Terminated for declining Chemo Patient

Replies to This Discussion

Permalink Reply by Gary W Addis, LMT on January 11, 2015 at 2:30pm

Vanessa, certification is not required for prenatal massage or giving oncology massage.  If you are uneasy about giving either massage, then, yes, for the good of the client, you made the correct decision, however. 

RE: pregnancy massage, obeying general restrictions / cautions hopefully you were taught in school should, imo, be sufficient.  Such as, support the abdomen and the back, use sidelying position only.  No hard pressure applied to joints.  Etc.

If lymph nodes had been removed, well, that is an added dimension: massage incorrectly given to that area could do harm.  Stephen Jeffrey provided great advice.  If the client is still undergoing chemo therapy, certainly wear gloves in order to protect yourself from the chemicals possibly leeching from the skin.

Permalink Reply by Neal Lyons on February 1, 2015 at 12:19pm

this is an old thread but one of our volunteers recently encountered the same. she asked for a doctor's note. none was provided. she then indicated that she cannot provide the massage unless the client signs a written liability consent beyond the standard release clients normally sign. the practitioner also indicated that she by no means makes any claims to be an expert at providing massage therapy to cancer patients.

Permalink Reply by George Lee, LMBT on February 1, 2015 at 8:48pm

Wow, such an old thread being brought back to life. I was notified because I had been following back then. But, now I feel compelled to reply due to some of the comments, but I'll be brief. A cancer patient can be very complex, much more so than a prenatal client. Lympedema is but one potential complication. When I teach I cover 14 aspects of massage the practitioner may need to modify to safely accommodate a given client. Each client will be different from the next and the same client will be different from day to day. Other considerations are sensitivity to certain lotions and creams from chemo and radiation, extreme sensitivity to odors, fragility of skin, brittleness of bones, positional issues, etc. Some have heart conditions from the chemo. Some have cognitive issues. Some have list of medications that combined with the medicines that are used to counter the effects of the primary medicines cover a whole page. If you don't have specific training then you should consider declining unless the person is far out from there last treatment and have been getting stronger in health. Even then you should know the lasting effects of treatments that can continue for 2 or more years beyond treatment.

To keep myself from going on and on, might I recommend, to gain some insight, Tracy Walton's site. She has several online CEU courses and webinars. Also, Gayle MacDonald has literately written the definitive book on the subject. These are primers and overviews. A real hands on class that brings in real patients for the clinical portion of the course is really suggested.

http://www.tracywalton.com/

http://medicinehands.com/

Permalink Reply by Gary W Addis, LMT on February 1, 2015 at 11:07pm

I do some volunteer work at a hospice center; for a year my most important client was my mother in law, now deceased.  There's no special ed needed to massage cancer patients.  Commonsense, and a caring, loving empathic nature coupled with standard massage therapy education that includes a class in pathology is sufficient.

Besides, the attributes I listed above would lead a caring LMT to study oncology massage on her own. 

Permalink Reply by George Lee, LMBT on February 1, 2015 at 11:56pm

I've spent the last 8yrs. as lead Oncology Massage Therapist at Novant/Presbyterian Cancer Center in Charlotte, NC. where I have literately worked on thousands of patients both inpatient and outpatient. I am STAR (Survivorship Training and Rehabilitation) certified. I've worked closely with oncologist, radiation oncologist and surgeons that will not refer patients to untrained therapist. I've trained dozens of staff massage therapist and volunteers. I have educated other hospital oncology programs on the topic. I speak at one of the local massage schools and they teach not to work on a cancer patient without training, as most do. I helped found the Society for Oncology Massage and was VP there for 2yrs, where we established standards of practice and educational standards for oncology massage. I've had patients come to me after experiencing medically inappropriate massage where they required medical intervention. 

We beg to differ.

http://www.s4om.org/

http://www.oncologyrehabpartners.com/star-certifications/

Permalink Reply by Gordon J. Wallis on February 2, 2015 at 1:38am

Uhm, I've worked on several breast cancer patients while they were going through their there medical kimo. Even working on them when they had no hair. I gave them good massages and they are fine. They now no longer have cancer and are my regular clients that I see about once every month or two. Maybe breast cancer is different then other cancers as far as a non oncology trained massage therapist negatively effecting their health? Those women enjoyed their massages and they told me it helped them through their trauma. But George I'm not an expert on Oncology massage. But there were no negative effects from my massage. Quite the opposite. Was I lucky? Or is breast cancer a different animal then other types of cancer, as far as massage goes?

Permalink Reply by Gary W Addis, LMT on February 2, 2015 at 2:10am

Sure, understood before I commented that you would differ from my viewpoint. No offense to you personally intended, but lots of people make lots of money by needlessly mystifying the process. 

