What brings you to this topic?

Are you feeling drawn to working with patients with a cancer diagnosis? Reasons vary and over the years of teaching face to face training and creating online eLearning courses in cancer care, I have met and spoken with over a thousand therapists.

Often a reflexologist is drawn to working in this area through personal life experiences with a loved one who has gone through cancer treatments, or through their own journey with a cancer diagnosis. They may have experienced a lack of support during this time and recognize the need for accessing relaxation and stress relief but have been unable to find reflexologists trained to deliver treatments in cancer care.

Some reflexologists may receive requests from clients with a cancer diagnosis, but they feel uncertain and recognize they need to learn more, to know how to adapt their reflexology routine. They do not know when to deliver reflexology during a client’s cycle of cancer treatments, and when not to, and what contraindications and best practices are recommended to deliver a safe treatment.

I have also met the most amazing and experienced reflexologists who are fearful to deliver their wonderful treatments. The reason for their fear is often based on feeling they need to know everything there is to know about every cancer.

Some Considerations

Please consider that there are over 200 different types of cancers, which Oncologists have trained in for many years to specialize in a specific area of cancer, such as bowel, breast, lung, throat etc.  With that in mind, do we really need to have an in-depth knowledge of every cancer to deliver a reflexology treatment?

Sometimes we might feel this is the case because we are so passionate about Reflexology and the many benefits it offers to clients. We are striving to demonstrate our professionalism and the effectiveness of our treatments to meet clinical standards, and we want everything to be perfect. We love what we do so much, and we want to elevate our profession and share the many benefits of reflexology with everyone.

What has been my personal experience?

When I worked at the groundbreaking Holistic Cancer Care Centre at James Cook University Hospital in Middlesbrough, I came across so many patients with very different cancers, cancer gradings and expected outcomes.

I was incredibly fortunate to be in a supportive environment with a wonderful Clinical Lead Heather Goodwill and Complementary Therapy Lead Lynne Gray. There were many times I would ask them for guidance as to the suitability of delivering a reflexology treatment.

Through their guidance I learnt that it was important to ask questions, to have an awareness of what and where the cancer was, how to adapt my reflexology pressure, suitable treatment time, how to position patients. All important aspects to create the best and most comfortable experience for patients.

I was also given contra-indications and guidelines to adhere to, which gave me a framework to adhere to as to when and when not to deliver a treatment. Importantly, I was taught the value of good communication skills and when to refer patients to other healthcare professionals in our team.

When I look back, I appreciate how fortunate I was to receive this guidance and support.

If I need to ask questions, does it mean I shouldn’t work in this area?

No, asking questions and looking for guidance demonstrates a level of professionalism and responsibility.

It also shows we never stop learning and need further education into how to adapt our reflexology treatments, our approach, our expectations and know contraindications. We need to be aware of a cancer diagnosis and the subsequent treatment pathways to treat clients in cancer and palliative care.

When in doubt, we stop, ask for guidance from a clinical lead or from the oncology team and proceed when we are satisfied it is safe for the client to receive our treatment.

How does Reflexology benefit your client with cancer?

I believe the gift we offer through our fingers, our reflexology skills, our energy and through our hearts is to truly be with that person, meeting them through touch and energy. We are there to alleviate stress, reduce anxiety and improve quality of life. At a time when a client’s physical, emotional, and spiritual wellbeing is challenged, we facilitate stillness, allowing our client’s system to calm, rest, rebalance and just be.

Wow, imagine what a gift this is to a traumatized system.

In summary, we can help in the following ways:

• Reflexology counterbalances the effects of stress
• Encourages deeper and easier breathing
• Improves joint flexibility and circulation
• Provides gentle relaxation with facilitates stillness
• It helps to boost the immune system by calming adrenals and releasing endorphins
• Induces better sleep patterns
• Provides a safe sanctuary to express fears and views
• Relaxes the patient before and during chemotherapy
• Gives the client that most important ‘me time’
• Relaxes muscles and nerve fibers which eases pain

 

How can I adapt my treatment for clients with cancer?

Below are some of the points covered in my online learning: 

Positioning: In our usual reflexology treatments, we are used to delivering the session with clients either on a plinth or lafuma chair, supine position, feet up and facing us. When you have a patient with cancer you may find they are not comfortable in this position depending on where they have pain. Allow the client to find the most comfortable position for their condition.

Patients with bone cancer will need to adjust their position frequently and at times could be laid on their side. Do not try and position the client so you can treat the whole foot. Let them stay in whatever position they find most comfortable and work the parts of the feet you can access. With prior permission, you can then go to the hands and work the areas you could not access on the feet.

