twilight   therapeutics


Oncology Massage

www.tracywalton.com


www.s4om.org


What is Oncology Massage?

Oncology massage is the modification of existing massage therapy techniques in order to safely work with complications of cancer and cancer treatment.  Anyone who has ever received cancer treatment, from those in active treatment to those in recovery or survivorship, as well as those at the end of life, should only be treated by a massage therapist who has received training in oncology massage.  


Essential aspects of an oncology massage therapist's skill set are an informed understanding of the disease itself and the many ways it can affect the human body; the side effects of cancer treatments, such as medications, surgery, chemotherapy and radiation; and the ability to modify massage techniques in order to adapt for these side effects, as well as for the disease.


Oncology Massage Assessments

Clinical assessments and adaptations to the massage session for someone experiencing cancer or with a history of cancer treatment are critical to providing a safe massage. Standard oncology massage intake questions include those pertaining to:

  1. cancer treatment history

  2. tumor site or metastasis

  3. compromised blood cell counts

  4. lymph node involvement

  5. blood clots or blood clot risk

  6. medications (short and long term)

  7. vital organ involvement

  8. fragile or unstable tissue or bones

  9. medical devices

  10. fatigue, neuropathy, or pain

  11. changes in sensation

  12. late effects of treatment

A properly trained massage therapist will ask questions about these issues and more, depending on your unique situation.  Many of the changes that will be made to your session will be virtually imperceptible to you as a recipient (and others may be quite obvious), but they are essential to safety and proper support of your well being.


Oncology Massage Guidelines

Clinical assessments and adaptations to the massage session for someone experiencing cancer or with a history of cancer treatment are critical to providing a safe massage.

For people in active treatment, recently into recovery, or at end of life, these clinical considerations can and do regularly change. Massage modifications as a result of positioning, pressure, pace or site considerations related to concerns like medical devices, side effects of drug treatments, surgery or radiation, compromised lymph nodes or blood cell counts, and other concerns, may apply, and are unique for each person and each session.

Certain massage modifications will remain crucial even decades after treatment is complete. When providing massage for someone who has a history of cancer treatment, primary massage considerations include but are not limited to bone integrity, vital organ involvement, and compromised lymph nodes.


Is Your Therapist Trained?

“Listening is a creative force. Something quite wonderful occurs when we are listened to fully. We expand, ideas come to life and grow, we remember who we are. Some speak of this force as a creative fountain within us that springs forth; others call it the inner spirit, intelligence, true self. Whatever this force is called, it shrivels up when we are not listened to and it thrives when we are.” —Kay Lindahl


Massage can make your cancer journey easier...but not just any massage; an oncology massage. Many of the body's responses to cancer and cancer treatment require changes to massage therapy. A properly trained therapist should be able to tell you why and how.

If you are currently receiving treatment or have ever received treatment for cancer in your life the safest way for you to get massage is to find a massage therapist who has had appropriate training in the specifics of cancer and cancer treatment and how to use a knowledge of those specifics to provide safely adapted massage therapy for people at all stages of the cancer journey.

Below you will find a few questions that will help you to decide if a massage therapist has enough training to work with you and your unique medical history as it relates to cancer.


1) Ask if she/he has special training covering contraindications, modifications, and benefits of massage for people with a cancer history.

If not, keep looking. Providing massage therapy for a person affected by cancer is not something that should be done without training. Any therapist who tells you that they have not had training, but "it shouldn't be a problem" or "It'll be ok. I'll just work lightly." simply doesn't understand what kind of risks he/she is taking with your health and safety.


2) If so, was the training on the internet, a one-day course or a Society for Oncology Massage recognized course of 24 hours or more including lectures and hands-on experience?

