I am often asked, “What is different about massage for people with cancer and massage for people without it?” In other words, why are entire advanced courses devoted to studying it?
The short answer is that massage should be modified to the signs, symptoms, and complications of cancer. This is usually quite straightforward. Also, massage must be adjusted to the effects of cancer treatment. This is more involved, as cancer treatment takes many forms.
That’s the short answer, the basics. It doesn’t describe the range of people with cancer, those whose cancer was years ago, the range of responses to treatment, or the range of appropriate massage techniques for each. But it does provide a framework from which to start. The best way to illustrate how “oncology massage,” as it’s beginning to be known, can be different from other massage treatment is to list a few common intake questions for a client with cancer.
Before listing some of these key questions, I want to acknowledge that not all massage therapists are comfortable with lengthy intake interviews. Most of us want to finish and get to the part that feels most comfortable to us, the hands-on session. Some MTs find long lists of questions overwhelming, especially if they are uncertain of what to do with the answers. But with good training and a good “cheat sheet,” the questions below become second nature, and the interview can take just a few minutes.
The questions themselves help us learn much about the client. An intake interview is one way the client tells us his/her story, and in the case of cancer treatment, it’s often a compelling story. It’s a journey we get to join in some small way. As touch providers, we are in the wonderful position of giving clients care, acceptance, and relief from isolation. Along with symptom relief—help with pain, anxiety, poor sleep, fatigue, and nausea—these things can be powerful beyond measure. The intake interview is the way in—the road to helping the person in front of us.
The first question, Where is the cancer in your body? leads the therapist to clear contraindications. By asking “Where?” we learn the type of tissue, the depth of it, and the anatomical region of the body. Identifying the location of tumors is important to good massage design. If the cancer is a solid tumor, superficial enough to be pressed by the therapist’s hands, the MT should be gentle with pressure in the area. If the tumor is deep, say, within a lung or liver, the therapist’s movement of the body is less likely to press on it.
This question Where is it? includes any metastasis, or cancer spread. If the cancer began in the prostate gland and has spread to the liver, or began in the breast and spread to the bone, all of these areas present, at the very least, a pressure contraindication. Specifically, cancer that affects the integrity of bone can lead to pathologic fracture, when unusually low stress on the bone causes fracture. Massage therapists need to know where these areas are so that they do not injure the bone, either with the pressure of their hands or by moving the joints. The risk of pathologic fracture varies from bone that is only slightly more prone than usual to fracture, to extremely fragile bone that breaks under the stress of daily living, such as lifting household objects or snapping a belt. For bone metastasis, the MT needs to establish with the client and the client’s doctor what the risk of fracture is and where the body is most vulnerable.
Another logical question is What kind of treatments have you had, and how do they affect you? Discussion about treatment and effects usually amounts to most of the intake and includes the effects of surgery, radiation, chemotherapy, biological therapies, or a bone marrow transplant. Often, more than one of these interventions have been tried, or are being used in quick succession. Conventional cancer medicine is strong medicine, with strong effects on the body. Ironically, most massage therapy contraindications are due to the cancer treatment rather than the cancer itself. A sample of contraindications includes less pressure if the client’s blood is clotting poorly, even rhythms and slower speeds for a client’s nausea, or shorter sessions for someone who is fatigued or feverish.
There are several other questions for the intake, including the client’s activity and energy level, whether there are any medical restrictions on activities, and what are the client’s blood counts? The activity and energy level tells us how demanding the massage can be—a slightly more vigorous massage for someone who is active, a very gentle one for someone who is tired and sedentary. If there are medical restrictions on activity, we know that someone on his/her healthcare team is concerned about the demand that it places on his/her body. We probe about the type of demand and adjust the massage in kind.
If clients tell us which blood counts are low, we know their bodies are struggling to fight infection (low white blood cells), clot the blood (low platelets), or deliver oxygen to the tissues (low red blood cells or anemia). Without having to memorize normal cell count numbers, we can still establish whether we need to modify massage in terms of pressure, demand on the body, and infection control.
We also ask them about their medications (many of them taken to control metastasis, increase blood counts, or prevent recurrence of the cancer). We modify massage therapy to the effects of these medications. Some medications cause pain that we may address with massage or energy work. Others cause constipation that we may help ease. Yet others increase the risk of thrombosis or blood clots, requiring us to communicate with the client’s physician about the likelihood of this before we use any pressure on their legs, where clots are likely to form.
In my experience doing and supervising massage for cancer patients, intake interviews take extra time at first. After a few such interviews, massage therapists figure out how to handle major issues more quickly but thoroughly. They know which issues they can think through on their own, which issues require more information from the client, and which ones require input from the client’s physician. Massage therapists tell me that the second time they see someone with pancreatic cancer, or on a certain chemotherapy protocol, or with low platelets, they can already feel their own familiarity and comfort increasing from the first time.
Finally, massage therapists tell me again and again how powerfully they connect with their client in the interview. Each question we ask gives us information needed for the massage session. But each question also tells us something important about what it is like to be the client on the journey.
Tracy Walton, LMT, MS, is the 2003 AMTA Teacher of the Year. She consults to hospitals, writes, and teaches “Caring for Clients with Cancer,” a course offered nationally for professional massage therapists. Back home, she works with the Beth Israel-Deaconess Hospital in Boston, researching the role of massage therapy with people with metastatic cancer.