Franklin Massage Therapy / Cancer Massage
For decades, many people who were undergoing cancer treatment
or who had survived cancer and its aftermath, avoided massage believing that massage spread the cancer cells to other sites
in the body. In fact, many massage schools still teach students to never touch a person who has been treated with cancer.
But now, new research has shown
that the development and spread of cancer cells inside the body has much more to do with genetic causes and not as
much with the movement of blood and lymph within the body. With that in mind, a specially trained massage therapist
can work with almost any client who is being treated for cancer, or who is recovering from cancer.
Because there is a history of cancer in my family,
I've taken it upon myself to get additional training in giving massage to cancer patients and survivors. Although
massage can help reawaken a body that has struggled to survive, it can be detrimental if preformed too deeply or without regard
to the treatment that a patient or survivor has gone through.
Anyone who wishes to schedule this specific type of massage must get permission from
their physician, and additional medical history must be provided. Please feel free to call or email me with any questions
about this type of massage.
Phil Mandley, LMT at Cancer Patient/Survivor Massage class,
January, 2007, Huntsville, Alabama.
The Courage of Touch
By Kieran McConnellogue
published in Massage & Bodywork magazine, December/January 2000.
Copyright 2000. Associated Bodywork and Massage Professionals. All rights reserved.
Like most attorneys, Jo Anne Adlerstein is a fiend for the kind of research that can make or break a case. So when
she was diagnosed with breast cancer in the summer of 1998, she used her research skills to find out all she could about how
to fight the disease that invaded her body.
"What I found is that despite the fact that I live near New York
City and have been to the top doctors throughout, each doctor -- the surgeon, the hematologist, oncologist and the radiation
therapist -- is concerned with getting rid of your cancer cells," Adlerstein said. "The other parts of your body
and the other parts of healing are not necessarily part of their agenda."
Adlerstein's research led her
to massage therapist Cheryl Chapman -- someone who did have holistic healing in her agenda. What research didn't tell
Adlerstein was that many bodyworkers, even as recently as a decade ago, would have turned her away. For years, massage and
bodywork was contraindicated for cancer patients. Massage schools, mostly fearing that bodywork could spread cancer, largely
taught their students to avoid working with cancer patients. The notion is still pervasive in the bodywork community.
"I think it's very common to hear this idea that it's absolutely contraindicated," said Christopher Quinn,
D.C., president of the Boulder College of Massage Therapy in Colorado. "There is such a variety in the levels of massage
therapy training in the country that we're a long way off from not only the information being standardized, but the competence
and the level of training being standardized as well."
Quinn likens the misinformation over contraindication
to the old days of sports coaches, who not only advised athletes not to drink water during activity, but also gave them salt
tablets. It's similar with massage therapists. "Unless it's something therapists do or specialize in, they may
not retain that knowledge base," he said.
But as the field of massage therapy matures, its knowledge base
expands. And thanks to schools such as Quinn's and therapists/teachers such as Chapman and others, the notion that massage
is contraindicated for cancer patients is changing. There are still hurdles to overcome. How massage therapy fits into traditional
insurance or managed care coverage is a gray area. And old attitudes about contraindication die hard.
and bodywork are increasingly important weapons in the fight against one of the most prevalent diseases in America today.
Therapists seeing clients with cancer tout the many benefits. It reduces stress and relaxes patients. It bolsters the immune
system and helps remove toxins from the body. It helps with circulation and restores energy. It reduces pain and minimizes
the effects of radiation and chemotherapy treatments. It enhances a patient's body awareness and allows them to direct
energy toward healing. And in cancer patients who will die from the disease, it can help ease their final days and hours.
Massage therapy is becoming an important arrow in the quiver of those treating cancer patients. The evidence covers a wide
spectrum of massage therapists and bodyworkers.
Hospitals are integrating massage therapists into teams of doctors
and health professionals. Therapists in private practice are getting the training they need to be able to see patients recovering
from cancer or in treatment. In hospice settings, bodyworkers are providing comfort to terminally ill patients and their families.
Schools are rethinking the blanket statement that massage is contraindicated for cancer patients and are developing programs
to give bodyworkers the specialized training they need.
Researchers are beginning to explore the relationship between
massage and cancer patients. And books such as Gayle MacDonald's Medicine Hands: Massage Therapy for People with Cancer
are helping guide bodyworkers into previously uncharted territory.
