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Palliative care
Comments and contributions are welcome
Introduction A review of the literature Using aromatherapy in palliative care
In a recent House of Lords Report into Complementary Health Practices, aromatherapy is recognised as having a valuable part to play in palliative care. (see Summary, paragraph 3). Buckle (1997, p227) describes palliative care as "alleviating the effects of disease without curing" and refers to the holistic and caring approach needed to achieve this.
There is much misinformation about how to treat the terminally ill, particularly regarding massage and cancer. Much is based on early fears developed while aromatherapy training was beautician-based, with therapists having little knowledge about the pathology of disease and the effects of massage in 'spreading' cancerous cells. Nowadays it is generally recognised that aromatherapy and massage with the terminally ill or in palliative care, particularly in the later stages of disease can have great benefits (Price et al. 1999, p247), the only precautions being to avoid the cancerous sites, treatment areas or deeper lymphatic massage if secondary cancers are present.
Aromatherapy and massage in palliative care: A review of some of the literature
Touching Cancer Patients:
Guidelines for Massage Therapists by Donna Williams
Provides guidelines for massage therapists who wish to work with cancer patients
to provide emotional relief as well as helping with pain, oedema and
nausea.
"Cancer Treatment Programs" and "Easing the Chemotherapy
Experience with Massage" 1998, 1999, 2000 Massage Magazine
Easing the Chemotherapy Experience with Massage by Gayle MacDonald
Massage to ease the side effects of cancer and cancer medication, the therapist
providing comfort through touch and assisting with relaxation techniques.
"Touching Cancer Patients" and "Cancer Treatment Programs"
1998, 1999, 2000 Massage Magazine
Breast Cancer by Brennan, M. J. and Weitz, J. Lymphedema
A case study using self massage with lymphodema.
American Journal of Physical Medicine & Rehabilitation, 71(1), 12-14.
2-1992.
Massage Therapy for Breast Cancer by Hernandez-Reif, M., Ironson, G., Field,
T., Weiss, S., Katz, G., Fletcher, M.A. & Burman, I.
Using massage to decrease stress hormone levels, help depression, enhance the
immune system and increase quality of life.
The benefits of touch an RCCM database listing the many benefits both physically and emotionally of the therapeutic use of touch and massage.
Complementary and alternative interventions in cancer Complementary and alternative interventions in cancer lists aromatherapy as a useful complementary approach, with guidelines on how to select a practitioner and what to expect from treatment.
Using aromatherapy and massage in palliative care
General safety considerations
Dilution: clients who are immobile, inactive and seriously ill will have slower metabolism than an ordinary healthy active person, therefore the dilution of essential oils to carrier must be adjusted accordingly to between 0.25 to 0.1% depending on the area to be treated and the contraindications of each oil used.
Massage: It is generally recommended that massage should avoid cancer areas, treatment areas (radiotherapy, surgery), cannula and intravenous sites, associated bruising, recent scars and tissue damage etc.
Oedema: unless qualified in treating lymphodema in a palliative context, deep massage on areas of oedema should be avoided. Light brushing and surface stimulation is normally regarded as acceptable to help increase immediate surface circulation, distract from discomfort and re-hydrate taut and dry skin with the moisturising effect of a carrier oil.
Permission and Guidance: Professional Aromatherapy Practitioner guidelines always require therapists intending to treat a client with a life-limiting illness to seek permission from the clients GP or Consultant if in a hospital setting.
Caution: Many Consultants and GPs with little knowledge about the effects of essential oils are willing to approve aromatherapy treatments because in their view, treatment will do no harm (especially in palliative care) and may neglect to inform the practitioner of relevant past medical history which may indicate certain precautions. It is therefore essential that Therapist using essential oils are knowledgeable about the oils and massage techniques they are using, particularly regarding the potential irritating effects of some common expectorant and mucolytic oils with asthma and lung cancer; the interaction of essential oils with medication; the effects of certain neuro-stimulating oils and the potential for seizures when neural tumours are involved.
Access to essential oils: In a hospital or hospice setting, there may not be any importance placed on the appropriate storage and purchase of essential oils. It may be up to you as a serious practitioner to help design protocols and guidelines for treatment records, storage of oils, and ongoing training for the medical staff.
Treatment
As treatment is palliative in nature, emotional needs are just as important as the physical needs which may are being looked after by conventional medication. Clients undergoing chemotherapy may need immune-stimulating oils to help support their compromised immune system. Essential oils can be used as sprays and vaporisers to mask unpleasant odours from wounds associated with certain invasive cancers or colostomy bags. Bedridden clients will benefit from the deodorising effects of essential oils used as part of their wash routine, and fragrances such as ginger, lemon or peppermint can be used to help address poor appetite and nausea. Relatives can be shown how to massage their partners hand and arms to help them feel able to contribute more to the emotional needs of their loved one in times of distress and frustration at not being able to help more.
Bedridden or inactive clients will benefit from massage to help increase the circulation and alleviate aches associated with lying or sitting for long periods. Massage can also be used as a distraction while medication takes its time to work, or to interrupt the pain signal pathway to provide temporary relief.
Recommended oils
Using essential oils during chemotherapy treatment takes special care and precautions. Price (1999) recommends a dilution of 4 drops of essential oil to 50 ml carrier, (p249). She also recommends skin patching first to safe guard against a skin reaction (skin at this time can be more susceptible to reaction). There are also special precautions for massage which should be done by a qualified therapist (unless confined to non-cancerous areas such as the hands and feet).
Essential oils such as peppermint, ginger and cardamom can help with nausea and can be used as a spray well diluted, or in a vaporiser. It would be best to avoid EOs with oestrogenic properties such as fennel, aniseed, clary sage and sage, naouli and geranium, and possibly rose (Buckle (1997 p223), because oestrogen is thought to feed some kinds of tumour.
Lemongrass, Dill and Caraway are all thought to have anti-carcinogenic properties (Buckle p223), and Lavender (angustifolia), Lemon and Frankincense would be very safe oils to choose for their antiseptic, antibacterial and emotional properties. Sweet marjoram would also be another good one to try as it is one of the safe oils and is a good general anti-infectious and calming oil.
It is also important to make a blend which is pleasant to the client to help on an emotional level and choosing the appropriate oil can be made into an important part of building the therapeutic relationship.
Please note that essential oils cannot cure cancer, but can help in other ways with their anti-infectious and stress relieving properties.
Essential oils and contraindications in palliative care
Jane Ellwood July 2001