Massage Therapy

Continuing Education

CANCER AND MASSAGE

NCBTMB Provider #451897-12

www.nirvanamassagecenational.com

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CANCER AND MASSAGE

2 CEUs

Content copyright 2012, 2013 Nirvana Massage CE National, LLC

All rights reserved. All trademarks and/or copyrights are in effect.

This course is for informational and continuing education purposes

only.

All information in this course has been thoroughly researched and

referenced. It is accepted as factual at the time of publication. Nirvana

Massage CE National, LLC disclaims responsibility for any contradictory

information.

It is the responsibility of the massage therapist and/or medical professional to

determine what precautions to take in the particular field and to abide by

their scope of practice.

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COURSE OUTLINE

Chapter One: What is Cancer?

Chapter Two: Who Gets Cancer?

Chapter Three: Deaths from Cancer

Chapter Four: Cancer Treatments

Chapter Five: Benefits of Massage for Cancer Patients

Chapter Six: Cautions and Contraindications

References

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Chapter One

What is Cancer?

Cancer is an all-encompassing term that includes a variety of diseases of

varying severity. The American Cancer Society defines cancer as “the

general name for a group of more than 100 diseases in which cells in a part

of the body begin to grow out of control. Although there are many kinds of

cancer, they all start because abnormal cells grow out of control.”i Cancer

cells differ from regular cells, which grow, divide, and die in a healthy way.

Cancer cells divide outside the rate of normal cells, and do not die when

they are supposed to.ii The process of normal cell death is called apoptosis.

Cancer cells do not undergo this process.iii

Along with growing, dividing, and not dying on time, cancer cells also

invade other tissues.iv Regular cells cannot do this. Cancer cells have

damaged DNA, and instead of repairing the damage or dying, the cancer

cells replicate. The replicated cells also carry the damaged DNA.v There is

no clear-cut cause for cancer, but causes can include hereditary factors,

lifestyle (diet, smoking, etc.), and environmental factors (such as pollution or

radiation).vi

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Carcinogens are substances that are responsible for “damaging DNA,

promoting or aiding cancer.”vii Examples include cigarette smoke, x-rays,

radiation from the sun, and car exhaust. Carcinogens produce free radicals

that rob electrons from molecules in the body’s cells, producing cell

damage.viii

Cancer cells can clump together to form tumors, which damage

surrounding tissues. Cancer cells can also break off from the tumor and

spread to other areas of the body. Once they invade other tissues, the cells

continue to grow and form new tumors. This is called metastasis.ix Metastasis

is the leading cause of death from cancerous diseases.x When cancer

spreads, it is still named after the original location of the disease. For

example, if you have skin cancer that has metastasized and spread to other

organs, it is still called skin cancer.xi Some tumors are benign, which means

they are not cancerous. These types of tumors do not invade other tissues,

though they can cause health problems when they press on other organs.xii

Not all types of cancer are tumor forming. Leukemia affects blood function,

for example.xiii Cancer can affect any and all of the body’s systems.

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Chapter Two

Who Gets Cancer?

American Cancer Society records from January 2008 showed that almost 12

million people had cancer in the United States.xiv Half of all men in American

will develop cancer during their lifetime, and 1/3 of all women in America will

develop some form of cancer.xv Almost 300,000 people in the United

Kingdom are diagnosed with cancer every year.xvi Almost 1.6 million people

in the United States get a new cancer diagnosis annually.xvii

The risk of getting cancer increases as you age. Seventy-five percent of new

cancer diagnoses occur in patients who are 60 or older. One percent of

cancer patients are children under the age of 14, and roughly 10 percent of

cancer patients are between the ages of 25 to 49.xviii The most common

cancer for men is prostate cancer (24 percent), and the most common

cancer for women is breast cancer (31 percent).xix Thirty-one percent of

childhood cancers are leukemia. For people between 25 and 49, the most

common cancers are “breast cancer, melanoma, bowel and cervical

cancer.”xx

Cancer occurs in people of every race, but there are some cancers that

have a higher risk factor for some races. For example, Caucasian women

have a higher risk of getting breast cancer than women of other races.xxi

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According to the Centers for Disease Control and Prevention, diagnosis rates

of new cancers in men are highest in black men, with the lowest rate of new

cancer diagnoses being among American Indian men.xxii Death rates from

cancer are also highest among black men, and are lowest among Asian

and Pacific Islander men.xxiii For women, the rate of new cancer diagnoses is

highest among white women and lowest among American Indian women.

