Massage therapy

Massage therapy is the use of touch to may help relieve stress, reduce pain, and improve circulation. Massage may also reduce some breast cancer symptoms and treatment side effects.

There are many types of massage therapy. Some types are specifically designed for people diagnosed with cancer. Below, we’ll explain:

• How massage therapy can be helpful for people diagnosed with breast cancer
• Oncology massage: what it is and how it works
• Massage safety considerations

Benefits of massage therapy

Research on massage therapy in people with cancer has shown several benefits, including:

• Reduced pain
• Reduced anxiety
• Improved sleep quality
• Decreased fatigue
• Reduced nausea
• Reduced chemotherapy-related neuropathy
• Improved physical functioning
• Improved quality of life

Oncology massage

Oncology massage is a specialized type of massage therapy designed for people who have been diagnosed with cancer. While other types of massage, such as Swedish or Shiatsu massage, focus on overall relaxation, oncology massage requires that practitioners have specific training.

The Society for Oncology Massage, which oversees oncology massage guidelines, requires that practitioners complete education in:

• Cancer and its treatment
• Safety considerations for people with cancer
• Massage therapy adjustments based on a person’s cancer diagnosis and treatment side effects

How oncology massage works

Oncology massage includes a medical assessment and individualized massage adjustments based on a person’s unique situation.

Before oncology massage therapy

Before your first appointment, your oncology massage therapist will have you complete a detailed intake form. Many factors are taken into consideration, including:

• Your specific diagnosis
• Your cancer treatment history
• Medicines and supplements you are currently taking
• The location of the tumor or area(s) of metastasis
• Whether there was cancer in the lymph nodes
• Whether your blood cell counts are normal or low
• Whether you have any implanted medical devices, such as a chemotherapy port
• Whether you have deep vein thrombosis or a history of deep vein thrombosis
• Whether you have pain, nausea, fatigue, or neuropathy
• Whether you have side effects of radiation therapy, such as fragile tissue or decreased range of motion

Before each session, your oncology massage therapist will make any necessary adjustments based on your current phase of treatment, side effects you may be experiencing, and any other changing needs. Adjustments may be based on:

• How you are feeling on the day of your session
• Your risk of lymphedema, a painful swelling condition that can develop in some people after lymph node removal, radiation to the lymph nodes, or taxane chemotherapy
• The location of incisions or painful areas of the body
• Whether you are currently undergoing a specific treatment or if you are in recovery

Different types of adjustments may include:

• The direction and pressure of massage strokes
• Your position on the massage table
• The length of your session

During oncology massage therapy

It’s important to know that oncology massage avoids deep pressure. If you are used to deep pressure during massage therapy, an oncology massage may feel different. There are different reasons for avoiding deep pressure:

• For people undergoing chemotherapy who have low blood platelets (parts of blood cells that help to form clots), deep pressure increases the risk of bruising and internal bleeding.
• In people living with bone loss or bone metastasis, deep pressure massage can increase the risk of fracture.
• For people undergoing radiation therapy, deep pressure massage can injure sensitive skin.

Oncology massage strokes work to:

• Activate the parasympathetic nervous system, the part of the nervous system that helps you relax
• Quiet the sympathetic nervous system, which triggers anxiety, fear, and the fight-or-flight response

This relaxed state can help relieve anxiety. Some people may experience a release of emotions through crying. This is normal, and can help support a greater sense of wellbeing.

If you are at risk for or have lymphedema

If you have had lymph nodes removed as part of your cancer treatment, this can increase the risk of lymphedema. It’s important to let your oncology massage therapist know:

• If you’ve had lymph node surgery
• If you have been diagnosed with lymphedema

Manual lymphatic drainage

For some people, a specialized type of massage called manual lymphatic drainage may help relieve symptoms of lymphedema.

Manual lymphatic drainage is different than oncology massage and other types of massage therapy. Manual lymphatic drainage is a technique designed to reduce fluid buildup, swelling, and discomfort in people who have developed lymphedema.

If your oncology massage therapist is also a certified manual lymphatic drainage therapist (CMLDT) or a certified lymphedema therapist (CLT), they can provide education about lymphedema risk and help monitor any changes if you are at risk. If lymphedema develops, they can help you manage it.

