Massage Therapy for People with Cancer:
Fear, Healing, and Changes in the Field
By Tracy Walton, LMT, MS,

A cancer diagnosis is one of the most frightening to hear; it ushers in a health crisis that can be consuming and exhausting. Cancer treatment is strong medicine; it includes some of the most harrowing treatments for a human body to integrate. People who have lived with cancer know the toll it can take on their bodies, their minds and spirits, their families, finances, and their level of function.

Against this backdrop, skilled, comforting touch can be profoundly corrective and healing. Touch offers an antidote to the frequent trials of medical procedures, a chance to connect through one’s body with another person, and welcome relief from challenges such as pain, anxiety, and depression. A massage therapist surrounds a client with acceptance and care, offers non-painful touch, and eases the injured body image that can come with cancer treatment.

Unfortunately in the past, people with cancer have met fear and uncertainty from the massage therapy profession. For years the contraindication against massage, expressed as concern about promoting cancer spread, has continued without supporting evidence or medical corroboration. This has robbed many potential clients and massage therapists of the chance to work together. But the contraindication has taken other serious tolls on the profession, preventing more meaningful discourse on safe practice for people with cancer.

My belief, shared by many practitioners and thoughtful educators in the massage therapy profession, is that some kind of skilled touch is possible at every stage of the cancer experience—from diagnosis through survivorship, during treatment, and at end of life. Against the old myth about massage spreading cancer, massage therapists, clients, and medical providers have still managed to move the work forward. I am grateful to those who have paved this way. Several books have been published on this topic: Gayle MacDonald’s Medicine Hands: Massage Therapy for People with Cancer1, and Debra Curties’ Massage Therapy and Cancer.2 Recently, MacDonald’s text on massage in the hospital setting has moved our work forward even further.3 Each of these texts elaborates on the guidelines and the emotional preparation needed to work with this population. Education has grown in the area, as well. A number of trainings exist around the country, including one at Memorial Sloan-Kettering’s Integrative Medicine Center and others at Oregon Health Sciences University and MD Anderson Cancer Center.4

Massage is getting attention in the medical community, as well. In September 2005 I had the honor of presenting at the Massage Therapy Foundation’s conference, “Highlighting Massage Therapy in CAM Research,” at which several researchers presented their work with cancer patients. We discussed current practice and research on the topic, which is growing as we speak.5 This November the third annual meeting of the Society of Integrative Oncology will be held in Boston, with a special session on massage therapy. I’ll be there as part of a panel of clinicians and researchers formulating research questions for the work. And in May 2007 the first “Oncology Massage Healing Summit” will be held in Toledo. Conferences draw massage therapists and other providers, and more physicians, nurses, and hospitals in cancer care are asking how massage can help their patients manage symptoms and side-effects of treatments.

Because of this interest and demand for our services and because the contraindication to massage was so restrictive for many years, it is tempting to rush forward in its wake and begin to work. But many massage therapists tell me that to meet this demand, they wish for more training in the area of clinical thinking, interviewing, and contraindications. I know from massage school teaching that simple lists of contraindications are not sufficient for massage therapists to work well with medically complex clients. Instead, we need to work as a profession to develop the information-gathering, reasoning, communication, and planning skills required to practice safely. These steps need to be straightforward, and they need to be manageable.

Over the sixteen years I’ve practiced, I’ve grown to appreciate both the art and the science of massage therapy. As my practice grew to include many people with cancer, I had to develop clear clinical decision steps to work safely and well with them. It was important to do this without erasing the role of my own intuition and heart in my work. In response to requests over the years, I have outlined some of the key decision-making steps in a structure that is clear and accessible.6

Our work must be thoughtful, informed by a client’s medical picture and medical staff, and carefully designed. It requires us to systematically collect and follow-up on several elements in the client’s health history. Some of the steps we need to take are:

  1. Through the intake interview, determine whether, how and where cancer currently manifests in the client’s body and how this intersects with massage contraindications. For example, if there are bone metastases leading to risk of fracture, we avoid pressure or joint movement in those areas.
  2. Through the intake interview, identify current and past cancer treatments the client has undergone, any side effects or complications that resulted and how those should be accommodated in the massage session. For example, if a client in chemotherapy has low platelets, we touch with gentle pressure so we don’t cause bruising or bleeding;
  3. To learn more about 1 and 2 above, look in the literature, including articles and appropriate texts on massage and cancer. Also, we use patient education literature (such as pamphlets or booklets about chemotherapy or radiation) to determine how to adapt massage therapy. For example, a booklet about radiation therapy might suggest that not just the radiation field, but the markings used to line up equipment should not be rubbed.
  4. Generate a list of the possible elements of the massage to adjust, such as pressure, joint movement, positioning, body areas to be massaged, duration of session, etc.;
  5. Where appropriate, check with the client’s medical staff (with written permission from the client) for input on the list of proposed contraindications;
  6. Update information as the client’s health or treatment change.

These steps are simplified and do not capture what’s needed from every client’s cancer history. Some steps need to be expanded and others will be shortened or even eliminated for some clients. But the steps describe a framework for us to rest on as we see medically complex clients. When we have managed information well and designed a safe session for a client, we can put our concerns to rest. And when we lay our concerns to rest, we make more room for our intuition, creativity, and heart. This is massage as it should be.

We have begun to publicly challenge the myth about massage spreading cancer and debunk it. As a profession, we are beginning to discuss the need for standard clinical decision-making steps needed to work with people with cancer. We are nailing down some concrete information and guidelines. We are on our way. This is a promising time for the profession and for the clients who so richly deserve this work.

Tracy Walton, LMT, MS, consults to hospitals and massage schools and teaches “Caring for Clients with Cancer,” courses offered nationally for massage therapists. Back home, she has worked with Harvard Medical School’s Osher Institute and the Beth Israel-Deaconess Medical Center in Boston, researching the role of massage therapy with patients with metastatic cancer. Tracy is the 2003 AMTA Teacher of the Year, and is currently working on a textbook, Medical Conditions in Massage Therapy. She holds a master’s degree in biology. She has provided massage in the hospital, spa, and private practice settings. She can be reached through her website,, which includes current research and resources on cancer and massage. Tracy will present at DSM this fall, 2006.

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