Radiation therapy uses high-energy radiation to kill or reduce the size of cancer cells & tumors. Radiation may be delivered externally by a machine or internally by a device that is surgically-implanted near the treatment area. Several studies have investigated the effects of massage on cancer patients who underwent radiation treatments, many of which were breast cancer patients.
One goal of radiation therapy is to damage the cancer cell’s DNA so they will stop dividing &/or die. To do this, radiation therapy targets fast-growing cells. However, normal cells exposed to radiation therapy are also affected. This leads to the side effects associated with radiation therapy such as skin irritation called radiation dermatitis, gastrointestinal issues including anorexia or loss of appetite, nausea, vomiting, malaise, & fatigue.
Massage Therapy Research & Radiation Treatments:
Several studies have investigated the effects of massage on cancer patients who underwent radiation treatments, most of which were breast cancer patients.
In one study, back massage using gentle, even pressure promoted relaxation, reduced tension, & decreased fatigue in patients with breast cancer undergoing radiation therapy (1). In another study, massage reduced anxiety, improved sleep quality, & perceived quality of life in patients with breast cancer undergoing radiation therapy (2). Campeau et al (3) found an immediate decrease in anxiety among patients with cancer who received massage therapy after radiation treatments, but no major impact on anxiety scores was found beyond this time frame.
Massage therapy & polarity therapy reduced cancer-related fatigue & improved the quality of life in patients with breast cancer undergoing radiation therapy (4). Myofascial release techniques reduced pain in patients with breast cancer who developed fibrosis after undergoing a lumpectomy & radiation treatments (5). This procedure began 2 months after the patients finished cancer treatments & they were evaluated to confirm that they did not have active cancer.
Ninety-five percent of individuals who receive external radiation therapy develop radiation dermatitis, or skin inflammation & irritation caused by radiation. Signs & symptoms of radiation dermatitis are dry, red, itchy skin that may be swollen & blistered, & is often painful. The rash looks like a severe sunburn. This condition can begin within hours or may occur several weeks after radiation exposure.
Massage Therapy & Radiation Dermatitis –
Be sure the client is not positioned on skin affected by radiation dermatitis. Be sure massage linens do not rub affected areas while massaging nonaffected areas, because friction could irritate the skin.
Assess the skin to determine if it is ready for massage. Assessment should include skin condition, temperature, & blanching. If the skin is red, dry, swollen, blistered, warm or hot to the touch, painful, &/or does not blanch, treat as a local contraindication. To perform the skin blanching test, press on the affected area with your finger using light pressure for a few seconds. This action reduces localized blood volume, causing the skin to blanch or turn white. Remove the pressure; the area should return to the color it was before pressure was applied within a few seconds. This response indicates good blood flow. If the skin does not blanch, appears red, blue, or purplish, blood flow is compromised & should not be massaged. Conducting the skin blanching test on dark skin has limited value because it may mask the amount of localized blood flow. The amount of time between the end of radiation treatment & when skin affected by radiation dermatitis is ready for massage may be up to 4 months or longer.
Once indicated, be sure to use only light pressure over affected areas. Avoid aggressive techniques & deep pressure because of the skin’s reduced capacity for healing & increased risk of lymphedema. Avoid alcohol or alcohol-based products because they can cause skin dryness & promote irritation. Do not use thermotherapy including heat lamps & hot packs because it promotes inflammation in healing skin.
Brachytherapy, or internal radiation therapy, is a procedure that places slowly-releasing radioactive materials in the body. Devices used to deliver the radioactive materials can remain in the body once the materials are exhausted, or the device can be removed after treatment. Permanent brachytherapy uses small containers such as pellets, which are about the size of a grain of rice. Once inserted, the pellets release radiation for several weeks or months & because they are small & cause little discomfort, they are left in place after the radioactive materials are exhausted. Temporary brachytherapy uses cylinders, catheters, or fluid-filled balloons to deliver the radiation & are removed after treatment.
Massage Therapy & Brachytherapy –
Inpatient high-dose temporary brachytherapy is an absolute contraindication for massage during treatment. Otherwise, follow the radiation oncologist’s instructions regarding contact precautions, especially for therapists who are pregnant.
Be sure to ask the client where & when the internal radiation device was implanted & if there are any contact precautions in place. Most clients are already following these precautions & clients are unlikely to seek massage unless they are cleared for contact. Clients are considered “hot” if implants are still in & if they are still radioactive. Radiation from implants are usually exhausted after 12 months. When in doubt, contact the client’s health care provider.
Salvo, S. (2013). Mosby’s Pathology for Massage Therapists, 3rd ed. Elsevier, St Louis.
Articles and Journals Referenced:
- Sims, S. (1986). Slow stroke back massage for cancer patients, Nurs Times. 82(47):47–50.
- Sturgeon, M., Wetta-Hall, R., Hart, T., et al. (2009). Effects of therapeutic massage on the quality of life among patients with breast cancer during treatment, J Altern Complement Med. 15(4):373–80.
- Campeau, M.P., Gaboriault, R., Drapeau, M., et al. (2007). The impact of massage therapy on anxiety levels in patients undergoing radiation therapy: Randomized controlled trial. J Soc Integr Oncol. 5(4):133-8.
- Mustian, K.M., Roscoe, J.A., Palesh, O.G., et al. (2011). Polarity Therapy for cancer-related fatigue in patients with breast cancer receiving radiation therapy: A randomized controlled pilot study. Integr Cancer Ther. 10(1):27-37.
- Crawford, J.S., Simpson, J., Crawford, P. (1996). Myofascial release provides symptomatic relief from chest wall tenderness occasionally seen following lumpectomy and radiation in breast cancer patients. Int J Radiat Oncol Biol Phys. 34(5):1188-9.
Susan Salvo is a board certified massage therapist with 30+ years of experience. Susan is passionate about massage therapy and massage education. You can contact her at firstname.lastname@example.org.