a national level to identify some of the knowledge gaps in the profession and begin to fill them in. We need to name some standard clinical decision-making steps needed in work with people with cancer and define, concretely, how to carry out those steps. Some of the necessary adjustments in massage therapy treatment include changes in pressure, positioning of the client, speeds, rhythms, and the regions selected for massage.
In my experience, more adjustments in massage are necessary to accommodate the effects of cancer treatment than the effects of cancer itself. Some of the effects of treatment are short-term and others, including the risk of lymphedema after lymph node removal, linger for years after treatment. All treatments must be considered, at least initially, in the design of a session. A complex medical history is daunting to deal with at first, but once the history is broken down into more manageable components, the course of decision-making is clearer. The therapist needs to collect information about cancer, how and where it manifests in the body, cancer treatments, any side-effects or complications, then generate lists of possible massage adjustments needed before consulting the client’s medical staff for additional guidance.ii Medical staff can then help determine which massage adjustments should be in force, and which can be discarded.
Throughout the decision-making process, it is critical to consult the literature. The two books on the subject, one by Gayle MacDonald and the other by Debra Curties, are essential. Moreover, each of three major trade publications—Massage Therapy Journal, Massage Magazine, and Massage and Bodywork—have devoted significant space to massage and cancer over the last two years, often with special sections devoted to current thinking, formal programs and safe practice measures. Massage therapists can learn a great deal from the dialogue therein. Moreover, several advanced trainings on the subject are available nationally.iii In addition, more and more massage therapy schools are incorporating clients with cancer histories into their basic curricula; some schools have been practicing with clients in acute care settings or in their student clinics.
Discussions in classrooms and seminars yield rich case reports, complex, safe practice decisions, and accounts of rewarding work. I am struck by the balance of information and intuition, science and art that therapists can bring to this powerful work. When massage therapists are able to work safely and well with people with cancer, their clientele broadens. They have more stories to tell, more experiences of clients, families, and medical staff to bring to bear on their practice and to reflect on in their own lives.
In my own practice, people who have lived with cancer provide me with some of the most profound experiences of touch and connection. From other massage therapists’ stories, I sense that this deepens their work, as well. It brings core issues—illness, treatment, isolation, connection, death and life—into sharper relief. I have met many massage therapists who navigate this important work with good judgement and care. Cancer is a provocative subject for discourse and healthy debate. We have wisdom to gain from each others’ personal and professional insights. We can draw strength and resources from continuing this conversation, in person and in print. To respond to the call from a population that is desirous and deserving of massage, we need to continue our conversations with each other, with medical staff, and with our clients about massage, the effects of massage, cancer, cancer treatment and the intersection of all of these. If we capture this momentum, we are well on our way.