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Cancer, Radiation and Massage The Benefits and Cautions

By Gayle MacDonald Mar 27, 2012


Martha had just completed many months of treatment for breast cancer and was on a cruise to relax after the arduous experience. What she was most looking forward to after boarding the ship was receiving a massage. For weeks beforehand she had anticipated it. But when the time finally came, Martha was turned away. The massage therapist had been taught never to massage clients with cancer. Unfortunately the therapist didn't know that a cancer diagnosis is no longer an automatic contraindication for massage. While it is true that a typical massage would not be appropriate for someone recovering from cancer treatment, there is always a way to safely perform some method of skilled touch.

Many credible sources advocate the use of massage for those affected by cancer. The American Cancer Society provides basic information on its website about bodywork. The site's entry concludes by saying, "Everything surrounding massage therapy -- a soothing environment, human touch which is essential to life, a caring therapist, the comfort of prolonged attention, relaxed muscles -- combine to make massage one of the most supportive and helpful complementary therapies available."1

In a short position paper regarding massage and cancer, the Norris Cotton Cancer Center (Dartmouth-Hitchcock Medical Center in New Hampshire) stated, "It is our belief that gentle, conscious massage is not only safe, but has many demonstrated beneficial effects (e.g. enhanced well-being, decreased anxiety, nausea and fatigue). There is no data to suggest that it causes any harm to persons with cancer."

Research on the effects of massage for cancer patients is being conducted or funded by reputable organizations such as The Marie Curie Cancer Centre (Liverpool, England), the University of Miami's Touch Research Institute, and The James Cancer Hospital and Research Institute (Columbus, Ohio). More and more cancer care centers in the United States include massage for patients: the New Mexico Cancer Associates (Santa Fe, N.M.), the Cancer Treatment Center (Tulsa, Okla.), Commonweal (Bolinas, Calif.), Memorial Sloan-Kettering (New York City), the Baptist Regional Cancer Center (Knoxville, Tenn.), California Pacific Medical Center (San Francisco, Calif.), Longmont United Hospital (Longmont, Colo.), and the Geffen Cancer Treatment Center (Vero Beach, Fla.) to name a few.

With proper training, there is always a way for a practitioner to provide skilled touch to those undergoing treatment for cancer. It is wise, however, for bodyworkers to decline massaging cancer patients if they are not yet trained to do so. A practitioner who is not knowledgeable about the special needs of cancer patients should help the client find another therapist who is, rather than telling people with cancer they cannot receive massage. Cancer is still a socially ostracizing experience. To be refused the comfort and acceptance a massage can provide, such as Martha was, adds further insult to injury.

Each of the three main forms of cancer treatment -- surgery, chemotherapy and radiation -- require certain adaptations to the massage session. We will focus specifically on the benefits and cautions associated with radiation therapy, also known as radiotherapy.


Radiation Basics
Nearly 60 percent of all cancer patients receive radiotherapy as part of their treatment. Some are given radiation only, while others are prescribed a combination of surgery, chemotherapy or radiation. Radiation is used to shrink tumors, to kill cancer cells or to keep them from growing and dividing. This is accomplished by damaging the DNA in tumor cells.2

Usually radiation is given externally directly to the tumor site or to areas where the cancer might have spread. Full-body radiation may be given to treat a cancer such as leukemia or as part of the bone marrow transplantation process. When given externally, the radiation does not cause the body to become radioactive. Touching these patients is completely safe.

Radiation also is given internally, usually via a sealed implant available in wires, needles, seeds, ribbons, tubes and capsules. Internal application of radiation allows a more concentrated dose to be delivered at a specific site, such as the prostate or thyroid. Patients will be hospitalized, usually for less than a week, when receiving treatment with a highly radioactive material. During this time, the person will be isolated because his body is radioactive. Obviously, massage is contraindicated for the safety of the therapist.

Internal radiation implants may be placed in the patient during an outpatient procedure and can remain in the body indefinitely. The radioactivity of the implant, however, will have run its course within a year or less. At-home patients may need to follow special precautions to avoid exposing others to radiation. Pregnant women and young children are the group most commonly advised to restrict their exposure to the patient during the first couple of months. The medical staff at the radiation oncology clinic can advise bodyworkers of any limits that should be observed regarding close contact with patients who are being treated with implants. In most cases the restrictions will be few or non-existent.