Be watchful of the client showing discomfort or restless, it is a sign they are in pain and need to adjust their position. Allow time for this and when the client is comfortable again, continue with your treatment.

Clients with lung or any upper respiratory cancer often need to be in a more elevated position. This is individual to the person, and for some this may be an upright sitting position. Allow time at the beginning of your treatment to make the position comfortable for the client. Be prepared to stop if you see the client becomes uncomfortable and reposition before continuing.

Comfort: I recommend you having a variety of soft to medium pillows and cushions. You will use these on an individual basis depending on the client’s needs.

Pillows are very useful to keep putting behind a client to elevate their sitting position. You can also find them useful for clients with bone cancer. You could place them for clients to sit on during the treatment, or place between the legs should they be more comfortable on their side. It really is a case of spending time positioning and placing pillows to the client’s comfort level and allowing time throughout the treatment to reposition again if necessary.

Relaxation: Our treatments are wonderfully relaxing purely on their own. However, there may be times your client will benefit greatly from some breath work, teaching them techniques such as accessing the solar plexus and spine on the hand and using stress balls.

I created ‘Sunrise Meditation’ specifically for patients and carers using Sound Therapy rather than music. The intention is to guide the client from darkness through to sunrise using nature to reconnect with the earth. The meditation runs for 37 minutes and can be used either alongside a treatment or separately.

You and your client can access Sunrise Meditation at: https://butterflytouchtherapiestraining.com/sunrise-meditation/

Time of treatment: Your treatment time will vary from client to client. We are used to giving clients a full 60-minute appointment with 45 minutes hands on treatment. When treating a client with a cancer diagnosis, we need to be aware of their cycle of chemotherapy and radiotherapy, of when their immune system is at its lowest and how this affects their energy levels to adapt the time appropriate for that client.

Often clients become more exhausted and fragile due to their chemotherapy or radiotherapy sessions and the severity of this will depend on the individual’s treatment plans. No two people have the same cancer and likewise no two people will have the same cancer treatments.

You will assess this and adapt your reflexology session times accordingly, this may reduce your treatment time to 30 minutes or less and your touch will become a lighter pressure suitable for that patient.

Please do not feel you are not delivering the full benefits reflexology can offer by reducing the treatment time, it is important to be aware that at times a 30-minute treatment time is perfect for that client.

I have at times gone to the bed of a patient who is in the final days of life and yet they still would love to receive a treatment. On these occasions I have given the lightest of touches ‘a Butterfly Touch’ and at times this could end up being a holding touch. In these situations, I have also adapted the treatment time suitable to that patient, which could be a 10/15-minute session. Be flexible and adaptable.

Always, always a patient has responded with gratitude and thanks for their treatment.

Pressure: I think everyone will agree that we are all taught initially to feel the feet with a deeper pressure. This is how we learn, how we start to uncover the stories the feet tell us. We recognize that by finding ‘tender or gritty points’, ‘crystals’or ‘nodules’ in a certain reflex area, the feet are telling us this is an area of imbalance and requires work. These points are an indicator to where congestion may be in the corresponding areas of the body.

Initially we are taught to apply pressure, a deeper pressure again and then release. We would continue to work this area, either with fingertip pressure or finger walking pressure until this area breaks down. These are all good effective practices with amazing results.

However, when we are treating patients going through cancer treatments, in pain and with a compromised immune system we need to adapt our pressure and make it lighter and gentler. The more fragile the client’s system the lighter we go, we use a ‘Butterfly Touch’.

Describing to others what the appropriate level of touch is for fragile systems or end of life patients, proved to be the most important part of this teaching. I pondered on this for a long time, looking for a way to demonstrate easily so everyone would understand without any question or ambiguity.

I hit upon the answer in my local supermarket store when looking at baby bath sponges. I know this sounds crazy, but the simplest ideas are often the most effective and I tested this out in many of my face-to-face Cancer Care Workshops with attending Clinical Leads and their therapists. The feedback was that it was an effective tool to demonstrate the pressure we should be using and many Clinical Leads asked permission to use it to demonstrate to massage therapists too, of course I am happy to share.

Go and buy a baby bath sponge, mine is a small soft round one and fits into the palm of my hand. The dimensions are depth just slightly over 4cm and the diameter is 10cm.

Bring your thumb and middle finger to the middle of the sponge and depress so they meet in the middle.

This pressure is a gentle to normal pressure suitable for most people but would be too deep for clients with a compromised immune system or towards end of life.

The appropriate gentler touch is half of this.

