How Breast Cancer Treatment affects Massage Therapy

Transcription

1 How Breast Cancer Treatment affects Massage Therapy A Webinar with Tracy Walton, MS, LMT Part 4 of the More about Cancer Care and Massage Webinar Series 11 Background Tracy Walton Author Educator Researcher Massage Therapist Specialist in massage therapy and cancer care 12 Things to Think about Side effects of common breast cancer treatments, and how to adjust massage techniques Examples of when to apply The Unstable/Vulnerable Tissue Principle Why The DVT Risk Principles should be applied to massage for at least 12 weeks after breast cancer surgery How hormone therapies and targeted therapies for breast cancer differ in terms of their actions and side effects 13 1

2 Download and print the Walton Side Effects Table for this webinar 14 Breast Cancer Treatments Biologic Therapy Surgery Hormone Therapy Radiation Therapy Chemotherapy 15 Chemotherapy for Breast Cancer Abraxane (paclitaxel) Cytoxan (cyclophosphamide) daunorubicin (Cerubidine, DaunoXome) Carboplatin (Paraplatin) Vincristine (Oncovin, Vincasar PES, Vincrex) Halaven (eribulin) Adriamycin (doxorubicin) Gemzar (gemcitabine) Mitomycin (mutamycin) thiotepa (Thioplex) Methotrexate (Amethopterin, Mexate, Folex) Ixempra (ixabepilone) Taxol (paclitaxel) Navelbine (vinorelbine) Ellence (epirubicin) Xeloda (capecitabine) Taxotere (docetaxel) Mitoxantrone (Norantrone) Doxil (doxorubicin) Fluorouracil (Adrucil) 16 2

3 17 Highlights of this Webinar Principles The Medication Principle The Procedure Principle The Unstable/Vulnerable Tissue Principle Myths and Truths about Breast Cancer Treatment and Massage Radiation Therapy and Gloves Chemotherapy and Gloves Selected Side Effects and Massage Adjustments Targeted Therapies for Breast Cancer Hormone Therapies for Breast Cancer 18 During Diagnosis Common Clinical Scenarios Stage I-III; in treatment Metastatic; in treatment Posttreatment 19 3

4 Cancer Where?? Breast Axilla Bone Liver Brain No cancer Signs, Symptoms Lump None from cancer Many None Effects on Organ Function? None from Liver, brain cancer affected None Tissue Instability? None from cancer Bone mets Bruising None from cancer Medical Treatments Side Effects None Several; Lymphedema risk Many; Lymphedema Hx?; Lymphedema 20 risk Cancer Where?? Breast Axilla Bone Liver Brain No cancer Signs, Symptoms Lump None from cancer Many None Effects on Organ Function? None from Liver, brain cancer affected None Tissue Instability? None from cancer Bone mets Bruising None from cancer Medical Treatments Side Effects None Several; Lymphedema risk Many; Lymphedema Hx?; Lymphedema 21 risk Cancer Where?? Breast Axilla Bone Liver Brain No cancer Signs, Symptoms Lump None from cancer Many None Effects on Organ Function? None from Liver, brain cancer affected None Tissue Instability? None from cancer Bone mets Bruising None from cancer Medical Treatments Side Effects None Several; Lymphedema risk Many; Lymphedema Hx?; Lymphedema 22 risk 4

5 Cancer Where?? Breast Axilla Bone Liver Brain No cancer Signs, Symptoms Lump None from cancer Many None Effects on Organ Function? None from Liver, brain cancer affected None Tissue Instability? None from cancer Bone mets Bruising None from cancer Medical Treatments Side Effects None Several; Lymphedema risk Many; Lymphedema Hx?; Lymphedema 23 risk Cancer Where? Side Effects Signs, Symptoms Effects on Organ Function Tissue Instability Medical Treatments 24 Cancer Where? Side Signs, Symptoms Effects on Effects! Organ Function Tissue Instability Medical Treatments 25 5

6 Cancer Side Effects Elements of Massage To Adjust Medical Treatments Contact Lubricant Pressure Joint Movement Friction Position Site of massage Draping Speed Rhythm Session length Session timing Session intent Medical consultation Medical referral 26 Cancer Side Effects Elements of Massage To Adjust Medical Treatments Surgery Radiation Therapy Chemotherapy Targeted Therapies Hormone Therapies Contact Lubricant Pressure Joint Movement Friction Position Site of massage Draping Speed Rhythm Session length Session timing Session intent Medical consultation Medical referral 27 Some side effects are obvious Some are hidden Some are lifelong 28 6

7 Strong Cancer Treatment Gentle Massage Treatment 29 Strong Cancer Treatment Gentle Massage Treatment Strong Cancer Treatment = Strong Side Effects 30 Support balance 31 7

8 Strong Cancer Treatments Strong side effects Persistent fatigue Recovery takes time (3-6 months even 1 year) 32 Learn about your client s treatment 33 Look up side effects 34 8