These are positive trends, both for cancer patients
and the bodywork community, for the need is great. Cancer is the second most prevalent killer of Americans, behind heart disease.
The American Cancer Society estimates that 563,100 Americans are expected to die of cancer this year, more than 1,500 per
day. Nearly 5 million Americans have died from cancer this decade. The statistics are grim, but there is a silver lining.
An increase in early detection and improved treatment means that cancer is no longer a death sentence. More people are surviving
and living with cancer, about 8 million in the United States today, which means a greater role for bodyworkers.
role is getting the approval of organizations such as the American Cancer Society, which now views massage therapy as an important
complementary therapy for cancer patients, although not one to specifically treat the cancer, said Terri Ades, RN, the society's
director of health content.
"We know that massage therapy makes everyone feel better, whether they're ill or
whether they're healthy," Ades said. "It is becoming more prevalent in the health professional community.
"There are more people surviving cancer than ever before. I see the complementary therapies as an important component
of helping the person improve their quality of life. Oncologists are becoming much more aware of the importance of complementary
Despite the evolution in knowledge and attitudes, the blanket contraindication is deep-seated
among bodyworkers. No one is quite sure from where it came. Most guess it had to do with the mistaken idea that massage could
either cause cells to break off from tumors and migrate to other parts of the body, or that increased lymphatic activity -
resulting from bodywork - promotes the spread of cancer cells. Bodyworkers are cautioned against working the sites of tumors,
but as MacDonald writes in Medicine Hands, "The more the medical profession understands how cancer spreads, the more
apparent it is that previous fears about massaging people with cancer are unfounded."
are still looking at how cancer occurs, most evidence points to a combination of genetics and environmental factors. These
same factors heavily influence how cancer cells spread. Malignant cells spread in two ways -- they migrate directly to the
adjoining site of tumors or metastasize and spread to distant sites. The potential for metastasis in any individual is similar
to how cancer occurs in the first place -- it is driven by genetic factors that are inherited or environmental factors that
While cancer cells do travel via the lymphatic system, MacDonald writes that "many oncologists
fail to see how comfort-oriented massage would contribute to the spread of cancer." Massage does not increase lymphatic
circulation any more than any of a number of day-to-day activities. If increased circulation led to increased spread of cancer
cells, doctors would warn patients against any activity at all, which they clearly do not.
The pendulum that is
swinging away from contraindication toward working with cancer patients travels with a variety of cautionary notes. It is
not a simple matter of what was once discouraged is now fine. The process of metastasis, or how cancer cells travel through
the lymph or blood vessels, is not completely understood. As with any foray into relatively uncharted territory, it is wise
for bodyworkers to learn from those who came before.
Cheryl Chapman of Springfield, N.J., is one of the pathfinders
in massage for cancer patients. A fourth-generation nurse, she burned out a decade ago on her job as a RN working with oncology
patients, which she had done since the mid-1960s. She decided on a career change to massage. In massage school, she was told
not to work on people with cancer, which went against her training and experience.
"I had been touching people
with cancer my whole career and I said, 'This is ridiculous'," Chapman said. "I would give them back rubs,
I would rub their feet. I don't think I spread anyone's cancer."
Shortly after she opened her massage
practice 11 years ago, a friend was diagnosed with breast cancer. Her treatment caused nausea, which Chapman tried to relieve
with Shiatsu. "It didn't take her nausea away completely, but what I found that it did was give her a little more
quality of life," she said.
After her friend's mastectomy, Chapman continued massaging her. When the friend
later went to a hospice, Chapman massaged her and her visiting family up until her death. The hospice nurses asked Chapman
to show them how to massage patients, and her second career suddenly took a different tack. "It changed my practice and
changed my life," she said.
For the past six years, Chapman has been teaching bodyworkers how to work with
cancer patients. She is a frequent presenter at conferences and conventions and said demand is such that she could give workshops
every weekend. She's spent as many as 30 weekends a year teaching.
"The students who come to me are searching
for something and they want to touch people with cancer, just as I did," Chapman said. "But they've always been
afraid because they weren't sure how to go about it or what was safe. Or they were taught the same thing - you can't
touch people with cancer.
