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Massage therapy in palliative care

Massage therapy is a systematic form of touch that is either applied directly to the skin or through clothing, generally focusing on soft tissue. Promoting soft tissue changes is important for a person’s physical and emotional symptom management. Massage therapy can be used independently or in conjunction with other treatments and is a complementary therapy that is not a replacement for conventional medicine.

How does palliative care massage therapy differ from a remedial or standard massage?

Remedial Massage Therapy

Remedial massage tends to focus on dysfunctions within the musculoskeletal system. For example, discomfort in the lower back due to poor lifting techniques that have damaged muscles in the lower back may require remedial massage therapy. The aim of a remedial massage is to restore the functions of the affected muscle groups. The remedial massage may include Trigger Point Therapy, which requires a deeper level of pressure, and may also use a variety of techniques including stretching, myofascial release, cupping or dry needling. 

Palliative Care Massage Therapy

Massage for a palliative client should be performed by a professionally trained massage therapist, or myotherapist, that has undertaken specific training in working safely with palliative care clients. The therapist will adapt their techniques to suit the client’s current state of health and any presenting symptoms, in order to achieve the desired outcome. The pressure of the strokes tends to be lighter than those applied during a remedial massage.  If a client is unable to lie face-down on a massage table, there are other positioning options that can be considered during the session, such as lying on their side, being seated or sitting in a recliner. The therapist may also avoid specific areas on the client’s body if they are contraindicated, such as massaging near an attached medical device.

Palliative care massage may include modalities such as relaxation massage, therapeutic massage, reiki, touch for health, craniosacral therapy, polarity therapy, tuina or acupressure.

A specialised treatment called manual lymphatic drainage (MLD) is also effective in addressing oedema and lymphoedema. MLD is generally combined with compression bandaging, decongestive exercises and compression garments to reduce and manage swelling in affected areas. Therapists will have completed specific training in the management of lymphoedema in order to offer these treatments.

What are the benefits?

Palliative care massage addresses the client’s symptom issues, the side effects of various treatments, the physical, psychological, social and emotional consequences of living with a terminal illness. Massage often promotes a greater sense of connection between the mind and body complexes.

Recent studies[1] have proven that massage decreases:

  • Pain
  • Fatigue
  • Stress
  • Anxiety
  • Nausea
  • Depression

Massage can also enhance a person’s quality of life, promoting a greater sense of wellbeing for the patient and their carers.  

Is massage therapy safe for someone diagnosed with a chronic and/or terminal illness?

The gentle and appropriately adjusted massage is safe for clients who have been diagnosed with a chronic or end stage terminal illness. In fact, massage therapy can support the person throughout all stages of their respective illness.

If the person has been diagnosed with cancer, the massage therapist must be trained in oncology massage so they know how to adjust the massage so that they may appropriately meet the needs of the client.  The therapist will establish the treatment plan according to the person’s diagnosis, presenting symptoms, conventional medical treatments, medications and desired treatment outcomes.

Will massage spread cancer cells?

A massage will not spread cancer cells as metastasis is a biological process. Pressure is never applied directly over or on a tumour site, and the massage will always be adjusted to promote a state of relaxation for the person.

Why is touch important?

Touch provides comfort and establishes a connection between individuals. This becomes even more important when other senses, such as sight, hearing and speech, are no longer available for patients.  Gentle touch conveys the message of caring and gives the receiver an opportunity to acknowledge their physicality. 

Does massage therapy complement my other health providers?

Yes, massage can be used safely with other therapies such as physiotherapy, osteopathy, art and music therapy, psychotherapy and all mainstream medicines. Massage may be chosen as a part of a treatment plan that promotes a greater sense of wellbeing in combination with the above therapies.

Your individual treatment plan needs to be based on what your goals are and what you enjoy doing.

How will the massage be conducted?

The massage can be arranged in various settings including your home, hospital, day hospice, day centre, aged care facility. Alternatively, you may visit the therapist’s clinic.

If you are at home, the therapist may perform your massage whilst you are lying on your bed, on a massage table, or sitting in a recliner or chair. Your therapist will discuss positioning options with you during the assessment process.