If a person has been diagnosed with lymphedema and their oncology massage therapist is not a CMLDT or CLT, the therapist is trained to only offer stationary touch. This means no moving strokes on the affected area.

Lymphedema should only be treated by a CMLDT or CLT.

Lymphatic massage is not the same as manual lymphatic drainage

Lymphatic massage is a broader practice sometimes used in spas and wellness centers.

Manual lymphatic drainage and oncology massage require specialized training. If you have been diagnosed with breast cancer and you are seeking massage therapy or treatment for lymphedema, it is important to look for professionals who are trained to work with people diagnosed with cancer and/or lymphedema.

How to find an oncology massage therapist

You can locate an oncology massage therapist by visiting the S4OM Preferred Practitioner Directory.

The Society for Oncology Massage (S4OM) is the only organization that oversees oncology massage education guidelines. S4OM is based in the U.S. and its guidelines are used internationally.

If oncology massage is not available in your area

While oncology massage is available in many areas of the U.S., it is not available everywhere. To find a board-certified massage therapist in your area, visit the National Certification Board for Therapeutic Massage & Bodywork.

If you have been diagnosed with breast cancer and are considering massage therapy with a practitioner who is not trained in oncology massage, it’s important to let them know about your diagnosis, treatments, and any side effects you may be experiencing:

• Let your massage therapist know if you have had lymph nodes removed. Having any number of lymph nodes removed increases the risk of developing lymphedema.
  • Tell your massage therapist to use only stationary touch (no moving of their hands) over the front and back of the arm and chest on the side where lymph nodes were removed.
  • If lymph nodes were removed on both sides, only stationary touch should be used on the upper half of your body, from the last rib up to the collarbone.
• If you have been diagnosed with lymphedema, tell your massage therapist to avoid the entire area where lymphedema is present.
• Tell your massage therapist to avoid deep pressure during any part of the massage, and to avoid using thumbs or elbows. The pressure should be no more than if you were rubbing lotion on your skin so that it absorbs deep into the skin.
• Tell your massage therapist to avoid hard stretching of the arms and legs.
  • While extremely rare, muscle or tendon rupture has been reported in people taking aromatase inhibitors as part of breast cancer treatment. Hard stretching in people taking these medicines may increase this risk.
  • Hard stretching also increases the risk of lymphedema if lymph nodes were removed.
• Tell your massage therapist to avoid using high heat, such as hot stones or hot towels, on any part of your body. High heat can increase the risk of lymphedema in people who have had lymph nodes removed. A warm treatment table is OK.
• Tell your massage therapist to avoid cupping. Cupping is a massage therapy technique that uses suction to pull on the skin. Some people use cupping to try to get relief from pain and other conditions. Cupping may increase the risk of lymphedema in people who have had lymph node surgery. Cupping can also injure delicate skin that has been radiated.
• If you are receiving chemotherapy, talk with your doctor before getting a massage. Some types of chemotherapy, such as cyclophosphamide (Cytoxan), may be excreted through the skin. Ask your doctor if your chemotherapy treatment is excreted through the skin. If so, your massage therapist will need to wear gloves.
• If you are having chemotherapy side effects such as a rash, hand-foot syndrome, or fungal infection, let your massage therapist know that it is not safe to receive massage over any of these areas of the body. The skin on these areas could be exposed to bacteria that causes infections.
• Let your massage therapist know if you are receiving external beam radiation therapy. If you are receiving this type of radiation therapy, your massage therapist should avoid the area being radiated from the time radiation tattoos are placed until 6 weeks after radiation has stopped. Skin that is being radiated can tear easily. If lymph nodes are being radiated, the risk of lymphedema is increased. Unaffected areas of the body can be massaged lightly during radiation therapy.
• If you have breast cancer metastasis to the bones, lung, liver, or brain, talk with your doctor about any precautions before having a massage with a practitioner who is not trained in massage for people with cancer.
• Avoid massage if you have a fever. This is a sign of an infection and you should contact your doctor immediately. Massage will not help you feel better if you have a fever.