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doors away from the Sheahan family, and Jack Sheahan has remained a friend of ours for the last fifteen years. When I offered to share with the readers of GWCCS what massage offers to cancer patients, he enthusiastically encouraged me to do so
I have had, as almost everyone has, friends and family members who have struggled with cancer. Hopefully you will find something in this article to help you live with your diagnosis of cancer, or something that might aid you or a loved one during a time of crisis.
The best research I have found on the health benefits of massage has been done by Dr. Tiffany Fields, who began her research efforts in 1982; in 1992 she formally established the Touch Research Institute (TRI), which is the first center in the world devoted solely to the scientific study of touch. TRI's team of researchers are from such respected institutions as Harvard, Princeton, Duke, McGill and Maryland. Their research shows that Touch, specifically massage, induces a sense of deep relaxation, reduces stress hormones (specifically cortisol which suppresses the immune system), alleviates depressive symptoms, and improves sleep and digestion. The research shows enhanced immune function in children and adults with various medical conditions, including cancer.
In addition to the above mentioned results, massage can bring about the relief of muscle soreness from prolonged bed rest, and relief from feelings of isolation that can sometimes be felt because of illness. Other benefits include improvement in body image, a greater ease of expression of emotions that might otherwise be suppressed, and a sense of active participation in the healing process. Any participation is vital to one’s sense of control when one is living with an illness that may seem to be overwhelming.
In his book The Healer's Calling, Fr. Daniel Sulmasy, MD, says that no matter how sophisticated technology becomes, those who are ill need compassion, touch, and conversation for true healing to occur. There is much to reflect on with that statement, and a massage therapist certainly has the opportunity to help meet those three needs during a long, uninterrupted bodywork session.
Indeed, many people benefit further from the massage experience by extending relaxation into other areas of their lives. Some recognize they have been neglecting the necessity of rest and relaxation for the rejuvenation of their bodies, their minds and their spirits. Some can now more confidently manage the stressors in their lives. Just the knowledge of cortisol suppressing
I wish to thank all the GWCCS members who have indicated their willingness to share their experiences with others. Although most of the people calling our office still ask for information on support groups, an increasing number wish to speak directly to someone who has had a similar experience to their own. This is particularly helpful to people who are newly diagnosed. We are able to provide these phone contacts because many of you gave the information and permission on your registration cards. If anyone else would like to be a telephone contact, just give us a call.
This was the title of an article in the Washington Post on January 18. In addressing the long-term emotional effects of cancer, studies have shown that supportive relationships, including cancer survivor support groups, are crucial for recovery. GWCCS was listed as an information resource and we received a large number of inquiries. If you would like a copy of the article and cannot get one through the newspaper, call our office.
This educational conference which will be held at NIH on Saturday, April 29. The goal of this four module program is to provide cancer survivors the information and skills to advocate for themselves in four arenas: communication with health care providers; strategies for self-empowerment; health insurance issues; and workplace concerns. GWCCS has been asked to coordinate the self-empowerment module. We will have much more information in our next newsletter.
We wish to acknowledge several members of the GWCCS community who have passed on recently: Judi Maiman a founder of the PanCAN movement, Barry Rifkin whose bicycle store was a sponsor of a benefit race last summer, Jennie Burgess of Bowie, MD, and Donna Dickman, executive director of the Bell Association (for the hearing impaired).
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immune function has inspired people to find ways to reduce those cortisol levels. Through massage, many are able to better manage anxiety concerning their illness and the medical treatments by recalling a strong memory of a session of deep relaxation. And almost everyone remembers the value of several deep breaths to calm the nervous system.
Three years ago, the Touch Research Institute looked at the effects of massage on HIV-positive male adults. Their findings included an increase in natural killer cells and natural killer cell activity, suggesting the positive effects of massage on the immune system. The results of this study inspired the TRI researchers to examine the effects of massage on patients with cancer since natural killer cells combat cancer cells. One of the three ongoing studies with women who have Stage I and Stage II breast cancer has already shown massage producing a reduction of anxiety and an increase in natural killer cell numbers. The second study is concerned with prostate cancer patients, and the results here have also shown reduced levels of the stress hormone cortisol and increased immune function. The third study was designed to determine the effects of parents massaging their children who were diagnosed with cancer. So far, the children have shown a decrease in stress during invasive procedures and a longer-term improvement is expected in their immune function.
