In most cases, massage can safely be given to the nearly 60% of clients who receive either chemotherapy or radiation in the course of cancer treatment. Radiation, which is used to shrink tumors or to kill cancer cells and keep them from growing and dividing, can be given internally or externally, though the usual delivery method is external. With external radiation, the body does not become radioactive, and touching clients who have received that type of treatment is completely safe for the practitioner.
Internal radiation, on the other hand, causes the individual to become radioactive at the site of the implant. The radioactivity runs its course within a year of implantation, and consultation with the medical staff at the radiation oncology clinic can help define what limits, if any, should apply in treating that individual.
Side effects of radiation are generally specific to the area that was treated and can include diarrhea, hair loss, damage to the reproductive system, difficulty swallowing, cough or hoarseness, bladder irritations and depressed blood counts. Additionally, the inflammation caused by high doses of radiation can cause tissues in the treated area to become fibrotic, which can lead to lymphedema.
Lymphedema occurs when the normal flow of lymphatic fluid cannot be accommodated by damaged lymph nodes, and blockage by scar tissue or swelling of the lymphatic vessels causes an accumulation of excess fluid and protein in tissues.
Radiation can also cause adhesions in muscle tissues, requiring attention and possible adjustments in treatment for clients experiencing this condition. Hard, thickened skin, soreness and a feeling of being “overstretched” are common side effects of radiation. Scar tissue can, in fact, develop as long as six months after treatments have ended. In the past, doctors told patients experiencing these side effects that there was little that could be done to relieve these symptoms. Increasingly, doctors are referring clients to massage therapists for careful massage therapy to release tightened fascia and return more normal circulation to the area.
Be aware that clients undergoing chemotherapy or radiation may have low blood platelet counts and will bruise easily; so gentle touch is crucial to their health and comfort. If cancer has spread to bone tissue, heavy pressure is contraindicated, due to the increased fragility of the bones, which can break more easily. Tumors and radiation burns should be avoided, but other areas of the body can be worked.
Radiation affects the skin like a severe sunburn; it can be itchy, painful and swollen. For clients with these symptoms, the affected area should be avoided until touch can be comfortably tolerated in that area. Herbal ointments (such as combinations of calendula, St. John’s wort, and comfrey) administered before and during this phase of treatment may prevent or reduce some of the burning effects. Do not use deep pressure, extreme heat, or extreme cold.
Nausea, vomiting, and diarrhea are common chemotherapy side effects, although many improvements in recent years have lessened the severity of some of these symptoms.
Depressed blood counts, particularly a drop in the white blood cell count, leave the client vulnerable to communicable diseases. Studies have shown that massage therapy reduces the prevalence of these side effects, and can help clients maintain their appetite and constant body weight during chemotherapy treatments.
Bodywork need not necessarily be delayed until chemotherapy or radiation treatments are complete. In fact, bodywork can be very beneficial during the time the individual is undergoing treatment.
Massage treatments can help the client associate his or her body with positive feelings at a time when negative feelings about the body are overwhelming, providing psychological support to help the individual get through the treatments. Cancer treatments may feel invasive and dehumanizing. Skilled, attentive touch can help the client with cancer feel emotionally whole again.
The massage therapist should consult with the client’s oncologist in cases where a potential client is currently undergoing or has just finished chemotherapy or radiation treatments.
Because these treatments increase inflammation, the focus of the massage, in this phase, should be cooling and soothing body processes. Individuals with no experience treating clients with cancer may prefer to assist the potential client in obtaining a referral to someone who has the necessary experience.
If you are not comfortable treating an individual with cancer, be sure to refer him or her to someone who can attend to their needs effectively.
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