Positive Health Online

Massage and Cancer

Helena, a bright and vivacious professional woman in her thirties, booked a massage session at a well-established complementary health centre as part of her strategy for looking after herself after recent treatment for cancer. When she told the practitioner about her current health issues, she was told that she would not be able to receive a treatment due to a fear of causing the cancer to spread.

In hearing about Helena's experience, I understood and respected this practitioner's ability to set a boundary and not be drawn into giving a treatment that she did not feel comfortable in providing. But at the same time I felt sad that our profession, which prides itself in offering one of the most profound and healing human experiences in therapeutic touch, had to exclude someone who had undergone a traumatic illness and treatment process and who could benefit in so many ways from relaxation, human contact and gentle support of the health of her body systems.

Like this practitioner, I had been told during my training that massage may contribute to the spread of cancer around the body and that massage should not be given if there was a risk of cancer being present. However, in 7 years of practice, I had learnt that it is not always easy to judge that risk and that there is much debate about the process of metastasis and the effects of massage for cancer patients. I knew that massage is given in some oncology departments and related community services, and that it is clearly judged to be helpful by some experts in the field.

Touch may have a positive effect upon health and well-being

A friend of Helena's had given her my telephone number and she contacted me a few days later. She had actually been through treatment for cervical cancer several years previously and had been in remission, but had recently received a short course of radiotherapy for residual cancer cells. She had discussed having massage with her consultant who was happy for her to go ahead. I suggested that she come for one session and we could see if she found it helpful.

When Helena arrived for her appointment she described her symptoms of chronic indigestion and her difficulty in keeping down food. She had been immobilized for two months and had felt very low in energy, but recently she had embarked on a nutritional immune boosting programme and was setting about building her strength again. She had pain in her groin and showed me some swelling in her right leg which had developed after an acupuncture treatment. The session was a short one and I worked with extreme caution and very light pressure, focusing on her back and shoulders, with a little work around her legs and hips. Helena was thin and seemed very depleted in her energy, although clearly full of mental determination and a strong will to regain her health. She was deeply relaxed after the session and spoke positively about how she felt physically and emotionally. She went home to rest, agreeing to let me know how she felt in the following days.

After Effects

Helena did call me a few days later. The day after the massage session, she had experienced severe pain in her groin and chest, seeming to centre around lymph nodes. She had consulted her doctor who had prescribed anti-inflammatory medication until the symptoms subsided – which they did in a few days. The experience, however, had clearly shocked her and knocked her confidence.

It knocked my confidence too. I had worked with deliberate care and attention and very light pressure and still Helena's body had reacted very strongly and I did not understand why this had happened. I had experience of practising therapeutic massage in many different situations and with a vast range of clients and not one client had ever had such a severe reaction. I believed I knew how to work safely and ethically, but clearly I had made some mistakes here.

The main mistake is the classic one for many people in the caring professions. By putting my sense of being helpful before clarity of boundaries, I failed to ensure that I had sufficient understanding and knowledge about the benefits and cautions of massage – in this case, before beginning a treatment. My priority now was to rectify this situation and try to understand the interplay of cancer, chemotherapy, radiotherapy, acupuncture and massage with the natural processes of the body, and to work out why Helena's body had reacted in this way.

I had read Gayle Macdonald's informative and compassionate book Medicine Hands: Massage Therapy for People with Cancer[1] and so was grateful to find an article of Gayle's Cancer, Radiation and Massage[2] specifically on the benefits and cautions of providing massage after radiotherapy. From these resources, and from some very generous mentoring from Gayle via email, I learnt that radiotherapy had probably made Helena's skin very sensitive and that there may have been some damage to lymph nodes in her groin. Even very light, limited massage around her leg and hip area had overloaded her lymphatic system and contributed to an inflammatory reaction which affected other lymph nodes. Her lymphatic system may have already been under pressure from dealing with the toxic products released from the destruction of cancer cells and the effects of acupuncture in promoting detoxification.

How many massage practitioners would have had the knowledge to foresee this? How many might have worked with more pressure and less knowledge? There are many massage therapists who have pursued an interest in working with people with cancer and who have the knowledge and supervisory support required to work skillfully and safely in this field. I am sure that there are also many massage therapists who would take this story as evidence that they should not 'touch' anyone with cancer for fear of doing harm. But I think that my level of knowledge and my cautiously positive approach would be in common with many practitioners working in private practice. These issues have been explored in depth by Patricia McNamara in her ground breaking study.[3]

Deep Listening is not Always Enough

As practitioners, we may have developed a highly attuned sensitivity and we may be very attentive to feedback from the people we work with. Our clients may seem to have a clear sense of their health and they may be enthusiastic about receiving massage. They may have enjoyed massage in the past and assure us that it is safe for them. But our best intentions need to be supported by our knowledge about disease processes and dangers, about the interaction with other treatments. We need to be clear about the precautions that we may need to take and the questions we need to ask.

