Reflexology in Cancer care by Sarah Dickson

Sarah Louise Dickson Cancer Patient Case study analysis and the implications treatments findings may have on professional practice.

In the past cancer has been seen as a complete contraindication to reflexology treatment.(O'Hara 2006) However reflexology offers an holistic approach to care supporting clients physically, emotionally and spiritually. (Kohn 1999) 70 % of cancer/ palliative care settings now provide a range of complementary therapies(Centrepiece 2000) with reflexology being in the top three treatments used (Byass 1999, Penson 1998) (Kohn 2002) There is a growing evidence base for reflexology in cancer care demonstrating that people with cancer find a significant improvement in physical and emotional symptoms. (Kunz&Kunz 2010) However there are cautions to be taken into account and laws to be adhered to when working in this specialist area. Reflexology practitioners are expected to have specific knowledge of the condition, as well as experience, and the ability to adapt treatment safely. Reflexology practitioners are expected to complete relevant CPD(continuing professional development) courses before treating cancer patients.(O'Hara 2006) Issues such as practitioner self care and clinical supervision are also of utmost importance when working in this specialist field (Isikhan et al. 2004)(Mackereth & Carter 2006; Wilson et al. 2007)(Mackereth & Mehrez 2011)and the practitioners fitness to practice should be taken into careful consideration(Mackereth & Mehrez 2011). There are controversial opinions about safety of reflexology treatment for people with some authorities seeing cancer and it treatments as contraindications to treatment (Hodkinson & Williams 2002). This controversy may be due to several reasons including the over use or misunderstanding of the word stimulate in regards to reflexology treatment (Soloman et al. 1990) Perhaps as an attempt to avoid patients being treated by inexperienced practitioners(Hodkinson & Williams 2002) or misguided concern due to lack of knowledge of pathology and physiology(Hodkinson & Williams 2002), resting on the belief that treatment may cause further spread of cancer cells or tissue damage(Mackereth & Mehrez 2011). Despite this there is no evidence to support the idea that cancer or its treatments are complete contraindications to reflexology treatment.(O'Hara 2006)

Sarah Louise Dickson (Mackereth & Carter 2006)(Wilson et al. 2007). There are however some specific contraindications to treatment(Hodkinson 2001;Hodkinson et al. 2006)(Mackereth & Mehrez 2011) Some oncologists are insistent in their support of the use of reflexology, provided it is delivered by skilled practitioners and complements conventional care(Bell & Sikora 1996)(Hodkinson & Williams 2002). The UK national curriculum for reflexology asserts that reflexology students must have knowledge of cancer and its treatments and know how to safely adapt treatment. (O'Hara 2006) However the reflexology practitioner must be fully aware it is illegal to take sole responsibility for treatment of cancer patients or to promise or imply a 'cure'. The difference between healing and curing should be addressed when engaging with clients about treatment outcomes. So as to avoid unrealistic expectations(Mackereth & Mehrez 2011). This should be done without going to the opposite extreme and implying that reflexology will not help in any way. (O'Hara 2006;O'Hara 2002) Research including case studies shows that reflexology can help cancer patients with the physical and emotional symptoms of the cancer journey.(Kunz & Kunz 2010) Reflexology has been found to help reduce the distress associated with the diagnosis of cancer. (Wright et al. 2002) Research also shows symptom and pain management following chemotherapy, radiotherapy, postoperatively and in palliative care. (Kunz & Kunz 2010) This research demonstrates the effectiveness at alleviating pain, this may be due to the stimulation of Proprioceptive or nonnoiceptive nerve fibres as explained in gate control theory(Kunz & Kunz 2010) or the release of endorphins(Kunz & Kunz 2003), easing nausea, relieving anxiety through the release of endorphins and possible increase in serotonin levels(Kunz & Kunz 2003), helping with fatigue and generally improving quality of life for people with cancer(Kunz & Kunz 2010). There is also evidence to suggest reflexology may affect cortisol levels(Kunz & Kunz 2008) The spiritual journey of the client, may be facilitated, due to the relaxing nature of reflexology treatment and the therapeutic relationship(Hodkinson & Williams 2002). People with cancer may open up to the practitioner expressing their innermost emotions about their illness or death thereby helping them to deal with their anxiety (Elsdon 1995)(Hodkinson & Williams 2002). This therapeutic relationship can be incredibly draining for the practitioner as a result self care for the practitioner is very important. Being a reflective practitioner is