Death from cancer is highest among black women and lowest among Asian

and Pacific Islanders.xxiv

Those with a family history of cancer, those who are exposed to

carcinogens, and those with unhealthy lifestyles have increased risks of

contracting cancer.

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Chapter Three

Deaths From Cancer

The American Cancer Society projects that there will be 571,950 deaths from

cancer in 2011.xxv In 2010, about 1,500 people died every day from

cancer.xxvi In 2008, 7.6 million people around the world died from cancer.xxvii

According to their records, there was a 22 percent decrease in cancer

deaths in men between 1990 and 2007, and a 14 percent decrease in

cancer deaths among women.

Lung cancer causes 28 percent of the cancer deaths in men and 26 percent

of the cancer deaths in women. The rate of death from lung cancer is

declining faster for men because they smoked in larger numbers earlier than

women, and also quit sooner than large numbers of women. xxviii Half the

cancer deaths in both men and women are caused by one of the four

major cancers: lung, breast/prostate, colon, and rectal.xxix

The decreasing rate of cancer deaths in America is due in some part to

improved cancer care after diagnosis, but is also largely due to better and

more frequent screenings (and therefore earlier detections) for common

cancers. Preventative lifestyle choices such as not smoking, a healthy diet,

and increased amounts of exercise have also contributed to the falling rates

of cancer deaths.xxx In 2007, 1 in 4 deaths in Americans were caused by

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cancer, which was in increase from 2006. The aging of the Baby Boomer

generation can account for this.xxxi

African American men have a 34 percent higher chance of dying from

cancer than white men. African American women have a 7 percent lower

diagnosis rate than white women, but a 17 percent higher chance of dying

after diagnosis. African Americans have higher death rates for every cancer

site and at every stage of diagnosis.xxxii

Cancer patients who come from a low socioeconomic status “have more

advanced cancers at diagnosis, receive less aggressive treatment, and

have a higher risk of dying in the five years following” their diagnosis.xxxiii The

ACS states that these disparities can be fought by “breaking down barriers to

health promotion and wellness care…barriers include lack of health

insurance, lack of transportation to wellness facilities, low literacy, and

speaking little English.”xxxiv Seventy percent of cancer deaths happen in

countries considered low or middle income.xxxv

The World Health Organization predicts that there will be 12 million deaths

from cancer across the world in 2030. xxxvi

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Chapter Four

Cancer Treatments

The treatment of cancer depends on the stage at which it is diagnosed, the

overall health of the patient, and the type of cancer the patient has. About

half of cancers diagnosed are curable.xxxvii There are four traditional and

standard treatment methods for cancer: surgery, radiation, chemotherapy

and immunotherapy/biologic therapy.xxxviii

Surgery is the most often used treatment for cancer, with 3 of 5 cancer

patients undergoing surgery to remove a tumor.xxxix In cases where cancer

has not metastasized, surgically removing a tumor cures the cancer entirely.xl

In cases of prostate, testicular and breast cancer, surgery can commonly

cure the patient.xli

Radiation treatment involves directing x-ray beams or other high-energy

beams at the site of the tumor.xlii Radiation is also known as radiotherapy,

and can be used alone or in conjunction with other therapies. Radiation

damages the cancer cells to the point that they commit suicide.xliii Side

effects of radiation can include: “fatigue or tiredness, nausea and vomiting,

skin inflammation, appetite loss, dry mouth and changes in sense of taste.”xliv

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Chemotherapy is a common treatment for cancer that has spread

