INTRODUCING PALLIATIVE MASSAGE THERAPY (PMT) TO HOSPICE AND PALLIATIVE SERVICES IN MALAYSIA BY
PERAK PALLIATIVE CARE SOCIETY
By Chandrika P. Choo
In recent years (approximately the past 15 years or so), there has been a great evolution in cancer care for supportive intervention to those in need of hospice and palliative attention. This integrated intervention has proven to be most useful with patients presenting with pain, anxiety, loss of sleep, depression, mood disorders, stress, nausea and fatigue. These are criteria set by AMTA (American Massage Therapy Association) and S4OM (Society 4 Oncology Massage) where Massage adaptations are required for fatigue, peripheral neuropathy, low blood cell counts, blood clots, bone pain, bone metastases, radiation or surgery, removal of lymph nodes, lymphedema, medications, medical devices and late effects of treatment.
Those under Hospice or Palliative care have immensely benefited from this integrated intervention which is evidence based on numerous studies conducted by leading oncology research bodies.
Perak Palliative Care Society has introduced Palliative Massage Therapy to its clients since late 2010, a Pilot Project in a Supportive Allied Health Care provision to its palliative clients.
This intervention is also knows as Oncology Massage or Cancer Massage which aims to deliver comfort and relaxation through touch and largely aims at pressure scales to connect the body and mind in a reciprocate manner in order to improve local musculoskeletal symptoms, mood state and pain threshold. Here, displacement of pressure includes skin, fascia, muscle, blood vessel, nerves, joint and bone. However the above pressure scale is not an absolute quantification of massage pressure; because pressure is subjective, it is delivered differently by different therapists according the client condition. This is further elaborated by Dr S M Sagar in his article, Massage therapy for cancer patients: a reciprocal relationship between body and mind
Massage in general is a generic term for a variety of techniques that involve touching, pressing, kneading and manipulation of the soft tissues of the body for therapeutic purposes (Calvert 1992; Jackson 1993). There are many types of massage, (Russell 1994) available which aims at client choice to choose which technique is most suited and comfortable which involves Physiological and Psychological Effects. The history of massage dates back to as long as human beings have existed with multitudes of methods from almost all culture, religion and ethnicity. There is vast evidence which is easily available in the net.
Having combined the art and science of touch, PMT creates a safe, effective massage session for people with cancer. This is a modification of massage techniques which allows massage therapists to work safely with effects of cancer and cancer treatment. When a massage therapist works with a medically frail patient or one who is terminally ill, the work performed takes on a much different purpose when compared to a healthy client coming in for health maintenance purposes. Often the touch is much lighter and offered as much for psychological comfort as for easing physical pain. In many situations the only touch they have received has been either cold and clinical or painful. Simply being there and holding a person’s hand, or gently rubbing his or her back can soothe anxiety and increase comfort.
One of the benefits a massage therapist might consider is to teach family members how to offer comforting touch to the hospice or palliative patient and others interested in it. This allows the family member to be involved in the care of their loved one as the massage therapist will not be at the patient’s home for hours on end, where else family members might. Rather than feeling frustrated and helpless just sitting there, a family member will be able to give that gentle touch to a loved one. Being able to feel at ease touching a loved one with healing intent can go a long way in reducing the feelings of powerlessness in a life-altering situation
Another important aspect in working with chronically ill or terminal clients is making sure the massage therapist has a thorough knowledge of treatment plans by other team members, which would include knowing the type of medications being given and the potential for massage either increasing or reducing their effects. This would be true in both hospice and palliative according to situation where in a palliative care, light Swedish massage might be given to someone receiving chemotherapy or in hospice care where even more passive massage might take place.
Providing massage to very ill clients or to those who are in the last months or weeks of life is much different than massage for those who are healthy or suffering from life’s daily aches and pains. Compassion and patience are the main tools – with warm, healing hands coming in a close second. The rewards are many and the emotions can be intense. Being well prepared for this important work is vital.
We at Perak Palliative Care Society will continue to uphold the spirit of care and live up to our mission statement.
Massage at PPCS Centre
Massage at a client’s home