Palliative care massage is aimed at reducing suffering and improving a patient’s quality of life at every stage of illness or injury
It’s a great privilege, as massage therapists, to serve children and adults with cancer, to witness their journey and be present with them as they walk a difficult path.
As practitioners and teachers, we practice integrative therapy including massage, acupressure, reflexology, warm stones, herbal-infused oils, and visceral/neuro manipulation to provide palliative care massage aimed at reducing suffering, providing support, and improving a patient’s quality of life at every stage of illness or injury.
When you are sick for the last time in your life,
walking around, shaky, frail with your final illness,
feeling the space between yourself and other people
grow wider and wider
like the gap between a rowboat and its dock —
you will begin to see the plants and flowers of your youth,
and they will look as new to you as they did back then —
little lavender bouquets arranged in solar systems
delicate beyond your comprehension…
— “I Have Good News,” in Priest Turned Therapist Treats Fear of God, by Tony Hoagland (Graywolf Press, 2018)
Palliative Care Massage
As massage therapists, we are uniquely suited to help patients through these challenging times. We have time in our sessions to foster a level of trust and continuity of connection from initial diagnosis through active treatment and all stages of survivorship.
If the eventual outcome is hospice, we can continue to be present and offer our loving expertise. Our unique role with our patients gives us a different perspective than many care providers.
Most providers do not see their patients through all these transitions. It is unusual for oncology and palliative teams to work concurrently. Once a patient is diagnosed with less than six months to live, they are often cared for solely by their hospice team. This can create sudden and confusing breaks in care that can be painful for everyone. Massage therapists trained in palliative care massage methods can provide a continuity of care that is reassuring and welcomed by patients and their families.
An important service we can provide an oncology patient is to be present for whatever they are experiencing. We can be the person with whom they can speak honestly.
Mary, a young adult patient, mentioned to me recently that she appreciates the time when I’m giving her a massage because she doesn’t have to work on getting well. “All the other providers do something to fix me. You just let me be whole again.” This is what we do in our discipline of care. As massage therapists we are present for each person and provide the care of deep listening with our touch and our being.
It’s late on a Tuesday and George is an 18-year-old kid who has been diagnosed with acute myeloid leukemia and is COVID-19 positive. He had been lying in his room all by himself for several days because he tested positive and no visitors were allowed. He had not had a bowel movement and was in general pain due to the virus and just having his first round of chemotherapy.
I was asked if I would help him with a massage. I had no problem with it.
From the beginning of this pandemic, I’ve had the opportunity to work side by side with doctors in the pediatric ICU and most of the other hospital units throughout this past year. Because of this all of my concerns about giving massage during this time had been dispelled. These concerns also translated into patient home visits.
Before entering into his room, I had to change out of my Sesame Street scrubs and put on a set of light green ones. I was met a at his door by his nurse and told to put on a hair net on both my head and face (I have a very short beard). After this I had to put on the plastic gown made for COVID-19 patients, then put on my N-95 with a surgical mask on over it.
Finally, putting on my gloves, I was ready to meet and work with George. The nurse reminded me to leave all of the PPE at the door and change out of the scrubs immediately. This was to be done after once again washing and sanitizing my hands before and after taking off my scrubs before putting on my other set.
During this whole experience I felt a sense of gratitude and humbleness. Working with this wonderful team to care and be present for this young man. He was so appreciative to have someone be with him and touch him in a loving healing way. He had a smile and could not say thank you enough
I told him if I could help in anyway just to tell the nurses that you want to see the massage guy. Then the doctors came in to do a procedure on him.
If we are following the guidelines of the unit and the individual situation, we should not have egregious concern of contracting the virus.
That said, without doubt we need to use the right PPE for all of the environments that we are in. We also have the obligation to observe the needs of our patients. If this means that they do not feel comfortable with receiving care at this moment then we need to honor this.
On the other hand, if we as the provider do not feel safe or a client /patient presents with COVID-19 symptoms, we need to say that it is not appropriate to give care at this time.
All of us are learning as we go. As long as we are mindful, we should be good to go.
Palliative Care Massage in the Last Days
In the decades that we have practiced and taught oncology massage for adults and children, we noticed that each year a few patients would seek a session with us in their last days. We decided to take a deeper look at what was special about the massage encounter at this transition.
Why did clients make the effort to come to our office when they otherwise were not leaving their homes, or ask us to care for them in their home environment? The result of this inquiry was to create massage training to address the unique needs of all our clients with life-altering conditions.