My mother in law welcomed my, in your opinion, undereducated touch, and she also received massage from other family members when they visited; the massages gave her a great deal of comfort.  Note that she did not have any lymph system involvement.  The massages given were all quite gentle, with an excess of lubrication, and she didn't hesitate to stop the massages whenever the touch was the least uncomfortable.

I am quite impressed with your list of certifications, though. I'm sure your skills provide a great public service, both to the clients, and to massage therapists whose intent it is to specialize in providing oncology massage. 

But my question to you, sir, is would you deny the small pleasure I (and her other loved ones) provided my wife's mother during her final months of life because we didn't first obtain certification?  Not every back pain sufferer needs a surgeon; not every cancer victim needs specialized massage therapy when a loved one is available.

Permalink Reply by George Lee, LMBT on February 2, 2015 at 2:51am

Breast cancer is the most common cancer and by far the majority of whom I've treated. Many can go through regular massage without side affects. The population tends to be self selecting because the one's feeling up to massage are generally healthier and stronger. Most of the one's at risk tend to feel worse and generally don't go to get massages. So, many that are treated often have little or no negative side affects while receiving the positive affects of massage. However, there can be lasting contra-indications that if the therapist isn't aware of them could cause problems. The goal is to find a way to help the patient by understanding what needs to be modified or avoided.

Don't get me wrong, massage is a great thing for cancer patients. That's why I've devoted so many years to it. But, we need be sure we do it safely, effectively and with knowledge of what we are doing rather than taking shots in the dark. Know why it was OK to do what you did. Know it's OK to use this technique or OK to use this level of pressure or why you need to work in this direction. Also, know why you shouldn't do certain things that might put the client at risk. This is where professionalism comes into play with massage therapist. Therapist want to please, so they tend to go along with request. However, professionalism is when the therapist declines a request because the therapist knows it's not to the best interest of the client. And maybe they can offer other bodywork that will still benefit them. This gets back to original poster of this thread. She showed the utmost professionalism by declining. She was asked to work outside of her scope of training and knowledge, she knew there was potential risk to the client and declined. Her school taught here that. Unfortunately, in the spa environments, therapist tend to be viewed as hourly production workers rather than professionals. I've been fortunate enough to be considered part of a medical team of professional care givers that helps decide what should or should not be done with a patient. 

 I have an entire dissertation on how cancer patients are some of the most in need of massage for a number of reasons, both physical and psychological. From the moment they are diagnosed, even before, almost all physical contact has negative implications, examinations, poking, prodding, needle sticks, blood draws, etc. At the same time loved ones and family members are pulling back from physical contact for a number or reasons including fear of injuring the patient. So, cancer patients are deprived of positive contact. Massage can intervene, provide positive contact, reassurance and provide positive re-enforcement of body image. It's a very needed thing. That's also why I'm trying to start a non-profit to support oncology patients. Many patients cannot afford ongoing services and insurance rarely covers it. 

Here are a couple of articles published by Tracy Walton in Massage Therapy Journal, that overviews oncology massage. These are the published versions of a couple of her online classes and I required them as a pre-requisite to my in-hospital training. 

http://www.tracywalton.com/downloads/Walton-CA-and-MT-Part-I-Essent...

http://www.tracywalton.com/downloads/Walton-Cancer-and-MT-Part-II-F...

It's late and I've ramble on. I hope I've made sense.

Permalink Reply by Gordon J. Wallis on February 2, 2015 at 2:59am

Ok, that answered my question.
And it is late. I'm off to bed, I think? George Lee, LMBT said:

Breast cancer is the most common cancer and by far the majority of whom I've treated. Many can go through regular massage without side affects. The population tends to be self selecting because the one's feeling up to massage are generally healthier and stronger. Most of the one's at risk tend to feel worse and generally don't go to get massages. So, many that are treated often have little or no negative side affects while receiving the positive affects of massage. However, there can be lasting contra-indications that if the therapist isn't aware of them could cause problems. The goal is to find a way to help the patient by understanding what needs to be modified or avoided.

Don't get me wrong, massage is a great thing for cancer patients. That's why I've devoted so many years to it. But, we need be sure we do it safely, effectively and with knowledge of what we are doing rather than taking shots in the dark. Know why it was OK to do what you did. Know it's OK to use this technique or OK to use this level of pressure or why you need to work in this direction. Also, know why you shouldn't do certain things that might put the client at risk. This is where professionalism comes into play with massage therapist. Therapist want to please, so they tend to go along with request. However, professionalism is when the therapist declines a request because the therapist knows it's not to the best interest of the client. And maybe they can offer other bodywork that will still benefit them. This gets back to original poster of this thread. She showed the utmost professionalism by declining. She was asked to work outside of her scope of training, knew there was potential risk to the client and declined. Her school taught here that. Unfortunately, in the spa environments, therapist tend to be viewed as hourly production workers rather than professionals. I've been fortunate enough to be considered part of a medical team of professional care givers that helps decide what should or should not be done with a patient. 