Now, move your thumb and finger from the middle to the edge of the sponge. Depress again but this time only take them halfway. Approximately depressing the thumb by 1cm and the finger by 1cm towards each other. You are not meeting in the middle.

This is the pressure you need to be using. However, please be aware that you may at times use an even lighter pressure, which would be more of a holding touch.

Key to this is to ask if this is gentle enough and give your client permission to say stop when they have had enough. Assure them you will be watching and they only need to signal and you will stop.

You can view a video demonstrating the appropriate pressure here: https://butterflytouchtherapiestraining.com/touch-and-pressure/

‘Do not underestimate the power of your touch and the strength in your gentleness’ Butterfly Touch Therapies Training

What kind of pain does Reflexology help with?

There are many types of pain with the most obvious being physical pain. Physical pain from surgery sites, lymphoedema, cellulitis, reduced bone density, arthritis, neuropathy and many more conditions.

I have treated many clients who have expressed great relief from physical pain during and after their reflexology treatment and it never ceases to surprise me what kind of pain is most relevant to a client.

Case Study 1:

On one session with a patient, I asked as always, what was their greatest need that day. I was surprised when the gentleman responded with ‘ooh, it’s my hemorrhoids, they are killing me’. Many patients going through chemotherapy or radiotherapy may experience at some point severe diarrhea and as we know that can result in painful or bleeding hemorrhoids. It was however the first time someone had said this to me.

Thinking quickly off the top of my head about the reflexes I would work and with the awareness that hemorrhoids are varicose veins in the rectum, I started by relaxing the patient with a slow rhythmic diaphragm rocking, gentle stimulation of the solar plexus, followed by working the head reflex, the spine and using spinal twists.  

Once the patient was relaxed, I went back to work the diaphragm, heart, adrenals, lumbar, coccyx, sacral and intestines, sigmoid colon, hip and sciatic nerve.  

The patient left expressing surprise as he said he already felt less discomfort and felt very relaxed.  

At the following appointment he was so delighted with the result he told everyone from the receptionist to clinic managers how much relief he had received from the reflexology session.

Moral of the story is, never assume what your client’s greatest need will be. Always ask at the beginning of the session and tailor your treatment to address their condition.   

How does Reflexology help our clients achieve balance?

Reflexology balances the body and mind allowing the system to reach its optimum recovery level. While a client is going through rounds of chemotherapy or radiotherapy this often means their optimum health is having a good night’s sleep, feeling relief from neuropathy, easing joint pain, lymphoedema or calming diarrhea and sickness and relieving constipation

We are not treating ‘the cancer’, our purpose is to treat the whole person.

Through our treatments we also facilitate the release of many emotions such as fear, anger, regret, or shock. Our treatments help to harmonize the mind and body and integrate a soothing caring touch to support clients through their cancer treatments.

Our typical Client requirements are changing

Fortunately, with the advance of medical science more and more cancers are curable, with some becoming a chronic illness, rather than a terminal one. This does mean we are not only treating clients through their cancer diagnosis, surgery, chemotherapy, radiotherapy, but also beyond. Some people will be left with significant body changes, scarring, lymphoedema and pain and our treatments will help to enhance their quality of life.

Post Cancer Shock

Clients may also be experiencing spiritual or emotional pain from the fear, shock and loss, they have experienced since being diagnosed with what is potentially a life limiting disease. This will not just affect clients at the time of their diagnosis and treatments. You may have heard people say this kind of diagnosis changes you forever. I have spoken with many patients post cancer diagnosis and treatments and they will say it has changed their outlook on life, their attitude, their way of living for the better.

However, you will also have patients who are still in pain and coming to terms with physical changes to their body or living in shock and fear.

I have had clients who never received any complementary therapies throughout their cancer treatments. Instead, they stoically carried on, holding the fear, shock, and loss while they locked down their emotions to just get through.

Case study 2:

One male client came to me 18 months post cancer treatments; he had been given the all clear and told he could now return to his life.  

It was only at this point he broke down emotionally and even though he was now cancer free, he could not rid himself of all the above emotions. He expressed that even his wife told him ‘it is all good now, you just need to move on.’

He was so grateful to be cancer free, but emotionally and mentally he just could not let go of the fear and shock he had suppressed and held down so tightly to ‘get through’ his diagnosis.

We agreed to him receiving reflexology treatments.

I started his treatments with the ‘holding of the ankles’, placing my hands underneath the heel of each foot and cupping, I raised his legs approximately 4cms off the bed. As I relaxed and softened my body and hold, I was aware of his energy flow being stagnant, slow and stuck, at times barely detectable. This was a useful indication of how locked his system had become, it was in a state of shock.