In Dr. Fields 1999 article, "Massage Therapy: More than a Laying on of Hands", she reports that there are a variety of mechanisms that may account for the alleviation of pain with massage. According to the “gate” theory, pressure alleviates pain because pain fibers are shorter and less myelinated than pressure receptors in the skin. Since pressure stimulus is received before pain stimulus, the “gate” is closed to the pain stimulus, and the pain stimulus is not processed. Another explanation for the alleviation of pain offered by Dr. Fields points to an increase in serotonin levels detected in urine after massage in both infants and adults. Serotonergic drugs alleviate pain, so it would not be surprising to Dr. Fields if the body's naturally produced serotonin also alleviates pain. In addition, numerous studies besides those done at TRI have documented that massage stimulates the pituitary gland to release endorphins, the body's own neurochemical pain inhibitor.
In addition, other studies have also demonstrated the benefits of massage on treating pain and anxiety. As an adjunct to pharmacological therapy, which sometimes does not adequately manage cancer pain, massage has been of great value when used by
nurses in a number of hospital-based studies. Boston's first hospital based massage program at Carney Hospital reports that most of the massage work is focusing on the treatment of chronic pain due to illness and traumatic injury. Boulder (CO) Community Hospital also reports that pain management is what their massage therapists address most often. A massage therapist's technique will be very specific for each kind of pain and for each kind of health condition. For example, people with musculoskeletal pain need one kind of massage and cancer patients need another kind of touch. With understanding and concern, presence and focused attention, a therapist can place gentle hands on a cancer patient, calming the nervous system and meeting some of the emotional need for nurturing and comfort.
Another interesting finding from TRI was reported in their Spring 1998 quarterly newsletter, "Touchpoints": that is, that the stimulation of the skin, whether it is touched by holding, rubbing or just a comforting touch as in gentle massage, also improves the immune system. According to the research, skin secretes an immune hormone that is very similar to the hormone from the thymus gland that produces T-cells. T-cells are a significant part of the immune system because they destroy antigens and are important for patients who have cancer or similar diseases. So even if you cannot tolerate massage on your skin during times of increased sensitivity or for any reason, it is helpful to know that your hand being held can benefit you with emotional support and possibly even immune support. Dr. Fields’ also found that sleep disturbance can compromise immune function and massage has been used to help people who need to sleep restfully.
A report from NIH showed cancer patients were much less anxious and fatigued when they had massage therapy while undergoing bone marrow transplants. Massage provides the sensory input to the nervous system that stimulates the nervous system from sympathetic nervous system responses to parasympathetic nervous system responses. This change is vital to a person who is ill and who is living in a state of sympathetic dominance.
Everybody needs time for rejuvenation, rest, absorption and assimilation of nutrients, maximum immune function and better blood flow to tissues to bring nutrients to cells and waste products away from cells. People who work in cardiac care have known for a long time that you are more prone to becoming ill when you exhaust your body's resources because of too much stressful living.
Yoga, meditation and prayer, time in nature, certain music, a few minutes of deep, slow abdominal breathing, recalling a memory, faith and many
mind/body/spirit approaches, open the doorway to a dominant parasympathetic response. I have read that smiling will cause a change in you, and discover what that change is yourself! The massage therapist can add emotionally and spiritually to the experience of relaxation through human touch, the presence of a compassionate heart who respects and honors who you are, and whatever amount of conversation you decide is comfortable and needed by you. Each session may be different with regard to the conversation; I have found it is always best to let the person being massaged make that decision.
In a few hospitals across the country, massage therapy is now being used as an integral part of the healing process. More and more doctors and nurses especially appreciate the individual time and nurturing touch that a massage therapist can give to their patients. And in most hospitals and medical centers where massage therapists are included as part of the health team, medical staff personnel themselves have become accustomed to receiving regular massage.
Massage is also being used for patients' family members at a few hospitals since family members are often worried, anxious, fatigued and emotionally in need of support for themselves. At the Children's House at Johns Hopkins, sixty graduates from the Baltimore School of Massage volunteer their time to offer massage to family members of the children who are going through medical treatments. The response from the parents has been genuine gratitude for the relief of stress, reduction of some aches and pains and for the emotional support given by the massage therapists. So if you are someone who is a caregiver, you may want to consider receiving massage yourself!
