Every now and again, during a chat with a client I will hear something I find shocking. Sometimes it’s about the world at large (I tend to avoid the news since I find the sensationalism and negative tone quite depressing), and sometimes it is something deeply personal to that client (perhaps a conversation, a reaction, a bill!!). I hope that when it is the latter, I have always reacted in a sympathetic and compassionate manner.
Unfortunately there is one instance recently when I failed in masking my shock, for which I am truly sorry. Let me back up.
I believe that the vast majority of people in their 30s have known someone who has had cancer of one form or another, and I am no different in that. One of the things I knew when I trained as a massage therapist was that I wanted to be able to work with anyone who wanted to work with me, whatever their circumstance, symptoms or medical history. On our course we spent considerable time looking at anatomy, physiology and pathology, including discussing when you cannot massage people, and when you can but with caution. I was thrilled that the former is really a very short list, including (but not limited to!):
- When a client presents with infectious symptoms which could either be transmitted to the practitioner (and obviously on to other clients!) or to other parts of the client’s body (the big one here is Deep Vein Thrombosis post heart attack).
But 'cancer' in all its many forms, symptoms and treatments, is not so black and white. In fact, when I searched for "Massage Cancer" to write this article, the first page of results included pages from Cancer Research UK, Macmillan Cancer Support, American Cancer Society and The Royal Marsden, all supporting or even facilitating massage therapy. I am absolutely thrilled by this because when I did my additional CPD training course Massage for People with Cancer back in 2013 it was still not this widely accepted. However, the same Google results page did contain a tabloid story from April 2013 Spa massage ban for cancer survivor - you’ve got to love the red top headlines – which writes:
Some experts think cancer sufferers should avoid massages because of the risk of moving cancer cells from one part of the body to another. But Charity Breast Cancer Care said: “There’s no evidence to support this theory”.
This concisely explains the problem, there is fear and confusion in the public domain around massage and cancer potentially spreading cancer cells throughout the body. Medics call the process of cancer spreading Metastasis – “The spread or transfer of any disease, but especially cancer, from its original site to another site where the disease process continues.” [The Human Body Book, Steve Parker, p. 243]. But, as the Breast Cancer Care quote in the article states, there is no evidence to support this fear. The real problem is, how can you DISprove a theory when there is no defined alternative? I am not a medical expert, so please bear with me whilst I try to unpack the biology of this as basically as I can:
- Lymph and circulation systems Massage is known to stimulate the lymphatic and circulatory systems so might massage not give ‘dodgy cells’ a free ride to somewhere new?
- Whilst both the lymph and blood circulation is increased as a result of massage, it is also increased through having a warm bath, climbing stairs and going for a brisk walk – none of which I have ever heard of being ‘banned’ for cancer patients
- The body needs flow and movement for healthy function
- Helpful little critters called lymphocytes (“White blood cell that is part of the immune system; it protects against virus infections and cancer” [The Human Body Book, Steve Parker, p. 243]) hang out in the lymphatic system and pack into lymph nodes (or lymph glands)
- The immune system appears to be enhanced by relaxation, as our body’s autonomic nervous system switches from ‘fight or flight’ mode (sympathetic nervous system) to the ‘rest and digest’ or ‘feed and breed’ mode (parasympathetic nervous system)
- Immune system If the body’s natural immune system is under attack, perhaps massage might over stimulate this making it harder work for the body?
- Gentle, relaxing massage will help to support the body’s immune system and encourage the central nervous system to switch out of ‘fight or flight’ mode
I hope that the above isn’t too much information nor an over simplification of my understanding of the biology. The issue is very ‘grey’ – even the term ‘cancer’ is actually the term given to label a wide spectrum of diseases and conditions.
At this point I should cover my own back and say that I do not see massage as any form of treatment, let alone cure, for cancer. Indeed, the American Cancer Society put it very simply - “available scientific evidence does not support claims that massage slows or reverses the growth or spread of cancer”. Massage is awesome but not quite that incredible!
So with so much greyness, I guess you may wonder what got my back up? Surely it couldn’t be a nervous question from a current or potential client? Well, perhaps some well intentioned bystander? Nope, it was hearing that a dear client had been advised by one of her medical team that she couldn’t have massage as it might cause a spread.
I could have howled. Particularly when I found out that this client was particularly disappointed because she felt she could benefit from the relaxation she had previously experienced in our sessions. But when you trust the diagnosis, their recommendations for surgery and further treatments, of course you are going to trust their recommendations about every aspect of your life. Were they to suggest you eat a banana a day and drink two cups of green tea to help boost your immune system, you are likely to do so. But to question one aspect of their ‘overall health’ advice (“don’t have massage”) does perhaps lead to confusion.
My answer to this is that the oncologist is going to be the specialist in the cancer, the symptoms, the drugs and surgery options, etc. But they are not necessarily experts in other areas such as the appropriateness of massage, or beneficial nutritional advice. Please don’t get me wrong, I think these wonderful people do an incredible job, and whilst if they are excellent at what they do we might forgive one or two of them for their ‘harsh’ bed-side manner, perhaps they could work with slightly more humility when it comes to the areas they are not specialists in.
Massage is NOT a cure, and will not make a patient cancer-free, but it can make a huge difference in helping a patient feel better. There is a wonderful book called Medicine Hands; Massage Therapy for People with Cancer by Gayle MacDonald, M.S., L.M.T originally published in 1990 which has a simple mission:
While it is true that a typical session of Swedish Massage, Shiatsu, or Trigger Point Therapy may be inappropriate for some patients, by adapting techniques or using another gentler, non-invasive modality, the benefits of touch can be experienced by all oncology patients. The goal of this book is to instill the idea that touch can always be safely administered to cancer patients, regardless of the severity of their condition … Skilled touch is beneficial at nearly every stage of the cancer experience, during hospitalization, the pre-or post-operative period, in the out-patient clinic, during chemotherapy and radiation, recovery at home, remission or cure, and in the end stages of life. Not only are physical needs addressed, but emotional, social, and spiritual ones as well. Receiving comforting, attentive bodywork reminds the patient that the body can still be a source of pleasure. As they relax, pain, fatigue, and nausea diminish. Touch reminds them they are still lovable and worthwhile. For a moment, this person, who may be disfigured, lonely, or without hope, feels whole again. [Preface]
Advice is meant to help us make decisions about what we want to do or should do. This is as true for the decision to have surgery, undergo a course of medication or treatment, as it is to have a massage. I will never fight someone about their decision, but am always happy to provide more information, signpost how to research the situation themselves and discuss their thoughts and fears. Likewise I will never encourage someone to be reckless with their decisions about health, but will support them in their decisions as far as I am able.
As I write this, I do not know whether the person whose cancer journey inspired me to write this will come to see me for a massage whilst on that path. But I hope that they, and anyone else reading this, will know that I support and respect their decision. Whatever their diagnosis, circumstances or beliefs.
A final thought, which says everything … about cancer and its impact on the whole of a person’s life, as well as about massage therapy:
Massage therapy is not contraindicated in cancer patients, massaging a tumor is, but there is a great deal more to a person than their tumor ~ Bernie Siegel, M.D. [p5]
This article has been published with kind permission of the client involved, for which I am very grateful:
"I’m very happy with your article and hope that it helps others who are unsure what to do for the best with regard to massage and cancer."