Discussion Concerning Massage Therapy with Cancer Patients:
Though cancer patients often use complementary medical therapies, including massage therapy, in conjunction with conventional treatment, many oncologists do not feel comfortable discussing Complementary and Alternative Medicine or CAM use with their patients.
Although massage is generally safe, cancer patients, particularly those undergoing active treatment, are at higher risk for complications. The Hippocratic Oath charges physiciansto “First, do no harm”; since massage therapy may put thepatient at risk, the oncologist has a duty to discuss massage with patients.
Certainly, the oncologist should ask patients not only about massage but also about any other CAM therapies they are using and, at the very least, discourage the use of harmful therapies. If a patient acknowledges using massage therapy, the oncologist should note any comorbid conditions (eg, anticoagulant use, heart failure, deep venous thrombosis, cellulitis, the presence of catheters, pregnancy, bonemetastases) that may put the patient at higher risk for complications. If any of these comorbidities are present, the patient should be advised to work with a therapist experienced in medical massage or cancer massage who can incorporate appropriate modifications in technique to decrease risk.
In addition, patients should be encouraged to consider the use of massage therapy for adjunctive management of pain and anxiety. If a patient is interested in using massage therapy, the physician should help in locating a qualified therapist. Variations exists in the philosophy and education of therapists, with some massage therapists under the mistaken belief that cancer is a contraindication for massage and others perhaps discouraging patients from receiving either potentially curative conventional care or potentially harmful therapies.
Thus, finding a massage therapist experienced and comfortable with both cancer patients and the conventional care commonly used is paramount. Oncologists can help patients find a qualified massage therapist. Given that many cancer centers, hospitals, and hospices now have integrative medicine programs offering massage therapy, oncologists can ideally refer patients to seek treatment in these settings. If such programs are not available, oncologists should encourage their patients to interview potential therapists or do so themselves to establish an ongoing consultant relationship for future referrals.
The right massage therapist will be knowledgeable about risks and benefits of massage in a cancer population and should be comfortable communicating with the referring physician on an ongoing basis. They should see themselves as an extension of the patient’s healthcare team, not as a replacement. Some massage therapists may have experience with other complementary therapies and should agree to encourage the patient to discuss any suggestions on other therapies with their oncologist.
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