At home, it is important to ensure that you are warm enough during the massage so that your body can relax. Consider heating the room before the massage, or having an extra blanket. Also, reduce interruptions during the session by turning off devices and not scheduling other appointments during massage time.

For the first massage, your therapist will use light pressure to ensure that there are no adverse effects following the massage. It is beneficial to note how you felt 24 hours after the massage. Some therapists will contact you a day after the massage to get your feedback, allowing the therapist to establish your body’s response to the massage and use the information to adjust the pressure and other considerations of future treatments.

If your massage therapist is part of a community-based health organisation, they may already have access to your medical information. In other settings, such as the therapist’s clinic, home or in hospital, the massage therapist may ask permission to contact your medical practitioner for your medical history. On the day of your massage, your therapist will need to gather other information such as presenting symptoms. If you have engaged a private massage therapist, they will require full disclosure of all medical information, so ensure you are able to convey this information so the therapist can tailor the treatment to meet your needs.

You should always feel safe and comfortable during the massage. Draping of towels and blankets will maintain your warmth throughout the session, and the therapist will ensure you are covered with the exception of the area being massaged. If at any time you feel uncomfortable, or need to cease the massage, communicate this to your therapist so they can take the appropriate action. Massage therapists trained in palliative care massage adopt a flexible approach so that they are always able to ensure that all your needs are being met.

Is massage appropriate for my child who has been diagnosed with a terminal illness? Yes, children of all ages benefit greatly from massage therapy and the massage therapist is generally happy for the parent to be present during the massage session. You might like to ask the therapist to demonstrate massage techniques you can offer your child that are safe and gentle, and that help to support your child during times of discomfort.

How much will the massage cost?

Costs vary among therapists and there may be an additional charge for travelling if you require a home visit from a private massage therapist. Massage Therapists who are working independently will have their own pricing structure. It is advisable to ascertain the total cost of the massage (including travel allowances), directly from the therapist. You can also ask if the massage therapist has a provider number with your health fund, so you can claim a rebate for the massage.

Massage Therapists employed by community-based organisations offer massage as part of the palliative service, so there is no charge for the massage. Depending on the organisation, the number of sessions may be capped at three and there may be an interval of 4-6 weeks between sessions. For example, Eastern Palliative Care, Melbourne City Mission and Banksia Palliative Care based in Victoria, provide massage as part of their palliative service.

Those clients who have a package through a community health service, may be able to allocate their funding to cover the cost of the massage. It will be necessary to enquire with hospitals or hospices that offer a massage service, to establish what they provide. Some organisations have private massage therapists and the hospice/hospital may offer to cover the cost of the massage, or provide volunteers who offer hand and foot massages.

Who will conduct the massage?

If you are an inpatient, and the hospital offers a massage therapy program, you can ask hospital staff to refer you for massage and the therapist will contact you to organise your appointment.

If you are a client of a community-based palliative program, you can ask nursing staff or allied health staff to refer you to the massage program or they may recommend massage if they believe it will help to address your presenting symptoms.

If you are engaging an independent therapist, ensure that your therapist is properly trained and has the experience to work safely with you. Massage therapists differ greatly in terms of their training and experience so you can refer to the guidelines below to assist you with this process.

To engage a private massage therapist you could:
  • refer to the community palliative care organisations in your state
  • check with your GP, specialist or oncologist
  • refer to the practitioner listing of one of the following associations Association of Massage:
    • Therapists (www.amt.org.au) Australian Natural Therapists Association (www.anta.com.au) Australian Traditional Medicine Society (www. atms.com.au)
    • Massage & myotherapy Australia (massagemyotherapy.com.au)
    • Society for Oncology Massage (www.s4OM.org)

 How do I know if my therapist is properly trained?

To ensure you select the right therapist who will meet your needs, you must verify that your therapist has undertaken appropriate training and has suitable experience with palliative clients. This screening process gives you the assurance that your therapist has the training and experience to work with you safely. The following guidelines provide you with questions you can use to screen prospective therapists.  (Adapted from S4OM document – “Is Your Therapist Trained?)

1)  What qualifications does the therapist require in order to offer massage therapy to a client with a life-limiting illness?