Radioactive iodine, gold and phosphorus are other forms of internal radiation. Patients take these treatments orally and are radioactive for two or more days depending on the material and dosage used. Bodywork can be administered after the radioactive period is completed.


Side Effects
The side effects of external radiation are dependent on many factors: the dose rate, the type of radiation, and the area and volume of the body treated. Usually symptoms will begin to occur a couple of weeks after the treatments have begun. Radiation response is generally specific and occurs locally in the tissues and organs treated or in neighboring areas. For instance, someone receiving radiotherapy to the abdomen may develop diarrhea, but will not lose her hair. A patient being treated for a brain tumor will lose his hair, but is highly unlikely to suffer damage to the reproductive system.

Some of the common side effects to specific areas are loss of taste, diminished saliva production and difficulty swallowing when treated for head and throat cancers, a cough, hoarseness or lump in the throat when administered to the chest, nausea, diarrhea, vomiting or poor intestinal absorption when administered to the gastrointestinal tract, bladder irritation or fertility difficulties when treatment is given to the pelvis, and depressed blood counts when areas that produce stem cells are irradiated, such as the skull, vertebrae, ribs, sternum and proximal ends of the humerus and femur.3

Certain effects are felt by many radiation recipients -- loss of appetite, fatigue and skin tenderness in the treated area being the most common. Fatigue may be due to many things. Toxic products are released from destruction of the tumor. It is hypothesized the energy needed to metabolize these by-products may account for some of the fatigue.4 The red blood cell count may be low, causing the patient to be anemic. Or, the patient may be exhausted from the physical effort of traveling to and from the radiation clinic on a daily basis for four to six weeks. Further contributing to fatigue is the psychological effect of cancer and its treatment.

The skin in the treated area is not usually the intended target, but despite advances in technology, it, along with the hair follicles and sweat and oil glands, are usually affected to some degree. This damage occurs because the radiation must pass through whatever tissues it encounters prior to reaching the cancerous destination point. The skin in this area may become very dry and look red, irritated, sunburned or tanned. In some cases, this is followed by peeling of the skin.

Recovery usually occurs several weeks after treatment ends. In some patients, the irradiated skin remains permanently darker. Other individuals may have permanent fibrosclerotic damage that leaves the skin smooth, taut and shiny.

The inflammation induced by radiotherapy, especially high doses, can cause tissue in the treated area to become fibrotic.5 This is especially relevant to massage therapy. Fibrotic development in lymphatic tissue can lead to lymphedema. Fibrotic conditions in muscles can cause painful adhesions. These and other conditions mentioned above require caution and the need for adjustments when administering bodywork to those with a history of radiotherapy. On the other hand, skilled touch also has the potential to be extremely helpful.


Implications for Bodywork
Unlike chemotherapy, there is almost no research regarding the use of massage for radiation patients. In a survey of the use of complementary health practices by prostate patients undergoing radiation therapy, Kao and Devine found many of the men in the study continued to employ a variety of complementary health practices during treatment. Among those surveyed, 18 percent reported the use of chiropractic, massage and relaxation techniques.6

Some people might assume bodywork always should be postponed until treatment is complete. Bodywork, however, can be highly beneficial during this time. One massage therapist recounted the story of a client, Deborah, whose breast cancer had recurred. Once again she had to undergo weeks of radiation. However, this time Deborah used massage to support herself through the process. Following the second bodywork session, Deborah said the very best treat imaginable following a radiation treatment before had been a Baskin & Robbins double rich chocolate malt. Now, the best possible reward was a massage.

However, most clients may not be like Deborah who went from the radiation clinic to her massage therapist's office. Because of the fatigue that accumulates over the weeks, many do not have the energy for extra activities and prefer to wait until the treatment regimen is completed before resuming massage. It is important to honor patients' wishes even if we know our loving, compassionate touch could assuage some of the symptoms caused by treatment.

