A Role For Massage In Palliative CareBy Atholl Reid

Oncology Massage Ltd

Registered Charity &

Not-for-profit

Oncology Massage, sometimes referred to as Gentle Touch, is increasingly being used as part of a multidisciplinary approach to palliative care, both in formal medical setting, e.g. at The Olivia Newton-John Cancer and Wellness Centre (ONJCWC), which is part of The Austin Hospital in Melbourne, and in community settings, e.g. in the homes of patients. Palliative care patients experience a variety of side effects and treatment outcomes, which affect them throughout all life stages post-diagnosis, including during palliative care. In addition, carers and loved ones are also impacted and can similarly benefit from Gentle Touch. Gentle Touch massage can offer symptom relief and therefore enhanced quality of life during palliative care. Research(1) shows that Gentle Touch massage reduces symptoms during cancer treatment, by reducing the side effects experienced from treatment and symptoms of the disease itself, and afterwards. These include symptoms such as pain, fatigue, nausea, depression and anxiety, plus it also increases endocrine and immune function. A comparative study(2) examining the benefits of massage versus meditation found both groups showed immediate positive effects on mental health parameters. Only the massage group showed significant improvements in qualitative measures of wellbeing and increased levels of dopamine, serotonin, natural killer cells and lymphocytes after 5 weeks of treatment. This presentation aims to highlight the benefits of Oncology Massage / Gentle Touch to patients, carers, loved ones and the medical environment and hence to increase integration, innovation and inclusion across the palliative care sector.

The box below shows one woman’s blood test results, which she charted along with her changes to side effects following chemotherapy if massage was provided throughout the chemotherapy cycle.

Her regular side effect was extreme fatigue from day two to day seven following her chemotherapy infusion. With massage provided on the day of infusion, side-effects came in on day one after chemotherapy and although more extreme, symptoms lifted within a couple of days and in the last instance she was well enough to fly to New York on day five following her last infusion.

References1) Cassileth BR, Vickers AJ, 2004, Massage Therapy for Symptom Control: Outcome Study at

a Major Cancer Centre, Journal of Pain and Symptom Management, 28:3:244-2502) 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

3) http://www.who.int/cancer/palliative/definition/en/4) Moraska A, Pollini RA, Boulanger K, Brooks MZ, Teitlebaum L. Physiological adjustments

to stress measures following massage therapy: A review of the literature. Evid Based Complement Alternat Med. 2010;7:409–18

5) Russell NC1, Sumler SS, Beinhorn CM, Frenkel MA. Role of massage therapy in cancer care. J Altern Complement Med. 2008 Mar;14(2):209-14. doi: 10.1089/acm.2007.7176.

Atholl Reid is the Tasmanian representative of 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 or similar journey have access to the benefits of safe touch.Atholl holds a Diploma of Remedial Massage and has completed all four levels of training offered by Oncology Massage Ltd..He is also a qualified Casley-Smith Complex Lymphatic Therapist and is a member of the Australasian Lymphology Association, a Preferred Provider with The Society For Oncology Massage, and holds memberships with several other professional organisations.

Acknowledgements: Thank you to Deborah Hart and Anne-Marie Halligan, OM Facilitators for South Australia, for the work that they did in creating an earlier poster presentation on Oncology Massage and allowing me to reproduce some of that poster, plus use its general layout, for this poster.

“Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”(3)

Massage is a therapeutic modality that is increasingly being used as complementary care in palliative care. In consideration of the massage adaptations required during palliative care, oncology massage education for touch practitioners and massage therapists is essential for clinical safety and therapeutic benefits.

Patients receiving oncology massage are often observed by their massage therapists to enter a state of profound relaxation during their massage.

Moraska et al (2008)(4) reviewed 25 studies published in peer reviewed journals to examine the effect of massage. The findings showed that the most important factor on outcome was the training of the massage therapist, where the type of training and level of knowledge determines the therapist’s understanding of the biological processes occurring in a cancer client’s body and their ability to match the treatment accordingly.

Overall, a review of the scientific literature indicates Oncology Massage helps improve quality of life(5).

Figure 2 represents this client’s reported blood test results and shows in graph form that neutrophils doubled when massage was provided at week 3 following chemotherapy.

This information has been shared with permission from this client.

Massage adaptations are required for: fatigue; peripheral neuropathy; low blood cell counts; blood clots; bone pain; bone metastases; radiation or surgery; removal of lymph nodes; lymphoedema; medications; medical devices; and the late effects of treatment.

