Is Massage Safe for People with Cancer?

For many years, massage therapists have been taught to approach cancer with considerable caution. Some older massage texts even describe cancer as an absolute or relative contraindication to massage.

One of the main fears has been that massage might somehow “spread” cancer by increasing circulation or physically moving cancer cells through the body. Other concerns are more practical: pressure over a bone affected by metastasis could potentially cause injury, while chemotherapy, radiotherapy or surgery may leave a person with fragile skin, wounds, low platelet counts or other conditions that make normal massage inappropriate.

A recent systematic review provides useful evidence for therapists. Its central message is reassuring:

Massage does not appear to increase the overall risk of harm in people living with or receiving treatment for cancer.

But this does not mean that every massage technique is appropriate for every person with cancer.

What did the researchers find?

The review screened more than 7,000 papers and ultimately included 66 studies. Twenty-nine intervention studies provided information about adverse events, while three cohort studies examined longer-term outcomes such as cancer recurrence or progression.

When the researchers combined the available intervention studies, they found no statistical evidence that people receiving massage experienced more adverse events than people in control groups.

The relative risk was:

RR = 0.69 (95% CI 0.43–1.10).

This means the massage group had about 31% lower observed risk of adverse events than the control group ( RR < 1.0 means lower risk in the treatment/exposed group).

In other words, the available studies did not demonstrate an increased risk from massage. This remained the case when researchers examined different cancer stages, cancer treatments and more severe adverse events. However, the authors rated the certainty of this evidence as very low, largely because adverse events were poorly reported in many of the original studies.

That qualification is important.

The evidence is reassuring, but it is not strong enough to conclude that every form of massage is completely risk-free.

Does massage spread cancer?

This is perhaps the most important question for therapists.

The traditional idea that increasing circulation through massage automatically causes cancer to spread is an oversimplification of how metastasis occurs.

Cancer metastasis is a complex biological process. Cancer cells must detach from a tumour, survive in circulation, escape into another tissue and successfully establish themselves in a new environment. Simply increasing local circulation does not demonstrate that this process will occur.

The review therefore does not support treating cancer itself as an automatic contraindication to massage.

There is also some reassuring clinical evidence. A cohort study involving 1,106 women with breast-cancer-related lymphoedema found no increased recurrence among women receiving manual lymph drainage compared with those who did not receive it, although the study had methodological limitations.

There were two older observational studies involving osteosarcoma that associated massage over the region subsequently diagnosed with cancer with poorer outcomes. However, both studies were judged to have a critical risk of bias. The people receiving massage already differed in important indicators of disease severity, and the massage itself was poorly documented. The review therefore concluded that it is very uncertain whether massage caused the poorer outcomes.

For therapists, the evidence therefore does not justify telling clients that massage causes cancer to metastasise.

The bigger issue is not cancer—it is the person’s condition

A much more useful clinical question is:

What is happening to this particular person’s tissues and physiology today?

Cancer and its treatment can create circumstances in which massage needs to be modified or avoided locally.

Examples include:

• low platelet counts or increased bleeding risk;
• fever or acute illness;
• open wounds or surgical wounds that have not healed;
• radiation-damaged or very fragile skin;
• infection;
• known bone metastases;
• unexplained pain or swelling;
• significant treatment-related fatigue or frailty.

Importantly, more than half of the studies in the review excluded people with conditions such as low platelet counts, fever, wounds or lesions in the massage area. Therefore, the reassuring safety findings cannot automatically be applied to every person undergoing cancer treatment.

This is why screening matters more than simply asking whether someone has cancer.

What about deep tissue massage?

Here the evidence becomes much weaker.

Most massage used in the studies was light or light-to-moderate pressure. Only three studies described the treatment as deep massage, and none of those studies adequately reported adverse events.

Therefore, the review could not determine whether deeper massage is as safe as lighter massage in people undergoing cancer treatment.

This does not mean deep massage is automatically dangerous.

It means therapists should be much more selective.

Before applying stronger pressure, consider whether the client has:

thrombocytopenia, bruising, fragile tissues, wounds, recent surgery, bone involvement, radiation injury or other treatment-related complications.

The review describes one particularly useful example. In a trial involving 269 people receiving chemotherapy, therapists could use relaxing, therapeutic and scar-tissue techniques without a specified pressure limit. However, clients were screened daily for temperature, bruising and bleeding, allowing therapists to adjust treatment according to the person’s condition. No massage-related adverse events were reported.

The lesson is important:

Safe oncology massage is not necessarily defined by “light touch only.” It is defined by appropriate assessment and modification.

What about massaging directly over a tumour?

This remains an area where caution is sensible.

A few studies used gentle massage in regions containing known cancer. Two trials included people with bone metastases, while another involved gentle abdominal massage in people with advanced gastrointestinal cancer. No massage-related local injuries were reported.

However, none of the intervention studies deliberately massaged known superficial tumour tissue.

Therefore, there is currently insufficient evidence to say that directly manipulating a superficial tumour is either safe or harmful.

For practical purposes, therapists should generally avoid directly working over:

a known tumour, an unstable bone metastasis, open cancerous lesions, radiation dermatitis or other structurally vulnerable tissue, unless the treatment is being undertaken within an appropriately supervised clinical setting.

You can often massage other areas safely instead.

Cancer is not one condition

Another limitation of the evidence is that most studies involved Swedish-style massage and predominantly gentle techniques.

The findings cannot automatically be extended to much more forceful forms of bodywork such as some forms of Thai massage, Tui Na, Shiatsu, vigorous stretching or strong joint mobilisation. The researchers specifically cautioned against assuming that the safety evidence applies equally to these approaches.

Similarly, nearly all study participants were adults, with an average age of approximately 53. Evidence is much more limited for children and very frail older adults.

A practical approach for massage therapists

When a client tells you they have cancer, the appropriate response is therefore not automatically:

“I can’t massage you.”

Nor should it automatically be:

“Massage is completely safe.”

Instead, conduct a proper clinical history.

Find out what type of cancer they have, whether they are currently receiving treatment, whether they have had recent surgery, whether there are known metastases, whether there is lymphoedema, and whether they are experiencing unusual bruising, bleeding, fever, wounds, skin changes or unexplained pain.

Then modify the treatment accordingly.

Pressure, positioning, treatment duration and the area being massaged may all need to change.

If something in the client’s history is unclear or concerning—particularly unexplained bone pain, swelling, bleeding, infection or a new lump—referral back to the treating medical team is more appropriate than attempting to treat through it.

The key message for therapists

The evidence challenges the old idea that cancer itself should automatically prohibit massage.

Current research has not demonstrated an increased overall risk of adverse events from appropriately delivered massage in people with cancer. Massage is already used in supportive cancer care and may help with symptoms including pain and fatigue.

But the research mostly concerns gentle or moderate massage delivered to carefully selected patients, and reporting of adverse events has been surprisingly poor. More than half of the intervention studies did not report adverse events at all, and the overall certainty of evidence remains very low.

So perhaps the most useful change in thinking is this:

Cancer is not automatically a contraindication to massage.

Instead:

Massage should be adapted to the person, the cancer, the treatment and the condition of their tissues on that particular day.

Good oncology massage is therefore less about being afraid to touch someone with cancer and more about screening carefully, modifying intelligently and knowing when not to treat a particular area.