9 Side Effects -- Sources Patient Education Oncology education websites (American Society of Clinical Oncology, Hospital websites (Mayo Clinic, Cleveland Clinic, U. of MD, cancer treatment clinics) Drug education websites, e.g., 35 Find massage adjustments for each side effect Books Where to look 2. Articles for download (See bibliography at

10 The Side Effects Table from Walton, T. Medical Conditions and Massage Therapy: A Decision Tree Approach. 2011, LWW. 38 Ask about side effects 39 Adapt massage to side effects 40 10

11 Principles The Medication Principle [The Procedure Principle] 41 The Medication Principle Adapt massage to the condition that the medication is prescribed for AND adapt massage to any side effects. 42 Nausea or vomiting Take antinausea drug Side effect: dizziness 43 11

12 Nausea or vomiting Take antinausea drug Side effect: dizziness 44 Nausea or vomiting Take antinausea drug Side effect: dizziness Adapt massage to this 45 Nausea or vomiting Take antinausea drug Side effect: dizziness Adapt massage to this and to this 46 12

13 Side effect: dizziness Gradual repositioning Slow rise from table Slow speed, even rhythm Medical referral if severe/persistent 47 Cancer cells Take anticancer drug Side effect: nausea Adapt massage to this and to this 48 The Medication Principle Adapt massage to the condition that the medication is prescribed for AND adapt massage to any side effects

14 The Procedure Principle Adapt massage to the condition that procedure is prescribed for AND adapt massage to any side effects. Linear Accelerator for Radiation Therapy 50 The Procedure Principle Adapt massage to the condition that procedure is prescribed for AND adapt massage to any side effects. 51 Ask the 4 Medication [Procedure] Questions What medications or procedures have you had over the course of your cancer treatment? [For each medication/procedure:] Spell it? Purpose of it? Was it effective? Side effects or complications? about each medication and procedure 52 14

15 Unstable/Vulnerable Tissue Principle If a tissue is unstable or vulnerable, do not challenge it with too much pressure or joint movement in the area. 53 Breast cancer treatment can make tissues vulnerable, unstable 1. Vulnerable tissues medical devices (port, hardware for bone fixation, collection bag) 2. Incision sites 3. Bone thinning 3. Easy bruising and bleeding 4. Blood clots and blood clot risk 5. Lymphedema and lymphedema risk 54 Port for chemo administration Source:

16 Incision Sites 56 Bone thinning 57 Easy Bruising and Bleeding 58 16

17 Platelet Levels 150+ Normal 100 Low but not dangerous 50 Patients monitored closely <40 Profound thrombocytopenia <20 Acute profound thrombocytopenia 59 Platelet Levels and Massage Most can tolerate pressures 2-3 <50 Maximum pressure = level 2 Avoid drag Consult w/dr. <20 Maximum pressure = level 1 (Or less!) Holding; avoid drag Work w/dr. 60 Deep Vein Thrombosis, DVT Risk 61 17

18 Lymphedema and Lymphedema Risk 62 Ask about unstable or vulnerable tissues Any medical devices? (port, hardware, etc.)? Any surgery history, incision sites? Any effects of cancer treatment on your bones? Any osteoporosis? Any easy bruising? Taking any medications or treatments that cause bruising/bleeding or lower platelets? How are your blood counts? In treatment now? Dates? (Also see lymphedema questions, webinar 2) 63 Myth 1: Clients in radiation therapy for breast cancer are radioactive Use gloves or avoid massage! 64 18

19 Truth: External beam radiation therapy (EBRT) stays in the room Client is not hot (contaminated) Radiation implants (brachytherapy) in the breast are not left in tissue Client is only hot during daily treatment in hospital Photo: National Cancer Institute 65 Myth #2: Wear gloves for massage with all clients in chemotherapy or you will absorb the drug through your hands! 66 Truth: Most chemo drugs eliminated through urine, feces Some through skin -thiotepa (Thioplex) -cyclophosphamide (Cytoxan) -methotrexate (Mexate, Folex) -cytosine (Cytarabine) 67 19

20 Source: National Cancer Institute Common Side Effects of Breast Cancer Treatments The Big Five Pain Fatigue Nausea & Vomiting Depression Anxiety 68 Myelosuppressive (bone marrow suppression) Side Effects of Breast Cancer Treatments Blood Counts Platelets (Bruising /bleeding) White blood cells RBCs (Anemia) 69 Effects of Chemotherapy on Blood Counts Myelosuppression = suppression of bone marrow activity low blood cell counts Thrombocytopenia: low platelets bruising, bleeding Neutropenia/leukopenia: low white blood cells poor immunity Anemia: low red blood cells fatigue, intolerance of cold, dizziness 70 20

