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Cancer in the Spa

Morag Currin June 2010 issue of Skin Inc. magazine
cancer survivor

Editor’s note: Before offering new or specialized services, spa professionals must undergo the proper training. Also, make sure clients living with cancer consult with their physicians before receiving any spa services.

With cancer statistics on the rise, there is a very good chance that a person living with cancer—or a cancer survivor, caregiver or family member—will seek out solace in a spa. Because of this, spa professionals should consider becoming educated about how to work with patients living with, or dealing with, cancer.

Although the focus of oncology esthetics is primarily on people living with cancer, it is important to understand that at times, these clients may have additional complications beyond the disease itself. They also may experience health issues or disabilities, including the effects that can occur by ingesting a cocktail of medications.

Personalizing spa treatments during each appointment is the key to a successful outcome. For clients, knowing that their chosen esthetician is qualified and trained to deal with their disease reassures them that they will be in the best hands. In some ways, clients with cancer are a forgotten population and offering services for them could result in a point of difference for your spa. Also, caregivers, family members and friends may be potential spa-goers, and many need emotional support in their lives, as well. Attracting new clients by offering oncology-based services can assure them that safe treatments can be enjoyed for people living with cancer. See Specialized Cancer Services for more information about what types of treatments can and can’t be offered to this unique clientele.

Can spa treatments spread cancer?

Cancer spreads while patients are living their lives, walking and doing household chores. There is no evidence to suggest that touch or gentle massage causes metastasis, but there is proof that touch or gentle massage is beneficial on a physical, emotional and spiritual level for people living with cancer.1, 2, 3 Research and anecdotal evidence has shown gentle massage to positively improve side effects such as nausea, insomnia, pain and anxiety. And for those leading stressful lives, being stress-free even for an hour is great for the psyche. Understanding the circulatory and lymphatic system is also necessary for spa professionals working with clients who have cancer. The removal or radiation of lymph nodes creates a serious concern, so the treatment must be personalized for each client in order to avoid serious repercussions that could result in lymphedema, which is the blockage of the lymph nodes.

Therapies and the skin

Clients who are undergoing cancer therapies can experience a variety of benefits from spa treatments that are personalized for their needs. Following are several of the therapies experienced by those fighting cancer.

Oncologic surgery. Oncologic surgery is one of the oldest forms of cancer treatment and is still often the first approach used in treating many forms of cancer. It may involve a minor procedure, such as removing a skin lesion, or it can be extremely invasive, resulting in the removal of all or parts of various organs.

The absence of adequate nutrients in the body will inhibit healing at the wound site if surgery is necessary. Cancer therapies can have a significantly negative impact on the delivery of necessary nutrients during both short- and long-term recovery. Improving skin health before any surgery takes place can be effective in the assistance of wound-healing. Spa treatments, such as massage therapy, are also recommended before and after oncologic surgery in order to support wound-healing and healthy skin, and improve microcirculation. Good hydration and nutritional topical skin care products are necessary to support healing, as is keeping the skin at a pH between 4.5–5.5 in order to maintain well-balanced skin.

Nutrients to be ingested via diet or supplements, such as protein, vitamins A and C, magnesium, copper, iron and zinc, are also important for wound-healing.

Protein. Protein is the only nutrient that provides nitrogen, and nitrogen balance is crucial to healing. Protein also provides energy and is needed for electrolyte and fluid balance, as well as for the growth, maintenance and structure of the skin. Protein deficiency appears to delay wound-healing by prolonging the inflammatory phase and inhibiting fibroblast proliferation, collagen synthesis and wound remodeling.4, 5, 6

Vitamin A. Vitamin A, a fat-soluble vitamin, is required for epithelial development and may function as an immunostimulant by increasing the quantity of macrophages in the wound.7, 8, 9

Vitamin C. Vitamin C, a water-soluble vitamin, acts as a free radical scavenger and has been demonstrated to lessen DNA damage in the cells. It also plays a role in the synthesis of connective tissue and collagen. 10, 11, 12

Magnesium, copper, iron and zinc. These nutrients help facilitate the wound-healing process.