People's response to cancer treatment is highly individual. The 66-year-old mayor of my hometown just completed six weeks of radiation during which time she continued to work 12-14 hour days, occasionally stopping to vomit or nap on the office couch. A friend's father who also received six weeks of radiation was unable to do little else but go back and forth each day to the treatment clinic. There is no single recipe for doing this work. Each client is unique and each session with that person is unique.

Each bodyworker is also unique. Some bodyworkers may not be able to perform massage on patients who have just received radiation. A few practitioners have reported to me that after massaging a patient on the same day the person received external radiation, they felt an intense and uncomfortable heat in the arms. Although radiation passes through the recipient and does not remain in the body, some practitioners may be sensitive to the radiation. The majority of bodyworkers can touch radiation patients immediately following the treatment. The few who are extra sensitive should wait until the following day.

When working with clients who are in, or just finished with, treatment, bodyworkers should confer with the person's oncologist and then proceed with the massage sessions in a gentle and careful manner. They should err on the side of caution, combine heart and head, intention and knowledge. Many touch therapists have shared with me they felt confident working with people who have a cancer history because their intention was pure. Without a doubt, intention is a powerful influence. However, it must be combined with knowledge and ideally with supervised clinical experience. Alice, a massage therapist in one of my weekend trainings, now concurs with this. During the presentation on lymphedema, she realized that despite beneficient intentions, she had contributed to a client's lymphedema by working too deeply.

Cancer is a disease characterized by too much growth, too fast. Radiotherapy inflames and heats the body. Bodyworkers should imbue their touch sessions with a sense of cool slowness to counteract the speed of the disease and the heat of the treatment. Tender, languid music can help the therapist shift into this state of being. Holding an image, such as a calm lake or a forest flower, helps other practitioners' massage step into this slow, cool place.

Until recently, most in the bodywork community worried about the possibility of massage causing cancer cells to spread. The seriousness of metastasis cannot be minimized. However, gentle, conscious massage will not cause cells to become metastatic. But, many other conditions related to cancer and its treatment are of immediate concern when performing bodywork. When working with a patient undergoing radiation, these conditions will most often relate to the skin, scarring, gastrointestinal side effects and depressed blood counts. Occurring less often, but none-the-less very important, is the potential for lymphatic damage.


Skin
The skin in the treated area almost always becomes tender after a number of external radiation treatments. For the first few weeks, the skin usually tolerates light touch with slow movement. As the weeks progress, the skin may have a burned appearance and may become too tender to touch. At this point, energy techniques such as Reiki, Therapeutic Touch or Polarity therapy can be substituted until the skin heals, usually several weeks following the end of the treatment regimen.

The skin in the groin, axilla and under the breasts often reacts earlier and more severely to external radiation because of the warmth and moisture in these areas. Patients receiving radiation in these areas are advised to keep them dry during the course of treatment, because moisture exacerbates the effects of radiation. The local use of massage oils and lotion, therefore, is contraindicated until the area heals. This is also true of hot and cold packs.

The use of certain lubricants on the treated area are contraindicated because they can leave a coating that can intensify the effects of radiation to the skin. Some also interfere with the skin's healing, such as lotions containing alcohol and metals. Alcohol dries the skin and metals, such as zinc oxide or aluminum stearate, can cause rashes to skin that is tender from radiation. Even lubricants specially prepared for radiation patients can create skin problems because of certain ingredients, such as alcohol. On the other hand, pure aloe vera gel has proven to be universally safe and beneficial. It rehydrates the skin, as well as decreases inflammation.

Prior to using any lubricant on areas receiving or recovering from radiation, it is important to check with the patient or the medical staff at the radiation oncology clinic. There also may be restrictions about applying skin products within a certain number of hours prior to the treatment. Practices differ from clinic to clinic. If the patient is unfamiliar with the exact guidelines regarding the use of lotions and oils, the practitioner should contact the clinic. The nurses will be knowledgeable in this area.

The field of treatment will be evident by markings on the skin. Take care not to remove them during massage. The tattoos indicate the entry point of the radiation beam. Opposite the entrance point is an exit portal where the radiation beam passes out of the body. Some people also will have tender skin or skin which appears to be burned at this site.


