Cancer Care and Massage Therapy

by Niamh Van Meines ('01), RN, LMT, NP

When considering the use of massage therapy for cancer care, patients as well as practitioners want to know if massage is safe and helpful. As interest in complementary and alternative medicine (CAM) grows, it becomes even more important to answer these questions with evidence-based information.

Although research on the use of massage therapy in the field of oncology is limited, there is some evidence that massage therapy can have significant value for this population (Billhult & Dahlberg, 2001). Specific issues for which massage therapy has been found useful in oncology include pain management, reduction of anxiety, nausea and feelings of isolation, as well as improvement of immune function. While many of these studies involve small patient populations, they do suggest that further research in this field would be of value.

Pain Reduction

Chronic pain is experienced in 30 to 50% of cancer patients undergoing treatment (Gecsedi & Decker, 2001), while ninety percent of these patients experience pain at the end of life. The use of pharmacological methods alone to manage pain is not always adequate for this population, due to the multifactorial nature of cancer pain. In addition, the depressive effects of analgesics and narcotics can interfere with activities of daily living and increase risks of systemic complications. However, when massage therapy is used on cancer patients, it can significantly alleviate or reduce the perception of pain.

Studies of massage therapy for cancer pain management show that patients report decreased pain and increased relaxation during and after a session (Billhult & Dahlberg, 2001). The ability of massage therapy to reduce different types of pain has been shown by many researchers. Moreover, such effects can be achieved even with relatively short sessions (Ferrell-Torry & Glick, 1993; Holme, Waterman, & Hillier, 1999; Weinrich & Weinrich, 1990).

One study (Ferrell-Torry & Glick, 1993) assessed subjective feelings of pain, anxiety and relaxation, as well as objective measures of pulse, blood pressure and respiratory rate in nine patients. Massage therapy consisted of thirty minutes of effleurage, petrissage, myofascial and trigger point work to the feet, back, neck and shoulders. Patients reported a 60% reduction in pain perception, a 24% reduction in anxiety and a 58% increase in feelings of relaxation. Pulse, blood pressure and respiratory rates decreased from baseline, also indicating a more relaxed state in the body.

Myofascial techniques have been shown to be of benefit to post-surgical patients. In a study of twelve patients who reported pain at the site of a lumpectomy, a course of myofascial release treatments three times a week for three weeks led to complete or nearly complete relief for eight patients and significant improvement for the remaining four (MacDonald, 2000). In research with hospitalized patients, Janet Travell, M.D., found that their discomfort was often not related to their disease, but rather to muscle anomalies which she named "trigger points" (Travell, Simons & Simons, 1999). Myofascial and trigger point massage can be useful to oncology patients who experience decreased activity and endurance due to chemotherapy or radiation treatments, as well as surgical procedures that impact their musculoskeletal system and posture.

Countering Stress and Its Effects

Massage therapy has consistently decreased measures of stress—cortisol and catecholamine levels—as well as increased measures of dopamine and serotonin, which indicate improvement in neurotransmitters involved in mood (Field, 1998). Additionally, oxytocin levels, which are responsible for feelings of attachment and intimacy, are augmented as a result of massage therapy (Fritz, 2000). The reduction of stress and support of immune function may prove beneficial from many perspectives for the oncology population.

The impact of massage therapy on immune function and its application in the oncology population is under investigation (Ironson, Field & Scafidi, 1996). Studies with other populations suggest that massage therapy can increase natural killer cell (NKC) activity, which improves the body's ability to recognize and destroy foreign cells, tumor cells and infected cells (Field, 1998). Studies have also demonstrated that stress will decrease NKC, as well as the immunological activity of T-helper cells and lymphoblasts (Olson et al., 1997). The clinical significance of these changes in immune functions is being studied.

Nineteen women with stage I or II breast cancer who received 45 minutes of massage therapy three times a week for five weeks showed significant changes in immune system activity. Those in the experimental group who received massage had increased lymphocyte markers (CD56 positive, CD3 positive, CD11A positive) and NKCs, as opposed to the control group. In addition, the massage therapy group reported decreased anxiety, pain and anger, along with improved mood (Field, 1998). The group also reported long-term changes involving improved body image, increased physical well being and less depression than the control group.

Since stress can also exacerbate feelings of nausea during cancer treatments, studies have been conducted to see if massage therapy, while alleviating stress, will also have a positive impact on incidents of nausea and vomiting in cancer patients. Some studies have shown that CAM techniques, such as massage, guided imagery and progressive muscle relaxation, can be successful in decreasing nausea (Arakawa, 1997).

A study of 87 cancer patients who received ten minutes of foot massage found a significant and immediate effect on perception of pain, nausea and relaxation. A 33% reduction in nausea was reported (Grealish, 2000). Another study that looked at patients receiving autologous bone marrow transplantation found that when patients received twenty minutes of massage therapy to the shoulders, neck and head, they reported a reduction in nausea, pain and anxiety (Ahles et al., 1999).

Is it Safe?

The primary concern about using massage therapy with oncology patients is the possibility of causing tumor progression, either locally or to distant sites, due to the increased blood and lymphatic circulation created by massage. However, the nature of metastatic disease suggests that tissue manipulation alone does not create the environment needed for cancer cells to proliferate.