The Society for Oncology Massage has agreed upon a standard core of elements that should be contained within any course that claims to be preparing massage therapists to work with people affected by cancer. We believe that competency in these elements and skills is essential to safe oncology massage. Typically, these compentencies are best achieved over a course of multiple days with an opportunity to receive hands-on instruction from an experienced instructor in a live setting and, ideally, including a directly supervised opportunity to work with an actual client affected by cancer. Most therapists are not able to safely learn and apply the information necessary when that information is provided online or through a course of one or less days. There are always exceptions, so you will have to use your intuition to decide how or if a therapist's answer to this and other questions is satisfactory for you and your needs.


3) Ask about her/his experience working with people with a cancer history.  How many and when?

As with any discipline, someone who has worked with many people over many years is going to feel preferable to most clients over someone who is just starting out. Keep in mind, however, that oncology massage is a relatively new discipline so many of the therapists you will encounter may be relatively new. If they've had proper training that training included an understanding of how to respond when the answer is "I don't know."


There is so much to know about cancer and about the thousands of different treatment options and variations. No massage therapist will know it all, but the more training and experience a therapist has the more likely he/she is to know things pertinent to you and your situation.


  1. 4) Briefly describe your cancer treatment history and/or plan (include surgery, chemotherapy and radiation history) and ask what kind of modifications she/he might make from standard massage based on this information.

Listen for things like changes in treatment time, pressure, positioning and joint movement, to name a few.


A properly trained oncology massage therapist should be able to tell you some basic adjustments he/she might make to your session based on a brief description of your treatment plan and/or history. It's a good sign if the information you share leads your therapist to ask you additional questions.


Nothing is black and white with oncology massage. Many details of your history will lead your therapist to seek further clarification. "Oh, you're receiving radiation? Is it external beam or brachytherapy?" "You mentioned you had a mastectomy. Did you have reconstruction? If so, what kind?" An oncology massage therapist's curiosity may surprise you at first, but a curious therapist is a good therapist.


5) Ask how being immune-compromised changes things.

Oncology massage therapists know how important the immune system is and they know that cancer treatment poses a big challenge to the immune system. If you are immune-compromised your therapist should be taking hygiene-related precautions to keep you safe.


6) If you have had surgery or radiation, ask how she/he approaches the risk of lymphedema.   

Lymphedema is a serious condition. If you are at risk, you have likely

been told just how serious that risk is and what you need to do to

prevent yourself from developing lymphedema. If you are at risk for

lymphedema and the massage therapist you are about to see has

never heard of lymphedema or doesn't have a clear plan to keep

your risk from developing into an acute condition, you will need to

keep looking for a trained therapist.


( Currently lymphedema is incurable once triggered, deep tissue techniques like trigger point

therapy and over-stretching have been known to trigger lymphedema. If you have had as few as one lymph gland removed in the axillary area or have had radiation therapy you are at risk and need to make sure your massage therapist is properly trained. )                                            


  1. 7) Will you need your physician's consent?

- It is always a good idea, but it does not replace a properly trained therapist.


8) Will you need to give a complete medical and cancer history?   This is essential.

If the therapist does not plan to take a complete medical and cancer history, keep looking. A complete history is essential to safe oncology massage. Many therapists feel that a thorough health history is an "inconvenience" for clients and many therapists practice in settings where the scheduling of appointments is such that there simply isn't time to conduct a thorough health history and still offer a 50-60-minute session. Be that as it may, it simply isn't possible to provide a safe massage session (oncology or otherwise) without a thorough health history.

All of these questions will help you to get a feel for how well-trained and prepared a given massage therapist is to support you safely and effectively. The many situations we have mentioned above do require changes to typical massage protocol. Some of the changes will be small and virtually imperceptible to you as someone getting a massage, but the making of these adjustments can mean the difference between healing support and acute complication. Listen for detailed, thoughtful answers. You want a massage that is effective and safe. It's not "just massage".


This information is reprinted from the www. S4OM.org website, except for the added notes on lymphedema in ( ).  The Society for Oncology Massage (S4OM) exists to support and educate massage therapists, consumers, and health professionals about the value and specific considerations and applications of oncology massage. For more information please visit the s4om website.



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