Sarah Louise Dickson important and clinical supervision can be the ideal way to do this. Counselling may also help practitioners to reflect and deal with emotions. Regular complementary therapy treatments including reflexology should be received by the practitioners to help deal with the stresses involved in working in the specialist field of cancer care(Mackereth & Mehrez 2011). According to (O'Hara 2006) the therapist is more likely to be contraindicated than the therapy. As the constitution of the therapist will determine their ability to cope with the stresses of this field and avoid burnout as it is a common phenomenon for therapists working in a hospice environment(Mackereth & Mehrez 2011). The importance of Hygiene procedure and avoiding cross contamination is also an important issue due to the impressionability of imuno-suppressed people undergoing cancer treatment. If client feels ill or has any infectious complaint this is also a contraindication to treatment(Mackereth & Mehrez 2011). It also seems there are differences between authorities regarding treatment length and frequency whilst some say a full treatment should be given(O'Hara 2006) others argue that shorter more frequent treatments should be given (Kunz & Kunz 2010) . According to Kunz & Kunz (2010) the evidence base gives recommendations for dosing where a particular amount of reflexology treatment gives a desired effect. Although this is useful the individualisation of treatment for particular client or situation should always be looked at with an holistic perspective(Mackereth & Mehrez 2011). Despite the controversy surrounding the use of reflexology in cancer care , there is obvious evidence to support its use and efficacy. The use of standardised language within the profession may help avoid some of this controversy(O'Hara 2002). Practitioners must be knowledgeable regarding the pathophysiology and psycho social impact of the condition. It is important practitioners are also aware of current research. (O'Hara 2006) It seems that working within an integrated health team or alongside health professionals would be best practice, so as to adhere to the cancer act(Cancer act 1939) and to enable important clinical supervision. Client and practitioner health and safety should be a paramount consideration when working in cancer care.(Hodkinson & Williams 2002)(Mackereth & Mehrez 2011). It is also important to note the value of good record keeping particularly when working in the field of research. Details of treatment length, frequency, pressure, medium

Sarah Louise Dickson used and treatment outcome are of major importantance as there is a need for more standardised research. (Kunz & Kunz 2010) References Books Hodkinson,E & Williams,J(2002)Enhancing quality of life for people in palliative care settings.In: Mackereth P & Tiran D (eds.) Clinical Reflexology A Guide for Health Professionals, Churchill Livingstone:UK.pp. 181-190 Hodkinson E et al.(2006)creative approaches to reflexology.In:Mackereth, P, Carter, A(eds.), massage and bodywork: adapting therapies for cancer care. Churchill livingstone, London. Kohn, M(1999)Complementary therapies in cancer care, Macmillan cancer care: London Kohn,M(2002)Complementary therapies in cancer care. Macmillan cancer relief, London Kunz,B & Kunz,K(2010)Reflexology in Cancer Care:Research shows how much helps patients, Reflexology Research ProjectRRP press.

Kunz,B & Kunz,K(2008)Evidence-Based Reflexology for Reflexologists The Reflexology Research Series, Reflexology Research Project:Albuquerque.

Kunz,B & Kunz,K(2003)Findings in Research about Safety, Efficacy, Mechanism of Action and Cost-Effectiveness of Reflexology (Revised),RRP Press.

Kunz,B & Kunz,K(2010)Reflexology Research in Cancer Care:What it means for cancer patients, RRP Press.

Sarah Louise Dickson Mackereth,P & Mehrez,A et al.(2011)Adapting reflexology for cancer care. In:Mackereth,p & Tiran,D.(eds.)Clinical Reflexology A guide for integrated practice, churchill livingstone Elsevier:UK.pp.159-170 O'Hara,CS(2006) Core curriculum for Reflexology in the United Kingdom, Douglas Barry Publications: UK. O'Hara,C(2002)Challenging the rules of reflexology.In: Mackerteth,P & Tiran,D(eds.)Clinical Reflexology A Guide for Health Professionals, Churchill Livingstone:UK. Soloman,E et al. (1990)Human anatomy and physiology, Saunders:Florida. Tiran,D & Mackereth,P(2002) Clinical Reflexology A Guide for Health Professionals, Churchill Livingstone:UK.

Tiran,D & Mackereth,P(2011) Clinical Reflexology A guide for integrated practice, churchill livingstone Elsevier:UK.

Journals Bell,L & Sikora,K(1996) Complementary therapies and cancer care. Complementary Therapies in nursing and midwifery.2(3):57-58 Byass,R(1999)Auditing complementary therapies in palliative care: the experience of the day-care massage serviceat mount Edgcumbe Hospice. Complementary therapies in nursing and midwifery, 5(2):51-60. Centrepiece(2000)The newsletter of the Bristol Cancer Help Centre, Issue 34:1 Elsdon,R(1995)Spiritual pain in dying people: the nurses role. Professional Nurse, 10(10):641-643 Hodkinson E(2001)The benefits of reflexology in palliative care. Reflexions. Journal Association of Reflexologists 63, 27. 5

Sarah Louise Dickson

Isikhan,V et al. (2004)Job stress and coping strategies in heralth care professioinals working with cancer patients. European journal Oncology nursing.8, 234-244. Mackereth P & Carter A(2006) Nurturing resilience: touch therapies in palliative care. Journal of holistic healthcare3(1)24-28 Penson,J(1998)Complementary therapies: making a difference in palliative care. Complementary therapies in nursing and midwifery.4(3):77-81 Wilson et al.(2007)Subsidised Complementary therapies for staff and volunteers at a regional cancer centre: A formative study. European journal cancer care. 16,291299. Wright et al.(2002)Clients' perceptions of the benefits of reflexology on their quality of life.Complementary therapies in nursing and midwifery. 8(2)pp 69-76 Acts of Parliament The Cancer Act 1939