"They're still teaching -- and they should teach -- that you don't massage
someone with cancer," she said. "I agree with that and they're right in teaching that, but what I think they
should say is that unless you understand cancer or take some kind of instruction, then you're better off not to do Swedish
massage. However, touch is always appropriate - there isn't anyone who is untouchable."
important to work with doctors to gain an understanding of patients' needs and to educate physicians about the benefits
of massage, she said.
"I don't take anyone without a doctor's order. They know it's not going
to spread the cancer and they know I'm not going to hurt their patient," she said. "But they often don't
know what massage is to begin with. They think Helga from the old country is going to come in and beat the living daylights
out of them."
Swedish massage is usually not the best for patients in active treatment. But with the proper
instruction, bodyworkers, who are far more sophisticated these days than Helga from the old country, can make a significant
difference in the lives of people living with cancer. Jo Anne Adlerstein began seeing Chapman shortly after her lumpectomy
and axial node dissection to fight her breast cancer.
"Aside from the general benefits of massage and suggestions
about other herbal remedies and meditation, I discovered that there are four very clear benefits from me having weekly massages,"
Adlerstein said. "I took them for granted, but as I visited each of the different medical doctors for return visits and
they made comments about these areas, I realized that they were kind of in the dark about what massage could do."
For Adlerstein, the four areas were a minimization in the formation of scar tissue, help in preventing lymphedema
(a painful swelling of the limbs common in breast cancer patients), improved range of motion, and the survival of her skin
during radiation therapy, which she attributes to herbal moisturizers. "I had one doctor saying 'Your scar looks
great,' another one saying, 'Your lymph looks great,' another saying, 'Your skin is great.' Meanwhile,
nobody quite focuses on why it's so great."
Chapman said it can be great when massage therapists do with
cancer patients what they do with the rest of their clients -- treat them as individuals with distinct needs.
is appropriate touch and modalities that you can use that are comforting," Chapman said. "You always have to keep
in the back of your mind exactly what your intent is with this person. And the intent for doing massage with cancer is not
to heal them or cure them, the intent is to touch them with love and to provide as much quality of life as you can without
doing any harm."
Meredith Biegel of Shorthills, N.J., another of Chapman's clients, dismisses the idea
that the massages she received as she battled breast cancer caused the disease to spread.
"I think that if
massage caused cancer to spread, I wouldn't be here today," she said. "When I would leave Cheryl's, I felt
like I was going to live, I was going to make it, I was going to be okay. It gave me a sense of well-being. I felt I was doing
something positive for me."
Biegel said she felt so strongly about the benefits of massage that she has accompanied
Chapman to training sessions and conferences. At one, in Washington, D.C., Biegel showed her mastectomy scars to more than
200 therapists who had gathered to learn about massage, cancer and its effects. And although she has been cancer-free for
two years, she remains wary of its return.
Increasing numbers of cancer survivors like Adlerstein and Biegel means
that those who work with them must look at things "through a different set of lenses," said Dr. Cad Dennehy, co-director
of the Rocky Mountain Cancer Rehabilitation Institute at the University of Northern Colorado. The institute promotes exercise
and dietary intervention to help recovering cancer patients deal with the fatigue which often accompanies radiation, chemotherapy
"The scenario given to most cancer patients is to proceed with caution. Clinicians often don't
look beyond the scope of what they do," she said.
The institute commonly refers patients for massage as part
of a broad program dealing with the fatigue of cancer treatments, which affects between 72 percent and 95 percent of patients,
depending on the therapy, Dennehy said. Combined with appropriate exercise and dietary changes, massage is an important part
of starting patients on a road to returned health.
"If you take the multiplicity approach, there are lots
of ways to get at the return to quality of life or to improve beyond that," she said. "Massage helps create the
conditions for success, both physiologically and in mind-set. "If you feel better, you exude that to your body,"
One of the hurdles for the institute, as well as for many bodyworkers, is convincing doctors of the benefits
of massage, exercise and alternative therapies for cancer patients. It is a wide, two-way street which must be traveled. Doctors
and other health care professionals must be educated about the benefits of bodywork for cancer patients, just as bodyworkers
must be educated about how to work with patients and doctors.
The literature in the bodywork community is helping
to bridge the gap. Research studies are appearing in prestigious medical journals and are funded by entities such as the National
Institutes of Health. Increasingly, medical publishing houses are recognizing the growing connection between massage and cancer
recovery and printing books to meet the interest.
