Embodywork

Even Here: On Learning Oncology Massage

Wed, Jun 27, 2018

In early June I went to Boston for a 4-day intensive course in oncology massage – that is, massage specially tuned to the particular needs of cancer patients.

We were a group of 17 students and two instructors. Early on the first day, one of the instructors stood at an easel, and asked us to think of someone in our own lives who has, or has had, cancer – because everybody, it seems, knows somebody with this disease, and for many of us that was what motivated us to take the class in the first place. Without sharing any details about the people, we went around the room and shared their first names; the instructor at the easel wrote each name down, and ultimately we had this list of people we love who have been touched by cancer. The list was then put on the wall and stayed there for the entire course. There was something powerful about having those names always present with us.

Much of the course was dryly informational, as it had to be. We got thorough overviews of how cancer grows and spreads, the various methods by which cancer is treated, and the many, many side effects which can accompany each form of treatment. A lot of time was spent discussing lymphedema (a lifelong risk for anybody who has had even one lymph node removed or irradiated, which is pretty common in cancer treatment) and deep vein thrombosis (a risk for anybody with cancer or who has been in cancer treatment in the last six months), as both of those are serious conditions which can be triggered or substantially worsened by vigorous massage.

We talked about the five most commonly reported side effects of both cancer AND cancer treatment: pain, fatigue, nausea, depression, anxiety. Everybody involved in cancer care knows about these five, and needs more and better ways to treat them; massage can actually be very effective in treating any or all of them. Studies have shown that massage can cut all these symptoms down by an average of 40 to 50% – which, obviously, is not 100%, but it’s still a pretty big improvement.

We learned lists upon lists of cautions. What are the conditions in which a person’s skin becomes toxic to the touch and we’d need to wear gloves; what are the conditions in which we absolutely should not touch the client’s hands or feet; what conditions would mean that we need to avoid boosting circulation, or use only the gentlest pressure, or avoid dragging over the skin. What is the timing of a chemotherapy cycle and where in that cycle should we avoid massage. What are the medical devices that might be implanted in the client and how do we work around those devices. And so forth.

We learned tips and tricks for making very gentle massage feel deeper than it is, or more satisfying. It’s amazing how much difference it can make to spread one’s fingers or bend the fingertips. For the purposes of the course we used Swedish massage, but I was happy to realize that the myofascial release I already practice lends itself readily to oncology work, as it’s all about gentle pressure and slow pacing.

We learned techniques for bolstering an extremely frail client so that they can lie comfortably with everything fully and evenly supported. First we saw demonstrations, then we partnered up and practiced bolstering with the “client” fully clothed, and then later we did a bodywork exchange using these bolstering methods, with the client unclothed and draped. During the exchange, we were encouraged to really think about the work we might do this way, with a client who might be very near the end of life, and I found myself crying quietly while I worked. Because yeah, that might happen – and I was grateful to have a practice run at this type of massage, where the stakes were low but I could imagine them much higher.

We spent a lot of time talking through intake interviews. I do a very brief intake with all my clients, but the oncology intake is much longer and more detailed, as there are so many potential variables and a client’s condition can change dramatically from one week to the next. Attention was also paid to tone of voice and pace of questioning, given that the client comes to us for relaxation, and they’ve probably already got a lot of people asking about their health info along with a fair bit of anxiety around these topics, so we need to be sensitive to that.

On our last day, we had a virtual clinic; each of us was assigned a role to play, as a client in cancer treatment, and given a thorough health history to discuss with our assigned therapist, along with a list of scripts to use in answer to questions we might get. Each of us, as a therapist, was paired with one of these “clients” and given their health history the night before, so that we could take the evening to research any unfamiliar terms, come up with specific questions for the intake interview, and outline a care plan that would be appropriate for that client. The care plan might have to get modified based on interview answers; for example, my “client” mentioned in the intake that he’d developed a new, intense pain on his right side. His pain was where the liver sits, and my client had a type of cancer which can compromise liver function, so that bit of information was an instant red flag. Then we gave each other 50-minute massages, while the instructors wandered around and corrected any mistakes they spotted, or checked in with us about our care plans and what modifications we had made to them.

The preparation and intake interviews were the most obviously educational aspects of the clinic, but I found the bodywork especially valuable because those 50 minutes showed me how much I could still do in spite of all the constraints I had to work with. My previous bit of education in the field of oncology massage was all about cautions and contraindications, and so my head filled up with what I could NOT do. It’s tremendously confidence-boosting to switch that focus over to what I CAN do – which, it turns out, is quite a lot.

One final thought: the lead instructor told us about an experience of hers, many years ago, working on a client who was very near the end of life. She herself had been going through a difficult time, and found herself outside the door of the treatment room, getting ready to go inside and begin work, feeling like she just wasn’t up to the task facing her and had nothing to offer. And the question she asked of herself was, “Is love available, even here?” She found that it was, and that that in itself offered her a way to begin; in seemingly hopeless moments ever since she has asked herself the same question, and the answer has always been yes. Love is available, even here.