Opinion: Cancer and Massage

Note: A revision was made to this blog 06/02/18 after Tracy Walton contacted me about leaving out the second part of her critique. The link to it is below. 

I feel compelled to offer my own opinion of the recent hullabaloo regarding a difference of opinion between Dr. Jeffrey Cullers and Dr. Ross Turchaninov and Tracy Walton about Oncology Massage. I have read the initial article put forth by Cullers and Turchaninov, the Wang et al study, the other research articles that were quoted by Cullers and Turchaninov, the initial response from Walton, and the second round, and feel compelled to comment. I have been a massage therapist, author, and educator for almost 20 years myself. My late husband was also a licensed massage therapist as well as a cancer patient, and this subject is dear to my heart.

For those who are unfamiliar, here are the links:


The original article by Dr. Jeffrey M. Cullers and Dr. Ross Turchaninov, Massage Therapy in Cases of a Newly Diagnosed Cancer

 

The critique from Tracy Walton, which appeared in Massage Today, Does Massage Spread Cancer

 

The second article from Tracy Walton, which appeared in Massage Today, Can Massage Spread Cancer in the Newly Diagnosed?

Another article from Walton,  Choosing Our Words Wisely…Language Matters which appeared in Massage Today

 

The original study from Wang et al, Manipulation Therapy Prior to Diagnosis Induced Primary Osteosarcoma Metastasis—From Clinical to Basic Research

 
First of all, Culler’s and Turchaninov’s  display of condescension towards Tracy Walton, and the standards of practice of the S4OM in general, is evident in their second response, “people are busy, but we are forced to address this issue so here we go again” attitude…it seems that neither thinks anyone should have dared to challenge them or offer any response.

Second, as every scientist including Cullers and Turchaninov are aware, or even a layperson with a basic knowledge of research (I fall into the latter category) knows, one research study does not an accepted scientific theory make. Research is meant to be replicated. If there was any subsequent replication of this study, I was unable to find it, and welcome anyone who is able to point to the replication of this one. I do not imply, nor does Walton, that Wang et al’s study does not have any value. She never said any such thing; she in fact referred to it as “an unusual and important contribution to discussion.” What she did say is that some important omissions existed in the paper: a lack of reporting of the timing of manipulation therapies prior to the diagnosis of cancer, and that the original study did not mention specific body areas that were massaged, pressure used, or joints moved–all valid points.

Third, the attack on Walton’s ethics is absurd. Yes, we are obligated to first do no harm, but due to the omissions in the original study by Wang et al mentioned by Walton , this is not even up for debate, although Cullers and Turchaninov have chosen to imply that it is. There is simply nothing in the study to indicate when a person had received massage prior to being diagnosed with cancer. That could be construed to mean that anyone who ever gets up in the morning with musculoskeletal pain and seeks a massage for relief better beware, because banish the thought, they might have bone cancer and that could affect their prognosis years down the line.

Simply put, the study was lacking some very important information, and to jump from that to accusations of unethical behavior on the part of Walton or any other massage therapist is unprofessional and beyond the pale. The statement that if there is even a 1% chance that MT could cause metastasis in a cancer patient between diagnosis and treatment, that is cause not to give a massage doesn’t ring true. None of us are guaranteed the next breath, and there is in all likelihood a 1% chance that any client could have a heart attack  and die on the table. Does that mean we shouldn’t give anyone a massage? No. It’s a big jump that  just doesn’t add up.

The S4OM has made invaluable contributions to the education and practice of massage therapy for cancer patients, as has Tracy Walton. That is not to minimize any contributions made by Cullers and Turchaninov, nor those of Dr. Wang. The organization does not feel that this one study from Wang et al, nor the subsequent discussion that ensued between Walton and Cullers/Turchaninov, warrants any change in their current standards of practice. Walton stated that the authors brought up interesting points, but they do not add up to a change in OMT practice. I feel confident that Walton and the S4OM do everything they can to keep up with current research and that whenever a change in their standards of practice are actually warranted, they will be implemented.

7 thoughts on “Opinion: Cancer and Massage

  1. Ruth Werner

    Laura, I am so grateful for your willingness to shine a light on this painful conversation. Your thoughtfulness and commitment to ethical practice are especially appreciated here.
    Let me repeat your important words: one study doesn’t change our understanding; it enhances it. But if the study is deeply flawed and leaves out information that could alter its meaning, it isn’t right to change protocols or judgments that have, heretofore, been effective.
    Brava, my friend!

  2. Dr. Jeffrey Cullers

    Laura Allen,

    I feel it is important to respond to this post.

    Respectfully, although you are entitled to your opinion, it may have been prudent for you to have read ALL the information regarding this very important and potentially life changing matter.

    There, in our 2 articles, you will not find any derogatory or condescending comments made about T. Walton, however, such was not the case for our opponent.