One of the better-received books recently has been MacDonald's
Medicine Hands. It takes a comprehensive look at all aspects of the debate over massage and cancer, tackling subjects such
as metastasis, recent literature on cancer and massage, how bodyworkers can serve cancer patients, and working in the hospital
setting, among others. The idea for the book came from bodyworkers who contacted MacDonald with their fears about working
with patients with cancer. She gained experience working with cancer patients and training massage therapists for several
years at the Oregon Health Sciences University's Oncology Unit.
I think the book decided to write me," she said. "Intuitively, I knew it was okay to massage people with
cancer, especially after we were asked to massage oncology patients at Oregon Health Sciences University. I started reading
immediately about metastasis and I read about it very intently for a couple of years, and wrote about it and kept refining
it. The more I read the more I could see that massage could be adapted for people with cancer.
"It just broke
my heart to hear cancer patients tell stories about being turned away from massage when I knew that if it was adapted properly,
it could be okay and it could be healing," MacDonald said.
The book took four years to research and write,
and since its release last May has received a positive response from bodyworkers, cancer patients and health care professionals.
MacDonald said one of her primary goals was to give bodyworkers the knowledge and confidence they need to work with cancer
patients. It also aimed to dispel the myth that massage is always contraindicated for cancer patients.
think it's become a myth that the bodywork community has not looked at deeply," she said. "They've just
accepted it, and myths get passed down from one generation to the next, and everybody just assumes it's true."
MacDonald, like every massage therapist who works with cancer patients, advocates a careful consultation with the
patient's physician before any massage. If patients have been in remission for more than a year, she generally does not
consult the physician. If they are recently diagnosed or in active treatment, she always consults the physician or asks for
a note. In turn, she provides doctors with a form that explains massage is just for comfort and relaxation. While she completes
an intake with patients on their first visit, just as she would with any client, the more she knows about a patient, the more
effective the treatment can be. A knowledge of working with these particular patients and training to achieve that knowledge
For patients in active treatment, some of the more gentle modalities are encouraged, such as cranialsacral
therapy, Polarity or Reiki. But with every patient, there are restrictions for bodyworkers to be aware of. People undergoing
chemotherapy or radiation therapy often have low blood platelet counts and therefore can bruise easily. They must be worked
on in a light manner. Restriction also comes with patients whose cancer has spread to the bones, which can become fragile
and break under heavy pressure.
Another restriction comes from areas of the body massage therapists need to stay
away from, such as catheters, tumors or radiation burns. There are also position restrictions for patients who may not be
able to lay on their stomach or back.
While working with cancer patients requires a degree of specialized knowledge,
the benefits are many, especially for patients in the hospital, MacDonald said. Treatment in the hospital can be a very fragmenting
experience. Specialists in one area or another are constantly coming and going through a patient's treatment.
"Massage gives them a chance to piece their body back together again, because for an entire hour they have the same
person working with them in a soothing manner, giving them an experience that has a beginning, a middle and end," MacDonald
said. "It allows them to rest, and the hospital is not a restful place.
"Consistently, people's pain
levels drop, their fatigue levels drop. They feel nurtured and loved and soothed. It calms their anxiety," she said.
"Massage can help people reclaim their bodies. After you've been traumatized by illness or injury, you tend to disassociate
from the whole body or parts of the body. If you have had a part of your body removed, a lot of times you remove your attention
from that area too. Massage can help bring you back into your body so you reclaim your whole body."
are increasingly recognizing the benefits of massage. The Hospital Based Massage Network estimates that there are at least
100 hospitals offering massage therapy to patients. In addition to cancer patients, hospitals usually offer massage in chronic
pain management and labor/postpartum.
One is Memorial Sloan Kettering Cancer Center in New York City, which has
one of the most highly regarded oncology programs in the country. Four licensed massage therapists (two of whom are also registered
nurses) offer massage, reflexology and Reiki to patients at the main hospital and at its outpatient center. Other therapists
offer mind/body work and music therapy.
Massage therapist Wendy Miner, director of the Memorial Sloan Kettering
Outpatient Center, said doctors there have responded favorably to the addition of massage to a broad program of treatment
for cancer patients.