Scarring
Scar tissue can develop up to six months after external treatment has ended. The skin may become hard, thick or feel bound in the areas that have been irradiated, surgical sites can also be aggravated. Even years later, the treated area can become sore, or as one client put it, "feel overstretched."

Consuelo experienced many of these side effects months after 30 sessions of radiation. Her treatment had begun with two lumpectomies, followed by four rounds of chemotherapy and then six weeks of radiotherapy. Consuelo's range of motion in the affected arm and shoulder was slightly limited after the surgeries but quickly returned to normal. It was following the radiation treatments that she lost range of motion due to adhesions, her lumpectomy scar became painful and the intercostal muscles on the irradiated side became tight.

A client of Lynn Van Norman's, a practitioner of the Lauren Berry method, was greatly incapacitated by radiation treatment for breast cancer. Until she found Van Norman, doctors told this woman she would just have to live with a shoulder distorted from scar tissue, the near inability to turn her neck (another side effect of scarring), a numb arm from pinching in the brachial plexus, and skin that had turned to rock-hard leather. Twice a week for many months, Van Norman "gently and sweetly" peeled apart the layers of fascia stuck together as a result of inflammation from the radiation, allowing the circulation to return. The client can now turn her neck, feel sensation in her arm, and the skin -- although not 100 percent -- has greatly softened.

Radiation oncologist John Crawford had patients who developed tenderness in the chest wall due to fibrosis following a lumpectomy and radiation. Anti-inflammatory drugs were successful in controlling the pain for most of the women, but a small group of patients did not respond favorably to the medication. In an effort to find relief for his patients, Dr. Crawford undertook a small study to examine the effect of Myofascial Release (MFR) on a group of 12 women. The treatments were given by physical or occupational therapists three times a week for three weeks. The sessions were begun two months after the patients finished their medical treatment to ensure no active cancer remained. This was determined from CT scans. All 12 participants experienced some pain relief. Eight of the 12 had complete or near complete relief, while the other four reported an improvement. Patients were followed for 4-65 months. Two people required additional treatment with MFR, resulting in relief of their symptoms.7


GI Side Effects
Chemotherapy has a well-deserved reputation for causing nausea, vomiting and diarrhea. These gastrointestinal (GI) side effects are less common with radiotherapy in general, but will be present if the recipient has been externally irradiated anywhere along the GI tract. This occurs because the mucous cells lining the tract are highly radiosensitive and become inflamed during treatment.

The literature has shown that bodywork significantly reduces chemo-induced nausea, diarrhea and vomiting. Acupressure to P6 and ST36 acupressure points have been reported to be helpful for chemo-induced nausea.8,9 Another study which included slow stroke back massage before and after chemo showed decreased duration, frequency and intensity of nausea and vomiting and decreased volume of diarrhea.10 Anecdotal evidence also indicates massage helps patients maintain their appetite and weight during chemotherapy. Skilled touch, it then can be hypothesized, may also be of benefit to radiation patients suffering from these same maladies.

Although GI distress is less common during radiation, patient anxiety about the treatment or the fear of vomiting and diarrhea may set the side effects in motion. The relaxation provided by gentle touch often can help prevent anticipatory nausea and vomiting. I have seen something as simple as a foot massage be effective in relieving GI symptoms. Relaxation, whether it is via a gentle Shiatsu treatment, a Reiki session or a superficial Swedish massage, seems to be the key.


Depressed Blood Counts
External radiation to the vertebrae, ribs, sternum, skull, ileum and upper part of the humerus and femur can depress red and white blood cell counts, as well as platelet levels.11 Bone marrow in these areas is involved with the production of stem cells, which are precursors to the various blood cells.

Immunosuppression -- A drop in the white blood cell count, referred to as neutropenia, depresses the patient's immune system, leaving him vulnerable to communicable disease. Skilled touch can be beneficial during this time. Some anecdotal evidence even indicates that subtle energy techniques applied to the stem cell producing areas can help blood counts return more quickly to normal.

