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Massage Therapy and Cancer Page 1
Decision-making Steps for Working Safely
ISST 2004, May 15
Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am-9pm est Part One: Introduction—
Historical Approaches to Massage and Cancer
Part Two: Revised Approach—
a Wholistic Model of Working with Clients with Cancer
A. Step One: Resolve the Concern about Massage and
Metastasis
B. Step Two: Manage Information Using a Decision Tree
C. Step Three: Fill in Information Gaps Using Literature, 8
Client, Physician
D. Step Four: Approve the Massage Plan with the Client’s
Physician
Part Three: Examples
A. Using the Tree
B. Some Massage Adjustments for Chemotherapy
Appendix I—Sample Format for Communicating
with Client’s Physician
Appendix II—Sample Intake Form
Appendix III—Resources
The bibliography in appendix III is updated regularly at
www.tracywalton.com/id8.html
Massage Therapy and Cancer
Decision-making Steps for Working Safely
ISST 2004, May 15
Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am -9pm est
Part One: Introduction—Historical Approaches to Massage and Cancer
♦ Massage has been flatly contraindicated for cancer ♦ Vague sense that massage could ↑ lymph flow or blood flow and ↑ metastasis ♦ Blanket permission from a physician, without clear guidelines Result? confusion about what is safe and unsafe
Many massage therapists were trained to turn away clients who have or have had cancer, or to work with them only with a physician’s permission. Under this model, massage therapists may lack the information and needed skills to make sound clinical decisions for the clients and provide touch guided by safety, intuition, compassion and care. Within this approach, many good candidates for massage have been denied its benefits. Part Two: a Revised Approach—
a Wholistic Model of Working with Clients with Cancer
Result? modified massage, instead of no massage at all!
Steps involved in this model are as follows:
1. Resolve the concern about massage and metastasis
2. Manage the information using a decision tree
3. Fill in information gaps using literature, client, physician
4. Approve the massage plan with the client’s physician
Massage Therapy and Cancer Page 3
Decision-making Steps for Working Safely
ISST 2004, May 15
Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am-9pm est
What do massage therapists need to follow these steps?

Massage Therapists do not have to:
Massage Therapists do need to be able to:
♦ Ask questions and gather information. ♦ Reason through the possible beneficial ♦ Use the available literature and stay ♦ Work gently with every client with a 1 Please note Mitchell Batavia’s 2004 review of sources on contraindications in JBMT. After an extensive review of physical rehabilitation texts, Batavia observed that “sources markedly varied regarding what conditions were considered contraindicated for massage.” He also noted that few sources of contraindications were evidence-based, or cited references in support of stated contraindications. His review excluded texts within the massage therapy field. Massage Therapy and Cancer
Decision-making Steps for Working Safely
ISST 2004, May 15
Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am -9pm est
A. Step One: Resolve the Concern about Massage and Metastasis


Debra Curties and Gayle MacDonald have both provided in-depth analyses of the question, “Could massage aggravate
metastasis?” These have appeared in The Massage Therapy Journal, Fall 2000 and Winter 2001 issues.

The concern over massage and metastasis has rested on the assumption
that massage, by increasing blood and lymph circulation,
could accelerate cancer spread.

In response to this concern, note the following:
1. The speed of circulation is not thought to influence cancer spread.

“Cancer spreads as patients go about the most sedate activities, watching television, cooking or even
sleeping. Metastasis is not a by-product of increased circulation, it is the result of genetic mutations, both
inherited and acquired, that cause uncontrolled cell proliferation, lack of cell surface adhesiveness, the
ability to secrete degradative enzymes and to induce new capillary growth.”
Gayle MacDonald, “How Cancer Spreads”, MTJ Winter 2001, p. 78.
2. If speed of circulation did influence cancer spread, many other normal and
accepted activities would also contribute to metastasis.

“If an increased risk [of metastasis with increased circulation] does exist, massage would not be isolated in
creating this type of effect. Were it to be true that stimulation of the circulation encourages metastasis, hot
showers, exercise, sexual activity and many other aspects of daily life would confer equivalent risks.
Individuals with cancer are almost always encouraged to exercise and remain as active as they can…”
Debra Curties, “Could Massage Therapy Promote Cancer Metastasis?” MTJ Fall 2000, p. 85-86.
3. Other factors seem to have greater influence on cancer spread than do
mechanical forces.

“The more we learn about the complex pathophysiological mechanisms involved in the development of
metastases, the less likely it is that mechanically dislodging cells seems important…
…in summary, it is our belief that GENTLE, conscious massage is not only safe, but has many
demonstrated beneficial effects (e.g. enhanced well-being, decreased anxiety, nausea and fatigue). There is
no data to suggest that it causes any harm to persons with cancer.”
Position statement signed by eight medical staff at Dartmouth Hitchcock Medical Center, Norris Cotton Cancer Center, October 1996. “Site predilection does not depend on the anatomy of the circulation as previously believed. Tumor cells flow through the circulatory system based on venous drainage from the primary tumor. However, the site and survival of the disseminated tumor cells depend on the qualities and properties unique to the tumor cell itself. Certain tumor cells possess an affinity for specific organs. The metastatic process is not random.” Karen A. Pfeifer, “Chapter 1: Pathophysiology,” Oncology Nursing. Mosby, 2001. Massage Therapy and Cancer Page 5
Decision-making Steps for Working Safely
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Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am-9pm est
4. Massage therapists can work most safely by avoiding known and suspected
tumor sites.
“Try to obtain as much information as possible about the location of known tumors, and avoid deep
pressure and other intense local modalities. In the most conservative view, accessible predicted metastasis
sites also could be approached with caution.”
Debra Curties, “Could Massage Therapy Promote Cancer Metastasis?” MTJ Fall 2000, p. 85-86. “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.”
5. Massage Therapists can follow some basic guidelines to avoid aggravating
primary sites and sites of metastasis.
a. Avoid pressure and movement at known tumor sites.
b. In the absence of knowledge about tumor sites, work very gently.
c. Investigate possible secondary sites for a client’s cancer.
Note: nursing oncology texts (Gates and Fink, and Itano in the Bibliography) and books about cancer for lay people can be useful sources of this informa tion. d. MOST IMPORTANTLY, communicate with client’s physician and client about results of
recent tests, bone scans, etc.
This must be done with sensitivity and care. Asking the client what kinds of tests they are undergoing and what they
are learning about from these diagnostics is one way to address the issue; the physician is an important resource, too.
e. If the physician has expressed concern about secondary sites that are superficial or tend to
sustain pressure during a massage, avoid using pressure or moving joints in the area.
Example: some cancers, such as breast cancer, are likely to metastasize to bone. Gentle pressure over ribs, spine and
other likely areas is in order. Do not “sandwich” the client between the table and hands with pressure.
f. If a client complains of pain in an area, do not be quick to assume it is muscular pain.
Avoid massaging with pressure or moving joints in the area. INSTEAD, ask whether they’ve
brought it to their doctor’s attention, had images taken of the area, etc. Pain can be a
symptom of metastasis.
g. Be aware that metastasis can be clinically silent, with no pain, for a long time.
Massage Therapy and Cancer
Decision-making Steps for Working Safely
ISST 2004, May 15
Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am -9pm est
B. Step Two: Manage the Information Using a Decision Tree