"Anything that will assist in making the patient more comfortable, they are in favor
of," Miner said.
"The benefits are improved blood circulation, assisting in the removal of toxins, equalizing
blood pressure, helping with fatigue and anxiousness. We don't make any claims, but these are common kinds of ways that
massage can be useful."
A key to the program's success is communication, Miner said. Massage therapists
contribute to patient files about types and frequency of therapy. They also work with nurses, doctors, nutritionists and other
therapists to take an integrated approach. If the therapists are unsure about what is contraindicated, they consult with doctors.
"It's a team approach, and we're constantly talking to one another," she said.
In both the hospital
and outpatient settings, the goal is to help patients return to some semblance of normalcy.
"It does remind
them that every day, you're going to feel a little better," she said. "We feel honored to be able to offer them
some time in which they feel comfortable again and optimistic."
The hospital expects to expand the program
and to continue to ensure that current therapists have the training necessary to work with cancer patients.
a continuing education for all of us. We're learning more and more about this," Miner said.
massage are one of the keys to the continuing education of therapists, both in the hospital setting and private practice.
The Boulder College of Massage Therapy has had a cooperative program with Boulder Community Hospital for about 12 years, said
Dr. Quinn. Of the 1,000 hours in the school's typical program, students complete a 60-hour, on-site internship in areas
such as sports medicine, industries, hospice or hospital-based programs. The internship is one of the final parts of their
"It's very popular. What we find is that when people serve in these internships, they go far
beyond the requirements in hours and end up putting in volunteer hours that are two, three, or four times the required hours,"
Quinn said. The students work under the supervision of on-site instructors from the school, as well as nursing supervisors.
"The patient feedback is incredible. We get notes and letters from people who say things like this made their
hospital stay more tolerable or that this was the best thing about their stay," Quinn said. "Our goal is to model
such programs and to introduce the medical world to this bodywork intervention with the goal being that the word will spread
and such programs will be incorporated around the country.
"The bottom line is that people who are going to
do this type of bodywork need a different knowledge base. It's not really for every massage therapist."
But for those who decide it is for them, the rewards can be great. And for patients such as Adlerstein, massage therapists
can be an integral part in their recovery, both physically and emotionally.
"I feel very lucky to have had
that emotional support," she said. "A massage therapist who doesn't care about your emotional needs is worthless,
because then you might as well go buy one of those fancy machines in the Sharper Image catalog. A massage therapist comes
with more than vibrating fingers."
Kieran McConnellogue is a freelance writer in Greeley,
Colo. He can be reached at firstname.lastname@example.org.
of Massage for Cancer Patients
There are so many different
forms of massage, and each form can have a different effect on the body. For cancer patients, depending on the type and the
stage of cancer, as well as many other factors, this could possibly even mean negative effects.
While there have been many studies on many different types of massage on cancer patients, as well as their very promising
results, there are still some situations, techniques, etc. that could provide a health risk to the cancer patient.
While it is always best to consult your physician before receiving a massage—especially
if you have cancer—it can also be beneficial to be informed in advance about the most well-known risks, so that you
can avoid these situations.
The following are a few health risks
that should be considered before a cancer patient receives massage therapy. These risks do not necessarily mean that massage
is out of the question; only that precautions must be taken to avoid them:
• Bone fractures—some forms of cancer can affect the bones, and deep massages on affected
areas can lead to fractures. Inform your massage therapist about your cancer so that they are able to avoid risks such as
• Tumor spreading—this is an issue that has been debated thoroughly. Many sources
claim that it is untrue that massage will cause metastasis while others say that deep massage directly on the site of a tumor
can break it down and cause it to spread or increase in growth rate. Since there are so many differences of opinion on the
subject, it is best to consult your specialist first in the case of a tumor. They will be able to provide you with the most
up-to-date information on the subject, as well as help you determine what is best in your situation.
massage should be avoided in patients who bleed easily.
• Lymphedema—if a patient has
recently had lymph nodes removed due to cancer, and then receive certain types of massage near or on certain parts of the
body (especially if the therapist is too vigorous with their pressure in this area), it can cause the patient to develop lymphedema.