As the benefits of massage therapy become more recognized and accepted by health consumers and health care providers, you may want to consider receiving massage as part of your treatment program for cancer. If you do so, your doctor's approval is absolutely necessary. Massage can be easily adjusted to meet the needs of each person. The concerns about using massage in cancer patient care have been centered around the fear of possibly dislodging an encapsulated tumor and causing lymph flow to circulate faster than it should because the most common route for distant metastases is through the lymphatic system. I have not found documentation that massage moves lymphatic fluid any faster that what usually pumps circulation of lymph, which is skeletal muscle. As you walk, your lymph is moving. So, I have to emphasize that you seek the valuable guidance your doctor can offer to you and the therapist about massage as part of your cancer treatment.
If you are receiving chemotherapy, you may feel especially ill shortly after treatment because of the toxins in your system. Then, only a light, slow, gentle, nurturing touch on your back or feet for fifteen minutes may be all you want. This is the gentlest of all the massage techniques I have learned. Shortly before another chemotherapy treatment, however, when you are feeling better, you may want an hour of light Swedish massage, which feels great if you have never before experienced a good Swedish massage. There are massages offered at resorts and spas but they are not always the quality you want. Always ask if a massage practitioner is state licensed or certified which means they completed at least 500 hours of education, and passed the National Certification Exam and any required state tests. A knowledgeable therapist will know that you may bruise easily from low platelet counts and a lighter touch is necessary and that bone cancer patients perhaps can only receive a gentle touch to the skin without any movement or pressure. That therapist should also know to ask you about areas of your body they should stay away from because of radiation burns, catheters and other reasons.
When looking for a massage therapist, find someone you feel completely at ease with, someone you trust, someone you really like to be with, and someone who has the qualities of a "healing presence" about them---take some time and think about what that means for you. It may mean they make you laugh, or they are a good listener, or their presence is assuring, or their touch just feels right to you. I have found that some people like to listen to opera, others classical music, some rock, and a few like silence with whatever sounds happen to be around, like birds at the window. The massage therapist is there to create a time with you that is rejuvenating, and also a memory for you to have during an anxious moment.
The therapist you choose should be a graduate from a program approved by the Commission on Massage Therapy Accreditation, or certified by the National Certification Board of Therapeutic Massage and Bodywork. You should also ask if the massage therapist is a member of the American Massage Therapy Association. It is not necessary but you may want to ask if they have any advanced training in working with people who have medical conditions. A good therapist will treat you respectfully, and will provide a safe, pleasant environment that will further enhance the relaxation response for the benefit of your well being. I think your body, your emotions, your spirit and your mind have the ability to support one another and I think that mutual support is a large part of well being.
How do you look for a massage therapist? Call the American Massage Therapy Association (AMTA) to
locate a qualified massage therapist in your area at (847) 864-0123 and then speak directly with them individually. AMTA also has an email address, which is: info@inet.amtamassage.org. Or you can call American Whole Health on the corner of Wisconsin Avenue and Bradley Blvd. in Chevy Chase. They have certified massage therapists---the phone number is (301) 652-3380. Another local source is Potomac Massage Training Institute (PMTI) which gave me the names of two graduates who have a special interest in massaging people living with cancer. PMTI can be reached at (202) 686-7046.
The Baltimore School of Massage recently graduated students from their new Medical Massage Program. You can call the school office at (877) 944-8855; ask to speak with Lee Bean who directs the community clinic at the school for names of massage therapists who have graduated and have a special interest in oncology and also those students who are in the Medical Program. Lee also assists in teaching a workshop at the school called "Gentle Massage for the Frail" which is mostly attended by graduates of massage schools---if requested, Lee keeps their names and numbers on file for reference. People call Lee often for names of massage therapists who desire to work with people with specific health issues.
I extend my heart's best wishes to all of you who live with cancer or who care for someone living with cancer. One way to keep yourselves informed on news about cancer is by subscribing to the Weekly Cancer Information Johns Hopkins e-mail list. The address is www.intelihealth.com/signup
Sources of Information:
Dunn, Teri, MSW, MPH, CMT and Marian Williams, RN, BS, CMT. Massage Therapy Guidelines for Hospital and Home Care, The Planetree Program, California Pacific Medical Center, 621 Sansome St., San Francisco, CA 94111. Phone – (415) 956-4215
Ellis, Vicki, RN, Jennifer Hill, MSW and Helen Campbell, “Strengthening the Family Unit through the Healing Power of Massage,” The American Journal of Hospice and Palliative Care, September 1995, Volume 12, Number 5.