throughout the body and involves the use of anti-cancer medication.xlv

These medications use chemicals that damage proteins or DNA within

cancer cells in order to interfere with the cancer cell division process.xlvi

Chemotherapy can affect healthy cells as well, but healthy cells can

recover while cancer cells will not; in fact, chemotherapy is given in cycles

so the healthy cells have time to recover.xlvii Chemotherapy can be given in

pill form or intravenously, and the side effects include: “hair loss, nausea,

fatigue and vomiting, fever and infection.”xlviii

Immunotherapy uses the body’s immune system to fight the cancer. There

are localized and systemic immunotherapies. Bone marrow transplants and

protein interferon alpha therapies are examples of these.xlix Hormone

therapy involves manipulating the production of certain hormones in the

body in order to inhibit cancer growth or kill the cancer altogether. This is

most commonly used for breast or prostate cancers. Some versions of

lymphoma and leukemia are also responsive to cortisone hormone therapy.l

When the body no longer contains cancer cells, the patient is considered to

be in remission.li

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Chapter Five

Benefits of Massage for Cancer Patients

Up to 53 percent of adult cancer patients have used massage therapy in

addition to their traditional treatments.lii Unlike traditional medicine that

focuses solely on ridding the body of the dangerous cells, massage therapy

can be part of a holistic treatment that addresses the patient’s physical,

mental and emotional well-being.liii Massage therapy can “reduce

symptoms, improve coping, and enhance quality of life.”liv

Studies conducted by the Touch Research Institute have shown that

massage therapy can reduce anxiety and depression among cancer

patients (both adults and children).lv Another study in the United Kingdom

showed that aromatherapy massage provided short-term relief from stress

and depression in cancer patients.lvi A 2007 Swedish study showed that

massage therapy helped breast cancer patients who were undergoing

chemotherapy maintain a positive outlook, distracted them from the fear of

treatment, helped them relax and made them feel more cared for.lvii

Massage therapy can also help ease a number of symptoms associated with

cancer or cancer treatments including: fatigue, nausea, pain and

sleeplessness.lviii A 1993 study of the effects of massage therapy on cancer

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patients showed a 60 percent decrease in pain perception among patients

who received massage.

A 2000 study in Australia showed that hospitalized cancer patients who

received a 10-minute foot massage had a dramatic decrease in pain and

nausea.lix Another New York study of 1,290 cancer patients revealed a 50

percent short-term reduction in cancer symptoms after a massage.lx The

same Swedish study mentioned earlier also showed that massage helped

alleviate nausea associated with chemotherapy.lxi

For patients who are terminally ill, massage therapy can be very effective at

easing their final days.lxii A relaxing environment and feeling as though one is

cared for may help the stress and cope with the depression that may be

present during a cancer patient's final days.lxiii

Massage therapy can also help patients recover from side effects of

treatment, such as loss of motion from radiation and scar tissue build up from

surgery.lxiv It has also been shown to increase circulation and release muscle

tension, help with fevers, and increase energy levels.lxv

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Chapter Six

Cautions and Contraindications

In the not-so-distant past, massage therapists were told to never massage

any cancer patient for any reason because the therapy would spread the

cancer cells and metastasize the disease. This is false, but there are some

instances where massage is not recommended or where special cautions

must be taken.lxvi In general, massage therapy is safe for cancer patients

and there is NO evidence that massage spreads cancer cells.lxvii

The myth that massage therapy speeds up metastasis comes from the idea

that massage therapy increases circulation. However, exercise and warm

baths increase circulation at the same intensity and they do not cause

metastasis. In fact, the spread of cancer through metastasis is far more

complex than the myth would have you believe, and is not caused by

simple circulation. The medical community has dismissed this myth.lxviii

Before you massage a patient with cancer, ALWAYS receive permission from

the patient’s oncologist.lxix Patients who are actively undergoing treatment

via radiation or chemotherapy may have low blood platelets and can

therefore form bruises easily. You will need to focus on lighter therapies such

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as cranial-sacral therapy or energy work while a patient is undergoing active