Metastasis is not purely a random process, but requires optimal environmental conditions. Cancer cells committed to circulation by inadvertent manipulation through massage are not viable unless their specific function is to migrate and invade other tissues. Once committed, they must also escape immune surveillance. An efficient immune system will create a hostile environment for cancer cells. Indeed, mortality of blood and lymph-borne cancer cells is high when the body's cytotoxic T-lymphocytes, activated macrophages and natural killer cells are active (Gibbons, 2000).

Cancer cells deposited to a new site must then establish a blood supply. The study of metastatic patterns indicates that cancer cells have a selective affinity to chemotactic substances found in different tissues (Gibbons, 2000). Additionally, invasion of tumors into adjacent tissues depends upon the degradation of adhesion molecules in healthy tissue caused by proteolytic agents secreted by cancer cells.

It seems unlikely, given the complicated scenario necessary for a cancer cell to travel and invade other tissue, that simple manipulation of tissue by itself will lead to metastasis. However, practitioners definitely need to use caution when working with people with cancer and should know how to modify techniques to suit individual needs. For instance, direct pressure over tumor sites is contraindicated, and caution should be used when massaging an area which may have post-operative anatomic distortions. Given the possibility that the oncology population is immunosuppressed, and many have a bleeding tendency from low platelet count or anti-coagulant use, practitioners may need to clarify the massage session goals and modify the amount of pressure used. (Continuing education in medical massage for cancer is a must; Memorial-Sloan Kettering's Integrative Medicine Center often has courses. Contact them at www.mskcc.org/integrative medicine or 212.639.2225 for more information.)

Conclusion

Massage therapy's impact on stress and anxiety is so significant that it can improve a cancer patient's quality of life. Other benefits have yet to be proven, but research may well indicate that massage therapy deserves to become a mainstream practice among health care practitioners, as well as part of an integrated health care plan for all patients.

Niamh Van Meines, RN, LMT, is a graduate of Columbia University's Nurse Practitioner Program with a subspecialty in Oncology and Integrative Therapies. This article is an edited excerpt from the thesis she submitted for her master's degree. Van Meines was a staff member in the Oncology and Bone Marrow Transplant Department at New York Presbyterian Hospital and is currently a faculty member at the Swedish Institute Massage Therapy Program where she teaches Pathology and Clinical Strategies.

Ahles, T., Tope, D., Pinkson, B., Walch, S., Hann, D., Whedon, M., Dain, B., Weiss , J., Mills, L. & Silberfarb, P. (1999), Massage therapy for patients undergoing autologous Bone Marrow Transplant. Journal of Pain & Symptom Management, 18 (3), pp. 157-163.

Arakawa, S. (1997), Relaxation to reduce nausea, vomiting, and anxiety induced by chemotherapy in Japanese patients. Cancer Nursing, 20 (5), pp. 342-349.

Billhult, A. & Dahlberg, K. (2001), A meaningful relief from suffering: Experiences of massage in cancer care. Cancer Nursing, 24 (3), pp. 180-184.

Ferrell-Torry, A.& Glick, O. (1993), The use of therapeutic massage as a nursing intervention to modify anxiety and perception of cancer pain. Cancer Nursing, 16, pp. 93-101.

Field, T. (1998), Massage therapy effects. American Psychologist 53, (12), pp. 1270-1281.

Fritz, S. (2000), Mosby’s Fundamentals of Therapeutic Massage (2^nd ed.), Philadelphia: Mosby, Inc.

Gecsedi, R. & Decker, G. (2001), Incorporating alternative therapies into pain management: More patients are considering complimentary approaches. American Journal of Nursing, 101, pp. 35-39.

Gibbons, J. (2000), Biology of Cancer. In Yarbro, C., (Author) Frogge, M., Goodman, M. & Groenwald, S. (Eds.). Cancer Nursing, Principles and Practice (5^th ed.), Boston, Jones & Bartlett Publishers.

Grealish, L., Lomasney, A. & Whitman, B. (2000) Foot massage: A nursing intervention to modify the distressing symptoms of pain and nausea in patients hospitalized with cancer. Cancer Nursing, 23 (3), pp. 237-243.

Hulme, J., Waterman, H. & Hillier, V. (1999), The effect of foot massage on patients’ perception of care following laproscopic sterilization as day case patients. Journal of Advanced Nursing, 30, pp. 460-468.

Ironson, G., Field, T., & Scafidi, F. (1996), Massage therapy is associated with enhancement of the immune system’s cytotoxic capacity. International Journal of Neuroscience, 84, pp. 205-217.

MacDonald, G. (2000) Medicine Hands. Tallahassee, Florida: Findhorn Press.

Olson, M., Sneed, N., LaVia, M., Virella, G., Bonadonna, R. & Michel, Y. (1997), Stress-induced immunosuppression and therapeutic touch. Alternative Therapies, 3 (2), pp. 68-74.

Travell, J., Simons, D. & Simons, L. (1999), Myofascial Pain & Dysfunction. The Trigger Point Manual. Philadelphia: Williams & Wilkins.

Weinrich, S. & Weinrich, M. (1990), The effect of massage on pain in cancer patients. Applied Nursing Research, 3, pp. 140-145.

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