1. Break the Clinical Presentation into its Key Elements (Left side of tree)
Gather information using a logical progression. Fill in the gaps using information from the client, the client’s family (where appropriate), the literature, and other resources. Manifestations
Complications
(side-effects,
Interventions
adverse reactions,
and complications)
Massage Therapy and Cancer Page 7
Decision-making Steps for Working Safely
ISST 2004, May 15
Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am-9pm est 2. Break “Massage” Into its Key Elements
Massage adjustments are often necessary during treatment. Sometimes they are necessary in people with cancer histories, as well, even if cancer treatment was years ago. Adjustments
is in Appendix V (still in the form of lists rather How do we know which adjustments to use, when? A combination of information from the client, the literature, the medical staff. 3. Generate Full Decision Tree
Massage Safe Practice – Basic Decision Tree Manifestations
Massage Adjustments
Condition
Complications
Interventions
Massage Therapy and Cancer
Decision-making Steps for Working Safely
ISST 2004, May 15
Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am -9pm est

C. Step Three: Fill in Information Gaps Using Literature, Client, Physician

Cancer

If you want to as much info as possible
Contact Canadian/American Cancer Societies Manifestations
Curties, Debra.
(signs and symptoms, tumor sites, etc.). Gates, Rose and Regina Fink
Oncology Nursing Secrets: Questions and Answers about MacDonald, Gayle. Medicine Hands, pp. 66-71, 85-
86
Chapman, Cheryl. “Lymphedema 101,” MTJ
Curties, Debra. Massage Therapy and Cancer, pp. 14,
Rattray, Fiona and Linda Ludwig.
“Thrombophlebitis,” in Clinical Massage Therapy. pp. Zuther, Joachim. “Is there a role for traditional
massage therapy in the treatment and management of lymphedema?” Lymph Link (Newsletter of the National Lymphedema Network): 3-4, April/June Alexander, Doug. “Deep Vein Thrombosis and
Massage Therapy,” Massage Therapy Journal, Walton, Tracy. “Clinical Thinking and
Cancer,” Massage Therapy Journal Fall 2001, p. 69-73. http://www.amtamassage.org/journal/fa_00_jour Massage Therapy and Cancer Page 9
Decision-making Steps for Working Safely
ISST 2004, May 15
Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am-9pm est
Radiation

Learn the effects of radiation
MacDonald, Gayle. Medicine Hands, 91-92.
MacDonald, Gayle. “Cancer, Radiation and Massage,”
Massage and Bodywork September, 2001, 16-31. Curties, Debra. “Cancer Therapies,” Massage Therapy Journal
Walton, Tracy. “Clinical Thinking and Cancer,” Massage
Therapy Journal Fall 2001, pp. 66-80. http://www.amtamassage.org/journal/fa_00_journal/cancer Curties, Debra. Massage Therapy and Cancer, 14-17.
Williams, Donna. “Touching Cancer Patients: Guidelines
for Massage Therapists,” Massage Magazine, March/April 2000, 74-79. Walton, Tracy. “Clinical Thinking and Cancer,” Massage
Chemotherapy
Therapy Journal Fall 2001, pp. 66-80. http://www.amtamassage.org/journal/fa_00_journal/cancer _and_massage_1.html. UPDATED IN THIS
HANDOUT.
MacDonald, Gayle. Medicine Hands, 87-91.
Curties, Debra. Massage Therapy and Cancer, 16-17.
Curties, Debra. “Cancer Therapies,” Massage Therapy
can lead to additional medical
MacDonald, Gayle. “Easing the Chemotherapy Experience
with Massage,” Massage Magazine March/April 2000, pp. 85- Massage Therapy and Cancer
Decision-making Steps for Working Safely
ISST 2004, May 15
Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am -9pm est
D. Step Four: Approve the Massage Plan with the Client’s Physician

This must be done with thought and care, in accordance with any hospital regulations or
jurisdictional considerations. We do not recommend simply getting a doctor’s note for
permission to massage the client. Instead: ♦ Research the issues thoroughly before beginning the process and develop direct, ♦ Obtain written client approval for communicating with their physician. Keep this record in a locked cabinet with your other records. ♦ Communicate in writing first, follow-up with a call. Make it less than one page. ♦ Use descriptive language to communicate massage techniques and adjustments (Steer clear of modality names; instead, use terms like “gliding strokes,” “stationary pressure,” “gentle abduction of the upper limb,” “pressure that displaces the skin,” “pressure that displaces the muscles,” “prone position,” etc.).
♦ Ask physician for input on specific massage design issues. This communication is
usually achieved through the “charge nurse,” or the doctor’s nurse, rather than the
♦ Involve client and client’s family, as appropriate, in the dialogue.
♦ Keep written records of communication, with names of practitioners, relationship to
♦ Have client follow-up with their practitioner if needed.