treatment.lxx

If a patient’s cancer has spread to their bones, extra lightness is necessary so

you do not cause fractures.lxxi In fact, deep massage in general should be

avoided while the patient is in treatment and for the first year after they are

in remission. As the body heals and recovers from treatment, it should not be

put under the added stress of deep tissue manipulation.lxxii The use of long,

light effleurage strokes relieve stress instead of causing it (as opposed to a

more sports-like massage, which raises blood pressure and causes stress to

the body) and should be the focus of your technique.lxxiii

Radiation

Patients who are under going radiation therapy for cancer require special

caution from massage therapists. Those patients who are receiving their

therapy via an internal implant are generally hospitalized for the length of

the treatment. These patients are radioactive and you should not massage

them for both your safety and theirs.lxxiv

It is important to honor a patient’s wishes during radiation therapy. The

treatment has a highly individualized effect on each patient. Some patients

may be thrilled about the idea of having a massage after each radiation

treatment. Others may be exhausted and will not be willing to travel to you,

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even if they know it would help with their symptoms. Honor the patient,

whatever they decide.lxxv

Radiation is a heating therapy and cancer is characterized by rapid

abnormal growth, so a massage therapist should focus on cooling, slow

modalities. The heat and energy of radiation therapy can cause the skin of

the patient to become sensitive, and eventually to become burned and too

tender to touch. If this occurs, focus on energy work and avoid touching the

radiation site. Do not use massage oils on these areas. Also, take care that

you do not remove markings placed on the radiation site by the patient’s

oncology team. The markings are used to direct the radiation beam and

should be left alone.lxxvi

If the patient is receiving radiation to bone marrow producing sites, they

may experience immunosuppression as the site decreases its white blood

cell production. If your client is immunosuppressed, take extra care to not

transmit infection.lxxvii

Patients undergoing radiation may experience lymph edema, which is the

accumulation of lymph in a part of the body because of damage to the

lymph system or removal of lymph nodes. Patients who have received

radiation to the “neck, axilla, abdomen or groin, or has had one or more

lymph nodes removed from these areas” must be approached with extra

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caution. Deep massage to these areas can cause trauma that leads to

lymph edema. If your client presents with lymph edema, do not massage

the affected area.lxxviii

Other Considerations

Patients who are undergoing chemotherapy may have the same sort of side

effects as those undergoing radiation (low platelet count,

immunosuppression, etc.), so show the same caution when those cases

present. Chemotherapy patients may also have catheter sites for their IVs,

and you should avoid those areas.lxxix Avoid massaging sites of open wounds

or infections.lxxx Patients undergoing chemotherapy may also be extra-

sensitive to back-and-forth or rocking motions of massage because of

nausea, so be careful with that.lxxxi

In cases of patients with cancerous tumors, avoid both local and regional

pressure to the area.lxxxii Avoid massaging patients who are recovering from

surgery and are at risk for thrombosis.lxxxiii

You will also need to be extra-mindful of the patient’s emotional or mental

state. Cancer treatments can be very traumatic and invasive, so the client

may have a severe emotional response to your touch. Avoid wanting to

“fix” the client’s illness. Focus on transmitting positive energy to the client,

and on just “being.”lxxxiv

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Always work in the client’s best interest as stated by the Code of Ethics. This

includes working as closely as possible with the client’s other medical health

team members, including the oncologist. Keep the doctor informed of any

reactions the client has to massage. Get regular updates on the patient’s

treatment so you can adjust your modalities as necessary.