 I have an entire dissertation on how cancer patients are some of the most in need of massage for a number of reasons, both physical and psychological. From the moment they are diagnosed, even before, almost all physical contact has negative implications, examinations, poking, prodding, needle sticks, blood draws, etc. At the same time loved ones and family members are pulling back from physical contact for a number or reasons including fear of injuring the patient. So, cancer patients are deprived of positive contact. Massage can intervene, provide positive contact, reassurance and provide positive re-enforcement of body image. It's a very needed thing. That's also why I'm trying to start a non-profit to support oncology patients. Many patients cannot afford ongoing services and insurance rarely covers it. 

Here are a couple of articles published by Tracy Walton in Massage Therapy Journal, that overviews oncology massage. These are the published versions of a couple of her online classes and I required them as a pre-requisite to my in-hospital training. 

http://www.tracywalton.com/downloads/Walton-CA-and-MT-Part-I-Essent...

http://www.tracywalton.com/downloads/Walton-Cancer-and-MT-Part-II-F...

It's late and I've ramble on. I hope I've made sense.

Permalink Reply by George Lee, LMBT on February 2, 2015 at 4:03pm

To be clear, there is not currently a certification in oncology massage. Part of this is due to the logistics of facilitating testing, records management, etc. Perhaps in a couple of years.

To answer your question... No, I would not deny a loved one any relief that could be offered. I lost my first wife to breast cancer several years ago. But, I wasn't a therapist then. If you read my above post you'll see I don't consider it a small thing either, but a significant need. I have taught loved ones to work on their family members. I have taught couples to use appropriate touch to reach across the void that has been left after the trauma of a life threatening illness. Touch is a powerful thing and we are stewards of this trust.

But, is it not your responsibility, as a professional, to research if there is potential harm and how to avoid it? Is it not better to find out what techniques work best and provide the most comfort and relief?

My focus is how to get around all of the complications of illness and treatment to get to the person, to provide relief, comfort and support.

I was taken back by the blanket statement that no special training or knowledge was necessary. This is why the medical community doesn't often respect those in "alternative" medicine. I'm trying to help change that image. Note that we have evolved in terminology over the last few years from alternative medicine to complimentary medicine to the current term of integrative medicine. This is where I want to see massage go, to be a recognized, respected and integrated part of healthcare rather than the perception of being uneducated quackery. Massage is a very powerful tool and the medical community is just now starting to recognize it. 

Gary W Addis, LMT said:

Sure, understood before I commented that you would differ from my viewpoint. No offense to you personally intended, but lots of people make lots of money by needlessly mystifying the process. 

My mother in law welcomed my, in your opinion, undereducated touch, and she also received massage from other family members when they visited; the massages gave her a great deal of comfort.  Note that she did not have any lymph system involvement.  The massages given were all quite gentle, with an excess of lubrication, and she didn't hesitate to stop the massages whenever the touch was the least uncomfortable.

I am quite impressed with your list of certifications, though. I'm sure your skills provide a great public service, both to the clients, and to massage therapists whose intent it is to specialize in providing oncology massage. 

But my question to you, sir, is would you deny the small pleasure I (and her other loved ones) provided my wife's mother during her final months of life because we didn't first obtain certification?  Not every back pain sufferer needs a surgeon; not every cancer victim needs specialized massage therapy when a loved one is available.

Permalink Reply by Therese Schwartz on February 3, 2015 at 9:18pm

Gary, I'm so glad you could help your mother-in-law!  I would like to add a different dimension to this conversation - that of liability.  We must never forget the culture we are part of - we have a very litigious society.  For that reason alone, it's a very good idea to have specialized training when dealing with challenging cases.  It's a very different thing to help a loved one - and a tremendously good thing - versus a member of the public at large, when viewed from a liability standpoint.

Permalink Reply by Gordon J. Wallis on February 3, 2015 at 10:02pm

Ok, here is my thoughts on this whole thing. What am I supposed to do.?. I work in a spa... And I have been there long enough to deny treatment to anyone I want without fear of being fired. Ive worked their 20 years. And like I stated above, I've worked on several cancer patients during their entire kimo treatments or whatever they are getting, and everything was fine. But at the same time I know George is right you should know more on the subject, and Therese you are right. It is a litigious
society. Now Im all paranoid to massage a cancer person.. So what are my options? I really can't afford to take time off work, go fly somewhere, pay a hotel room, buy food and pay for a seminar. I would buy a DVD though, or read a good book. I read medical text books all the time( MD, Osteopathic, PT, Chiropractic and Acupuncture).. I am now. So George. Are there any really good books on the subject, or DVDs. I am an experienced educated therapist. I just need info. I dont need or cant be in a seminar. And I could care less about certification.

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