♦ Update communication periodically, with staff directly or through client, as

♦ Realize that this process is limited in its impact. The suggestions here are for safe and
professional education of, and communication with medical staff. Any form you
use is not legally enforceable, it does not protect you from litigation, nor does it transfer your liability for harm to the medical practitioner. It does document that your safe practice decisions were made thoroughly, in good faith, with clear Massage Therapy and Cancer Page 11
Decision-making Steps for Working Safely
ISST 2004, May 15
Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am-9pm est Part Three: Examples
A. Using the Tree

Massage Safe Practice – Basic Decision Tree
T. Walton 10/00
Manifestations
Massage Adjustments
Complications
Interventions
Massage Safe Practice – Basic Decision Tree
Manifestations
Massage Adjustments
Complications
Interventions
Massage Therapy and Cancer
Decision-making Steps for Working Safely
ISST 2004, May 15
Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am -9pm est
B. Some Massage Adjustments for Chemotherapy

These are not exhaustive lists—they are general guidelines, not meant to replace the guidance of the client’s medical staff.
Side Effect or
Massage Adjustments
Medical Issue
Low platelets
Poor clotting and easy bruising means medium or deep pressure is
contraindicated. In order to avoid bruising, stroke with gentle contact, but little pressure, without displacing the underlying connective tissue or muscles. If a client’s platelets are severely low, they may be hospitalized for transfusions. In this case, no pressure at all would be used and the massage may amount to simply At 50K individuals are monitored closely. In the 50-70K range, gentle to moderate massage pressure may be okay. At around 20K, generally individuals are hospitalized and being transfused. At that level, massage therapist should use only Get help deciding on pressure if needed. If uncertain, err in the lighter direction. You might demonstrate various pressures to medical staff and ask them it if it is safe to displace the skin and underlying fascia, adipose, etc. with your strokes. Also check in with client regularly. General circulatory massage is probably contraindicated during this time due to
the potential circulatory effects or just because it’s too vigorous. Client could be fighting infection at any point and needs their resources for this fight. Other kinds of contact may be safe but are dependent upon physician and client
input. Work closely with them to determine what kinds of touch are appropriate staff whether ct. is Regardless of techniques used, avoid exposing the client to infection. Practice immuno- Standard Precautions against infection in terms of client drape and equipment.
Be sure that bolsters, face cradle, etc. are disinfected and covered with clean linens. Always place bottle on clean surface, NEVER the floor. Offer to reschedule a client if you or a family member has an infection or is
“coming down” with one (this is the most contagious time!). Try to schedule client
so that they will not encounter many others in your waiting room or building. In-
home massage may be best.
Anemia is a common side-effect of chemotherapy that causes fatigue, shortness of breath, and intolerance of cold.2 Massage therapy should be gentle to accommodate
the drop in strength or stamina, extra drapes should be available to keep the client
warm. Client might need to rise slowly from their position on the table after the
massage. If anemia is severe and prolonged, a heart condition can develop. If so,
follow-up with medical consult and investigate references a bout massage
adjustments for people with heart conditions.
2 Werner, Ruth. A Massage Therapist’s Guide to Pathology. Baltimore: Williams and Wilkins, 1998, p. 180-181 Massage Therapy and Cancer Page 13
Decision-making Steps for Working Safely
ISST 2004, May 15
Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am-9pm est
Side Effect or
Massage Adjustments
Medical Issue
Fatigue
This can be due to poor nourishment, anemia, or a host of other factors during
chemotherapy. Massage therapy should be at gentle pressure, with even rhythms
and slow speeds. Session duration may need to be shorter.
General circulatory massage is contraindicated during fever. The body needs its
resources for healing. Gentle contact may be possible, but consult with client’s
medical staff.
Fever can be caused directly by chemotherapy, but it may also be a sign of
threatening infection, so medical referral is necessary if it comes up in the session.
If you refer client to medical staff, document this in your notes.
Dryness, rashes and touch sensitivity and “prickliness” all contraindicate local and
regional pressure or even contact if it causes discomfort. Often chemotherapy
causes skin reactions that look like infections but are merely reactions to the
medication. Consult with medical staff and client about the origins of any skin
changes.
Fragile or thin skin contraindicates pressure.
Open lesions contraindicate contact—follow standard precautions. Do not
introduce any pathogens from your skin or clients, or from any surface into the
openings. Wear gloves if working with someone with open, weeping lesions. Even
if you are avoiding the region, as you should, fluid from open lesions can be
present elsewhere on the body due to transfer from sheets, fingers, etc. It is safest
for therapist to work using gloves.
Massage at the site of hair loss may be contraindicated, may be irritating or client’s
preference may dictate massage restrictions.
If client prefers to keep wig or scarf on, you may need to avoid using lubricant
such as oil in NK/FACE area to avoid damaging it. Follow client’s lead about how
and where to touch their head
Pressure at the sites of the jaw or cheek may be contraindicated to avoid tugging
on sores. Face cradles may exert too much pressure, necessitating position
changes. Check in with client, do not aggravate area.

