Lymphovenous Canada: Discussion point

Can providing massage therapy to individuals who have active cancer or who are terminally ill promote the spread of cancer?

Some lymphatic massage therapists have a policy of not providing therapy to individuals with active or terminal cancer, believing that such therapy might promote the spread of cancer through the lymphatic system. As a result, consumers with lymphedema - sometimes in great pain and distress - report having to go to several therapists before finding a therapist who is willing to assist them.

Similar cautions also also exist with the use of extremity pumps.

In the Professional Supportive care/Screening/Prevention Information on Lymphedema produced by the U.S. National Cancer Institute in November 2000, it notes under Treatment, When using compression pumps and other techniques, caution should be taken if there is potential for a tumour to be mobilized into venous or lymphatic channels.

There appears to be little concrete scientific evidence which suggest massage therapy promotes the spread of cancer. Many studies seem to indicate that massage therapy can potentially enhance the health, sense of well-being and quality of life of individuals with cancer.

In Diagnosis and therapy of malignant lymphedema, Fortschr Med 1998 Apr 30; 116(12):28-30, 32, 34 K. Ruger of the Fachklinik fur Lymphologie und Odemkrankheiten, St. Blasien, reports,

"With the standard physical treatment of edema...successful clinical management of malignant lymphedema is also possible. The sole contraindication of manual lymph drainage, we believe, locoregional tumor reoccurance, which can be completely eliminated by the immediate initiation of radical tumor treatment. The tumor reoccurance is the result not of falsely indicated manual lymph drainage, but of inadequate primary treatment that leaves behind residual tumor tissue, the early detection of which still remains an unresolved problem. Manual lymph drainage is indispensable for improving the quality of life of tumor patients with lymphedema."

In a retrospective study of 191 patients treated for head and neck cancer on the occurrence of lymphedema and therapy with manual lymph drainage, Preisler VK, Hage R, and Hoppe F report in Indications and risks of manual lymph drainage in head-neck tumors, Laryngorhinootologie, 1998 Apr; 77(4):207-12:

• "100 patients had received lymphatic drainage, whereas 91 patients belonged to the group without lymphatic drainage therapy. In 37 cases a tumor reoccurance or local metastases were reported, 18 of whom had received lymphatic drainage and 19 belonged to the control group. Among these 37 patients neither the group with lymphatic drainage nor the control group differed significantly concerning stage of cancer, histopathological grading, the in sano/non in sano resection of the primary tumor and a lymphangiosis carcinomatosa.

• Conclusion: A lymphatic drainage therapy for patients presenting with lymphedema after the oncological therapy does not increase the rate of local recurrencies. Moreover it improves the quality of life after the cancer therapy. As only few data are available for cases with non in sano surgery and tumors with lymphangiosis carcinomatosa, these cases should be excluded from lymphatic drainage therapy. A spreading of occult tumor cells in these patients might be possible."

Relief of anxiety and other physical symptoms associated with cancer or HIV/AIDS-related illnesses is well-documented:

• A four-year study at the James Cancer Hospital in Columbus, Ohio, researchers found that the immune system was actually stimulated during the massage, blood pressures dropped and circulation improved. In many cases researchers saw a dramatic drop in pain. (Source: Cancer Massage, December 27, 1999 Eyewitness News, KlS-TV, Salt Lake City; results were published in Psychology Today and in the Massage Therapy Journal.)
• In a study initiated by the Touch Research Institute, University of Miami School of Medicine, Florida, U.S.A. 29 gay men with and without HIV received daily massages for one month. 11 of the 20 HIV positive men experienced a significant incarease in Natural Killer Cell number, Natural Killer Cell Cytotoxicity, soluable CD8, and the cytotoxic subset of CD8 cells. There were also significant decreases in anxiety and increases in relaxation which were significantly correlated with increases in NK cell number. (Source: Int. J. Neurosci 1996 Feb;84(1-4): 205-17)

Health care professionals have also reported to us that therapeutic ultrasound over a site of possible metastasis is contra-indicated because it's been shown to enhance tumour growth in lab mice.

• Sicard-Rosenbaum L, Lord D, Danoff JV, et al. Effects of continuous therapeutic ultrasound on growth and metastasis of subcutaneous murine tumors. Physical Therapy 1995;75:3-10
• Sicard-Rosenbaum L, Danoff J, Guthrie J, Eckhaus M. Effects of energy-matched pulsed and continuous ultrasound on tumor growth in mice. Physical Therapy 1998;78:271-277.

Medical opinion on this topic is divided. Some physicians believe that there is little chance of spreading a cancer through a manual technique while others advise their patients to error on the side of caution. This is a decision which must be made by the patient in conjunction with their physician and therapist.

Clearly this is also an area where more scientific study is needed.