Clinical assessments and adaptations to the massage session for someone in palliative care are critical to providing a safe massage and these clinical considerations can and do regularly change. Massage modifications as a result of positioning, pressure, pace or site considerations related to concerns like medical devices, side effects of drug treatments, surgery or radiation, compromised lymph nodes or blood cell counts, and other concerns, may apply, and are unique for each person and possibly for each massage.

Oncology massage does not aim or try to “fix” anything, and unlike many massage modalities it is not a series of techniques or applied protocols. Rather, it is the ability of the therapist to recognise and safely work within clinically established guidelines, given a patient’s unique circumstance.

Clinical research supports the use of massage in reducing pain and anxiety(1). Patient reported massage benefits include improved sleep, decreased sense of isolation, enhanced body image, and increased feelings of well-being(1).

Oncology Massage Training is a nationally and internationally accredited not for profit training charity. It is dedicated to training fully qualified Remedial Massage and Bowen therapists to treat those with a diagnosis or history of cancer effectively and safely. It aims to ensure national benchmarks and standards of care are met by its therapists. The four module program is a refined and updated version of a program that has been running for more than 10 years in the United States. Modules III and IV are taught at the Austin Hospital’s Olivia Newton-John Cancer and Wellness Centre (ONJCWC) in Melbourne, where training includes work on hospital wards including palliative care and haematology, and also in the day units for chemotherapy and radiotherapy.

“Happiness is not a destination, but the journey. Dealing with cancer

is both the destination and the journey. Medicine focuses on the destination. Oncology Massage

focuses on the Journey”Bruce Hopkins, Founding Director,

Society for Oncology Massage (S4OM)

With the diagnosis of life limiting disease increasing and death rates decreasing, a larger percentage of the community are now living into a palliative care situation.

Abstract

Oncology Massage / Gentle Touch

Oncology Massage Adaptations Massage as part of a MultidisciplinaryApproach to Palliative Care

Oncology Massage Training

Massage reduces common side effects of cancer treatment by approximately 50%(1). When examined more closely these results become more impressive with anxiety reduced by 59%.

Pain improved 47%

Fatigue improved 42%

Anxiety improved 59%

Nausea improved 51%

Depression improved 48%

Other (including shortness of breath, memory problems, dry mouth or disturbed sleep)

Improved 48%

This study(1) went on to state “Massage therapy appears to be an uncommonly non-invasive and inexpensive means of symptom control for patients with serious chronic illness. It is non-invasive, inexpensive, comforting, free of side effects and greatly appreciated by recipients.”

Date Day 0 Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Week 3Neutrophil

Week 4 Neutrophil

22/06/2012 Chemo No symptoms

Bedridden by 2pm

Bedridden Bedridden Bedridden Bedridden Bedridden Symptoms lifted

0.25 2.03

20/07/2012 Chemo No symptoms

Bedridden by 2pm

Bedridden Bedridden Bedridden Bedridden Bedridden Symptoms lifted

0.23 2.00

17/08/2012 Chemo Oncology massage – headache late afternoon, vomiting early evening

Aching bones, bedridden mid afternoon

Bedridden, then collapse 6:30am

Bedridden Bedridden, symptoms lifted early evening

Fall (blackout)

0.5 2.70

14/09/2012 Chemo Oncology massage

Aching bones, bedridden mid afternoon

Bedridden Bedridden Symptoms lifted early evening

0.5 2.80

13/10/2012 Chemo Oncology massage

Aching bones, bedridden mid afternoon

Bedridden Symptoms lifted early evening

To New York

0.3

Neu

trop

hil c

ount

(ce

lls/m

l)

Chemotherapy Cycle

◆ 3 weeks after chemotherapy

n 4 weeks after chemotherapy

* Massage given prior to blood test

3.5

3

2.5

2

1.5

1

0.5

00 1 2 3 4 5 6 7

Figure 2

For more information or to find a qualified oncology massage therapist go to:

www.oncologymassagetraining.com.au

Oncology Massage is the modification of massage techniques to be appropriate for anyone at any point on a cancer or other medical journey. It allows a suitably qualified therapist to safely work with the effects of cancer and cancer treatment, and includes people in active treatment, those in recovery or survivorship, as well as those at the end of life, whether following cancer or other medical diagnoses.