    The 2 articles we published were intended to serve ONE purpose – TO SERVE THE ONCOLOGY PATIENT and to EDUCATE MTs – that is it, period. It was not to create this unnecessary argument.

    Instead, the study conducted by Wang et.al was critiqued, as well as, Dr. Ross Turchaninov MD (whom may I mention worked with Oncology patients in the Ukraine prior to moving to the US) and myself. Again, I will reiterate, we NEVER mentioned T. Walton prior to our being critiqued by her, not once but twice.

    As a result, we chose to respond accordingly. Although you and others may not like the way we did, non the less what we posted is a fact that simply cannot be denied.

    Should an MT choose to ignore the information we have provided, that is their choice – I would think however, if a cancer patient with a NEW DIAGNOSIS of cancer was aware of what could happen if they received massage therapy prior to starting cancer treatment, I’m sure they would choose otherwise.

    Ultimately, we as MTs need to make our own educated decision, therefore I am posting the links in chronological order of our 2 articles and T. Waltons critiques for review:

    https://www.scienceofmassage.com/2017/05/science-of-oncology-massage-part-1/

    https://www.scienceofmassage.com/2017/10/science-of-oncology-massage-part-2/

    http://www.massagetoday.com/mpacms/mt/article.php?id=15349

    https://www.scienceofmassage.com/2018/01/jms-response-to-tracy-waltons-critique-published-in-massage-today/

    http://www.massagetoday.com/mpacms/mt/article.php?id=15397

    https://www.scienceofmassage.com/2018/05/response-to-new-critique-by-t-walton-published-in-massage-today/

    Professionally,

    Dr. Cullers

  3. Dr. Jeffrey Cullers

    Laura Allen,
    Since I am co-author of original article and further unfortunate exchanges with T. Walton I think I need also to weight in. First, thank you for taking time to read and write lengthily opinion. Apparently, we have different views on the same issue. I personally don’t teach Oncology Massage and I don’t have ANY benefits from this exchanges. However, I am sure that I familiar with this issue since my PhD in medicine was on a topic of replacement of bone defects after bone cancer and patients’ rehabilitation after that in part using medical massage.
    So, let me answer your concerns.
    1. First of all nobody expressed condescension to T. Walton. It was expressed to her position and these are two different things. We examined Dr. Wang expertise by reading his articles in prestigious medical publications. I would like to tell you that his expertise in Oncology way surpass T. Walton and our combined experiences. So, from our perspective T. Walton expressed condescension to the brilliant work of Dr. Wang and his colleagues by COMPLETELY denying results of their study and she did it without ANY data just based on her own opinion. I think that this supposed to strike you more than our attempts to clarify Dr. Wang and our position.
    2. You said that “ even layperson with a basic knowledge of research (I fall into the latter category) knows, one research study does not an accepted scientific theory make. Research is meant to be replicated”.
    What you said is correct in many cases (e.g. how to treat Carpal Tunnel) or in the field of pure science, (e.g. physiology). Situation with rules about CLINICAL research changes dramatically if it concerns harmful side effect of new medication, cancer patients, patients with strokes or heart attacks. For these cases principles you mentioned don’t work anymore.
    Let me give you following example as illustration of what I just said. In 1957 new anti-depressant medication called Thalidomide was introduced and it was widely prescribed including pregnant women to fight with nausea and stress. Within two years it was obvious that medication triggers teratogenic effect with babies born with defects and only 50% of these babies survived. As soon as STATISTICAL correlation between drug and teratogenic effect was established it was first immediately suggested to physicians to stop prescription of the medication to the pregnant women and by 1960 it was taken from the market. If physicians at that time had similar approach to Thalidomide, as T. Walton and you have to Oncology Massage application, the bad medication stayed longer on the market waiting for the full scientific validation of its negative effects while it continued to kill babies. There IS direct analogy between this and many other cases in medicine and matter of our discussion because incorrect prescription of Oncology Massage may have same grave consequences to lives of cancer patients. So, you don’t wait to change policy based on further research when new clinical data arrived, you change it IMMEDIATELY and continue to study this matter AFTER to find out optimal solution. Thus, in regard to the clinical application of any therapy for the critically ill patients you position that there no changes needed in “…current standards of practice” is clinically and medically incorrect.
    I don’t know in what degree you are familiar with quality of scientific publications in medicine but the best studies are when experimental and clinical data gave SAME results. In medicine it is called ‘bullet proof’ study. This is exactly what Dr. Wang and colleagues did. They detected clinical correlation between MT and rate of metastases spread and to make sure that their conclusion is correct they double checked it on experimental animals. I don’t think you fully appreciate the authors approach to science. Dismissing their results on the ground of ‘just because I said so’ is simply nonsense, professionally irresponsible to other therapists and dangerous to the patients.