Chemotherapy. Chemotherapy, a systemic treatment using anti-cancer drugs to treat cancerous cells, affects how the whole body performs. The skin—the body’s largest organ—becomes affected in many ways, causing it to require a gentler and less demanding approach.

Many people undergoing chemotherapy tolerate it very well and have few negative reactions, although most must alter some aspects of their lives to accommodate the treatments and the side effects. During chemotherapy, side effects can differ with each type of drug, with the dosage and with the way the drug is administered.

Skin-related side effects are common in clients living with cancer and receiving chemotherapy. The most rapidly dividing cells in the body relating to dermatologic cells are skin cells, hair follicles and the nail matrix, and together with other cells, such as those of the gastrointestinal tract, they are the most affected by chemotherapy. Hypersensitive reactions can cause temporary pale or reddened elevated patches with severe itching on the skin, and/or patches of swelling. Minimizing this hypersensitivity can be done in the spa environment with the use of hydrocortisone creams; however, clients need to be encouraged to see their physicians in the event this swelling is an allergic reaction.

Radiation therapy. Radiation therapy, a localized therapy, affects malignant cells primarily in treated areas. Different types of radiation therapy are available today, and alterations in skin integrity resulting from radiation therapy can cause short- and long-term side effects.

The epidermis, which is relatively sensitive, loses a fixed number of basal cells when they are destroyed by radiation therapy. A disruption occurs in the balance between the rate of cell renewal and the destruction of cells at the skin surface, causing cells to become cornified and to shed more quickly. When this happens, the basal cells are then stimulated to make new cells. Also, the destruction of basal cells from ongoing radiation therapy causes inflammation and a potential for permanently altered fibroblasts. Collagen in the treated area is then often immature or insufficient to meet the demands of normal wound-healing.13, 14

New developments in cancer radiation therapy have made it possible for radiation to be delivered to smaller areas, causing less damage to healthy tissue. The use of very advanced scanners and radiation technology allow treatments to be administered with a degree of precision that was not achieved in the past, therefore increasing the effectiveness of the treatments with fewer side effects.

Estheticians who have been trained in cancer and the skin can more accurately advise clients who have undergone radiation therapy about appropriate skin care for the area of radiated skin; what to avoid; and what to use. These estheticians can provide psychological benefits by understanding what the client is going through.

Biological therapies. Biological therapies stimulate a person’s immune system in the hope of attacking and killing cancer cells in the body. In this group of cancer therapies, the targeted therapy agents assist in preventing tumors from growing, metastasizing and interfering with the immune system. The most common side effect of targeted therapies is the development of papulopustular reactions, which appear to be dose dependent.15 Skin needs to stay moisturized and hydrated at all times, as well as protected from injury.


Every esthetician who takes their profession seriously should attend advanced education courses and read industry books and magazines to become the best they can be. So many different modalities for advanced education are available; however, if you have been touched by cancer, whether directly or indirectly, you may feel compelled to give back to other survivors who are going through debilitating cancer therapies. Understanding cancer therapies, their side effects, and the combination of therapies with medications is important in order to personalize a spa treatment for every client who comes into your spa. By comprehending how taxing cancer therapies can be on the entire person—physically, emotionally and mentally—treatments can be personalized for the client, at the moment, and in the moment.


1. BR Cassileth and AJ Vickers, Massage therapy for symptom control: outcome study at a major cancer center (Sloan Memorial Kettering), J Pain and Symptom Management, (3) 244–9 (Sep 28, 2004)

2. JS Kutner, MC Smith, L Corbin, L Hemphill, K Benton, BK Mellis, B Beaty, S Felton, TE Yamashita, LL Bryant and DL Fairclough, Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial, Annals of Internal Medicine 149(6) 369–79 (Sep 16, 2008)

3. S Wilkinson, K Barnes and L Storey, Massage for symptom relief in patients with cancer: systematic review, J of Advanced Nursing, 63(5) 430–9 (Sep 2008)

