The Science Behind Massage Therapy

Scientists have scrutinized the general effects of massage for decades, but now a number of studies have zeroed in on its far-reaching advantages for cancer patients. Research and review studies, including a 2010 study in the journal Supportive Care in Cancer, has shown that massage can:

• Lower pain

• Reduce nausea

• Improve fatigue

• Help with emotional and physical discomfort

• Reduce depression

• Lower anxiety

“We’re managing pain, anxiety… all these things at a lower cost,” says Kim Turk, Lead Massage Therapist at Duke Integrative Medicine in Durham, N.C. “Clients get some personal attention to their bodies that doesn’t have to do with a treatment they’re scared of or that makes them nervous. It’s a whole hour just to comfort them…”

Nanette Schoeder, a two-time breast cancer survivor, appreciated how regular massage therapy cut her nausea and fatigue during multiple rounds of chemotherapy. She had already made massage part of her wellness routine before she was diagnosed at age 48. “It made it easier for me to get up and do something,” says Schoeder, who also underwent a mastectomy and radiation.

More research is being conducted to explore the mind-body relationship of cancer survivors who receive therapeutic massages. Researchers are hopeful a better understanding of the mind-body relationship will reveal exactly how massage reduces side effects and which types of therapy will provide the most benefit. 

While some have expressed concern about the possibility of massage causing cancer cells to spread, this has never been shown to be the case, and most experts do not feel this is a risk. However, many do stress the importance of using a qualified massage therapist. 

The Importance of Working With a Qualified Massage Therapist

Just as with pregnancy and advanced age, cancer brings special considerations to the practice of massage therapy. “It’s important that massage therapists working with patients be specially trained in cancer care,” says Lauren Muser Cates, a licensed massage therapist and former president of the volunteer organization Society for Oncology Massage.

Special considerations include:

• Bruising. Vigorous massage can lead to bruising among those with chemotherapy-induced low blood counts.

• Sensitivity. Areas undergoing radiation may be too sensitive to touch or may feel burned if massage oil is applied.

• Lymph node removal. Lymph node removal, even if minimal, requires a customized evaluation of the benefits and risks of massage to avoid triggering lymphedema rather than reducing it.

• Metastases in the bone. A customized approach extends to people with metastatic cancer. Metastases in bones require a lighter tough to avoid fractures.

• Palpable tumors. Experienced therapists recommend that an active tumor site (such as one palpable under the skin) not receive direct massage due to irritation risks.

All of these factors dictate whether a massage will be “light” (concentrating on the skin) or “deep” (focusing on underlying muscle tissue). Good therapists will ask detailed questions about each client’s treatment and wellbeing before each session, so they can customize the massage as needed. 

“You can have someone sailing through treatment, such as a lumpectomy with no nodes taken out, and their massage can be relatively normal,” says Cates. “For someone who’s had radiation or their nodes removed, we’re going to work much differently. It’s a very client-centered massage.” 

Finding a Qualified Massage Therapist

Before beginning massage therapy and choosing a therapist, you should talk to your doctor to get recommendations. Your doctor can determine if a massage therapist with special training is needed to minimize potentially negative reactions. 

Ideally, your massage therapist should have a broad knowledge of cancer and its treatments to determine the correct amount of pressure to use and areas to avoid. To decide if a massage therapist will be a good addition to your healthcare team, we recommend taking the three additional steps below. 

Interviewing Massage Therapists

Ms. Cates suggests cancer survivors interview several therapists by asking them very direct questions like: 

• Have you had special training covering modifications and contraindications of massage for people with a history of cancer?

• How many cancer patients have you worked with and for how long?

• How does your approach change for those who have had surgery, radiation or chemotherapy?

• Do you need my doctor’s consent?

Checking State Licensing and Certifications

Nearly all states require massage therapists to be licensed, and some cities require special licensure as well. Therapists can also receive professional certification through the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB). Within the practice of massage therapy, there are also numerous specialties that are learned through specific coursework.

Factoring in Insurance Coverage

Despite its documented advantages to cancer survivors, most health insurance plans offer only limited coverage for massage therapy, if at all. For example, although manual lymphatic drainage is often covered when administered by a physical therapist, treatment by a massage therapist typically leaves patients paying out of pocket. The good news is more health care plans are beginning to cover massage therapy, particularly if recommended by a doctor.

Before selecting a massage therapist, check with your insurance provider to see if it is covered under your current plan. If so, you will likely have to use a massage therapist within your network to avoid paying out of pocket.

Ms. Turk encourages patients to submit massage bills to their insurance companies in hopes they will help establish that the therapy is relatively inexpensive and highly effective.