In addition to multiple physical modalities, this training includes deep listening, whole-hearted presence, acceptance of patients’ needs and desires, and the willingness to meet patients where they are.
We have repeatedly witnessed that oncology patients are ready to accept and release into death before their caregivers are ready, including their most intimate family members. The culture of cancer is often framed with battlefield metaphors in which patients believe they must fight to beat cancer, and death is seen as a failure. Health care providers in oncology often feel like they are giving up on their beloved patients if they don’t offer treatments, sometimes well past the point of utility. Family members also feel their role is to encourage their loved ones to try anything and everything and hope for a miracle.
Before Christmas I was with a pediatric oncologist checking up on the kiddos before the day’s end. We walked into a 10-year-old boy’s room who was vomiting after chemo treatment for Ewing’s sarcoma. His doctor crawled in next to him. She cuddled him, holding the bedpan till he moved through the bout of nausea. I got a washcloth and wiped his face. He smiled and thanked me. That night I sat with him after the doctor left. We watched the movie Elf on TV. We didn’t talk. We just sat in silence till he fell asleep. After that we had a deep connection and he would always ask where the “massage guy” was.
I was there for Bobby, as were his other providers. His mom was in and out of jail, his dad was nowhere to be found, and his siblings were too young, so the staff and providers became his family. Bobby’s treatment lasted for several years until the age of 13 when he just couldn’t do it anymore.
He was in the PICU moving in and out of consciousness. I happened to be there when he was lucid. He looked at me and said, “I don’t need to do this anymore! I’m ready to go.” I asked what he meant. With clear eyes, he said, “It’s OK if I die now.”
What strength, grace and insight this kid had to have endured what he did and to realize that he was done. Two weeks later, with his mom, one of his siblings and all his hospital family at his side, he took his last breath.
While staying positive can be a helpful mindset, it can also suppress a patient’s own needs and feelings. Oncology patients will often confide in their massage therapists that they are “done” like Bobby was, but that they will continue with treatments and interventions because they believe that’s what their family wants. They don’t want to let anyone down. Family and friends often find it easier to keep encouraging these prolonged medical responses rather than listening to and touching their loved ones because they can’t face the fear and depth of their own loss.
The Family Dynamic in Palliative Care Massage
Another role of the oncology massage therapist performing palliative care massage is to re-insert compassionate touch into the family dynamic. Many times, family members will not touch their ill or dying loved one out of fear or not knowing what is appropriate. As massage therapists, we show caregivers how to safely use touch, whether gentle techniques to address symptoms, or reminding them that simply holding hands or lying beside their loved one in bed is profoundly comforting.
Massage elicits the relaxation response, and we have found that palliative care massage addresses many symptoms of distress including pain, fatigue, anxiety, insomnia and GI dysfunction (“Providing Massage Therapy for People with Advanced Cancer: What to Expect,” in JAMA, April 2009). Feeling better offers patients a better quality of life and the opportunity to interact as they wish with their loved ones.
The promise of healing can be held for our oncology patients until their last breath because healing is, by definition, to make whole. The massage therapist/client relationship ideally conveys an intact view of the patient through compassionate and intentional attention to the body just as it is, in the present moment.
Support at Every Stage
The focus of integrative palliative medicine for massage therapists includes offering support at every stage of illness and symptom management whether it’s physical, emotional, familial or spiritual. Communication and presence are foundational to all forms of palliative medicine to assure that the patient’s care plan, goals and end-of-life decisions are aligned.
Not all massage therapists have a desire to work with patients with life-limiting conditions, but for those who do, we suggest that you make a six-month commitment to interact with medically complex patients and learn appropriate techniques of care. Volunteer for a palliative or hospice organization in your area. You may find the work as fulfilling as we have.
Compassionate and wholehearted listening through touch fosters a quality of presence and acceptance that can help patients remember who they truly are in one of the most potent and transformative gateways of their lives.
About the authors
Emilie Brough, DOM, LMT, RMTI, combines her 20 years as a practitioner and teacher of massage into her acupuncture practice with a focus on oncology, palliative and hospice care. She is a DOM at the University of New Mexico Hospital’s Preventative and Integrative Medicine Clinic and co-founder of Gateway Healing, providing integrative palliative care training for massage therapists.
David M. Lang, LMT, RMTI, COMT, is director of Advanced Manual Therapies at the University of New Mexico Hospital’s Preventative and Integrative Medicine Clinic, The Center for Life (hsc.unm.edu/health/patient-care/integrative-medicine). He has taught since 2000, has lectured at integrative medicine conferences in the US and abroad, and is co-founder of Gateway Healing.