Hospital-based oncology massage sounds like a specific modality that can be easily defined.
The Society for Oncology Massage lists more than 130 “Hospitals Incorporating Oncology Massage.” This is just one self-reporting list. In the U.S. there are hundreds of clinical settings that incorporate oncology massage.
The presence of oncology massage in these hospitals ranges from robust, well-integrated, fully-funded programs staffed by highly trained therapists to a single volunteer, who may or may not have oncology massage training.
The good news is that an increasing number of hospitals are interested in including massage therapy into the standard of care.
The bad news is that many hospital decision-makers—and even some massage therapists—are not aware that oncology massage exists.
Another challenge is that eager massage therapists often enter hospitals without proper preparation, or as volunteers.
The result is a decided lack of meaningful integration of oncology massage therapy and, more importantly, oncology massage therapists into patient care.
Three Stories of Hospital-Based Oncology Massage
The following three examples show how different one massage therapist’s employment as an oncology massage therapist can look compared to another’s, depending on the environment and position requirements.
Our first oncology massage therapist has a one-year contract, for one four-hour shift a week, funded by a grant from a grateful former patient. Every Tuesday he receives a verbal or written list and a brief medical profile of patients who have been vetted and consented by a nurse, doctor, or social worker.
He is encouraged to see as many of the patients on the list as possible in the time that he is there. At the end of his shift, he provides handwritten notes to the unit secretary who will scan them into the patients’ electronic medical records (EMR).
Our second oncology massage therapist is employed part-time by another hospital. She has a dedicated census that includes all patients in the oncology unit. She huddles with the nurses each morning and together they decide which patients would most benefit from massage that day.
She may spend as much or as little time with each patient as she feels is necessary. She has full access to the EMR (or EHR, electronic health record, in the case of institutions that have a more serious commitment to integrative care) and charts her notes directly into the EMR.
Our third oncology massage therapist sees patients in the hospital as part of a research study twice a week. She is an independent contractor with a third-party nonprofit organization that has been hired by the hospital.
She receives a printed census from the research coordinator. She has access to the EMR, but charts into a specific template.
Her shift, and therefore, her pay, fluctuates depending on the number of patients who have been consented and randomized to receive massage that day and her massage, in both time and technique, must adhere to a strict protocol.
These are just three examples. Ask a dozen oncology massage therapists who work in the hospital what their day is like and you’ll hear a dozen different scenarios. Each hospital has its own culture, mission and budget priorities that inform the logistics of the program and the role of the massage therapist.
So, what is consistent?
What Every Oncology MT Needs
Despite differences in the ways, and how much, they interact with other members of the care team, how much they get paid, and how and by whom the care they provide is defined, our three oncology massage therapists do have some things in common:
1. Advanced training. In addition to standard massage therapy training, anyone who is providing oncology massage in a clinical setting should, at the very least: complete a foundational oncology massage training (the Society for Oncology Massage recommends a minimum of 24 hours).
The therapist must also complete a hospital-based massage therapy training with supervised hands-on experience (several established programs are listed at the end of this article); and attend the full orientation required of all direct patient care staff at the facility where massage will be provided (this will address critical protocols specific to the facility including HIPAA, ethics, documentation/charting, safety, infection control and signage).
Additional training that will increase a therapist’s value in a clinical setting includes research literacy, manual lymphatic drainage training, education in end-of-life care, scar tissue mobilization training, and completion of courses offered to allied health professionals, found via such venues as nursing schools, physical therapy programs, and social work continuing education providers.
2. Vaccination. They’ve all had a flu shot. There are universal vaccination requirements for care providers who come into direct contact with patients. Massage therapists absolutely fall into the category of direct contact and will need to show proof of immunizations and get annual flu shots.
3. Scope of practice. They stay within their scope of practice. As massage therapists, we practice massage therapy. A massage therapist in the hospital is not hired to be a life coach or nutritionist or to give her opinions on … well … anything outside of massage therapy.