4. CA Worly, Why won’t this wound heal? Factors affecting wound repair, Derm Nursing, 16(4) 360–1 (2004)

5. SJ Hughes, Nutrition and healing, J of Clinical Nutrition, 17(4) 21–6 (2003)

6. E Wallace, Feeding the wound: Nutrition and wound care, British J of Nursing, 3(13) 662–7 (1994)

7. A Barbul, B Thysen, G Rettura, SM Levenson and E Seifter, White cell involvement in the inflammatory, wound healing and immune actions of vitamin A, J of Enteral and Parenteral Nutrition, 2(2) 129–138 (1978)

8. HP Ehrlich and TK Hunt, Effects of cortisone and vitamin A on wound healing, Annals of Surgery, 167(3) 324–328 (1968)

9. MJ Connor, Retinoid stimulation of epidermal differentiation in vivo, Life Science, 38(20) 1807–1812 (1986)

10. Food and Nutrition Board, Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride, National Academies Press, Washington, DC, (1997)

11. RA Jacob, Vitamin C, Modern Nutrition in Health and Disease, 467–483, Williams & Wilkins, Baltimore, (1999)

12. AJ Bailey, Collagen and elastic fibres, J of Clinical Pathology, 21(Suppl. 12) 49–58 (1978)

13. SR Hymes, EA Strom and C Fife, Radiation dermatitis: Clinical presentation, pathophysiology, and treatment 2006, J of the American Academy of Dermatology 54(1) 28–46 (2006)

14. MK Tibbs, Wound healing following radiation therapy: A review, Radiotherapy and Oncology, 42(2) 99–106 (1997)

15. ME Lacouture, Insights into the pathophysiology and management of dermatologic toxicities to EGFR-targeted therapies in colorectal cancer, Cancer Nursing, 30(4, Suppl. 1) S17–S26 (2007)



What is Cancer?

Cancer is the term given to a group of diseases caused by an uncontrollable growth and spread of abnormal cells. Cancer cells, also referred to as malignant cells, are cells that have been genetically altered to look and function differently from normal cells. Thus, cancer is actually a disease of the cells and involves a series of mutations or changes in the genetic makeup, or DNA, in the cell.

Normal cells in the body usually divide when the body needs more cells. When signaling for new cells, the body is careful that it only triggers cells to divide when it needs more so that cell birth equals cell death.

Proto-oncogenes, cells that promote cell division, and tumor suppressor genes, which keep cell division in check, are in place to control cell division in an organized way.

In most cancers, the cells undergo at least four mutations, and in many cancers, mutations occur in both the proto-oncogene, making it an oncogene, as well as the tumor suppressor gene, so that there is no longer any control of cell division.

Cancer cells differ from normal cells in a number of ways. Cancer cells have uncontrolled, often rapid, growth rates. Generally, they are not encapsulated, so that the shape of the tumor is irregular, often with finger-like projections that invade neighboring tissue. They also have an abnormal structure, which often is poorly differentiated and has the ability to migrate or spread.

Metastases, or spread of tumor cells beyond the primary mass, can occur in three specific ways:

  • Direct invasion of tumor cells into nearby tissue or organs.


  • Lymphatic spread of tumor cells to local or distant lymph nodes.


  • Hematologic spread of tumor cells to distant sites through the blood.


Specialized Cancer Services

Each client needs to have a spa treatment personalized based on how they are at the moment; whether the treatment is taking place during cancer therapies or during recovery. Estheticians can add services such as an oncology facial, or any hand or foot massage, Reiki, reflexology and oncology massage after receiving advanced training.

Lymph node removal or radiation require adjustments during massage in both pressure and direction. Certain situations, such as a port in the décolleté, require avoidance of that area. Radiation to the chest or throat requires avoidance of that area both on the back and the front of the body. Positioning, pressure, site restrictions, skin side effects and product selection all have to be taken into consideration when working on a person living with cancer.

No spa equipment should be used on clients during cancer therapies. For the most part, cancer patients have dry, dehydrated, sensitive skin that tears easily and requires soothing, hydrating and moisturizing treatments. Psychologically, clients require touch, listening and acceptance of their condition.

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