General circulatory massage and pressure are contraindicated during nausea, as
are passive joint movements such as ROM, jostling, rocking, etc. Rhythms
should be even and speed should be slow. Unless client approves a given scent,
avoid scented lubricants around the chemotherapy cycle, and whenever nausea is
present.
Persistent nausea and vomiting leads to weight loss (see below) and to loss of
stamina. It also creates risk of dehydration. Be sure your client is adequately
hydrated before using challenging techniques.
Massage Therapy and Cancer
Decision-making Steps for Working Safely
ISST 2004, May 15
Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am -9pm est
Side Effect or
Massage Adjustments
Medical Issue
Diarrhea
Easy access to bathroom is necessary. Persistent diarrhea leads to weight loss (see below) and to loss of stamina. It also creates risk of dehydration. Be certain your client is adequately hydrated before challenging them with stronger techniques. Depending upon condition and location of cancer, gentle massage of the abdomen may be indicated, but rule out other contraindications (such as colon cancer, or secondary sites in the abdominal area, or swelling) and get physician permission first. Weight loss leads to more vulnerability to pressure sores. Assess health of tissue before massaging with pressure at the site of the sores. Massage is thought to
help prevent pressure sores, but will aggravate sores that are already present.
Nerve and vascular endangerment sites may be more vulnerable when there is less
muscle and adipose to protect them. Be careful of pressure at those sites.
Atrophy of muscles may make joints hypermobile. Careful with joint movement
such as RO M or stretches—gentle only.
With weight loss, stamina may be markedly reduced.
General pressure and stimulation should be conservative.
Neuropathy, with its sensations of numbness, pain, burning, etc., contraindicates pressure at the site, but lighter pressure or broader contact (not specific or
“pointy”) may be tolerable. Note that in the case of numbness, client feedback about pain is absent. It is easier to damage tissue without client’s reports of pain. Massage Therapy and Cancer Page 15
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Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am-9pm est

Side Effect or
Massage Adjustments
Medical Issue
Other nervous
People with poor balance may need assistance getting on and off table, dressing,
etc. Other nervous system symptoms can range from seizures to confusion, to optic neuritis. Investigate these on a case-by-case basis to determine safe practice directives. Ports and catheters Local and regional pressure are contraindicated at port and catheter sites. Do not
massage immediately proximal or distal to these sites or do anything that might mechanically speed movement of medication. In the case of an arm IV as high as the antecubital area, gentle massage of the hand may be okay. Check with medical staff. Client may require certain positions in order to be comfortable.
Drape, position or massage must not tug or press at port or catheter site.
Types of Vascular Access Devices (VAD’s)
Central Line (top left)
PICC Line (Peripherally-inserted central line)
Several types, but can involve arm on same side
Port-a-Cath (bottom left)
usually covered with bandage
There is controversy about this issue. Some authors encourage massage therapists to avoid direct contact with the skin, and instead to glove when working with
clients soon after infusion of thiotepa or cytoxan. Others disagree. To be sure, nurses glove when mixing chemotherapy reagents for infusion; the degree of danger to others when eliminated through the skin is unclear. In any event, the first 48 hours after infusion of those two reagents is cited as the window of concern. Massage Therapy and Cancer
Decision-making Steps for Working Safely
ISST 2004, May 15
Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am -9pm est



Massage Safe Practice – Basic Decision Tree
Manifestations
Massage Adjustments
Complications

Interventions
Massage Therapy and Cancer Page 17
Decision-making Steps for Working Safely
ISST 2004, May 15
Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am-9pm est Appendix I
A Sample Format for Communicating with Client’s Physician
The following is a brief version of a form that may be tailored to an individual client. Not all of the primary safe practice concerns of working with people in cancer treatment are listed below, but some principal issues are described. Not all medical staff will be able or inclined to return such a form, completed and signed. Still, MT’s may use this tool as a starting point for dialogue with the client’s medical staff. For other suggestions, see also “Contraindications to Massage Part III: Communicating with a Client’s Clinician,” Massage Therapy Journal 38(3): 40-48, Fall 1999, by Tracy Walton. Dear (Physician’s name): Your patient, (name), has expressed an interest in receiving massage therapy during the course of her/his cancer treatment. I am writing to you to 1. Outline some common cautions I use when working with people in cancer treatment 2. Seek your input on which cautions should be in force with this client. My Techniques: with most clients, I use kneading and stroking techniques and apply compressions to
the tissues with my hands. I might also do gentle passive stretching and ROM.
Common Adaptations for Clients in Cancer Treatment:
Sites affected by surgery, radiation therapy, IV’s, drains, skin conditions, pain, edema, or bone
involvement
We will avoid these sites. If there is any nodal involvement with risk of lymphedema, we will use no pressure on the distal
extremity and use only gentle pressure (“applying lotion”) on the trunk quadrant. If needed, the limb will be elevated during
the massage.

Low platelet levels; easy bruising.
We will use gentle strokes that displace skin and other superficial tissues, not deep muscle layers.

Side-effects of treatments such as chemotherapy and radiation therapy
the therapist will work gently in order to avoid aggravating fatigue, nausea, etc., and will adapt other elements of the session to
any presenting side-effects
Any risk of deep vein thrombosis, secondary to malignancy, inactivity or cancer treatment (the massage
therapist will avoid use of pressure on the lower extremities if there is any risk of thrombosis in those areas).

(Patient name) has my permission to receive relaxation massage described above.
I’ve read through the common massage therapy adjustments, above. I have circled any concerns for this
patient. If I have any additional concerns for the massage practitioner, I have described them below:
__________________________________________________________________________________
_________________________________________
_________________________________________ Print Physician’s Name Massage Therapy and Cancer
Decision-making Steps for Working Safely
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Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am -9pm est Appendix II
Sample Intake Form
Name, date, address, etc.

1. Have you had Massage Therapy before? Yes No If yes, was there anything that you liked or didn’t
like?
__________________________________________________________________________________
2. When were you first diagnosed with cancer? ________ What type of cancer? __________________
3. Where was/is it located?
________________________________________________________________
4. Are you being treated now? Yes No If no, what was the date of your last treatment?
______________
NOTE: if you are currently in treatment, or if your last treatment session was less than 12 mos. ago, please
have your physician complete the accompanying permission form.
5. What treatments have you undergone? Please supply detail, with dates and types of cancer treatments.