21 Effects of Chemotherapy on Blood Counts Myelosuppression = suppression of bone marrow activity low blood cell counts Thrombocytopenia: low platelets bruising, bleeding Neutropenia/leukopenia: low white blood cells poor immunity Anemia: low red blood cells fatigue, intolerance of cold, dizziness 71 Elements of Massage To Adjust fatigue intolerance of cold dizziness Contact Lubricant Pressure Joint Movement Friction Position Site of massage Draping Speed Rhythm Session length Session timing Session intent Medical consultation Medical referral 72 Breast Cancer Treatments Effects on Skin & Mucous Membrane Skin changes Hair loss Mouth sores Hand-foot syndrome 73 21

22 Drugs that cause hand-foot syndrome Adriamycin (doxorubicin) Adrucil (5-fluorouracil) Doxil (doxorubicin) Ixembra (ixabepilone) Xeloda (capecitabine) Hand-Foot Syndrome (HFS) 74 Avoid circulatory strokes on hands or feet if at risk of hand-foot syndrome Limit pressure to level 1 on hands and feet Avoid direct contact at open lesions 75 Breast Cancer Treatments Gastrointestinal Side Effects GI upset Nausea & Vomiting Constipation Diarrhea 76 22

23 Elements of Massage To Adjust? Nausea & Vomiting Contact Lubricant Pressure Joint Movement Friction Position Site of massage Draping Speed Rhythm Session length Session timing Session intent Medical consultation Medical referral 77 Nausea & Vomiting Mild Dehydration Elements of Massage To Adjust? Contact Lubricant Pressure Joint Movement Friction Position Site of massage Draping Speed Rhythm Session length Session timing Session intent Medical consultation Medical referral 78 Neurological Side Effects of Breast Cancer Treatments Neuropathy Brain fog 79 23

24 Breast Cancer Treatments Side Effects/Complications of Surgery Infection Scarring Lymphedema 80 Other Breast Cancer Therapies & Side Effects Targeted therapy (Herceptin) Fever Chills Muscle aches Nausea tend to lessen after 1 st infusion Hormone Therapies Menopause hot flashes night sweats mood swings osteoporosis Joint pain Nausea Vomiting Diarrhea Constipation 81 Targeted Therapies Monoclonal antibodies Most widely used biologic therapy ( Immunotherapy ) Bind to cancer cells Cancer therapies target cells, destroy them Herceptin, Tykerb, Avastin 82 24

25 Herceptin (trastuzumab) Treatment of 25% of breast cancers that are HER2-positive For video on herceptin See Source: Fvasconcellos, [public domain], via Wkimedia Commons 83 Client with metastatic breast cancer Chemo/Targeted therapy combinations Navelbine (chemo) + Herceptin (targeted) or Xeloda (chemo) + Tykerb (targeted) 84 Hormone Therapy 80% of breast cancers ( estrogen positive ) grow in presence of estrogen Anti-estrogen therapy reduces circulating hormones, or blocks them from stimulating cancer growth 85 25

26 Hormone Therapy Used to prevent recurrence after successful treatment for early stage hormone-receptor-positive breast cancer Used to shrink/slow growth of metastatic hormone-receptor-positive breast cancer 86 Hormone Therapy Selective estrogen receptor modulators (SERMs) e.g., tamoxifen (Nolvadex) raloxifene (Evista) toremifene (Fareston) Aromatase inhibitors e.g., anastrozole (Arimidex) exemestane (Aromasin) letrozole (Femara) Estrogen receptor downregulator fulvestrant (Faslodex) 87 Side Effects of Hormone Therapy G-I Symptoms Nausea & Vomiting Vomiting Diarrhea Constipation Menopause hot flashes night sweats mood swings osteoporosis Joint pain Blood clots Stroke 88 26

27 Source: National Cancer Institute Can Massage Help The Big Five? Depression Pain Fatigue Nausea & Vomiting Anxiety Can Massage Ease the Journey? Body Image Isolation Resources in Cancer and Massage Articles in massage publications DVD Collinge, W. Touch, Caring & Cancer: Simple Instruction for Family and Friends View trailers at complete description at Society for Oncology Massage

28 Resources in Cancer and Massage MacDonald, G. Medicine Hands: Massage Therapy for People with Cancer. Available at MacDonald, G. Massage for the Hospital Patient and Medical Frail Client. Available at Wible, J. Curties, D. Massage Therapy & Drug Handbook Cancer. for Massage Therapists Available at Resources in Cancer and Massage Walton, T. Medical Conditions and Massage Therapy: A Decision Tree Approach. Philadelphia: LWW, The Society for Oncology Massage

29 Thank you! Questions? 95 Walton, T. Medical Conditions and Massage Therapy: A Decision Tree Approach. Philadelphia: LWW, CONTEST How to enter: Write a review of a More About Cancer Care and Massage webinar on Facebook ( You re eligible for one entry per webinar What you can win: Autographed copy of Medical Conditions and Massage Therapy A complete set of the More About Cancer Care and Massage webinar series to give to a friend or colleague 97 29

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