Cancer, Treatment, and Massage
(Adapted by permission from Medical Conditions and Massage Therapy: A Decision Tree Approach, by Tracy Walton. Philadelphia: Lippincott Williams & Wilkins.)
When working with clients who have cancer, I try to remember that each person will respond differently to cancer and cancer treatment. The variety of responses to chemotherapy is the most striking example. Some people are profoundly weakened by chemotherapy and are very sick, and others sail through it, maintaining nearly normal activity levels.
From this variation, I’ve learned two things. The first is to question clients closely about their treatment and responses to it. When a client says, “I’ve been really tired and sick, and I haven’t been able to do much at all,” what does that mean, exactly? Sometimes when I ask clients to elaborate, I’ve been surprised by their activity levels. For one client, the definition of “I’ve been a slug because I’m so tired” meant doing just three workouts at the gym that week. Before cancer treatment, she went to the gym daily, so this was a marked change. For another, it meant “I am on the couch, literally all the time.” And for another, working part-time and parenting took every ounce of energy and strength she had left after chemotherapy. She was completely spent. For most people, chemotherapy is completely consuming. All people in chemotherapy need to be treated with hands of kindness. Training and skill in oncology massage are needed in order to make these assessments and adjustments.
Over time, it’s important to use less demanding pressures as the effects of chemotherapy are cumulative. At the first session, it’s very important to err on the gentler side, with all clients. I tell them, “I haven’t worked with you during chemotherapy before. We don’t know how you’ll respond to the combination of chemo and massage. We need to be gentle, especially at first, and see how you do.” Along the way, I make very fine adjustments, using intuition as well as information about the client’s activity level.
The second thing I’ve learned is that neither of the client’s responses—robust or frail—to cancer treatment is better or worse. They’re just different. This is important because we tend to admire and marvel at the folks who are strong through chemotherapy, who don’t miss a beat, who keep working and fighting and keep on keeping on. We tend to idealize their strength, sometimes at the expense of others who are home on the couch, who are very, very sick and can barely move. We become tempted by simplistic theories: this person is doing well because she has a positive attitude, for example, or that person is sick because he is hopeless, weak, or angry. Too easily, we assign blame, praise, or meaning to our clients and their experiences. By doing so, we do them a disservice. Cancer, treatment, and healing are more complex than any one theory or belief system. We all have different bodies and different lives. We all respond differently.
Seeing this range in responses to cancer treatment has strengthened me as well—in compassion, understanding, and clinical judgment. My hands have learned how to let up when they need to, how to lean in very gently when they can, and how to know the difference. With everyone, I sit quietly for a time, with soft, still hands holding a head, or a shoulder. I place one hand at the sacrum, the other between the scapulae. I bear witness to the courage and spirit of the person on the table. With my hands, I wish them strength and support for the next treatment, and the next step on the path.