__________________________________________________________________________________
6. Current medications, not described above:
7. Did your treatment include any removal or
therapy? irradiation of lymph nodes? (if yes, please describe) (if yes, please describe where, below) __________________________________________
9. Do you have any Site Restrictions due to:
10. Do you have any Pressure Restrictions due to:
____ incisions, open wounds, drains or dressings ____ skin condition, rash or sensitivity ____ anticoagulants ____ low platelet count ____ medical devices such as IV or ostomy ____bone metastasis ____steroid medication ____ fragile/sensitive skin ____ fragile veins ____ a history or risk of blood clots or phlebitis ____ area of pain or burning ____ fatigue ____ bone or spinal metastases ____ neuropathy ____ recent surgery ____ infection or fever ____ history of fractures ____ area of infection ____ other please describe ________________________ ____ other please describe ___________________ Massage Therapy and Cancer Page 19
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Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am-9pm est 11. Do you have any Position Restrictions due to:
___ incision ___medication ___ostomy ___tumor site ___ difficulty breathing ___ tender skin
___ swelling or risk of swelling (any area of body require elevating? please describe _____________________
___ medical devices please describe __________________________________________________________
___ discomfort please describe ______________________________________________________________

12. Has cancer or cancer treatment affected any of the following in your body?
___Lungs ___Liver ___Nervous System ___ Heart ___Kidney ___ Blood counts ___ Energy Level
If yes,describe________________________________________________________________________

General Signs and Symptoms
Check “yes” and add further comments if you have or
have had any of the following signs and symptoms Comments
1. Is there any swelling or tendency to swell
anywhere in your body?
2. Are there any sites of pain or tenderness
anywhere in your body?
3. Are there any sites of numbness or
diminished sensation in your body?
4. Are there any areas of infection in your

Specific Medical Conditions
Check “yes” and add further comments if you
Comments
have or have had any of the following conditions: 1. Skin Conditions (e.g., rashes, infections,
allergies, itching)
2. Known allergies or sensitivities
If you use any physician-approved lotion for your skin,
please bring some with you to the session
3. Cardiovascular Conditions e.g., heart
condition, angina, high blood pressure, arteriosclerosis,
blood clot, etc.
4. Liver or Kidney conditions

5. Respiratory or Lung conditions

6. Diabetes

7. Arthritis

8. Injuries e.g. disc problems, tendinitis, knee
problems, fractures, etc.
9. Surgery

Any conditions NOT MENTIONED
Massage Therapy and Cancer
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ISST 2004, May 15
Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am -9pm est Appendix III
Resources
A. Trainings on Massage and Cancer
Chapman, Cheryl, “Mastectomy Massage,” and “Cancer Massage,” both courses offered nationally in the US. Cheryl also teaches Geriatric Massage and Prenatal Massage. Contact her at Quality of Life Therapies, 973 912 9060 or [email protected]. Curties, Debra, teaches cancer workshops and breast massage workshops in Canada and the United States. Her publishing company, Curties-Overzet Publications, is on the web. See Debra’s teaching schedule on the “author’s workshops” link at http://www.sutherland-chan.com/copi/works.htm. MacDonald, Gayle, “Massage Therapy for People with Cancer,” a training offered internationally. Gayle also offers an intensive 7-day course for teachers at the Scherer Institute of Natural Healing, 505 982 8329. Visit her website for a description of author’s trainings and training schedule: www.medicinehands.com. Memorial Sloan-Kettering Cancer Center, “Medical Massage for the Cancer Patient,” a training offered by the Integrative Medicine Service several times a year, on-site in New York City. Call 212 639 8629. Walton, Tracy. “Caring for Clients with Cancer,” a three-day training, 24 continuing education hours. For her national teaching schedule see her website, www.tracywalton.com, or call 617 661 5800 between 9 AM and 9 PM Eastern Time
B. Texts on Massage and Cancer
Curties, D. Massage Therapy and Cancer. Moncton, NB: Curties-Overzet Publications, Inc., 1999. Toll free 888.649.5411.

MacDonald, G. Medicine Hands: Massage Therapy for People with Cancer. Forres, Scotland: Findhorn Press, 1999. 877 390 4425

C. Texts on Massage and Disease
Burch, S. Recognizing Health and Illness: Pathology for Massage Therapists and Bodyworkers (2nd ed.). Lawrence, KS: Health Positive Publishing, 2001. Available at 888 Newton, D. Clinical Pathology for the Professional Bodyworker. Portland, OR: Simran Publications, 1995. Available through them at (800) 325 1286 or at Persad, R. Massage Therapy and Medications. Moncton, New Brunswick:: Curties-Overzet Publications Inc., 2001. Available at 888-649-5411 or at Premkumar, K. Pathology A to Z—a Handbook for Massage Therapists (2nd ed.) Calgary, Alberta: Meducational Skills, Tools & Technology, Inc.: 2001. Order at 403 Rattray, F. and L. Ludwig. Clinical Massage Therapy: Understanding, Assessing and Treating over 70 Conditions. Toronto, Ontario: Talus, Inc., 2000. Available at 416 Rattray, F. Massage Therapy: an Approach to Treatments. Toronto, Ontario: Massage Therapy Texts and Maverick Consultants, 1997. Available at (416) 422-5459. Werner, R., A Massage Therapist’s Guide to Pathology (2nd ed.). Washington, DC: Williams & Wilkins, 2002. Available through many massage school bookstores or from the publisher at LWW.com or 800 638 3030.
D. Journal Articles on Massage Therapy, Contraindications and Cancer

Ahles, T.A., D.M. Tope, B. Pinkson, S. Walch, D. Hann, M. Whedon, B. Dain, J.E. Weiss, L. Mills, P.M. Silberfarb. “Massage Therapy for Patients Undergoing Autologous Bone Marrow Transplantation,” Journal of
Pain and Symptom Management 18(3):157-63, September 1999.

