The American Cancer Society advocates massage to comfort and help improve the quality of life of cancer patients. *— In addition to the benefits listed, massage can also play a vital role in stress reduction for the cancer patient, family members, and caregivers. *— What other side effects can be helped by massage therapy? Edema can be reduced or prevented; nausea and vomiting can be decreased; fatigue can be reduced; and skin quality can be improved. A cancer patient might receive one or a combination of these treatment methods, each of which has its own set of risks. Massage therapy can address various side effects of each type of treatment. Surgical excision is commonly used to remove tumors, cancerous organs, and often neighboring lymph nodes. *— The massage therapist needs to consult with the client’s health care provider to find out when massage can be safely administered. When might massage be contraindicated? Massage is contraindicated around recent incision sites, during any period that might put the client at risk of forming a blood clot, or if infection is present. *— What effects can massage therapy have on the muscles in the affected area? Muscular spasm can be reduced or eliminated; muscular tension can be decreased; muscle strength can be maintained; and local circulation can be increased, which increases nutrition to the muscle tissue. Radiation therapy uses radiation directly on tumors to decrease their size or inhibit their growth. A person’s entire body can be treated with radiation. Radiation therapy can also be used to prevent rejection of a transplanted tissue or organ. *— What are some of the changes that might take place in a cancer patient’s skin? Redness, dryness, irritation, and itching are common skin changes. These areas can be thought of as being burned, as in a sunburn. A general guideline for massaging cancer patients undergoing radiation therapy is to avoid massaging irradiated areas. However, the therapist can use light pressure if it is tolerable for the client and the health care provider approves. *— What methods should be avoided if the client is experiencing nausea but is able to be massaged? Joint mobilizations, stretches, jostling, or moving client limbs are methods that are contraindicated because all of these can increase nausea. Gentle pressure should be used to help promote relaxation and decrease nausea. Nausea and vomiting are two of the most dreaded side effects of chemotherapy. The client may also have mouth sores associated with digestive tract disturbances. *— What are the symptoms of peripheral neuropathy, and what are the massage considerations? The symptoms of peripheral neuropathy include pain, tingling, burning sensations, or numbness in the extremities. Deep pressure massage is contraindicated because the client cannot give accurate feedback about pressure. The considerations for massaging chemotherapy patients are the same as those for surgery patients. Muscular spasms can be reduced or eliminated; muscular tension can be decreased; muscle strength can be maintained; and local circulation can be increased, which increases nutrition to the muscle tissue. *— What are some helpful techniques to use with patients undergoing chemotherapy? Helpful techniques include gliding strokes, kneading, deep friction, and ischemic compression. It is important to communicate with the client’s health care provider about the specific muscles to be addressed and the massage techniques to be used. Communication with the client about the pressure and effectiveness of the techniques is also very important. As with all types of cancer treatments, the massage therapist must be in close communication with the client and the client’s health care provider to keep the client comfortable and safe. The massage therapist also needs to do in-depth research to become familiar with the challenges that the client faces. The massage therapist needs to obtain information relevant to each particular client. Questions need to be asked in the premassage interview and findings need to be documented. *— In what ways will the answers to these questions affect the massage therapist’s treatment? The type of cancer and cancer treatment will significantly affect the choice of massage therapy techniques, the level of pressure that is appropriate for the massage, the areas that will be avoided, and whether massage is contraindicated altogether. If the client has a low white blood cell count or decreased immunity, what precautions should the massage therapist take to protect the client? The massage therapist should not massage the client when the massage therapist is sick. If anyone in the therapist’s office is sick, the client should not come to the office for massage treatment at that time. Also, the sanitation guidelines for massage therapists, as outlined in Chapter 1, should be followed diligently. *— The areas of the client’s body where indwelling medical devices are located are contraindicated for massage. Observation of the client can provide important indicators for the massage therapist. Slow, gentle massage should be used if a client appears fatigued. Pressure, techniques, length of massage, and position might need to be modified for a client who is grimacing, holding his or her breath, breathing rapidly, flinching, or tightening his or her muscles. Signs of inflammation should be brought to the attention of the client. It is imperative that the massage therapist follow the massage considerations delineated for each type of cancer treatment along with these general guidelines for working with cancer patients. When documenting symptoms, therapist observations, areas of the body worked, techniques used, and the outcomes of the techniques used. *— Why should the massage therapist ask questions before each massage therapy session? The symptoms a client is experiencing can be different for each visit. By asking questions each time, the therapist is better able to tailor the massage treatment to the client’s needs. Why is the pressure used in massage so important? The pressure used is critical because light stroking is generally aversive (much like a tickle stimulus) and does not produce the documented benefits of massage for cancer patients. Moderate, firm pressure should be used, unless the client is debilitated. If the client is debilitated, the therapist might need to use gentler pressure so as not to overtire the client. The side-lying position and/or special propping might be necessary to ensure client comfort. The side-lying position can also be used as an alternate position if the client cannot lie prone because of central venous catheters on the upper chest wall, radiation burns, or surgical wounds. *— The image labeled A shows how to use a towel to anchor the drape in the side-lying position. *— The image labeled B gives an overview of how to massage the client’s arm in the side-lying position. These illustrations give an overview of how to massage the inside of client’s leg (C), the outside of the client’s leg (D), and the client’s back (E) in the side-lying position. Breast self-examination includes the inspection of the breasts in a mirror while in an upright position. The breasts should then be palpated while in an upright position by holding the breast with one hand and examining it with the fingers of the other hand. Palpation should then be repeated while lying down with one hand extended above the head. The diagram on this slide shows the different steps involved in breast self-examination. What is the best preventative measure anyone can take to reduce the risk of skin cancer? The best preventative measure is to avoid overexposure to the sun and to use a sunscreen lotion with a sun protection factor (SPF) of 15 or higher. Breast massage is learned through special training and involves specific techniques that are mainly modified petrissage (kneading). *— These techniques are geared toward achieving what effects? They are geared toward increasing blood flow and lymphatic drainage. These techniques are most useful after nearby muscles, such as the pectoralis major, have been relaxed. Therapists need to be very clear about the legalities of breast massage in the state in which they practice massage therapy. *— When performing breast massage, what must the massage therapist never do? The massage therapist must never touch the nipple during the treatment. The massage therapist must also always obtain consent from the client before proceeding with breast massage.

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