By Deborah Hart.
Are you aware of Oncology Massage, a specialised area of massage therapy? Many of your patients may want to continue regular massage sessions to help manage a variety of musculo-skeletal conditions and stress but should be cautious when seeking a massage therapist once they have a cancer diagnosis.
Their reasons for seeking or continuing massage will be varied. They may want to feel ‘normal’ again, feel touched or it might be that massage helps to reduce their anxiety or relieve pain around areas of scarring.
Most patients will ask their doctor or oncologist for their approval when seeking massage whilst undergoing treatment for cancer; but some won’t.
If your patient asked your approval for a massage would you know what questions to ask about the massage therapist? If a therapist is well qualified would that be enough or which qualifications would you expect they have? The 2013 Position Paper on CAM from COSA recommends the use of “reputable and competent practitioners, preferably with oncology experience” but is that enough?
Oncology Massage is available as a post graduate course to qualified massage or Bowen therapists. Many therapists are drawn towards this specialised area of massage training as most are taught in their initial training that they shouldn’t massage anyone experiencing cancer.
Oncology Massage therapists are taught that metastatic spread is far more complex than a mechanical movement of cells around the body. They also understand the impact of chemotherapy, radiation and surgery on a patient physically and psychologically, adjusting a massage or therapy session to accommodate the complexities of treatment side effects including low platelets or neutropenia, ports and catheters, radiotherapy and surgical sites. They understand how to work safely with a client at any stage of the cancer journey from diagnosis through treatment, into survivorship or to end of life.
Although the diagnosis of cancer is increasing, death rates are decreasing which means that a larger portion of the community are living with cancer, cancer treatment or the lifelong side effects such as peripheral neuropathy or the risk of lymphoedema.
In many cases the shock of the cancer diagnosis drowns out the information that follows regarding treatment, surgery and self-care. An Oncology Massage therapist can offer support to your patients in relation to managing the side-effects of treatments and reducing the risk of developing lymphoedema following breast cancer surgery, radio therapy treatment or treatment to inguinal lymph nodes following prostate, bowel or reproductive organ cancer.
Increasing studies are showing the benefits of massage for those experiencing cancer treatment however research into the benefits of massage are not as common as those in the profession would like to see. This is most likely due to a lack of funding and the fact that gentle touch applied through well trained hands is not an easy thing to research.
Massage has been shown to reduce common side effects of cancer treatment. The largest study into massage for symptom control for cancer patients has been one from the Memorial Sloan-Kettering Cancer Center. This study surveyed just under 1,300 patients over a 3 year period representing 3,359 treatments.
This study showed the benefits of massage in relation to symptom control and resulted in 47% improvement in pain levels, 42% improvement in fatigue levels, 59% improvement in anxiety levels, 51 % improvement in nausea and 48 % improvement in reports of depression with other symptoms such as dry mouth, shortness of breath, memory problems or disturbed sleep improving by 48%. Outpatients improved about 10% more than in-patients with benefits persisting including no return toward baseline scores over a 48 hour follow-up. Patients used a 0–10 rating scales of pain, fatigue, stress/anxiety, nausea, depression and “other” and surveys were handed into staff not associated with the trial to eliminate bias. Changes in symptom scores and the modifying effects of patient status (in or outpatient) and type of massage were analyzed. Symptom scores were reduced by approximately 50% across all fields, even for patients reporting high baseline scores. These data indicate that massage therapy is associated with substantive improvement in cancer patients’ symptom scores.
Benefits have also been demonstrated in a variety of research studies showing a reduction in cortisol and inflammatory markers and an increase in dopamine, immune and endocrine functions. Oncology Massage therapists regularly see and hear about changes for our clients especially in relation to pain and anxiety but also in relation to improved blood results with well timed massage sessions suggesting an increase in neutrophils during chemotherapy cycles. We also observe changes in relation to depression and fatigue and their experience of chemotherapy induced peripheral neuropathy (CIPN).
Of course these are qualitative results only noticed in our case notes and in feedback sheets but with increased targeting of research projects we could see some amazing results backed up by science and clinical trials. With an estimated 30 to 40 percent of cancer patients treated with chemotherapy experiencing CIPN and it being one of the common reasons that cancer patients cease their treatment early, research showing that massage may reduce the incidence of this often debilitating condition could be a major breakthrough.
Research opportunities to test the efficacy of massage in support of cancer treatment are timely with cancer and wellness centres opening in hospitals and health services across Australia. Such research questions could include:
Can well timed massage increase neutrophils enabling patients to adhere to scheduled chemotherapy?
Can massage at the time of infusion reduce the incidence of CIPN in patients receiving Cisplatin?
Can massage on the day of infusion reduce common side effects of chemotherapy?
Can massage prior to treatment reduce anxiety during radiotherapy?
Oncology Massage therapists are trained in Australia by Oncology Massage Ltd, a not for profit training charity dedicated to providing training to massage therapists to ensure that all of those on a cancer journey have access to the benefits of safe touch. OM Ltd is the only organisation outside of the USA that is accredited to deliver Oncology Massage training. Oncology Massage Therapists can be found on the National Referral Listing at http://www.oncologymassagetraining.com.au/
Deborah Hart is the South Australian Coordinator for Oncology Massage Ltd, a non-for-profit organisation that trains fully qualified massage and Bowen therapists to treat those with a diagnosis or history of cancer effectively and safely.
Clinical Oncology Society of Australia (COSA): https://www.cosa.org.au/publications/position-statements.aspx
Cancer in Australia: an overview, 2010: http://www.aihw.gov.au/media-release-detail/?id=6442472394
Cassileth BR, Vickers AJ, 2004, Massage Therapy for Symptom Control: Outcome Study at a Major Cancer Centre, Journal of Pain and Symptom Management, 28:3:244-250
Hernandez-Reif M, Ironside G, Field T, Hurley J, Katz G, Diego M, Weiss S, Fletcher MA, Schanberg S, Kuhn C, Burman I, 2004, Breast cancer patients have improved immune and neuroendocrine functions following massage therapy, Journal of Psychosomatic Research 57:45-52
Hernandez-Reif M, Field T, Ironside G, Beutler J, Natural killer cells and lymphocytes increase in women with breast cancer following massage therapy J.Neuroscience, 115: 495-510, 2005
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NCI Cancer Bulletin February 23, 2010 • Volume 7 / Number 4: http://www.cancer.gov/aboutnci/ncicancerbulletin/archive/2010/022310/page6