Chemotherapy uses drugs to destroy cancer cells. These chemicals can be administered intravenously, by injection, topically, or orally in pill or liquid form. The most common method of administration is intravenous by various vascular access devices.
Similar to radiation, chemotherapy targets fast-growing cells. However, normal cells are also affected, which explains many of the side effects of chemotherapy. Common side effects include but are not limited to post-chemotherapy cognitive impairment (PCCI), malaise & fatigue, anemia, thrombocytopenia, erythrocytopenia, leukocytopenia, neutropenia, bicytopenia (2 blood disorders), or pancytopenia (3 or more blood disorders), GI distress, mouth sores, fever, chemotherapy-induced peripheral neuropathy (CIPN), & hair loss. More than half of all people diagnosed with cancer will receive chemotherapy at some point in their cancer journey.
Slow stroke back massage reduced pain, & fatigue, & improved sleep in adults with acute leukemia while undergoing chemotherapy (1). Khiewkhern et al (2) found that combining light-pressure Thai massage with aromatherapy ginger in coconut oil increased lymphocyte count by 11% as well as reduced fatigue, pain, & stress in persons diagnosed with colorectal cancer who received chemotherapy. Massage also reduced cortisol levels in persons with hematologic cancers such as leukemias & lymphomas also undergoing chemotherapy (3). Reduced cortisol levels are associated with improved psychological well-being. Massage reduced anxiety, improved sleep quality & perceived quality of life associated with chemotherapy in women with breast cancer (4). In people with CIPN, massage greatly decreased symptoms (5, 6), increased skin temperature in fingers & toes, & improved the quality of life in person affected by CIPN (5).
Chemotherapy & Glove Use: Contact precautions & use of disposable gloves are not required in most facilities when working with clients who are receiving chemotherapy (7). There are two exceptions. Gloves are needed for skin-to-skin contact during and within 24 hours of infusion with thiotepa (Thioplex) &/or cyclophosphamide (Cytoxan) because they are secreted through sweat glands & may pose a risk to the therapist from skin-to-skin contact during massage. Some therapists use gloves as a precautionary measure. When in doubt, be sure to contact the client’s health care provider.
Implanted Vascular Access Devices: Implanted vascular access devices (IVAC) such as a Port-a-Cath, or port, is a small device inserted beneath the skin in the upper chest wall, abdomen, or arm used to administer chemotherapy intravenously. A catheter attaches the port to a vein so that the tip of the catheter is located in the superior vena cava or right atrium of the heart. Some IVACs may be used to collect blood specimens or instill other medications or fluids.
Massage Therapy & IVACs or Ports: Avoid the area around the port during massage. If it is recently inserted, avoid joint mobilization to the shoulder near the port until the area has completely healed.
Post-chemotherapy cognitive impairment (PCCI), or chemo brain, is loss of cognition, memory, fluency, & other cognitive-related abilities associated with chemotherapy treatments. Approximately 20%–30% of individuals who receive chemotherapy experience some level of PCCI. This condition is more prevalent among persons treated for breast cancer, ovarian cancer, prostate cancer, & cancers requiring aggressive chemotherapy treatments. Some researchers have suggested that PCCI is more related to the cancer experience than to the chemotherapeutic drugs themselves.
Massage Therapy & PCCI: Support the client by reminding him or her of the appointment date, day, & time the day before & the day of the massage. Provide a written appointment card or design an email, phone or text reminder system.
Malaise & Fatigue: Malaise is a general feeling of discomfort, uneasiness, & ill-health with or without fatigue. Fatigue is the feeling of extreme tiredness & is closely associated with malaise. Persons receiving chemotherapy &/or radiation therapy may experience malaise & fatigue feel “out-of-sorts” & not have the energy to do their usual daily activities. These feelings may occur suddenly or slowly over time& persist for several days or longer.
Massage Therapy & Malaise/Fatigue: Discuss the timing of your sessions with the client. Be willing to adjust the time & date of the massage depending on how the client feels the day of the massage appointment. Clients affected by malaise & fatigue may require varying degrees of modifications, including fewer changes in body positions & massage techniques of lighter pressure & slower speed.
Massage was found to reduce cancer-related fatigue (8, 9). Slow-stroke back massage reduced fatigue in adults with acute leukemia who were undergoing chemotherapy (1). Breast cancer patients who received massage experienced a reduction in cancer-related fatigue (10, 11) as did patients with breast cancer who were undergoing radiation therapy who received both massage & polarity therapy (12). Foot reflexology decreased fatigue in patients with breast cancer undergoing chemotherapy (13).
Articles and Journals Referenced:
- Miladinia, M., Baraz, S., Shariati, A., et al., (2016). Effects of slow-stroke back massage on symptom cluster in adult patients with acute leukemia: Supportive care in cancer nursing. Cancer Nurs. Epub.
- Khiewkhern, S., Promthet, S., Sukprasert, A., et al. (2013). Effectiveness of aromatherapy with light Thai massage for cellular immunity improvement in colorectal cancer patients receiving chemotherapy. Asian Pac J Cancer Prev. 14(6), 3903-7.
- Stringer, J., Swindell, R., Dennis, M. (2008). Massage in patients undergoing intensive chemotherapy reduces serum cortisol and prolactin. Psychooncology. 17(10):1024-31.
- 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.
- Cunningham, J. E., Kelechi T., Sterba, K., et al. (2011). Case report of a patient with chemotherapy-induced peripheral neuropathy treated with manual therapy (massage). Support Care Cancer, 19(9):1473-6.
- Menendez AG, Cobb R, Carvajal AR, et al. Effectiveness of massage therapy (MT) as a treatment strategy and preventive modality for chemotherapy-induced peripheral neuropathy (CIPN) symptoms. Poster presented at: 2016 Palliative Care in Oncology Symposium; September 9-10, 2016; San Francisco, CA
- Goodman CC, Fuller KS: Pathology: implications for the physical therapist, ed 4, St Louis, 2014, Elsevier.
- Cassileth, B.R., Vickers, A.J. (2004). Massage therapy for symptom control: Outcome study at a major cancer center. J Pain Symptom Manage. 28(3):244-9.
- Karagozoglu, S., Kahve, E. (2013). Effects of back massage on chemotherapy-related fatigue and anxiety: Supportive care and therapeutic touch in cancer nursing. Appl Nurs Res. 26(4):210-7.
- Fernández-Lao, C., Cantarero-Villanueva, I., Díaz-Rodríguez, L., et al. (2012). The influence of patient attitude toward massage on pressure pain sensitivity and immune system after application of myofascial release in breast cancer survivors: A randomized, controlled crossover study. J Manipulative Physiol Ther. 35(2):94-100.
- Listing, M., Reisshauer, A., Krohn, M., et al. (2009). Massage therapy reduces physical discomfort and improves mood disturbances in women with breast cancer. Psychooncology. 18(12):1290-9.
- 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.
- Yang, J. H. (2005). The effects of foot reflexology on nausea, vomiting and fatigue of breast cancer patients undergoing chemotherapy. Taehan Kanho Hakhoe Chi. 35(1):177-85.
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.