A colleague, Warren Nistad, has developed a simple routine which focuses on these stem cell producing areas. I have slightly altered Nistad's original routine. From the supine position, begin by resting both hands on the client's head. Hold this position for three to five minutes. Move one hand down to the upper humerus, leaving the other hand on the head. Then move to the right shoulder and ribs, ribs and ileum, ileum and knee, knee and ankle, both ankles, left ankle and knee, knee and ileum, ileum and ribs, ribs and shoulder, upper humerus and sternum. Although the knee and ankle are not stem cell producing areas, I like to include them in order to connect the upper and lower parts of the body.

From the prone position, start with the hands on the lower cervical and upper thoracic vertebrae and systematically work down the spine. End with both hands resting on the posterior portion of the ileum. Hold each position for three to five minutes.

Bodyworkers must take care to observe protective isolation precautions when working with immuno-suppressed clients. These protocols are designed to protect patients from coming into contact with transmittable diseases. Protective isolation precautions include:

- 30-second handwashing immediately prior to touching the client.

- Mindfulness about touching the client after coughing or sneezing into your hands. Always rewash if this has occurred.

- Postponing the massage session if the practitioner has even the slightest fever, flu, cold or other communicable condition or is in constant contact with others who are ill, such as a child, roommate or spouse.

- Conducting the session in the client's home so she doesn't have to go out in public.

Fatigue -- A drop in the red blood cell count creates anemia and therefore fatigue. Although drugs such as procrit assist in the rebuilding of red blood cells, fatigue usually accompanies radiation treatment. Bodywork during this time should aim to provide comfort. It should soothe rather than stir up. The body needs all of its resources just to endure the stress of the situation and the side effects of radiation. Trying to rid muscles of waste products, as many massage modalities do, can overload an already fatigued body with more toxins than it can handle. Swedish massage can be adapted to work at the level of the skin and superficial muscles, or other gentler techniques can be substituted, such as Jin Shin Jyutsu, Compassionate Touch or cranialsacral therapy.

Easing Bruising -- If the platelet level drops sufficiently, a condition known as thrombocytopenia, clients will bruise more easily. This is a systemic, rather than a local condition. Gentle touch should be applied over the entire body if thrombocytopenia is present, not just to the area that has been treated.


Lymphatic Damage
Radiation treatment is one of the most common causes of secondary lymphedema in the United States. Secondary lymphedema is the result of trauma to the body such as surgery or external radiation. The potential for lymphatic damage as a result of radiation has received little attention in massage education. With the exception of those who specialize in lymphatic drainage techniques, most bodyworkers are unaware of this possibility, as are many mainstream health care professionals. I encourage readers to thoroughly digest the information in this section.

Lymph is a clear, colorless fluid containing water, proteins, fats, lymphocyte and cell debris. It circulates through lymphatic vessels and is filtered by lymph nodes. As one colleague puts it, the lymphatics act as the body's sewer system.

Lymphedema is the excess accumulation of fluid and protein in tissues. It may be caused when lymphatic vessels become blocked by scar tissue following radiation treatment or become swollen when the normal flow of lymphatic fluid cannot be accommodated because of damage to lymph nodes. The lymph, having nowhere to go, is trapped in the tissue, unable to be processed by damaged or absent lymph nodes. This pooled fluid contains excess protein. The longer it stagnates, the more the proteins congeal, so to speak, making it difficult for the lymph system to perform its job.

Numerous lymph nodes are clustered in the neck, axillary, abdominal and inguinal areas, making these sites more vulnerable to damage. Therefore, people who have received radiotherapy for breast cancer, pelvic malignancies -- such as those of the prostate, uterus, bowel and rectum, or head and neck cancers -- are especially at risk. The risk is even higher for those who have had lymph node removal in combination with radiation to the area.12,13

Many patients have subtle cues that they are in the early stage of lymphedema, but are not knowledgeable of these signs. For instance, the individual may have a subtle fullness in the limb, a ring or shoe that is too tight, warmth, a reddish tinge or blotchiness to the skin, an infection slow to heal, joint pain, or reduced range of motion.