Training

Accredited massage training courses prepare practitioners to deal safely with a large range of illnesses and injuries which they may come across in their practice. Many schools continue to tell students never to massage clients with a history of cancer, which creates confusion for practitioners who would like to work in this field.

Gayle Macdonald has provided massage to cancer patients since 1994 and currently supervises massage students on the oncology unit at Oregon Health Sciences University in Portland, Oregon. One of the best outcomes of this story is that Gayle will be offering two weekend courses in March 2004 at Energetics, a complementary health centre in Edinburgh, Scotland. This will be an opportunity for massage practitioners and other touch therapists who are working privately or within institutional settings to increase their knowledge and confidence in working with people living with cancer.

Health Assessments.

Once a practitioner has the appropriate training, they still need to follow a careful intake procedure and to have a reliable source of health information. As is normally the case, clients can provide much of the necessary information and this consultation process is vital. But clients may also be tired and exhausted by their illness and treatment; they may have been through countless consultations and assessments; they may not fully appreciate the effect that massage may have on their body systems, and they may actually not have the full picture of their health. Practitioners should always contact their client's doctor to clarify specific questions and to ensure that there are not any additional reasons that the client may not safely receive massage – but these requests may present a difficulty. While a consultant may respond in a generally positive way to a patient's question about massage, I have found that consultants more often ignore my letters requesting specific details about a client's health. I assume that this is due to concerns about confidentiality and litigation, and possibly a lack of time to attend to what is perceived as non-essential correspondence. This highlights the importance of establishing a recognised protocol with the medical establishment for such communication.

Professional Responsibility

If massage therapy is to develop as a profession, we need to take our clinical judgement more seriously. If we deem ourselves to be health practitioners, we cannot turn away people with severe illnesses just because we don't have the knowledge to work with them, nor is it right to go ahead with a treatment without the appropriate skills. I believe that we have a duty of care to ensure that we have the skills to work safely with everyone who would benefit from massage.

At the very least, the public needs to be able to differentiate between therapists who offer 'lifestyle' treatments, who are not prepared to work with clients with any specific health issue, and practitioners who offer 'health' treatments who can assess and adapt sessions to meet a client's somatic needs. At the moment we have the absurd situation where 'massage' can mean anything from highly developed support in complex physical and emotional conditions, to spa treatments or prostitution. It is a confusing situation that undermines the profession and inhibits recognition of the vital benefits of massage.

Time and again, careful, attentive touch has been shown to have a positive effect on human health and well-being, at any stage of life and in all experiences of illness. It is an essential experience for anyone who wishes to enhance their self-esteem, their sense of connectedness and their natural capacities to rest and recover. Specific massage techniques can have additional effects on the body's circulatory, nervous and muscular systems which can help in minimizing symptoms and promoting healing. The question is, how do we need to adapt techniques of touch with different clients to ensure that practitioners are providing safe, informed care within established boundaries of practice? If massage practitioners, and all those who believe in the importance of therapeutic touch, can succeed in moving the profession forward to standards of expertise and confidence, perhaps we can contribute to a future where massage plays a recognized role in our health services and where human touch is valued, rather than reared, in our culture and in our communities.

References

1. Macdonald Gayle. Medicine Hands: Massage Therapy for People with Cancer. Findhorn Press ISBN 0899171770. 1999.
2. Macdonald Gayle. Cancer, Radiation and Massage. Associated Bodywork and Massage Professionals Aug/Sept 2001 (found at www.abmp.com)
3. McNamara P. Masssage for People with Cancer. The Cancer Support Centre, Warndsworth. 1994.

Further Information

Gayle Macdonald will be teaching two separate courses in 'Massage Therapy for People with Cancer' at Energetics on March 5-7th and March 19-21st 2004. Cost £200.00 per participant. Open to qualified practitioners of all touch modalities including Massage, Reflexology, Aromatherapy and Reiki and other interested medical professionals. For booking and further details contact Energetics Tel: 0131 557 9567; enquiries@energetics.uk.com www.energetics.uk.com