RMT Considerations -- Chemotherapy PDF

**RMT Considerations -- Chemotherapy** [DURING] 1\. Depending on where the patient is during their current chemo cycle (eg. 2 days post-session), they may experience a varying degree of side-effects. Communicate with the patient to determine when a massage treatment would be the most effective. 2...

**RMT Considerations -- Chemotherapy** [DURING] 1\. Depending on where the patient is during their current chemo cycle (eg. 2 days post-session), they may experience a varying degree of side-effects. Communicate with the patient to determine when a massage treatment would be the most effective. 2\. Side-effects are wide-ranging. Depending on which are present, you may need to modify elements of your treatment such as: - Duration (due to possible fatigue) - Positioning (due to possible dyspnea) - Pressure (due to possible trophic changes from toxicity/atrophy, hypocoagulability from low platelet, sensory changes ranging from hypesthesia to dysesthesia) - Communication/clarity (due to possible "chemo brain", fatigue, sleep disruption) - Hygiene/infection control (due to possible neutropenia) - Hydrotherapy temperature (due to possible sensory changes) 3\. Consider the powerful benefits of relaxation and sleep promotion when designing your treatment plan, especially given the pervasiveness of fatigue and disturbances in mood and sleep. That said, understand that massage therapy can also play a pivotal role in addressing more specific issues such as chemotherapy induced peripheral neuropathies. 4\. There is some risk of chemo agent transference between patient-therapist. Research the skin absorption potential of the agents in your patient's chemo protocol, especially if administered topically. You may need to modify your treatment by: - Wearing gloves or treating through clothes - Avoiding/changing medium - Controlling the amount of direct touch - Ensuring your patient washes before the treatment 5\. Remember that neutropenia is one of the common side-effects. Be extra vigilant with hygiene and infection control -- especially in the presence of chemo lines and in post-surgical situations. When it comes to chemo lines, follow standard guidelines on skin openings and tubing: - 4"/10 cm rule in effect. - Avoid tugging forces on lines (during position changes or mobilizing body parts) - Avoid wetting the dressing with hydro or medium - Be aware of pressure on any lines directly underneath the skin 6\. Awareness of patient's emotional needs - Consider your therapeutic relationship as part of the treatment plan (safe person to confide in/complain to, creation of an "oasis", nurturing presence and touch in stressful time, etc.) - Have a list of referrals and supports (e.g. support group) [AFTER] The body will recover rebound from intense side-effects of chemotherapy at different rates. Certain modifications may continue to be important months after the protocol is over: +-----------------------+-----------------------+-----------------------+ | **Timeline** | **Description** | **Modifications** | +=======================+=======================+=======================+ | 1-2 months | High cell-turnover | Pressure d/t possible | | | tissues (esp. skin, | tissue fragility | | | BVs) | (bruising, bleeding, | | | | cracking) | +-----------------------+-----------------------+-----------------------+ | Several months | Blood cells | Pressure d/t | | | (platelets, RBCs, | inhibited clotting | | | neutrophils) | response, tissue | | | | fragility | | | | | | | | Orthostatic | | | | hypotension | | | | modifications d/t low | | | | blood oxygen | | | | | | | | Infection control d/t | | | | neutropenia | +-----------------------+-----------------------+-----------------------+ | 1 year | Fatigue | Tx duration | | | | | | | | Tx planning -- goals, | | | | self-care | +-----------------------+-----------------------+-----------------------+ | Ongoing | Sensory changes | Hydro temp. extremes | | | | | | | Bone density changes | Pressure d/t bone | | | | density changes | | | Organ issues | | | | | CCHF modifications w/ | | | | potential damage to | | | | heart/lungs | +-----------------------+-----------------------+-----------------------+