Even though a radiation patient may have never exhibited symptoms of lymphedema, they remain at increased risk for its occurrence indefinitely. The literature recounts many stories of people whose lymphedema did not occur until years after treatment. Although their lymph nodes and vessels had been removed or damaged, enough functioning lymphatic tissue remained to accommodate the lymph. However, a slight trauma to a compromised lymphatic system can induce lymphedema. For some individuals, the trauma is an airline trip, for others it is an infection, having blood pressure taken, or receiving a flu shot in the affected limb. Vigorous massage involving deep pressure also could be the trauma which initiates an episode of lymphedema.

Not enough is known about which patients at risk for lymphedema will have an occurrence of the condition at some time in their life. Therefore, we must approach all clients who have had radiation treatment to one of the main cluster of nodes as if they are at risk. This is especially true if lymph nodes were also removed from the area.

Lest you think I am overstating the case, I will briefly relate three stories in which lymphedema was triggered or exacerbated by massage. One woman, after completing treatment for breast cancer, returned to her massage therapist. Neither the client nor the therapist realized the risk and proceeded ahead with the same session they had been doing for years. The next day the woman's arm was swollen. It took many months of Manual Lymphatic Drainage by a trained practitioner to reverse the swelling.

Another breast cancer client reported having a bout of lymphedema in the past, which appeared to have resolved on its own. At the time she came for massage, the client was experiencing a slight fullness in the affected arm. The bodyworker massaged the arm gently. However, when the client asked for deeper pressure on the back of the affected side, the therapist complied, even pulling the arm behind the back to better access the scapular muscles. The next day the client's lymphedema returned.

A third woman, also treated for breast cancer, went with her husband for a celebratory massage session at a well-known resort. This patient had experienced several episodes of swelling, mostly in her hand, but thought little of it. She related to me how pleased she was that the bodyworker had been so careful with the arm on her treated side. However, that night the client's hand and abdomen had swollen and she did not feel well. I quizzed her about how the therapist had massaged the back on the affected side. "Deep," was her answer. Most likely it was the vigorous massage to the back that triggered another episode of lymphedema. Like many patients at risk for lymphedema, she had not been thoroughly educated. It hadn't occurred to her that the swelling was caused by the bodywork.

Those at risk for lymphedema, which is anyone who has received radiation to the neck, axilla, abdomen or groin, or has had one or more lymph nodes removed from these areas, must be massaged with caution. Unfortunately for the average massage therapist, consensus has not yet been reached concerning the exact protocols to follow. In an article published by the National Lymphedema Network, Joachim Zuther writes, "The application of traditional massage -- that also includes other massage techniques which cause active hyperemia -- is therefore contraindicated in extremities affected by lymphedema, as well as in the ipsilateral trunk quadrants."14 He goes on to say this is also true for areas in which lymphedema is not present, but for which there is a risk. Zuther, the director of the Academy of Lymphatic Studies, also believes massage to the contralateral quadrant may have negative effects. I believe the term "active hyperemia" is the pivotal point upon which Zuther's position rests.

One physical therapist who has been generous enough to speak with me several times on this topic recommends a more moderate stance to her MLD patients who want to treat themselves to a relaxation massage. She suggests patients instruct the massage therapist to avoid massaging the affected limb and to gently massage the back on the affected side. The pressure should be just a little heavier than would be used to apply lotion. These are certainly safe guidelines to give patients, especially when the skill and knowledge of the massage practitioner are unknown.

Another MLD practitioner advises her clients to refrain from relaxation massage to the affected quadrant that is either too heavy or too light. Her concern about deep pressure is the same as Zuther's. But, she is also apprehensive about pressure that is too light for fear it will move more lymph than the damaged area can process.

The above examples give the reader a taste of the various opinions which exist on this subject. I would like to add my voice to the discussion and propose the following guidelines when giving relaxation massage to clients at risk for lymphedema. Whenever it is safe to do so, I advocate including the entire body in the massage session as a way of helping clients feel whole again. To exclude parts of the body can contribute to the fragmentation and dissociation which already exists in areas traumatized by cancer treatment.

Down the road, it may be discovered that these rules are too conservative. However, we are just beginning as a profession to gain knowledge and clarity about working with cancer clients. It is imperative we are cautious in this infancy period to gain the trust of clients and their health care providers.