The minimum requirement held by the therapist should be a Diploma of Remedial Massage or equivalent. Further training in oncology massage and/or palliative care massage should have also been undertaken and successfully completed by the therapist. These courses may have been studied in Australia or overseas. Your therapist should hold a current First Aid Certificate, be a member of a professional massage association and have Professional Indemnity and Public Liability Insurance.

2)  What recent experience in palliative care has the therapist undertaken in order to work with you and your specific medical condition?

The therapist may work or have worked with a community-based palliative organisation, hospital, hospice or aged care facility to provide massage therapy to palliative clients. You can ask the therapist when they completed their training and how often they work with clients who are palliative. You might also like to know how clients have responded to his/her treatments.

3)  How many clients living with a life-limiting illness, would the therapist typically massage per week?

This would ensure the therapist has currency working with palliative clients and provides reassurance that they have applied the knowledge and skills from these specialist courses to their client work.

4)  Briefly outline your medical history and what your goals are for the massage. Ask how the therapist might approach your session in terms of varying their approach from a standard massage.

The therapist may discuss how you would be positioned for the massage, what pressure they would apply for strokes used during the massage, what techniques they may use, what oils/creams would be appropriate, whether they would use a massage table, chair or recliner for your massage, the duration of the massage and what areas of the massage they may avoid.

5)  Ask what you can expect to occur during the session.

The therapist will either have access to your medical information if they are employed by a palliative care organisation. If the therapist is an independent therapist, they may take about 10 minutes to gather information relating to your full medical history as part of their initial assessment and then develop and discuss your treatment plan. The therapist will work with you to optimise your comfort level during the session by ensuring that you are well supported either on a massage table, in your bed, on a recliner or other chair.

The session will be conducted after you have both agreed on the treatment plan so there aren’t any surprises.  Following the session, your therapist may reassess you to gauge if the treatment has been effective in achieving your desired outcome. If you receive the massage on your bed or in your recliner, you may elect to remain there following your session provided it is safe to do so. The therapist would have discussed this with you during your assessment.

6)  Are there any reasons why a massage would not be appropriate for you?

The massage may not be appropriate if you are currently unwell with an infection, such as the flu or a virus, or your medical specialist has recommended that massage is not advisable.

7)  What is the cost of the session, how long it will take and if there is a payment and cancellation policy?

Costs vary among therapists and there may be an additional charge for travelling if you require a home visit. Consultations are generally scheduled for a minimum of one hour if a home visit is involved. The actual massage time may be from 30 minutes to 50 minutes depending on the goals of the treatment plan.

Payment is usually required on the day of the service for an independent therapist, and generally there is no cost for community-based palliative organisations who provide massage therapy as part of their service. Therapists will have their individual cancellation policy. This may include providing at least 24 hours’ notice if you wish to cancel the massage appointment, otherwise a fee may be charged.

8)  Ask if you will need to provide anything for the session, such as your own towels or lotions.

Depending on where the session is offered, listed below are some general approaches to towels and lotions:

  • Hospital or Hospice – towels will generally be provided by the hospital.
  • Therapist’s Clinic – towels and lotions are provided by the clinic. If you have a preference for using a specific lotion, you may wish to provide this.
  • Home – This may vary among therapists as some prefer that you provide your own towels and linen to reduce the risk of infection, whilst others provide towels and lotions for your session. If you would prefer not to be disturbed following your massage, it is advisable to provide your own towels so you don’t have to be moved following the session.
9)  If you have had surgery or radiation to any nodal areas, ask what precautions are taken to reduce the risk of lymphoedema.

A properly trained therapist will know how to adapt the massage to ensure that the risk of lymphoedema is minimised. Following surgery or radiation to nodes, the risk of lymphoedema is always a possibility. Lymphoedema is a chronic condition that requires daily management and can be triggered by massage that is too forceful and inappropriate. If your therapist is not familiar with this term, consider another therapist.

 10) Will you need consent from your GP?

Consent from a GP or specialist is not required for you to receive massage, however, it is advisable that you contact your health team if you have any concerns before having a massage. The referral does not replace the need to properly screen your massage therapist.

[1] Cassileth BR, Vickers AJ. Massage Therapy for Symptom Control: Outcome Study at a major Cancer Center Journal of Pain and Symptom Management 2004; 28 (3): 244-9.

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