• Pain—patients with cancer are often in tremendous pain, and then some treatments will
even add to that pain temporarily. If this patient seeks out massage in an effort to reduce pain and anxiety, they may well
have excellent results. But, if they do not inform their therapist of their medical condition, or if the therapist isn’t
prepared to do massage on a cancer patient, the results could be more pain instead of relief. Many massage therapies require
deep pressure that could, in the beginning, be considered pain by many patients. This quickly turns to pleasure and relief,
but if the person receiving the massage is already in pain before the massage begins, the pain can be excruciating.
• Flu-Like Symptoms—there have been many cases of patients who are undergoing chemotherapy showing
flu-like symptoms after receiving bodywork treatments. This usually happens because nausea is a side effect of the chemotherapy
as well as the bodywork (this is only with some forms, but it shows why it is important for the practitioner to be aware of
Even with the variety of risks involved with
massage for cancer patients, massage therapy has many benefits to offer. To avoid situations such as the above, talk to all
of your caregivers before receiving a massage to find out which therapies are safe for you and if there are any techniques
that should be avoided. Once you have done this, you can locate a therapist and, before the first session begins, inform them
of your medical condition. If it makes you feel safer, you can find a massage therapist that is experienced in treating cancer
Massage therapy can provide an excellent complimentary
therapy for cancer patients, but it should never replace traditional medicine. Instead, it should be used only for pain relief
and relaxation, as well as to help manage some of the side effects of medicinal treatments. If you continue your traditional
forms of healing, and simply add massage as a complimentary therapy to your cancer treatment, it could lead to a happier,
healthier body and life starting immediately.
This article is
courtsey on Associated Bodyworkers & Massage Professionals, ABMP www.abmp.com
Easing Cancer Pain and Anxiety
The Value of a Good Foot Rub
By Shirley Vanderbilt
published in Massage & Bodywork magazine, June/July 2001. Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.
When cancer is diagnosed, many fears can arise in the mind of the patient. What will happen to my body, my family,
my career? Can I stand the pain? Will I survive? Foreboding thoughts of disfigurement, difficulty in daily functioning and
physical discomfort come to the forefront. Pain can be a constant reminder of the ravaging, internal monster cells hell-bent
on bodily destruction. And frequently pain and anxiety reinforce each other, leading to chronic distress. Although pharmacologic
pain treatments are standard, they don't always provide the relief needed. And many care centers have yet to establish
an effective means of assessing the patient's true experience of pain. For many patients, "pain is a 'vital sign'...and
often is more relevant to their care than pulse or blood pressure."1
Surveys conducted over the past few years highlight the need for more diligent and effective treatment for cancer
patients suffering from pain and anxiety. A study by Bernabei et al of more than 13,000 elderly cancer patients found 4,003
reported daily pain. The survey, published in JAMA (June 17, 1998) indicated that not only is cancer pain prevalent, it is
also undertreated in older and minority patients.2 C. S. Cleeland
pointed out in an editorial in the same issue, "Patients with pain are also less able to commit to fighting their disease."3 Lesage and Portenoy suggest undertreatment of pain, as noted in recent
surveys, can be due to several factors: "Physicians may not be adequately educated about pain control or they may be
more focused on control of the disease than on control of pain and other symptoms, patients may be reluctant to report their
pain, and both physicians and patients may be reluctant to use morphine and other opioids for pain control because they fear
addiction, which is extremely rare in people with cancer."4
Left untreated or inadequately controlled, cancer pain can have a significant impact on emotional function. The patient
may develop feelings of isolation, depression and anxiety if their pain is not given validation. If pain persists, it can
have a negative influence on relationships and most importantly, healing.5
Severity of pain has been shown to be an important factor in patients' assessment of their quality of life.
studying 216 patients with metastatic cancer, the Pain Research Group at University of Texas M.D. Anderson Cancer Center in
Houston concluded in its 1999 report, "Increasing severity of pain was associated with health-related functioning, even
when an estimate of disease severity was taken into account."6
A recently published study in the British Journal of Oncology revealed that symptoms of stress, anxiety and depression
are often overlooked by physicians. In a survey of 2,300 cancer patients, researchers noted doctors were detecting these symptoms
in only about one-fourth of the cases in which they occurred. The authors recommended appropriate intervention, "...whether
this be medication, taking treatments or alternative or complementary therapies -- as soon as they first need it."7
Thus the problem of dealing with pain and accompanying emotional
stress presents a conundrum for both medical staff and cancer patients alike -- one which cannot be solved with a set medication
schedule, but demands consideration of a holistic care approach and the individualization of treatment.