    3. You mentioned that the attack on Walton’s ethics is absurd. We didn’t as you said attacked Walton’s ethics. We just responded to her absolutely baseless attacks on Dr. Wang’s and our article which she published in 3(!) issues of national publication – Massage Today. Our initial article was just informational review of latest data and T. Walton didn’t even know about this study. Let’s say that I am therapist or especially national figure on the subject and I read new piece of data which confronts my views. If I don’t have any scientific or clinical counter-argument except my opinion, as a responsible health practitioner, who puts patient’s interest first, I will adopt this data to better serve my patients. Real absurd of situation in me fighting with my teeth and nails just to prevent this data to get to other therapists while acknowledge that what I am saying indeed my personal opinion (please carefully read third critique by T. Walton).
    As soon as T. Walton publishes results of the study with the same careful approach to its design and her results prove that Dr. Wang and his colleagues were wrong we will be first to support her.

    On a personal note, we both Dr. Jeff and I gave Hippocrates Oath. Also, I am fourth generation of physicians and my work with patients and my family legacy is very important for me. As I mentioned before Oncology Massage doesn’t have anything to do with my daily activities: I see 10-15 patients daily with various somatic and visceral abnormalities, lecture, put each issue of Journal of Massage Science together, etc. However, I guarantee you that I will spend my free time to fight with this insanity for the sake of cancer patients. We will contact oncologists in every major hospital where Oncology Massage is practiced, and we will inform physicians about result of Dr. Wang’s study. I think it will be decisive answer to yours and Ms. Walton critique. Let’s people who are in charge of entire treatment process measure values of study by world respected oncologists and compare it to T. Walton’s personal opinion. We will do it until our opponent is forced to correct her views.
    Sorry for the long response, but we both consider this issue of great importance to the patients and clear consciousness of the therapists.

    Posted for Dr. Ross Turchaninov MD by Dr. Cullers

  4. Sharon

    Dr,

    As your example of “1957 new anti-depressant medication called Thalidomide” — 1960 it was taken from the market. That was only 3 years time that you have given an example of how FAST Medical Knowledge Expands and MODIFIES previous information.

    Dr Wang’s article says “this study from July 1995 to June 2012”, and publish “2014”.

    Can you please provide more current sources of information from any of the leading Medical Universities and Research Centers to collaborate with Dr Wang’s 6 year old data analysis?

    You provided the example of how even with the resources available between 1957-1960, the significance of differing information discovered. One can only imagine what new data is available between 2012-2018, especially with the increase in trillions of dollars and thousands and thousands of Medical Professionals since Dr Wang’s did his research.

    When my mother had cancer, it was believed by the medical field that any cancer after the original discovered cancer was a metastasized from the first discovered cancer – no matter where the further cancer was discovered.

    After many years and trillions of dollars of further research and learning, it was discovered that that assumption was no longer true. A person can have multiple types of cancer, and treatment for each of these types CAN be different.

    Due to several of my family members having cancer, I have read and studied CURRENT information on the characteristics and knowledge of cancers and their behaviours.

    I have learned that the spread of cancer is not mechanical. Cancer starts and spreads because of biochemical changes in the body, which are orchestrated by genetic and epigenetic changes.

    Regards,

  5. Gayle MacDonald

    Words matter. Referring to another professional as an “opponent” turns the discussion into something akin to a battle. It is not the normal terminology I am used to in professional journals.

  6. Ruth Werner

    Thank you for posting this, Laura, and for shining a light on a very important discussion.

    I’m still waiting to hear a defense of the limitations in the Wang study. #notholdingmybreath

  7. Lisa Mertz, PhD, LMT

    In this opinion piece, Laura Allen cites the study upon which Cullers and Turchaninov draw wide-ranging conclusions about Massage Therapy and metastasis. The study extrapolates from an in vivo study in which mice are injected with human osteosarcoma cells, massaged, and then measured for mets:

    “Though it was difficult to assay the pressure on mice skin when conducting MT treatment, we standardize the MT protocol by putting the force on xenografted tumor as a touch press pushing back and forth for three times per treatment and two treatments per week for simulating the clinical manipulation protocol. Under MT treatments, the cancer cells migrated not only into bilateral lymph nodes but also in lung tissue…”

    Their concluding sentence:

    “As there are increasing evidence that MT on tumor may take the risk to promote tumor progression and induce metastasis[6], [9], [28] and taken our previous clinical observation and in vivo evidence together, we conclude and suggest that physicians should pay more attention on those patients who seek MT or massage and should take prior diagnosis to get rid of the possibility of osteosarcoma.”

    This study focuses on mice that were injected with osteosarcoma cells and is entirely insufficient evidence to consider oncology massage therapy as a contraindication for all new patients with all types of cancer.

    As to oncology massage therapy: we do not apply pressure directly on known tumor sites, and we always modify our treatment plans according to the diagnosis, activity level, medications (both cancer and non-cancer related), and other important considerations. We always modify the pressure of our treatments, sometimes down to practically no pressure. And we usually work with the healthcare team to make sure we apply oncology massage therapy effectively and safely.

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