i American Cancer Society, “What is Cancer?”, http://www.cancer.org/Cancer/CancerBasics/what-is-cancer ii KidsHealth, “What is Cancer?”, http://kidshealth.org/kid/cancer_center/cancer_basics/cancer.html iii Medical News Today, “What is Cancer? What Causes Cancer?” http://www.medicalnewstoday.com/info/cancer-oncology/ iv ACS, “What is Cancer?” v Ibid vi Ibid vii Medical News Today, “What is Cancer? What Causes Cancer?” viii Ibid ix KidsHealth, “What is Cancer?” x YouTube, “3D Medical Animation- What is Cancer?” http://www.youtube.com/watch?v=LEpTTolebqo xi ACS, “What is Cancer?” xii Ibid xiii Medical News Today, “What is Cancer? What Causes Cancer?” xiv American Cancer Society, “Cancer Prevalence,” http://www.cancer.org/cancer/cancerbasics/cancer-prevalence xv ACS, “What is Cancer?” xvi Macmillan Cancer Support, “Who Gets Cancer?” http://www.macmillan.org.uk/Cancerinformation/Aboutcancer/Whogetscancer.aspx xvii American Cancer Society, “Who Gets Cancer?” http://www.cancer.org/Treatment/UnderstandingYourDiagnosis/AfterDiagnosis/after-diagnosis-who-gets-cancer xviii MCS, “Whot Gets Cancer?” xix Ibid xx Ibid xxi Alta Bates Summit Medical Center, “About Cancer,” http://www.altabatessummit.org/ehi/ehicancer.html#Who Gets Cancer? xxii CDC, “Health Disparities in Cancer,” http://www.cdc.gov/Features/CancerHealthDisparities/

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xxiii Ibid xxiv Ibid xxv Stacey Simon, American Cancer Society, “Annual Report: U.S. Cancer Rates Decline, But Disparities Remain,” June 17, 2011, http://www.cancer.org/Cancer/news/News/annualreport-u.s-cancer-death-rates-decline-but-disparities-remain xxvi Dr. Len, American Cancer Society, “The 2010 Statistics Are Out, and 767,000 People Have Celebrated More Birthdays,” July 07, 2010, http://www.cancer.org/AboutUs/DrLensBlog/post/2010/07/07/The-2010-Statistics-Are-Out-And-767000-People-Have-Celebrated-More-Birthdays.aspx xxvii World Health Organization, “Breast Cancer Awareness Month,” http://www.who.int/cancer/en/ xxviii Dr. Len xxix Ibid xxx Ibid xxxi Ibid xxxii Ibid xxxiii Science Daily, “Low Socioeconomic Status Increases Risk of Death After Cancer Diagnosis,” June 23, 3008, http://www.sciencedaily.com/releases/2008/06/080623092544.htm xxxiv Simon xxxv WHO, “Breast Cancer Awareness Month” xxxvi Ibid xxxvii Net of Care, “Cancer,” https://docs.google.com/viewer?a=v&q=cache:zWUtZq7qUP8J:www.netofcare.org/content/pdf/6-spec_illness-cancer.pdf+&hl=en&gl=us&pid=bl&srcid=ADGEESjvfmUZoe_Y58xi0ihYR2G_39q4HYmTxwfqWdBvNCI6kUnmI-_4BaOIYLV_nQe4quXoWjaB02A2jem2qjJT9hcGteIfpHmA78pKEbmdextoRH66zQVyw9xNLbtDNBSCn_GVz39c&sig=AHIEtbSJgI8Y-Ya70CbTOKj4k_mLdIlUIg&pli=1 xxxviii Lisa Fayed, About.com, “What is Cancer?” July 17, 2009, http://cancer.about.com/od/newlydiagnosed/a/whatcancer.htm xxxix KidsHealth, “What is Cancer” xl MNT, “What is Cancer? What Causes Cancer?” xli Ibid xlii Net of Care, “Cancer” xliii MNT, “What is Cancer? What Causes Cancer?” xliv Net of Care, “Cancer” xlv Ibid xlvi MNT, “What is Cancer? What Causes Cancer?” xlvii Ibid xlviii MNT, “What is Cancer? What Causes Cancer?” xlix Ibid l Ibid li KidsHealth, “What is Cancer?” lii Renee Gecsedi, Integrated Care, “Massage Therapy for Patients with Cancer,” https://docs.google.com/viewer?a=v&q=cache:FQOTMSfCAVMJ:www.hawaii.edu/hivandaids/Massage%2520Therapy%2520for%2520Patients%2520With%2520Cancer.pdf+&hl=en&gl=us&pid=bl&sr