A Personal Perspective
to Margo McCaffrey, pain management expert and co-author of Pain: Clinical Manual, "Pain is whatever the experiencing
person says it is, and exists whenever he says it does."8
Pain is subjective, expressing itself individually through the psychological and physical make-up of each person. Belief systems
-- spiritual, cultural and religious -- as well as states of anxiety and depression also affect the patient's experience
of pain.9 Although not everyone with cancer will experience pain,
approximately 30 percent to 50 percent of those undergoing tumor treatment and 70 percent to 90 percent of those with advanced
disease will have to contend with episodic or chronic pain during their illness.10 Cancer pain can result not only from the disease itself, but also from medical procedures, whether dispensed
for diagnosis, cure or monitoring physical status. As many as half to two-thirds of those with well-controlled chronic pain
can experience a "breakthrough" of acute pain.11
-- Simple, Effective, Non-invasive
Cancer patients, their families and nursing staff have been increasingly
turning to complementary and alternative treatments as an adjunctive aide.12
Although empirical evidence of effectiveness of these interventions is limited, there has been a slow, steady stream of successful
studies using massage and various relaxation techniques to address chronic pain and anxiety in cancer and other disorders.
In a pilot study, Weinrich and Weinrich (1990) reported significant pain decrease following a 10-minute massage administered
to male cancer patients. Within a hospice setting, male and female patients demonstrated improvement with a three-minute back
massage (Meek 1993). Ferrell-Torry and Glick (1992) also reported positive results in cancer patients receiving a 30-minute
More recently, researchers have turned to
the foot as a receptor for massage aimed at relieving cancer pain and anxiety. In a study published in 2000, foot reflexology
was described as a successful nonpharmacologic adjunct in the control of these symptoms. Basing their proposal on the foundation
of previous research, a team at East Carolina University, N.C., found that patients with breast and lung cancer experienced
a significant decrease in anxiety, and pain relief was expressed in one of three measures in breast cancer subjects.14 An Australian study published within months of the reflexology article
also showed foot massage to decrease perception of pain and nausea and increase relaxation in hospitalized cancer patients.15 Both studies emphasized the adaptability of their approach to home
and nursing care, noting the techniques could be easily learned by caretakers or self-administered by the patient.16,17
Foot massage for good health dates back to ancient Far Eastern,
Egyptian and Native American cultures. While the "good old" foot rub is still very much alive today, a more refined
and specifically medicinal form has found a place in alternative treatment. Reflexology began its evolution in the early 1900s
with William H. Fitzgerald's development of zone therapy. Fitzgerald noted that pressure applied at various points produced
an analgesic effect on corresponding body parts.18 Eunice Ingham
refined the technique, identifying sensitive "reflex points" by mapping out parts of the body on specifically defined
areas of the foot. Ingham's approach expanded the treatment beyond its singular use for pain, noting other therapeutic
benefits could be achieved as well.19
When the N.C.