Alexander, D. “Deep Vein Thrombosis and Massage Therapy,” Massage Therapy Journal, Spring 1993:56-63.
Alexander-Gregory, J. “Feeding the Skin: Skin Care Therapist Finds Creative Way to Help Friend with Cancer,” Massage and Bodywork August/September 2001:62 -67.
Barnes, J.F. “Pain Relief for the Cancer Patient,” PT & OT Today , April 29, 1996:18-19.
Batavia, M. Contraindications for therapeutic massage: do sources agree? (2004). Journal of bodywork and movement therapies 8:48-57.

Billhult, A. and K. Dahlberg. “A Meaningful Relief from Suffering —Experiences of Massage in Cancer Care,” Cancer Nursing 24(3):180-184.
Bottorf, J.L. “The Use and Meaning of Touch in Caring for Patients with Cancer,” ONF 20(10):1531 -1538, 1993.
Bredin, M. “Mastectomy, Body Image and Therapeutic Massage: A Qualitative Study of Somen’s Experience,” Journal of Advanced Nursing 29(5):113-120, 1999.
Burke, C., et al. “The Development of a Massage Service for Cancer Patients,” Clinical Oncology 6 (1994):381-385.
Burt, J. and G. White. Lymphedema: A Breast Cancer Patient’s Guide to Prevention and Healing . Hunter House Publishers, 1999.
Buss, IC, Halfens, RJG, Abu-Saad, HH (1997). The effectiveness of massage in preventing pressure sores: a literature review. Rehabilitation Nursing 22(5): 229-242.
Massage Therapy and Cancer Page 21
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Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am-9pm est Casciato, D.A., B.B. Lowitz. Manual of Bedside Oncology (1st ed), Boston: Little, Brown, 1986. Cawley, Nik. “A Critique of the Methodology of Research Studies Evaluating Massage,” European Journal of Cancer Care 6:23-31, 1997. Cawthorne, L. and D.A. Boyle. “Massage as Cancer Nursing Therapeutic: Impact on Symptom Distress During Hospitalization,” (Abstract of podium psession, 2001 Oncology Nursing Society 26th Annual Congress, San Diego, CA). Oncology Nursing Forum 28(2):324-325, 2001. Chamness, A. “Massage Therapy and Persons Living with Cancer: Some Basic Information for the Massage Therapist,” Massage Therapy Journal, Summer 1993:53 -64. Chapman, C. “Lymphedema 101: What Every Therapist Should Know,” Massage Therapy Journal, 39(4):86-89, Winter 2001. Chapman, C. “Cancer vs. HIV/AIDS: A Comparative Overview,” Massage Therapy Journal, Fall 2000:107-110. Chapman, C. and E. Kennedy, “Mastectomy Masssage,” Massage Therapy Journal Fall 2000:91 -99. Chikly, B. “Post-Mastectomy Care and Lymph Drainage Therapy,” Journal of Bodywork and Movement Therapies 3(1):11-16, 1999. Corner, J., N. Cawley and S. Hildebranc. “An Evaluation of the Use of Massage and Essential Oils on the Well-Being of Cancer Patients,” International Journal of Palliative Nursing 1(2): 67-73, 1995. Crawford, J. “Myofascial Release Provides Symptomatic Relief from Chest Wall Tenderness Occasionally Seen Following Lumpectomy and Radiaiton in Breast Cancer Patients,” International Journal of Oncology, Biology and Physics 34(5):1188-1189, 1996. Cullen, C. et al. “Pediatric oncology Patients Benefit from Massage Therapy,” in T. Field, Touch Therapy. Edinburgh: Churchill Livingstone, 2000. Curties, D. “Cancer Therapies,” Massage Therapy Journal, 39(4):80-85, Winter 2001. Curties, D. “Could Massage Therapy Promote Cancer Metastasis?” Journal of Soft Tissue Manipulation, April/May 1994:3-6. Reprinted in Massage Therapy Journal, 39(3):83-88, Fall 2000. Curties, D. Breast Massage. Moncton, NB: Curties-Overzet Publications, Inc., 1999. Toll free 888 649 5411. Curties, D. Massage Therapy and Cancer. Moncton, NB: Curties-Overzet Publications, Inc., 1999. Toll free 888 649 5411. Dalton, J., T. Toomey and M. Workman, “Pain Relief for Cancer Patients,” Cancer Nursing 11(6):322-328, 1988. DeLany, J.W. “Breast Cancer Reconstructive Rehabilitation,” Journal of Bodywork and Movement Therapies 3(1):3-4, 1999. DeLany, J.W. “Neuromuscular Therapy Treatment in Post-Mastectomy Care,” Journal of Bodywork and Movement Therapies 3(1):5-10. Damsky, DD (2002). Deep vein thrombosis in the patient with cancer. Clinical journal of oncology nursing 6(1):43-46. Dibble, S.L., J. Chapman, K.A. Mack, A.S. Shih. “Acupressure for nausea: results of a pilot study,” Oncology Nursing Forum 27(1):41-47, Jan-Feb 2000. Dudley, G., KN McGrath, AM Pheley (2003). Length of stay and medication use in hysterectomy patients treated with a single massage treatment. Journal of bodywork and movement therapies 7(4):222-227. Dunn, T. Massage Therapy Guidelines for Hospital and Home Care (3rd ed.). Derby, CT: Planetree, 1996. Available by calling 203 732 1365 or writing Planetree at 130 Division Street, Derby, CT 06418. Durak, E., P. Lilly, S. Seligsen. “A Wellness Program for Cancer Patients: a Mind/Body Approach to Conditioning,” Somatics 1996-97:42-48. Eliska, O. and Eliskova, M. “Are Peripheral Lymphatics Damaged by High Presure Manual Masage?” Lymphology 28(1):21-30, 1995 Feldman, J. “Diane’s Story: the Benefits of Holistic Massage for One Breast Cancer Patient,” Massage and Bodywork December/January 2000:24-28. Ferrell-Torry, A.T., and O.J. Glick. “The Use of Therapeutic Massage as a Nursing Intervention to Modify Anxiety and the Perception of Cancer Pain (review),” Cancer Nursing 16(2):93-101, 1993. Field, T., Cullen, C., Diego, M., Hernandez-Reif, M., Sprinz, P., Beebe, K., Kissel, B., & Bango-Sanchez, V. (2001). Leukemia immune changes following massage therapy. Journal of Bodywork and Movement Therapies, 5, 271-274. Finch, Mary Ann. Care through Touch: Massage as the Art of Anointing. New York: Continuum, 1999. Gach, Michael R. Acupressure’s Potent Potents: A Guide to Self-Care for Common Ailments. New York: Bantam Books, 1990. Gates, R. and R. Fink. Oncology Nursing Secrets: Questions and Answers about Caring for Patients with Cancer. Philadelphia: Hanley & Belfus, Inc., 1997. Gecsedi, RA (2002). Massage therapy for patients with cancer. Clinical journal of oncology nursing 6(1):52-54. Gerber, L. H. and M. Vargo. “Rehabilitation for Patients with Cancer Diagnoses,” in Rehabilitation Medicine: Principles and Practice (3rd ed.), Joel A. DeLisa dn Bruce M. Gans (eds.), Philadelphia: Lippincott-Raven Publishers, 1998. Gibson, K. Developing a Hospital-Based Massage Therapy Program. Glenwood Springs, CO. Call or write her at P.O. Box 1617, Glenwood Springs, CO 91601. 