Medicine Hands - Massage Therapy for People With Cancer

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Touch is vital to cancer patients’ health and well-being and massage is a proven way to receive the benefits of touch. Medicine hands teaches bodywork practitioners, oncology professionals, patients and family how massage can safely support patients as they receive treatment and during their recovery process.

The field of oncology massage is maturing into discipline with a deeper and deeper body of knowledge. The 3nd edition of Medicine Hands reflects this maturation. Every chapter contains updated information and insights into massaging people affected by cancer. New chapters have been added to cover each stage of the cancer experience: treatment, recovery, survivorship, side effects from the disease, and end of life. These new chapters and organizational structure will make it easier for the reader to find the information needed to plan the massage session for a given client. In addition, a new chapter has been added that focuses on the Pressure/Site/Positioning framework. This is the clinical framework around which the massage session is planned.

As with the first two editions, the focus of medicine hands is on the use of touch techniques to provide comfort and ameliorate the side effects of conventional cancer treatment:

• Experience has now shown that the major factors affecting how massage is used are the types of treatment a person has received-chemotherapy, radiation, and/or surgery. Medicine Hands clearly informs therapists how to adjust their massage techniques in order to give massage sessions in a safe, effective manner.

• Oncology professionals will find Medicine hands to be an important resource in advising their patients about the benefits and cautions in using a massage as a complementary therapy.

• Lay persons, too, will find Medicine hands to be easily accessible to them as they explore ways to support themselves or loved ones through the rigors of cancer treatment.

Gayle MacDonald, MS, LMT, began her career as a teacher in 1973 and as a massage therapist in 1989. In 1991, she blended her two career paths. Since 1994, she has given massage to cancer patients and supervised massage therapists on the oncology units of Oregon health and Science University. MacDonald works in a variety of ways to support the development of Oncology Massage. She travels widely to teach practitioners how to massage people living with cancer.

Soil is created through a process that takes many, many years. Slowly, on top of bedrock, particles of weathered rock, decayed plant material and decomposed animals are laid down. Eventually, enough organic material has been deposited to create a soil deep and rich enough to support life.

A new professional discipline, such as Oncology Massage, also takes time to build the layers of soil in which it will grow. At first, smaller plants grow in the beginning layers, but as the soil deepens, larger and larger projects can be planted and anchored. The soil in which Oncology Massage exists is maturing; just now reaching a middling depth. Much more is needed, and this will come through educating the general massage profession, patients, health care practitioners, and researchers. As well as this, we must examine our own educational infrastructure for elements that are lacking.

Each edition of Medicine Hands mirrors the last layer of soil that has been laid down. The first edition (MH1) basically served to challenge the long-held belief that massage would cause cancer to spread, and should therefore be contraindicated. By today's standards, MH1 was light on content. The Internet barely existed, which meant that I gleaned much of my information from American Cancer Society pamphlets, a variety of nurses, and medical and nursing literature. There were fewer than a dozen research studies, most of which would not pass muster these days. Only a few professional colleagues were available to consult with, and at the time, many massage practitioners were still aghast that we were providing massage for people being treated for cancer. "I thought we weren't supposed to touch people with cancer" was a comment I often heard. In 1999, there was no such thing as Oncology Massage.

The second edition, published in 2007, showed the huge leap that had been made in experience and knowledge. More than three-dozen new research projects had been completed. The Internet had become the place to research new treatments, medications, and types of cancer. Highly-visible programs were available at places such as The Christie Hospital in Manchester, England, at The Royal Marsden in London, at Memorial Sloan Kettering in New York City, and MD Anderson in Houston, just to name a very few. And the first professional association, the Society for Oncology Massage, was on the brink of being created.

As publication of the third edition approaches, some massage students now enter school with the intent of specializing in massage for people with cancer; schools have created clinical experiences in the community to allow massage students to gain experience in cancer clinics and hospitals, and a few schools even have specialized tracks in Oncology Massage. Professional organizations have formed internationally—the Iris Cancer Partnership in Scotland, Oncology Massage Training in Australia, and Massage bij Kanker in the Netherlands. The infrastructure that accompanies this new field is slowly developing.

The background reading for the third edition (MH3) was mindboggling; akin to an informational tsunami. In 2004, a Google search using the words "cancer and massage," "oncology and massage" or "oncology and cancer massage" yielded 242,000 pages. By 2013, just using the keywords "cancer massage" showed that nearly 41 million pages were available!

There is so much new information as of 2013, and so many practitioners with specialized knowledge, that part of my job in creating this new edition of Medicine Hands was to recruit contributors who could add their expertise to mine and make MH3 as complete as possible. Medicine Hands has evolved into a meeting ground where both givers and receivers of Oncology Massage the world over can pour in their contributions, sharing information and stories. I have become the steward for a collective process.

Despite a great deal of new knowledge and experience on a collective level, Medicine Hands is still a primer in a discipline that is wet behind the ears. We have much to learn about how touch therapies affect people who have been through cancer treatment. It takes years of experience to figure out best practices. We have no idea which people could benefit from more pressure, or whether patients, once recovered from treatment that includes a sentinel node biopsy, can have deeper massage on the affected quadrant. There is little research on how long the benefit of a massage lasts or what the best frequency is. Just as the medical field is learning more and more every year about how cancer treatments affect people over time, Oncology Massage still has much to learn.

Standards of Care

There are no Standards of Care within the field of massage, let alone Oncology Massage. The clinical guidelines put forward in Medicine Hands were based initially on my own experiences with patients at Oregon Health and Science University, and later with clients in private practice. Over time, the experiences of many other therapists have affirmed my ideas. This is not to say that we are all in unanimous agreement. We each do certain things slightly different, but there is an over-all similarity in our practices, which has come about without conferring any sort of professional meeting to establish Standards of Care.

However, as Oncology Massage matures, we must look toward establishing something akin to Standards of Care. They raise the bar and will support us as therapists, and support patient and client care. The process of establishing a Standard of Care, however, is rigorous and involves an evaluation of the evidence. Oncology Massage is short on that kind of evidence and so we may be a long time in coming to Standards of Practice.

In the mean time, I continue to take a conservative approach when massaging people affected by cancer treatment. Just as I teach therapists the concept of 'inching forward' with clients, I take the same tack with Medicine Hands, advocating slow, steady progress within the field, pushing the envelope in judicious ways; inching forward. To some practitioners, my go-slow approach may seem too cautious at times, but for the most part, we are still in a phase where safety must be the prime directive.

**Contents and Sample Pages**