research team set out to study reflexology for cancer patients, they noted while a variety of nonpharmacologic treatments
had been tested in cancer studies, none of those reported had included reflexology. A 1991 study by Ferrell et al showed a
decrease in cancer pain, following foot massage and reflexology, had been noted to reduce anxiety in a study on premenstrual
symptoms (Oleson and Flocco, 1993).20 Using the Original Ingham
Method, the N.C. team developed a "quasi-experimental, pre/post, crossover trial with patients serving as their own control."21 This approach entailed having one group of patients first serve as
control, the other as intervention and then allowing a minimum of 48 hours to lapse before alternating the patients' assigned
groups. The sample group of 23 patients (majority female) with breast or lung cancer were recruited from an inpatient oncology
unit. Of the 13 with breast cancer, 10 had metasticized, there were five cases of metasteses in the remaining 10 with lung
cancer. Researchers excluded cases involving recent surgery, radiation to the site of pain, those reporting no anxiety and
those potentially experiencing acute rather than chronic pain. A medical consultation was required by oncologists prior to
treatment of patients with symptoms of deep vein thrombosis. In cases of lower limb circulatory problems, those areas of the
foot associated with the diseased body part were avoided during reflexology.22
At the beginning and end of each 30-minute session, relaxation techniques were administered to the foot and ankle
area for 10 minutes. Reflexing of areas corresponding to pain and cancer sites accounted for 15 minutes of the session with
a five-minute reflexing of the entire foot to ensure coverage of all body areas. Those patients reporting no pain at the time
of their intervention session were administered reflexing on points corresponding to the location of their cancer. Researchers
noted, "The specific areas reflexed for breast cancer and lung cancer, (i.e., the balls of the feet and on top of the
feet over the balls) are identical."23
of the study were based on measurements of anxiety and pain as quantified by a visual analog scale (VAS) and the Short-Form
McGill Pain Questionnaire (SF-MPQ). Although all patients experienced pain at times during their hospitalization, it was not
always present at the time of measurement. In the breast cancer group, the 11 subjects reporting pain had a significant decrease
following reflexology as measured by the SF-MPQ. Because only two lung cancer patients reported pain during measurements,
researchers noted "results from this group could not be calculated." Significant decrease in anxiety was noted for
both types of subjects with the greatest decrease in lung cancer patients, the majority of which were male.24
In light of the fact that 61 percent of the subjects reported pain during
the study despite pharmacologic management for their symptoms, the success of the reflexology intervention to ease pain and
decrease anxiety validates this approach as an effective and viable adjunctive treatment. The study team suggested, "Replication
with a larger sample of a single cancer type is necessary to limit the type of pain." In addition, they recommend comparison
studies with other complementary and alternative therapies such as massage, healing touch and relaxation response.25
As noted previously, within the same year of publication of the N.C. study,
a team of Australian researchers reported their findings on the use of foot massage as a complementary therapy to relieve
pain and nausea in cancer patients. The mixed-gender sample group of 87 patients represented a wide range of cancer types.
Although the intervention was limited (two sessions, 10 minutes each, and a third control session), results showed a significant
positive effect on perception of pain, nausea and relaxation as measured with a VAS. Based on their findings, the authors
recommended implementation of this approach by nurses and family members.26
Whether reflexology or a simple foot massage, these caring interventions have proven to be of great benefit to cancer
patients, not only relieving the uncomfortable symptoms of their illness but also meeting a basic need for human touch.
Shirley Vanderbilt is a staff writer for Massage & Bodywork magazine.
References1. Cleeland, C.S., "Undertreatment
of Cancer Pain in Elderly Patients," JAMA 279, 23 (June 17, 1998): 1914-1915.
2. Bernabei, R., Gambassi, G., Lapane,
K., Landi, F., Gatsonis, C., Dunlop, R., Lipsitz, L., Steel, K. and Mor, V., "Management of pain in elderly patients
with cancer," JAMA 279,23 (June 17, 1998): 1877.
3. Cleeland, Ibid.
4. "Understanding Cancer Pain."
www.cancer--pain.org. Apr. 2001.
6. Wang, X.S., Cleeland, C.S., Mendoza, T.R., Engstrom, M.C., Liu, S.,
Xu, G., Hao, X., Wang, Y. and Ren, X.S., "The effects of pain severity on health-related quality of life: A study of
Chinese cancer patients," Cancer 86, 9 (Nov. 1, 1999): 1848.
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12. Grealish, L., Lomasney, A. and
Whiteman, B., "Foot Massage: A nursing intervention to modify the distressing symptoms of pain and nausea in patients
hospitalized with cancer," Cancer Nursing 23,3 (June 2000): 237. 13. Stephenson, N., Weinrich, S. and Tavakoli, A., "The
effects of foot reflexology on anxiety and pain in patients with breast and lung cancer," Oncology Nursing Forum 27,1
(Jan.-Feb. 2000): 68.
14. Ibid, 67.
15. Grealish, 237.
16. Stephenson, 71.
17. Grealish, 242.
18. Booth, Brian, "Reflexology," Nursing Times 90,1 (Jan. 5, 1994): 39.
19. "Reflexology." Yahoo!Health.
http://health.yahoo.com/health/Alternative_Medicine/Alternative_ Therapies/Reflexology. Mar. 2001.
20. Stephenson, 68.
21. Ibid., 68-69.
22. Ibid., 68-70.
23. Ibid., 69.
24. Ibid., 70.
25. Ibid., 71. 26. Grealish,