970 945 3060. Goodfellow, LM (2003). “The effects of therapeutic back massage on psychophysiologic variables and immune function in spouses of patients with cancer.” Nursing research 52(5): 318-28. Grealish, L., A. Lomasney, B. Whiteman. “Foot Massage: A Nursing Intevention to Modify the Distressing Symptoms of Pain and Nausea in Patients Hospitalized with Cancer,” Cancer Nursing, 23(3):237-243, 2000. Greaves, M. Cancer: the Evolutionary Legacy. Oxford University Press, 2000. Groopman, J. “Annals of Medicine: a Healing Hell,” New Yorker, October 19, 1998:34-39. Hernandez-Reif, M., Ironson, G., Field, T., Weiss, S., Katz, G., Fletcher, M.A. & Burman, I. “Massage Therapy for Breast Cancer,” Unpublished manuscript, 2000. Hernandez-Reif, M., Ironson, G., Field, T., Katz, G., Diego, M., Weiss, S., Fletcher, M., Schanberg, S. & Kuhn, C. (In Review). Breast cancer patients have improved immune functions following massage therapy. Hodgson, H (2000). Does reflexology impact on cancer patients’ quality of life? Nursing Standard 14(31):33-38. Howard, L. “Hands of Medicine: Working with Oncology Patients,” Massage and Bodywork, August/September 2000: 48-58. Itano, J. and K. Taoka. Core Curriculum for Oncology Nursing (3rd ed.), Philadelphia: W.B. Saunders, 1998. Jackson, K (2003) “Reiki: Rising Star I Complementary Cancer Care,” Radiology Today 4(10): 10-13. King, C.R. “Nonpharmacologic Management of Chemotherapy-Induced Nausea and Vomiting,” Oncology Nursing Forum, 1997 Supplement 24(7): 41-48, 1997. King, P. [Interview with]. “Interview with AMTA Foundation Grantee Pauline King,” Massage Therapy Journal 36(1): Winter 1997:117-120. Kirby, P. “Real-World Examples: Cancer Treatment Programs Offer Massage,” Massage Magazine 84:80-82, March/April 2000. Massage Therapy and Cancer
Decision-making Steps for Working Safely
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Tracy Walton www.tracywalton.com [email protected] 617 661 5800, 9am -9pm est
Kite, S.M. et al. “Development of an Aromatherapy Service at a Cancer Centre,” Palliative Medicine 12:171-180, 1998.
MacDonald, G. “Easing the Chemotherapy Experience with Massage,” Massage Magazine (84):985-91, March/April 2000.
Kunz, K. and B. Kunz. Reflexions: The Journal of Reflexology Research Project, 2001. at reflexology-research.com.
Lawvere, S. The effect of massage therapy in ovarian cancer patients. In Rich GJ, ed. Massage Therapy: The Evidence for Practice. Edinburgh: Mosby; 2002:57-83.
Lively BT, Holiday-Goodman M, Black CD, Arondekar, B. “Massage therapy for chemotherapy-induced emesis.”
In Rich GJ, ed. Massage Therapy: The Evidence for Practice. Edinburgh: Mosby; 2002:85-104.
MacDonald, G. “Masage for Cancer Patients: a Review of Nursing Research,” Massage Therapy Journal, Summer 1995:53-56.
MacDonald, G. Medicine Hands: Massage Therapy for People with Cancer. Fores, Scotland: Findhorn Pres, 1999. 877 390 4425.
MacDonald, G. “How Cancer Spreads,” Massage Therapy Journal, 39(4):74-78, Winter 2001.
MacDonald, G. “Massage for Cancer Patients Undergoing Radiation Treatment: the Benefits and Cautions,” Massage and Bodywork, August/September 2001: 16 -32.
Malloy, J. “Do the Benefits of Massage Outweigh the Risks,” Massage Therapy Journal, 39(4):60-73, Winter 2001.
Manzulli, S. “Bodywork and Visualization Therapy for Breast Cancer Clients,” Massage and Bodywork August/September 2001:36-47.
McConnellogue, K. “The Courage to Touch: Massage and Cancer, Massage and Bodywork Quarterly, Dec./Jan. 2000:13 -20.
McGowan, K. “Use Caution when Treating Radiated People with Cancer,” (letter to the editor), Massage Therapy Journal 40(1):15-18, Spring 2001.
Menard, M. “The Effect of Therapeutic Massage on Post-Surgical Outcomes,” Doctoral dissertation, University of Virginia, 1995.
Meziere, Y. “Breast Cancer: How Massage Aids Recovery,” Massage Magazine September/October 2001:66 -77.
Mowen, K. “Embraced by Water: Water Fitness for Breast Cancer Survivors,” Massage and Bodywork August/September 2001:52-59.
Nelson, D. Making Friends with Cancer. Forres, Scotland: Findhorn Press, 2000.
Nixon, M., J. Teschendorff, J. Finney, W. Kamilowicz. “Expanding the Nursing Repertoire: the Effect of Massage on Post-Operative Pain,” Australian Journal of Advanced Nursing 14(3):21-26, March 1997.
Post-White, J., ME Kinney, K Wavik, JB, Gau, C Wilcox, I Lerner (2003). “Therapeutic massage and healing touch improve symptoms in cancer.” Integrative cancer therapies 2(4):332-44.
Rexilius, S.J., Mundt, C., Erickson Megel, M., & Agrawal, S. (2002). Therapeutic effects of massage therapy and handling touch on caregivers of patients undergoing autologous hematopoietic stem cell transplant.
Oncology Nursing Forum, 29, E35-44.
Rhiner, M., B.R. Ferrell, B.A. Ferrell., and M.M. Grant. “A Structured Nondrug Intervention Program for Cancer Pain,” Cancer Practice 1(2): 137-142, July/August 1993.
Rose, M.K. The Gift of Touch: Comfort Touch—Massage for the Elderly and the Chronically and Terminally Ill. Reach the author at 3003 Valmont Road #71, Boulder, 80301-2142. 303 449 3945.
[email protected]. Also visit www.comforttouch.com.
Schwanz, M. “Massage Makes its Mark at Memorial Sloan-Kettering Hospital,” Massage Therapy Journal 39(3): 100-106, Fall 2000.
Scott, D., D. Donahue, R. Mastrovito, T. Hakes. “The Antiemetic Effect of Clinical Relaxation: Report of an Exploratory Pilot Study,” Journal of Psychosocial Oncology, 1(1):71-83, 1983.
Sims, S. “Slow Stroke Back Massage for Cancer Patients,” Nursing Times 82(13):47-50, 1986.
Smith, MC, Kemp J, Hemphill L, Vojir, CP (2002). Outcomes of therapeutic massage for hospitalized cancer patients. Journal of Nursing Scholarship 34(3):257-262.
Steingraber, S. Living Downstreatm: a Scientist’s Personal Investigation of Cancer and the Environment. New York: Vintage Books (Random House), 1998.
Stephenson, N.L., S.P. Weinrich and A.S. Tavakoli, “The Effects of Foot Reflex ology on Anxiety and Pain in Patients with Breast and Lung Cancer,” Oncology Nursing Forum 27(1):67-72, 2000.
Swirsky, J. and D.S. Nannery. Coping with Lymphedema. Avery Publishing, 1998.
Tope, D.M., D.M. Hann and B. Pinkson. “Massage Therapy: An Old Intervention Comes of Age,” Quality of Life—A Nursing Challenge 3:14-18, 1994.
Toth, M., J. Kahn, T. Walton, A. Hrbek, D.M. Eisenberg, R.S. Phillips (2003). “Therapeutic Massage Intervention for Hospitalized Patients with Cancer —a Pilot Study,” Alternative and Complementary Therapies,
June 2003, 117-124.
van der Riet, P (1998). The sexual embodiment of the cancer patient. Nursing Inquiry 5:248-257.
van der Riet, P (1999) Massaged embodiment of cancer patients, (review), Australian Journal of Holistic Nursing 6(1):4-13.

