More than 250,000 women are diagnosed with breast cancer each year; it is the second leading cause of death for women.
Now, those enduring treatment may have better access to additional, holistic methods of dealing with their illness.
In June, the American Society of Clinical Oncology endorsed an evidence-based guideline created by the Society for Integrative Oncology that recommends complementary therapies, including massage therapy, for cancer patients.
Early diagnosis is just one factor of surviving breast cancer. Once that diagnosis is made, it is very important to manage the process of treating cancer, which often results in medical interventions for patients’ bodies, but little that helps them fight the mental and emotional battle cancer wages.
Healing the Mind and Spirit
Pilar Hook, a massage therapist, is all too familiar with what that battle looks like. With over 13 years managing a thriving massage practice in St. Petersburg, Florida, Hook knew she was going to go an unconventional route and seek integrative care for her breast cancer diagnosis.
When her doctor recommended a double mastectomy along with an aggressive chemotherapy plan, Hook was interested in other options. Like many women diagnosed with breast cancer, she found her initial visit with an oncologist lacked compassion and understanding regarding what she wanted her cancer journey to look like.
“I was not going to settle for that diagnosis,” Hook said.
She made her way to an integrative medical center in Arizona. That facility offered her cancer treatment that was aligned with her beliefs about healing the mind, body and spirit.
“I was able to do the healing that I needed to do, which wasn’t just the medicine,” said Hook, who was diagnosed in January of 2018 and declared cancer-free in June.
“I did the mental, emotional, physical and spiritual work behind it all. I feel it ultimately was the real contributor to the success of my treatment being so short. Had I not done the physical, emotional and spiritual work, I would have been hitting roadblocks with my body.”
Massage Therapy for Pain and Mood Management
This holistic approach to cancer treatment falls along the lines of new guidelines for breast cancer care released in June; these guidelines are designed to expose oncology workers to complementary therapies like the ones Hook used in her treatment plan.
On June 1, ASCO endorsed complementary therapies, including massage therapy, to help cancer patients manage pain and mood disorder symptoms during and after treatment.
This is monumental in the field of integrative oncology because the endorsement uses evidence-based research to support the value of the integrative care that has been the cornerstone of the Society of Integrative Oncology’s (SIO’s) mission throughout its 15-year history.
“We are excited that a larger group of clinicians working in oncology would be aware of the SIO guidelines and be aware of evidence-based complementary therapies that could be helpful to patients,” said SIO President Lynda Balneaves, PhD, RN.
Moving Oncology Massage Forward
This is the first endorsement ASCO has made in the field of integrative oncology, and Balneaves thinks it’s just the beginning.
“We see this as a significant step forward for the field of integrative oncology to increase our exposure to [the] mainstream oncology world, and we really hope that this is a way of moving beyond an ‘us versus them’ mentality so we are simply talking about evidence,” Balneaves said.
This development brings renewed excitement and new credibility to those in the field of oncology massage. Massachusetts-based massage therapist, oncology massage trainer and researcher Tracy Walton has worked on clinical trials, funded by the National Institutes of Health’s National Cancer Institute, involving massage and caregivers. She has long advocated for the benefits massage brings to patients facing cancer and other illnesses.
“The specific recommendation of massage therapy for depression and mood disorders is a clear endorsement of our work. We have known for a while from a meta-analysis of massage therapy across many populations that massage therapy can provide potent help for people with anxiety and depression,” Walton said.
Massage for Cancer Patients: What the Guidelines Say
Integrative oncology delivers evidence-based research on complementary therapies that support patients undergoing conventional care. The idea of integration is merging standard care cancer treatments with mind and body practices, natural products and lifestyle changes. The SIO breast cancer guidelines are based on peer-reviewed analysis of trials conducted between 1990 and 2013.
According to SIO, studies analyzed had to include more than 50 percent breast cancer patients or separately report results for breast cancer patients; use an integrative therapy as an intervention during standard treatment or address symptoms and side effects resulting from diagnosis and/or treatment of cancer; and address an endpoint of clinical relevance for breast cancer patients and survivors.
The complementary therapies recommended were graded A, B and C.
Modalities with a grade A can be offered or provided to patients with a high certainty that the benefits are substantial
Grade B modalities provide a moderate to substantial benefit to patients and are recommended to be offered or provided.
