By Jyothirmai Gubili, MS, Jane Greene, RN, LMT, and Jun J. Mao, MD, MSCE
An ancient form of bodywork that encompasses hands-on manipulation of muscles and soft tissues, massage increases circulation, reduces muscular tension and promotes relaxation. It also produces emotional and psychological benefits.
Commonly practiced types of massage include:
- Swedish massage, the most popular form, comprised of five basic strokes and their variations
- Reflexology, the application of pressure on specific “reflex” points of the hands or feet, which is believed to benefit corresponding parts of the body
- Shiatsu and tuina, with origins in Japan and China, involve stimulating acupuncture points and meridians to ensure proper flow of energy and blood to promote healing.
Massage therapy is employed in many cancer centers around the world as a complementary adjunct to provide symptom relief and to enhance comfort across the cancer continuum.
Current Evidence for Massage Therapy in Cancer
Massage has been evaluated in several studies in the oncology setting. In the largest published study of 1,290 patients with cancer, massage affected a 50% reduction in pain, stress, anxiety, nausea, fatigue, and depression. Improvements in pain and anxiety were also reported in a review of 19 studies involving 1,274 patients. And a meta-analysis that included 16 trials showed that massage is safe in patients with cancer and useful in reducing pain, fatigue, and anxiety. It also helped mitigate the psychological and neurologic complications associated with bone marrow transplantation.
A few studies have investigated the effects of reflexology as well. In a trial of 58 patients with breast cancer undergoing radiation therapy, reflexology treatments affected statistically significant improvements in fatigue, pain, and quality of sleep and life. Treatments also helped relieve dyspnea and improved functional status among patients with advanced-stage breast cancer receiving chemotherapy and/or hormonal therapy.
Additionally, manual lymphatic drainage, a specialized light rhythmic massage, has been shown to produce significant reductions in excess limb volume and dermal thickness in the upper arm along with improvement in quality of life in patients with breast cancer who have lymphedema. Manual lymphatic drainage was also found effective in preventing secondary lymphedema.
Although the biologic mechanisms underlying the salutary effects of massage are yet to be elucidated, proposed therapeutic components include a quick direct effect on local fascia, muscle, and nerves and a slower delayed effect on the subcortical central nervous system, which ultimately incorporates remodeling of plastic neuronal connections.
Incorporating Massage Therapy Into Care
Massage, provided by a licensed therapist, is generally considered safe. Furthermore, training programs for oncology massage therapists emphasize safe and effective ways of working with this population. These include determining the amount of pressure applied, which can range from extremely light to deep, after careful assessment of the patient’s clinical status. Importantly, precaution is advised to avoid massaging vulnerable areas of the body, including open wounds, rashes, bruises, sites of deep vein thrombosis or pulmonary embolism, a tumor or surgical site, areas near a medical device (e.g., port, drain), or sensitive skin following radiation therapy. Precaution should also be used in patients with altered mental status or delirium. In patients with very low platelet count, extreme caution should be observed during massage treatment and consultation with patients’ nurses prior to massage or reflexology treatment is advised. Also, deep massage may not be suitable for some patients with multiple bone metastases because of the risk for fractures.
Oncology nurses spend a considerable amount of time with patients at the bedside, at outpatient clinics making assessments, inquiring about side effects and symptoms at the time of treatment, and tracking the severity of symptoms to be addressed by the medical team. Therefore, nurses trained in nonpharmacologic interventions such as massage are better equipped to assist patients with bothersome symptoms. A nurse, as a health educator, can inform both patients and physicians about therapeutic options such as massage for managing challenging symptoms and improving patients’ clinical outcomes.
Massage therapy is a safe, noninvasive modality, and increasing evidence points toward its beneficial role in alleviating symptoms associated with cancer and its treatments. It can be offered to inpatients, outpatients, and in critical care settings using techniques that best suit patient needs and preferences. Massage also can be an empowering experience for patients who can direct the therapist to address the bothersome symptoms that arise and change during the cancer trajectory, affecting areas most impacted by surgery, chemotherapy or by radiation treatments.
The Society of Integrative Oncology recommends massage therapy for reducing stress, anxiety, depression/mood disorders, and fatigue and for improving quality of life. However, massage has low utilization rates with barriers including lack of awareness and physician non-referral, cost, lack of time, and concerns over transportation. But important findings from a recent study of patients with breast cancer demonstrate feasibility of safe and effective integration of oncology massage into chemo-infusion suites, thereby overcoming above mentioned barriers.