Active cancer and manual therapy
Walt Fritz, PT, Foundations in Manual Therapy: Voice and Swallowing Disorders Seminars
May 23, 2022
Input encouraged on what I know to be a contentious topic.
From a recent question about the safety of manual therapy used when a patient has active cancer, I endeavored to collect data on this topic. I found precious little that firmly defines what is safe and not. Manual therapy during cancer treatment is well-documented in many studies, including in the SLP community with Krisciunas et al (2015) and Krisciunas et al (2019). But thorough studies on the timing of treatment before the beginning of therapy are rarer. Commonly held concerns over manual therapy and massage breaking loose metastases or spreading cancer via its mechanical properties or through changes in circulation abound. Over the past decade, much has been written about these concepts, pointing to allowing more gentle interventions for comfort and pain relief.
Due to a single case example with sarcomas, Miwa et al (2019) suggest that clinicians be aware of the possibility of disseminating malignancy with massage and manipulation. Similar findings were reported by others (Wang et al, 2014; Wu et al, 2010). Findlay (2020), while citing the benefits when massage is utilized by those with cancer or undergoing cancer treatment, expresses concerns about the limited applicability of such studies (just mentioned) and points to the excessive pressures used in mammograms as not being shown to increase the risk of spreading metastases. The National Breast Cancer Foundation maintains that mammograms cannot cause cancer to spread (Myth: A mammogram can cause breast cancer to spread, N.D.). Field (2016) reviews the benefits of massage with the cancer population.
Reinforcing the standard precautions, Penny and Sturgeon (2021) stated, “though safe and helpful, “one of the universal cautions for oncology massage: do not massage directly over a known tumor site” (Penny and Sturgeon, 2021, pg. 45). The avoidance of deeper pressures is also cautioned by Penny and Sturgeon, who also reiterates that the mechanisms of metastasis are cellular and chemical, not mechanical. They say that “massage therapy is a mechanical intervention, and thus will not spread cancer” (Penny and Sturgeon, 2021, pg. 54). They rightly question claims that massage increases circulation, which has been disproven, as a means to “spread” cancer.
Is it prudent to apply manual therapy/massage to active cancer patients? Until further studies prove it safe, it is advisable to avoid MT directly over sites of active cancer or metastatic involvement.
Do you have insight into this topic? I invite your input. Please leave your comments below.
- Field T. (2016). Massage therapy research review. Complementary therapies in clinical practice, 24, 19–31. https://doi.org/10.1016/j.ctcp.2016.04.005
- Findlay, S. 2020 https://www.susanfindlay.co.uk/cancer-and-massage-therapy-is-what-theyre-saying-true/#post-437-footnote-13
- Krisciunas, G. G. (2016). A novel manual therapy programme during radiation therapy for head and neck cancer – our clinical experience with five patients. Clinical Otolaryngology, 41(4), 425-431.
- Krisciunas, G. V. (2019, January). Application of Manual Therapy for Dysphagia in Head and Neck Cancer Patients: A Preliminary National Survey of Treatment Trends and Adverse Events. Global Advances in Health and Medicine, 8, 1-8.
- Miwa, S., Kamei, M., Yoshida, S. et al. Local dissemination of osteosarcoma observed after massage therapy: a case report. BMC Cancer 19, 993 (2019).
- Myth: A mammogram can cause breast cancer to spread. (N.D.). Retrieved May 2022, from National Breast Cancer Foundation: https://www.nationalbreastcancer.org/breast-cancer-myths/a-mammogram-can-cause-breast-cancer-to-spread/
- Penny, J., & Sturgeon, R. (2021). Oncology Massage: An integrative approach to cancer care. Jessica Kingsley Publishers.
- Wang JY, Wu PK, Chen PC, Yen CC, Hung GY, Chen CF, Hung SC, Tsai SF, Liu CL, Chen TH, et al. Manipulation therapy prior to diagnosis induced primary osteosarcoma metastasis–from clinical to basic research. PLoS One. 2014; 9(5):e96571
- Wu PK, Chen WM, Lee OK, Chen CF, Huang CK, Chen TH. The prognosis for patients with osteosarcoma who have received prior manipulative therapy. J Bone Joint Surg Br. 2010;92(11):1580–5
I have used manual therapy at for breast cancer survivors for the last 20 years. Thanks you for the review, especially the mammogram example. My experience is that hands on treatments are usually not asked for by the patient at the tumour site. Manual therapy can be applied in so many other locations to manage general pain and movement disorders. It is also a moot point when suggesting that the massage can distribute cells by lymphatic massage; if people are moving and walking, then their lymphatics will be inevitably be active.
Thanks for your comments, Denise. In the head and neck cancer community, those are asked to intervene before or in lieu of treatment, which is how the post originated. It is a situation of little mention in the research.