Grade C modalities are selectively offered to patients based on professional judgment and patient preferences, with small benefits.
The guidelines, published in the Journal of Clinical Oncology, provide these recommendations in relation to massage for cancer patients:
- Massage, acupuncture and relaxation can be selectively offered for reducing anxiety.
- Acupressure can be offered in addition to antiemetic drugs to control nausea and vomiting during chemotherapy.
- Massage is recommended for improving mood disturbance, offering moderate to substantial benefits. Acupuncture, healing touch and stress management can be selectively offered for improving mood disturbance and depressive symptoms.
- Low-level laser therapy, manual lymphatic drainage and compression bandaging can be selectively offered for improving lymphedema.
- Acupuncture, healing touch, hypnosis and music therapy can be selectively offered for pain management.
- Acupuncture, qigong, reflexology and stress management can be selectively offered for improving quality of life.
Read ASCO’s endorsed guidelines in full here.
A Step Forward
While the news about massage having a positive impact on breast cancer patients may not be new to those in the field of massage and integrative health, it does provide a seed of hope that change is on the horizon for its adoption into medical settings, in particular oncology teams.
“I think it’s a step, but I think it’s a tiny step,” said Kerry Jordan, oncology massage instructor and operations manager for Healwell, a nonprofit that aims to improve quality of life for people affected by acute, chronic and serious illness through massage therapy. Jordan is cautiously optimistic about the new endorsement and believes there is a long way to go before massage therapists can celebrate.
“I am pleased that it’s getting the coverage that it has, but we are still fighting an uphill battle to get massage meaningfully integrated in a hospital setting,” Jordan said.
The issues, she explained, are a combination of mindset toward complementary therapy, clinicians’ limited exposure to the vast number of complementary therapies available, and clinicians’ exposure to research supporting what works.
SIO is diligently working on overcoming these issues.
“There is research suggesting that many of these therapies can help people with their quality of life and some of the symptoms they may be experiencing as part of being a cancer patient and undergoing cancer treatment,” Balneaves said. “These therapies just expand clinicians’ toolboxes in terms of being able to offer patients more choices that may support them in their cancer journey,” she added.
Education in Oncology Massage
Is an endorsement enough to effect meaningful change in the field of massage?
Oncology massage therapists Jordan and Walton believe massage therapists need to be better informed and educated about cancer in general. Walton believes massage therapists need to gain skills such as client interviewing, clinical reasoning, good communication on parameters of oncology and massage, keeping up with current research, and a great deal of compassion.
“We [massage therapists] have to move ourselves forward. There are many ways that this needs to occur. One is in education, both basic massage therapy education and CE [continuing education],” Walton said.
“We cannot afford to sit back and assume with a little education or a little reading that we’re up to the task,” she continued. “This is cancer: It is prevalent, it is complex and it represents more than 200 different diseases. This takes more than a superficial list of precautions or a quick solicitation of advice on Facebook. We need a lot of depth and commitment.”
Both Walton and Jordan have their own educational programs that teach massage therapists oncology massage and how to work with patients with chronic and acute illnesses. Training like theirs covers massage for cancer patients, as well as understanding cancer and the emotional aspects of the disease.
Above all, it provides therapists the confidence to work with cancer patients and create custom sessions to fit their needs.
Many massage therapists leave school with limited knowledge about how to properly work with cancer patients, so they may end up turning these clients away. An estimated 1.7 million Americans will be diagnosed with cancer this year, according to the American Cancer Society. With those statistics, a working massage therapist is likely to have clients with cancer or who have survived cancer.
Educators like Walton and Jordan believe it is critical for massage therapists to have training in oncology massage, either as part of their curriculum in school or in continuing education trainings.
Similarly, to get allopathic clinicians on board with complementary therapies as part of breast cancer treatment plans, they need exposure to these therapies — a gap that the SIO guidelines are aspiring to fill with evidence-based research.
“If we can prove that these therapies reduce the use of pharmaceuticals … if it improves their health outcome, I think we will see more and more policy makers and key stakeholders embedding these individuals into hospitals and community settings,” said Balneaves.
“But it is going to take time because it is a new way of providing care—and change does not happen overnight in healthcare.”
About the Author
Aiyana Fraley, LMT, is a freelance writer and healthcare professional with more than 17 years of experience in the massage field. She teaches yoga and offers sessions in massage, reiki, sound healing and essential oils.