I started a slow, rhythmic rocking of the legs side to side. This is a gentle slow move and as I rocked, I could feel releases in his system, where his energy was meeting mine. The feet started to drop and relax, letting go with each little gentle motion. I felt it was now time to start.

Although the Butterfly Touch technique is often used as the lightest of touches suitable for patients with a compromised immune system or in palliative care, I felt this client’s system would benefit from this nurturing and gentle holding.

As I began my reflexology treatment, I adapted my pressure to a butterfly touch, taking more time to work over the spine, head and solar plexus. I gently worked the kidneys and adrenals, encouraging them to respond, soften and relax.  

At different stages during the treatment, I incorporated this hold:

Part way through I used balancing techniques on the big toes (zone 1). I worked at the base of both toes by placing my thumb at the lateral side and forefinger at the medial points. I then applied a gentle squeeze and pressure and held, listening to the system as I relaxed into the hold. I stay there until I feel a release (a softening).

We are working the throat and the neck, which is an extremely loving and nurturing hold. When was the last time we are held by someone in this way? For most of us it is as a baby, as our parents hold in one hand our cranium and in the other our lower spine (our powerhouse).

Another version of this hold would be to work right foot first by placing one thumb on the throat reflex, finger on the neck and with your other hand on the lower spine/coccyx, again soften and hold. When you feel a release or different vibration gently come off and do the same on the left foot.

I use this technique often when I feel a client needs to release emotions but is struggling to give themselves permission to do so. It is so simple but extremely effective.  

During the treatment the client wiped away tears and at one time allowed his tears to freely flow. He expressed how he lived in constant fear of the cancer returning and could not let go of it. It was affecting his sleeping and ability to be positive about life. With each truth he spoke, his body softened, released and let go. 

With 15 minutes to the end of the treatment he had stopped crying and talking and was calm and asleep.

 As the session closed, I went back and held at the heels once again. This time his system felt different, there was an energy flow albeit it slow, it was less agitated and calmer.

This was the power of one reflexology treatment.

We had another four sessions and he continued to release, each time his energy was stronger and flowing freer. He said he felt ready to speak with a counsellor, so I referred him to an excellent counsellor who specialised in cancer and palliative care. He continued to come to me for reflexology once a month for another six months. It was so rewarding to see this man who had been in so much emotional pain gradually join life again.

Summary of consideration when treating a client with cancer:

I could write many chapters on reflexology and cancer care and there is so much more to share, but in summary the points you need to consider when treating a client with cancer are:

• Be aware of the cancer diagnosis. What is it? Where is it?
• At what stage is your client’s cancer treatment?
• Are they pre-surgery? Post-surgery?
• Are they receiving radiotherapy?
• Are they receiving chemotherapy?
• Do they need extra professional support?
• Are you aware of where to refer them onto?
• Are you aware of contraindications, guidelines and protocols?
• Who do you reach out to for your support?

A Final Word

Cancer is global, touching all of us, with many more people diagnosed each year.

My intention through my training is to empower more reflexologists to adapt their skills, to increase their knowledge and awareness when treating clients with cancer or at end of life, and to provide contraindications, best practices and guidelines to support patients with cancer wherever that may be, in our clinics, Hospitals, Hospices or their own home.

It warms my heart to see reflexologists go forward with a deeper awareness and confidence to support clients and carers, at what is often the most challenging time of their lives.

Working in this field is heartfelt work and incredibly rewarding.  If you feel working in this field is for you and wish to know more, please contact me at:marie@butterflytouchtherapiestraining.com

Reflexology Research & RCT’s

1. The effect of foot reflexology on fatigue, pain, and sleep quality in lymphoma patients: A clinical trial  https://pubmed.ncbi.nlm.nih.gov/31669916/
2. Effects of foot massage applied in two different methods on symptom control in colorectal cancer patients: Randomised control trial

https://pubmed.ncbi.nlm.nih.gov/28176423/

3. Health-Related Quality-of-Life Outcomes: A Reflexology Trial With Patients With Advanced-Stage Breast Cancer

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576031/

4. The Effect of Reflexology on Chemotherapy-induced Nausea, Vomiting, and Fatigue in Breast Cancer Patients

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473096/

5. Partner-delivered reflexology: effects on cancer pain and anxiety. https://pubmed.ncbi.nlm.nih.gov/17562639/

6. Effects of aroma self-foot reflexology on peripheral neuropathy, peripheral skin temperature, anxiety, and depression in gynaecologic cancer patients undergoing chemotherapy: A randomised controlled trial

https://pubmed.ncbi.nlm.nih.gov/31473465/