Versagi, C. M. “Like a Summer Wind: Manual Lymph Drainage Helps Those with Lymphedema,” Massage Magazine September/October 2001:78-87.
Walton, T. “Contraindications to Massage Part IV: Clinical Thinking and Cancer,” Massage Therapy Journal 39(3): 66-80, Fall 2000.
Walton, T. “Contraindications to Massage Part III: Communicating with a Client’s Clinician,” Massage Therapy Journal 38(3): 40-48, Fall 1999.
Walton, T. “Contraindications to Massage Part II: Taking a Health History,” Massage Therapy Journal 37(4):70-92, Winter 1999.
Walton, T. “Contraindications to Massage Part I: Roadblocks on the Way to Consensus,” Massage Therapy Journal
37(2):108-112, Summer 1998.
Weiger, WA, Smith, M, Boon, H, Richardson, MA, Kaptchuk, TJ, Eisenberg, DM (2002) Advising patients who seek complementary and alternative medical therapies for cancer. Annals of Internal Medicine
137:889 -903.
Weinrich, S.P. and M.C. Weinrich. “The Effect of Massage on Pain in Cancer Patients,” Applied Nursing Research 3(4):140-145, 1990.
Wilkie, D., J. Kampbell, S. Cutshall, H. Halabisky, H. Harmon, L.P. Johnson, L. Weinacht, M. Rake-Marone. “Effects of Massage on Pain Intensity, Analgesics and Quality of Life in Patients with Cancer P:ain: A
Pilot Study of a Randomized Clinical Trial Conducted within Hospice Care Delivery,” The Hospice Journal 15(3): 31-53.
Wilkinson, S. “Aromatherapy and Massage in Palliative Care,” International Journal of Palliative Nursing 1(1):21-30, 1995.
Wilkinson, S. “An Evaluation of Massage and Aromatherapy Massage in Palliative Care,” Palliative Medicine 13:409-417, 1999.
Williams, D. “Touching Cancer Patients: Guidelines for Massage Therapists,” Massage Magazine 84:74-79, March/April 2000.
Zuther, J. “Is there a role for traditional massage therapy in the treatment and management of lymphedema?” Lymph Link (Newsletter of the National Lymphedema Network): 3-4, April/June 2001.

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