Chelsea Sullivan, LMT
Oncology Massage Therapist
If I am actively receiving chemotherapy or radiation are there precautions or contraindications to massage therapy?
Contraindications: No deep tissue work, pressure should be between 0-3, avoid areas of radiation, avoid areas with scars/scabs/surgery sites until healed, no close work (at least 1 hand length away) from a port, piccs & catheters, if lymphedema or removed nodes - would need to reroute strokes and see a therapist that is certified in Lymphedema (or the therapist would have to avoid that area affected/watershed), depending on the client's treatment plan, may need to adjust their massage schedule/treatment for the session, low WBC number, if the therapist or the client are not feeling well it is best to not offer massage, blood clots, DTV.Precautions: positioning of the client, possible blood clots, skin sensitivity, could easily bruise, DVT, dry skin, susceptible to fractures, possible burned skin with radiation, scar tissue, immune compromised, a decrease in ROM, hand/foot syndrome, possible sores, therapist might need to wear gloves depending on clients treatment process, edema, reconstruction, mucouses, areas of trauma, heat & ice treatments, some massage modalities (depending on client's treatment/conditions/overall feeling), dizziness post massage. The client also may not want to fully disrobe, which is fine as well. They could also be wearing a wig or currently losing hair, so being sensitive to those as well.
- What modalities CAN active breast cancer patients and/or survivors participate in safely?
Light work (pressure 0-3); Swedish massage, effleurage, energy work (Polar Therapy, Reiki, or Craniosacral therapy), scar tissue work, lymphatic work (if needed & done by a lymphatic trained therapist), myofascial work. Can do some other light techniques just making sure to make modifications and if this is the first time seeing the client, my approach is always a bit more on the cautious side. Range of motion techniques could also be used, but cautiously and modifications may need to be made depending on patient comfort and their current treatment plan.
- Can massage therapy metastasis breast cancer? No it cannot metastasis breast cancer. However, precautions and modifications do need to always be taken into account to provide a safe massage for the client and not cause harm or cause lymphedema, especially if lymph nodes have been removed or tested.
- If individuals have undergone a mastectomy what precautions should a massage therapist keep in mind?
Lymph Node removal or testing of lymph nodes & there is always the possibility of lymphedema (which should only be treated by a massage therapist who is certificated in lymphedema), scar tissue, possible decrease in ROM for the client, pain/discomfort or increased sensitivity in the area affected, client could also be going through breast reconstruction (tissue expanders), so positioning of client is important & avoiding pressure on the chest & timing (letting the incision heal), possible swelling, light pressure is best near area affected, therapist could be in communication with clients healthcare team with consent from client. They also may need medical clearance before massage work. This could also be an area of trauma, so having an understanding of that and meeting the client where they are and working within their comfort level.
- Are there things AFTER a massage that breast cancer patients/survivors must be aware of?
This could be different for everyone and depends on where they are in their treatments or the type of treatment that they are receiving. Some people could have an increase in nauseousness, an increase in tenderness, feel more fatigue post massage or it could reduce fatigue. They could have an increase in relaxation and sleep better. It could also help with mood or stress. They may be on medications that have side effects, so making sure of what medications they are taking and side effects as to not exacerbate them (if possible) during the massage and should update their therapist with a change of medication or treatments.
- How can massage therapists adapt positioning when patients have extremely sensitive areas? (i.e. Chest, axillary, neck, pelvis)
Different positions could include: laying on their back, side or stomach based on their area of sensitivity. They could also be positioned semi-reclined (such as in a hospital setting) . If they have a picc, port, catheters or colostomy bag, you will want to position them in a way in which they are not laying on top of them and that they are not being compressed or being pulled. The therapist may need to use bolsters/pillows to support the client in their positioning. The therapist can also ask the client if there is a position in which they feel most comfortable. They also may have limited ROM, so make sure to move slowly with any ROM and always check in with the client on pressure in extremely sensitive areas (staying in that 0-3) pressure level.
- How does your clinic/organization address sexual health and intimacy?
I have not had experience with my clients asking me directly, so I do not have a great answer for this. I know that some clinics offer massage therapy + mental health therapy, so that clients can address both the physical and mental.
- How often do your patients initiate the conversation about sexual health concerns? Is there a question on your intake form addressing sexual health?
I have not had patients in the past initiate conversation about sexual health concerns and I do not have a question addressing that.
- What other information should patients be aware of before going to a massage therapist? Are there certain questions to ask a massage therapist prior to treatment?
I think doing research on therapists and making sure to see a therapist that does specifically treat people going through cancer and making sure that they have had extensive training in Oncology massage (A Foundational Course (24 - 36) hours of Oncology Training) and then other supplemental training. They should not be receiving lymphedema work from a therapist that has not been certified in Lymphedema and fully understands how to do that work safely. If they are seeing someone who meets these: they can ask ask about experience working with neuropathy, how they will modify their massages based off of their cancer treatment/diagnosis, etc, what to expect with their massage sessions, contraindications/precautions, how will they meet the client where they are at, the therapists experience with working with cancer patients, is the therapists aware of side effects of cancer treatments (the patients treatments specifically), what the pressure level will be, the client should be able to stop the massage at any point (as any client). I have seen clients before where I have been the first person to mention lymphedema to them and what it is. Checking in with this clientele is also very important to make sure that they are not feeling sick, or need to change position or are feeling cold or their symptoms have worsened.