She may have a nursing background, training in coaching or a doctorate in nutrition, but she was hired to provide massage therapy. We repeat: She was hired to provide massage therapy. It’s easy to forget, but important to remember: Massage therapy is enough.
4. Mainstream participation. They choose to participate in mainstream medicine. Even if the therapist would not personally choose the interventions her patients are receiving, it would be completely inappropriate and unethical for her to criticize or comment on the choices made by the patient or the medical team.
Even if a therapist has worked with other people, such as at a spa or multi-therapist massage business, they probably haven’t worked as part of an integrative team. This collaborative role is key to what can be different about hospital-based massage and is a challenge for many therapists.
The massage therapist is not the primary caregiver and often does not have a quiet, private 30 or even 15 minutes to provide massage. A session may be interrupted many times and still be very effective for the patient. It is all about creating calm and allowing for relaxation and connection in the midst of chaos.
5. HIPAA. They are HIPAA-compliant. HIPAA (Health Insurance Portability and Accountability Act of 1996) is United States legislation that provides data privacy and security provisions for safeguarding medical information. While massage therapists in private practice absolutely should be adhering to HIPAA, massage therapists in the hospital must do so. It’s federal law.
6. Flexibility. The therapists are all capable of adapting to a situation—quickly. The hospital setting requires extreme flexibility and the ability to be happy in the role of support person. The entire culture is different.
A hospital-based oncology massage can look like a lot of different things, but it almost definitely doesn’t look like the massage a therapist provides in an individual treatment room. The therapist may be giving gentle foot massage or holding someone’s hand with little or no movement while the patient receives another medical intervention.
He may be in the hallway massaging a caregiver’s shoulders. The massage therapist might be in the ICU, fully gowned and gloved, wedged between the bed and machinery, reaching around tubes while busy nurses and frightened family members move in and out of the room.
There are beeps and squeaks and loud talking everywhere. The lights are bright.
A patient’s whole body is almost never available—nor advisable—for massage, and it’s not uncommon to be turned away by patients, family members or other health care providers.
Often working in a hospital means hanging in the background and understanding when it is time to come forward and when it is not. It requires adaptability and grace, like jumping double-dutch rope … while juggling.
Engage in Evidence-Based Practice
Oncology massage therapists must also be advocates and educators. Some medical professionals believe massage doesn’t do anything and so is therefore always safe, but also mostly useless. Others may only know massage as the deep tissue work that they personally receive and so understandably believe massage would be unsafe for their patients.
Part of the job of a hospital-based massage therapist is to skillfully demonstrate that these are misconceptions while simultaneously gaining the trust and respect of the other person.
Not all health care providers understand the value of massage therapy. Some have simply chosen not to introduce it into their system. Even massage therapists are still in the process of educating ourselves, hospitals and consumers about the benefits of oncology massage. Presenting ourselves as professionals in our language, appearance and demeanor is imperative.
We are in the beginning stages of hospital-based massage therapy of any kind, not to mention hospital-based oncology massage. Competencies, best practices and educational requirements for both massage therapy and oncology massage therapy are in the process of being created and are yet to be fully adopted in this country.
(If you are interested in pursuing oncology massage in the medical environment, familiarize yourself with the Academic Collaborative for Integrative Health’s Hospital Based Massage Therapy Competencies for Optimal Practice in Integrated Environments.)
In order to fit into the medical model, we do not need to abandon massage therapy as compassionate, individualized treatment—but we do need to engage in evidence-based practice. The good news? It is possible for both of these qualities to exist in every massage.
About the Author
Kerry Jordan, LMT, is an instructor and operations manager for Healwell. She is a fervent lover and teacher of physiology and pathology. Jordan provides massage and participates in research at Washington, D.C.-area hospitals and hospice facilities. She specializes in working with people who are affected by serious illness and those in the midst of gender transition.
Julie Ackerman, LMT’s private practice focuses on people affected by cancer, lymphatic issues and chronic pain. She has provided massage in several hospitals, including Cancer Treatment Centers of America. Ackerman serves as massage advisor for Unite For HER, and is an active member of Society for Oncology Massage and an instructor with Healwell.