The guidelines are designed so areas of the body that have been treated by radiation or lymph node removal are not overwhelmed by too much fluid, so strokes are performed in the direction of lymphatic flow, and so the body's inflammatory response is not triggered. Histamines released during the inflammatory response ultimately can result in the accumulation of water in the interstitial spaces.15 An injured lymphatic system will not readily be able to process this extra fluid.

These guidelines apply to the entire quadrant, front and back. The remainder of the body usually can be massaged in a more typical fashion. But, it would be prudent to massage the other quadrants in a moderate manner, especially when beginning. Although the lymphatic system is divided into separate sections, it is also interconnected, damage to one area impacts the entire structure.


Final Thoughts
Although unintended, cancer treatments are invasive, fragmenting and dehumanizing. Skilled, attentive touch can piece the body together again, as well as heart, mind and soul. Touch can help patients participate in their own healing, relax the back that has laid too long on a cold, metal table, restore hope and remind people they are lovable.

The most recent statistics from the American Cancer Society regarding invasive cancers are extremely sobering. At some point, usually later life, more than one in three American women will be affected and nearly one out of two men.16 The massage community should be at the forefront in embracing these individuals and teaching others about the importance of touch during this time. Bodywork education must begin to include training on this subject for all touch practitioners -- those who wish to practice relaxation massage, as well as those who use bodywork as a treatment modality.

People with cancer want and need to be touched. And, there is always a way to provide bodywork for them, no matter where they are in their treatment or recovery. The massage therapist not yet trained to work with cancer clients can at least give a gentle hand or foot massage, a Reiki treatment or a Polarity therapy session. Deep, effortful bodywork is not necessary to create a profound effect. Deep contact is made not by what we do, but by being with people as they undergo their experience. As massage therapists, we have much to offer those who are traveling this road. They also have much to offer us.

Gayle MacDonald is the author of Medicine Hands: Massage Therapy for People with Cancer, Findhorn Press, 1999. Her home base is the Oregon School of Massage. She can be reached at medhands@hotmail.com or 503/288-2943.

References
1. American Cancer Society website, www.cancer.org/alt_therapy/massage.html.
2. Tafas, C.M. and J.D. Bucholtz. Handbook of Oncology Nursing, 3rd Ed. Sudbury MA: Jones & Bartlett, 1998.
3. Groenwald, S.L, M.H.Frogge, M.Goodman, and C.H. Yarbro. A Clinical Guide to Cancer Nursing. Boston: Jones and Bartlett, 1995.
4. Ibid, et. al.
5. Ibid, et. al.
6. Kao, G.D. and P. Devine. "Use of Complementary Health Practices by Prostate Carcinoma Patients Undergoing Radiation Therapy." Cancer. 2000: 88(3):615-619.
7. Crawford, J. "Myofascial Release Provides Symptomatic Relief from Chest Wall Tenderness Occasionally Seen Following Lumpectomy and Radiation in Breast Cancer Patients." International Journal of Oncology, Biology, and Physics. 1996,34(5): 1188-89.
8. Dibble, S.L., J.Chapman, K.A. Mack, and A. Shih. "Acupressure for Nausea: Results of a Pilot Study." Oncology Nursing Forum. 200,27(1):41-47.
9. King, C.R. "Nonpharmocologic Management of Chemotherapy-Induced Nausea and Vomiting." Oncology Nursing Forum Supplement. 1997,24(7)41-48.
10. Scott, D., D. Donahue: R. Mastrovito: and T. Hakes. "The Antiemetic Effect of Clonical Relaxation: Report of an Exploratory Pilot Study. " Journal of Psychosocial Oncology. 1983,1(1):71-83.
11. Groenwald, et. al.
12. Swirsky, J. and D.S. Nannery. Coping with Lymphedema. Garden City Park, NY: Avery Publishing Group. 1998.
13. Burt, J. and G. White. Lymphedema: A Breast Cancer Patient's Guide to Prevention and Healing. Alameda, CA: Hunter House Publishers. 1999.
14. Zuther, J. "Is There a Role for Traditional Massage Therapy in the Treatment and Management of Lymphedema?" National Lymphedema Network Newsletter. April/June 2001. p 3-6.
15. Zuther, et. al.
16. Cancer Facts and Figures - 1998. American Cancer Society.

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