A cancer diagnosis is one of the most frightening to hear; it ushers in a health crisis that is often tough, consuming, and possibly fatal. Cancer treatment is strong medicine; it includes some of the most harrowing trials for a human body to integrate. People who have lived with cancer know the toll it can take on their bodies, their minds and spirits, their families, and their level of function.
Against this backdrop, skilled, comforting touch can be profoundly corrective and healing. Touch offers an antidote to the frequent trials of medical procedures, a chance to connect, through one’s body, with another person. Touch offers welcome relief from challenges such as pain, anxiety, and depression. A massage therapist can surround a client with acceptance and care, help to remedy the damaged self-esteem and body image that can accompany cancer treatment.
Unfortunately, people with cancer have met fear and uncertainty from the massage
therapy profession. For years, the contraindication against massage, expressed
as concern about promoting cancer spread, has prevailed without supporting evidence
or medical corroboration. This has robbed many potential clients and massage
therapists of the chance to work together. But the contraindication has taken
other serious tolls on the profession, preventing more meaningful discourse
on safe practice for people with cancer.
My belief, shared by many practitioners and thoughtful educators in the massage therapy profession, is that some kind of skilled touch is possible at every stage of the cancer experience—from diagnosis through survivorship, during treatment, and at end of life. Against the prevailing contraindication, massage therapists, clients, and medical providers have still managed to move the work forward. I am grateful to those who have paved this way. In the last few years, at least two books were published on this topic: Gayle MacDonald’s Medicine Hands: Massage Therapy for People with Cancer,1 and Debra Curties’ Massage Therapy and Cancer.2 Both elaborate on guidelines and the emotional preparation needed to work with this population. Moreover, three major trade journals: Massage Therapy Journal, Massage magazine, and Massage and Bodywork have all featured special sections on massage and cancer in the past two years. The literature continues to grow, and several trainings are offered locally and nationally.3
Over the years I’ve practiced, I’ve grown to appreciate both the art and the science of massage therapy. As my practice grew to include many people with cancer, I had to develop clear clinical decision steps to work safely and well with them, without erasing the role of my own intuition in my work. In response to the requests of many therapists and students over the years, I have outlined some of the key decision-making steps in a structure that is clear and accessible.
Some massage therapists tell me that they wished for more training in the area of clinical thinking. I know from designing science curriculum that simple lists of contraindications are not sufficient for massage therapists to work well with medically complex clients. Instead, we need to work as a profession to develop the information-gathering, reasoning, communication, and planning skills required to practice safely. These steps need to be straightforward, and they need to be manageable.
Because the contraindication to massage was so restrictive, it is tempting to rush forward in its wake and begin to work. But the work must be thoughtful, informed by a client’s medical picture and medical staff, and carefully designed. It requires systematic collection and study of several elements in the client’s history. Some of the steps we need to take:
These steps are simplified and do not capture the measures taken for every client’s cancer history. Some will be expanded in complexity, and others will be shortened or even eliminated for some clients. But the steps describe a framework, within which we can work safely and well in medically complex situations. When we have managed information well and designed a safe session for a client, we can put our concerns to rest. And when concerns are laid to rest, we can more easily let our intuition and creativity into the session.
We have begun to publicly challenge the concern about metastasis and refute it. As a profession, we are beginning to discuss the need for standard clinical decision-making steps needed to work with people with cancer. We are nailing down some concrete information and directives. We are on our way. This is a promising time for the profession and for the clients who so richly deserve this work.
1 MacDonald, Gayle. Medicine Hands: Massage Therapy for People with Cancer, Findhorn, Scotland: Findhorn Press, 1999.
2 Curties, Debra. Massage Therapy and Cancer. Moncton, NB: Curties-Overzet Publications, 1999. Available from the publisher at 888 649 5411.
3 Advanced instruction on massage with clients with cancer
is available in several areas. The Holistic Downeast School of Massage will
offer Tracy Walton’s three-day course, Caring for Clients with Cancer:
Simple Steps to Safe, Effective Massage Therapy, June 18-20, 2004; national
teaching schedule is at www.tracywalton.com.
Gayle MacDonald teaches in various locations, visit her website at www.medicinehands.com
. Cheryl Chapman, RN, LMT offers courses in the area and can be reached at touch2RN@aol.com
or 973 912 9060. The Memorial Sloan-Kettering Cancer center offers trainings
periodically; they can be reached at 212 639 8629 or http://www.mskcc.org/mskcc/html/11997.cfm.
Walton, Tracy. “Clinical Thinking and Cancer,” Massage Therapy Journal 39(3): 66-80, Fall 2000. Available on-line at http://www.amtamassage.org/journal/fa_00_journal/cancer_and_massage_1.html