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cid=ADGEESiQtteU30BqplAK65TkHsofKgIlnLUcC-TSHwP7e9H_gWKZeyAN_DR4whPgBzUx4gP7yve8ROsELGzSkzZLIkwmgxpprL3VW2A4oWeeaOhDghzkDkwQJZuZwhGZUxPxUKtnKrUF&sig=AHIEtbRhu7D2dXPd2uIGcqVr09RJ5HTt2Q liii Kieran McConnellogue, MassageTherapy, “Massage and the Cancer Patient,” December/January 2000, http://www.massagetherapy.com/articles/index.php/article_id/278/Massage-and-the-Cancer-Patient liv S.M. Sagar, T. Dryden, R.K. Wong, “Massage Therapy for Cancer Patients: A Reciprocal Relationship Between Body and Mind,” April, 2007, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1891200/ lv Aurora Health Care, “Clinical Massage for Cancer Patients,” http://www.aurorahealthcare.org/services/compmedicine/cancer.asp lvi Cancer Research UK, “Massage Therapy,” http://cancerhelp.cancerresearchuk.org/about-cancer/treatment/complementary-alternative/therapies/massage-therapy lvii Ibid lviii Ibid lix Gecsedi lx Sagar, Dryden and Wong lxi MassageMag, “Massage Relieves Nausea in Breat Cancer Patients Undergoing Chemotherapy,” March 26, 2009, http://www.massagemag.com/News/massage-news.php?id=6092&catid=236&title=massage-relieves-nausea-in-breast-cancer-patients-undergoing-chemotherapy lxii McConnellogue lxiii Gayle MacDonald, MassageTherapy, “Cancer, Radiation and Massage,” August/September 2003, http://www.massagetherapy.com/articles/index.php/article_id/184/Cancer-Radiation-and-Massage lxiv Ibid lxv Mesothelioma, “Massage as a Palliative Treatment for Cancer Patients,” http://www.mesotheliomaweb.org/mesothelioma/treatment/massage/ lxvi McConnellogue lxvii Lisa Corbin, M.D., “Safety and Efficacy of Massage Therapy for Patients with Cancer,” https://docs.google.com/viewer?a=v&q=cache:XtMxspShx14J:www.moffitt.org/CCJRoot/v12n3/PDF/158.pdf+&hl=en&gl=us&pid=bl&srcid=ADGEESjoA-0TZ0gEyw6Qc8d95t7M39cVPrPCqfNrYY06CqXEz3o6imnF0uLK0xSIFp_d0op53JgDuBc5clqmoo6X602tQDB8Wi_Rwlyc_LznBi2XoWBXRBAwTP8Cv348TtgfwfZHTysD&sig=AHIEtbRQo9ZA6Z7RRQRHcSmbxt3FjoNh_g lxviii Tracy Walton, Breastcancer.org, “Massage Spread Breast Cancer Cells?” September 29, 2008, http://www.breastcancer.org/treatment/comp_med/ask_expert/2005_03/question_13.jsp lxix McConnellogue lxx Ibid lxxi Ibid lxxii MacDonald lxxiii Ibid lxxiv Gayle MacDonald, MassageTherapy, “Cancer, Radiation and Massage,” August/September 2001, http://www.massagetherapy.com/articles/index.php/article_id/184/Cancer-Radiation-and-Massage

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lxxv Ibid lxxvi Ibid lxxvii Ibid lxxviii Ibid lxxix MacDonald lxxx Sagar, Dryden, Wong lxxxi Gecsedi lxxxii Ibid lxxxiii Ibid lxxxiv MacDonald