By Janet Penny RMT
Massage for people affected by cancer has always been in our treatment rooms, even if we haven’t paid it too much attention. With 2 out of 5 Canadians being diagnosed with cancer, all massage therapists, in all practice settings, must be ready to work with the diverse and often persistent side effects of cancer treatment.
To best illustrate how we can adapt our treatments we will look at intake and treatment through the lens of a client. Cory, 48 years old, is a runner who often takes part in 10 km competitions. Two years ago, he was diagnosed with colon cancer. It has been almost a year since he completed all the recommended treatments including surgery to remove a small part of his colon, chemotherapy and radiation. Once his energy had improved, Cory returned to running. Although used to deep tissue massage for tight leg muscles, Cory has come for a massage for persistent low back pain and mentions that burning in his feet makes working out more challenging.
What might Cory’s massage look like if his cancer treatment wasn’t part of our intake and planning? Given the presenting symptoms, a massage therapist might start with focused, deep treatment to Cory’s low back, glutes and hip flexors. The burning in his feet and low back pain could be explained by a lifestyle with too much sitting and running. Without careful probing during intake, the proposed treatment could overlook some critical information that ensures safe treatment adaptations.
A not-yet-oncology-aware massage therapist might not know to expand their usual intake questions to properly assess how side effects of cancer treatment could be contributing to Cory’s presenting signs. Which brings us to the question of how much do we really need to know to treat someone affected by cancer? Following are some of the lines of inquiry necessary to work with Cory and to pique our curiosity to learn more.
Surgery, the most common primary cancer treatment, may result in often predictable short and long-term side effects. According to Cory, other than some pain and fatigue in the weeks following surgery, he didn’t have the bowel and bladder changes that could have occurred. As part of our inquiry, we can explore the possibility that the surgical incision and resulting scar may be impacting his low back. This information will not only help to streamline our assessment and treatment, but it is also part of the education we bring to our clients: Cory didn’t know that scars can impact function.
During chemotherapy Cory mentions that he lost his hair, had mouth sores and was very tired. He also had many of the classic signs of chemotherapy-induced peripheral neuropathy (CIPN) such as cold and tingling in his hands and feet. Cory had forgotten that chemotherapy could cause persistent and long-lasting side effects and the likelihood that the burning in his feet is caused by the neurotoxic impact of chemotherapy. Before addressing this symptom, the massage therapist makes a mental note to further explore CIPN, whether there are precautions to consider and how best to provide massage.
Skin reddening and peeling are common side effects of radiation and, once healed, it is easy to overlook its deeper impact. Densification can occur in every structure within the field of radiation including muscle, fascia and organs as well as blood and lymph vessels. Bringing 3-dimensional awareness to massage treatment planning will widen the therapist’s thought process and critical thinking.
The densification after 20 sessions of radiation Cory underwent could be a contributing factor to his low back pain. The irradiated area can also often lead to fragile tissues and damaged lymph vessels and nodes. This knowledge signals a need for precautions during massage with careful use of pressure and stroke direction.
Did you know? There is a lifetime risk of developing lymphedema for anyone whose lymphatic system is compromised by cancer treatment including:
surgical removal of lymph nodes
radiation
A careful intake process for someone affected by cancer naturally leads to consideration of contraindications and precautions. Cory’s cancer treatment ended a year ago and there are no signs of absolute contraindications such as blood clots and infection. There are, however, many precautions that need to be considered.
CIPN may reduce sensory awareness requiring very cautious use of heat, cold and pressure.
Persistent inflammation that can last years after radiation treatment may cause tissues to be sensitive and easily overworked, requiring careful adaptation to pressure and treatment duration in the irradiated area.
The compromised lymphatic system is best treated by a therapist trained in lymphatic drainage.
Cancer metastasis can cause pain and requires massage adaptations until medical testing confirms or clears diagnosis
Think back to the not-yet-oncology-aware treatment plan. Transpose the deep pressure on Cory’s back, glutes and hip flexors onto an area that we now know has been affected by surgery, chemotherapy and radiation and imagine the potential adverse side effects from a massage that overworks damaged tissues.
It is not always clear how to proceed with treatment when a client presents with the complex and overlapping side effects of cancer treatment. A well-planned massage will proceed slowly and cautiously and take into consideration all contraindications and precautions. As well, careful monitoring of our client’s reactions and tissue changes can help to guide our work. Finally, follow-up within a few days of the massage is an essential step to track our client’s reactions to their treatment.
We have grown accustomed to categorizing and hyper-focusing our work. Sports massage works on injury prevention and recovery. Prenatal massage provides treatment for the physical changes that occur during a relatively short period of time. Providing massage for people affected by cancer is, by necessity, geared to the whole person. Each person’s physical and emotional reactions to cancer and its treatment are unique. Although there is no template upon which to build a treatment plan, foundational knowledge of the side effects of cancer treatment will allow us to provide informed care.
As massage therapists we work alone in a room with our client. The onus is on each of us to ensure that our knowledge is sufficient to work with the complexity of cancer treatment side effects. We don’t have to know everything, but we do need to know when we don’t know enough. Small efforts in learning about cancer treatments and the implication for our work as massage therapists will go a long way in ensuring safe treatment for clients with any type of cancer at any stage of treatment and beyond.
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