Ferrell-Torry, Andrea T., MA, RN, and Orpha J. Glick, PhD, RN. “The Use of Therapeutic Massage as a Nursing Intervention to Modify Anxiety, and the Perception of Cancer Pain,” Cancer Nursing, 1993, 16 (2): 93-101.
Gibson, Karen S., RN, NMT. “A Guide to Developing Hospital-Based Massage Therapy Programs,”
1024 Pitkin Avenue, Glenwood Springs, CO 81601.
(970) 945-3060.
Kreiger, Dolores, PhD,RN. The Therapeutic Touch, New Jersey: Prentice-Hall, 1978.
McConnellogue, Kieran, CMT, “The Courage to Touch: Massage Therapists Overcome ‘Old Truths’ to Work With Cancer Patients,” Massage and Bodywork Magazine, Associated Bodywork and Massage Professionals, Inc., Dec/Jan 2000, page 13
Sulmasy, OFM, MD. The Healer's Calling: A Spirituality for Physicians and Other Health Care Professionals. Paulist Press, 1997.
Tappan, Frances M., and Patricia J. Benjamin, Healing Massage Techniques: Classic, Holistic, and Emerging Methods. Appleton & Lance, Stamford, CT, 1998.
Weinrich, Sally P. and Martin C. “The Effect of Massage on Pain in Cancer Patients,” Applied Nursing Research, Vol. 3, No. 4, November 1990, pp 140-145.
Natalie Davis Spingarn , an outspoken advocate on survivorship issues and one of the founders of the GWCCS, is the author a recently published book, The New Cancer Survivors: Living With Grace, Fighting with Spirit. She was the featured speaker at the GWCCS annual meeting in November and is pictured above answering questions from our audience.
You can still get a copy of Natalie’s book through GWCCS for only $15.00, including shipping, which is several dollars less than in the stores or on-line. Call our office with your order and, if you want an inscription from the author, let us know that too.
Throughout the year Cancer Care offers a series of free teleconferences on a variety of cancer-related topics. You can reach them at 1-800-813-HOPE or www.cancercare.org
February 11 Intimacy, Sexuality and Love (1-2 PM)
February 16 Helping Children and Teenagers Cope With Cancer in the Family (12-1 PM)
February 23 Treatment of Brain Metastases 1-2 PM
March 22 How to Communicate with Your Employer (12-1 PM)
Comprehensive Cancer Care, an annual conference on Integrating complementary & alternative therapies will be held at the Hyatt Regency Crystal City, Arlington, VA on June 9 -11. This is being presented by the Center for Mind-Body Medicine (202) 966-7338.
The conference is organized into four tracks: research, integrative practice. patient and healing. Additional information and the registration form are contained in the enclosed brochure. We are providing this material now because there is a special “early bird” conference fee for cancer survivors who register by March 1. That $75 fee is a savings of 50% from the on-site fee.
Dr. Steven Hersh will be leading free monthly seminars for families who are dealing with cancer. These interactive educational seminars will held on Wednesday evenings from 4-6 PM at the center in Chevy Chase starting February 9. Call (301) 654-3638
As mentioned in our Spring 1999 newsletter, Gilda’s Club will soon be in the Washington area. A location is being sought in the downtown vicinity. Lucia Effros is looking for volunteers. She can be reached at H (703) 830-1919 and by fax at (703) 631-2094. More information about Gilda’s Club is at www.gildasclub.org
Project WISH (Women Into Staying Healthy) is a breast and cervical cancer program for women in the District of Columbia. Free services are offered to women age 18 & older who have limited health insur-ance, no health insurance or only Medicare, Part A. Call the D.C. Department of Health 1 (888) 833-9474.
February 9 New Treatment for Lung Cancer
Georgetown @ Ballston, VA
February 17 An Update on Colorectal Cancer
Georgetown @ Rockville, MD
[Lectures are free. Call (202) 784-4000 to register]
Sibley Hospital recently opened a new Center for Breast Health to provide comprehensive, coordinated care; prevention, diagnosis, treatment, follow-up and rehabilitation. The Center is open for imaging 7 AM – 6 PM, Monday through Friday. To learn more or to make and appointment, call (202) 537-4545.