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Reflexology, Chemo and Radiation: Am I Safe?

Are you a good therapist, but concerned about your ability to help someone who is undergoing treatment for cancer, who may be in a delicate state? Are you afraid you may do more harm than good, or that treating your client may even be harmful to you? Or maybe you're the one looking for some complimentary health care during your cancer treatments, and you heard reflexology helps manage difficult symptoms and improves quality of life. As common as it is to hear about cancer, many therapists aren't sure of the proper safety protocol. Here comes help.

Cancers are typically treated with (one or some combination of): chemotherapy (chemo), radiation therapy, and surgery.

Chemotherapy (chemo) is a strong treatment, involving drugs used to treat cancer. It is a systemic treatment, meaning that it affects the whole body, in order to stop the spread of cancer to other parts of the body. Chemotherapy is administered by a medical professional, frequently as an outpatient procedure in a hospital or doctor's office, via an injection or an oral medication, or an external skin application. Chemo is designed to kill fast-growing cancer cells, but the body’s other fast-growing cells, can also be affected, leading to some of the side-effects below.

General side effects of chemo relate to: bone marrow (anemia, increased risk of infection, bruising), temporary hair loss, cells in the mouth, digestive and reproductive tract (nausea, loss appetite, constipation, diarrhea), and sometimes involve cell damage in the heart, kidneys, bladder, lungs, and nervous system. Other side effects may occur, depending on the type and amount of the drugs, the severity of the illness, and how the body reacts to it.

Safeguarding the client: "There is no evidence to suggest that Reflexology can have adverse effects on a patient having chemotherapy. There is no evidence to show that reflexology spreads cancer; current literature supports this. Knowledge of the anatomy and physiology of cancer demonstrates the complexities of the cancer cell and how it spreads rather than being due simply to an increase in lymphatic flow or the circulation.'" -Paraphrased from Edwina Hodkinson BSc(Hons) RGN, "Reflexology for People with Cancer." (1) Safeguarding the client, therefore, comes down to the health and practices of the reflexologist; in the first, so as not to compromise a diminished immune system (low white blood cell levels) by exposing them to infection or viruses, and in the second, so as not to bruise a them, as they may have with low platelet count, and therefore more sensitive tissues.

Safety for the reflexologist: Chemotherapy drugs are generally eliminated through urine and feces, but two drugs eliminate through the skin: thiotepa, and, to some extent, cyclophosphamide (Cytoxan). There is no strong evidence to mandate gloving when massaging clients on cyclophosphamide (Society for Oncology Massage 2011) (2). Therefore, a reflexologist should wear gloves if:

  • pregnant or may become pregnant (extra caution)

  • the client has received thiotepa within the last 24 hours, or more than 24 hours ago and has not bathed (3)

Radiation therapy is the use of high-energy particles or waves to destroy or damage cancer cells. It is used to treat the tumor, so it affects only the part of the body that has cancer, but, like chemo, it can also damage healthy cells. Radiation therapy can be used on its own to treat cancer or to help with related symptoms, like bone pain, but it’s often used with chemotherapy. Radiation can be administered externally or internally.

External beam radiation is delivered by equipment, similar to an X-ray, only lasting a few minutes. However the frequency is typically five days a week for one to ten weeks; internal radiation therapy (brachytherapy) involves a radioactive implant placed inside of the body by the tumor. Some implants may be removed after a period of hours or days, at which point the patient is no longer radioactive; some may be left in the body permanently, with special instructions to avoid or limit time with children or pregnant women for a few days as the radioactivity breaks down. Internal radiation therapy is common for cancers of the breast, cervix, ovary, pelvis, head, neck, lung, perineum, and prostate.

General side effects of radiation therapy include fatigue, skin problems, hair loss (alopecia), loss of appetite, nausea and vomiting, low blood cell counts. Other side effects depend on the location and severity of the cancer, and intensity of the treatment.

Safeguarding the client: In other forms of bodywork, the radiation site is to be avoided in direct touch treatment as, essentially, it acts as a burn. Reflexology does not have this contraindication and the full feet can be treated, including the reflexes for tumor sites. "Reflexology can in no way interfere with the radiotherapy treatment," Edwina Hodkinson BSc(Hons) RGN (4). Safeguarding the client therefore comes down to keeping your client clear of exposure to infection or viruses, and using a lighter touch until tissue response is determined.

Safety for the reflexologist: After a radiotherapy treatment there is no radioactive material within the body, posing no risk to reflexologists. Permanent internal radiation implants are typically monitored in the hospital, and by the time the patient leaves, they are deemed non-radioactive, with instructions for limited contact only with children or pregnant women, and only for a few days. Reflexologists who are pregnant or may become pregnant can schedule appointments after this cautionary period.

Post-surgical reflexology considerations are consistent with usual reflexology protocol: check with medical professionals as to the risk of blood clots, as they remain a contraindication. As soon as the client is cleared of that risk, reflexology can proceed.


1. Edwina Hodkinson BSc(Hons) RGN, "Reflexology for People with Cancer.",

2. Sociaty for Oncology Massage;, retrieved 2019/06/09

3. Macdonald, G (1999, 2007) Medicine Hands; Massage for people with cancer. Findhorn press, Florida

4. Edwina Hodkinson BSc(Hons) RGN, "Reflexology for People with Cancer.",

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