Modern medicine has transformed death and dying. Whereas a "terminal" diagnosis once meant that death was more or less imminent, increasingly "terminal" illness refers to a chronic and potentially fatal disease. It begins with a diagnosis. That can lead to a protracted process that includes treatment, remission, possible relapse, treatment again and so on. In this way, death has become a process for millions of us, as opposed to the sudden event it once typically was.
In the course of writing "Saying Goodbye: How Families Can Find Renewal through Loss," we interviewed a great many patients, caregivers and family members. We were looking for common themes and experiences in an effort to draw a rudimentary "road map" of what families can expect -- and what they can do to make this process more manageable. One of the themes that emerged was the increasing use of alternative and complementary treatments (ACT's) conjointly with treatments such as chemotherapy, radiation therapy and surgery, all of which can have pernicious side effects.
As I did in my first blog on complementary treatments, I have tried to base this material as much as possible on objective evidence that can be found through the National Institutes of Health, the National Cancer Institute and the National Center for Complementary and Alternative Medicine (NCCAM). Recognizing that there are many advocates for various kinds of complementary therapies, I should make it clear that I am a clinical psychologist, not a massage therapist or Reiki practitioner. As a psychologist, however, I am well aware that it is possible to obtain testimonials attesting to the effectiveness of virtually any treatment. That is not to say that those treatments did not help those individuals. But that is not the same as controlled clinical research. I carry no brief for any complementary treatment, and I am open to the possibility of their effectiveness.
My previous blog looked at acupuncture. This one focuses on two additional therapies: Massage and Reiki. Conceptually, they are thought to work in somewhat opposite, yet perhaps complementary ways. Massage is a hands-on therapy that is based on manipulating tissue. Reiki, in contrast, is a hands-off (or light touch) therapy that seeks to free up innate bodily energy (ki) that is believed to have healing power.
Reiki, in its original form, is a self-administered treatment; however, it cannot be self-taught. One must learn Reiki from an experienced practitioner and it involves three levels of learning. As a complementary treatment, it has been used to treat many conditions. Although Reiki can theoretically be performed at a distance, in the cancer treatment centers where it is used, it is often applied in-person at one-to-one sessions lasting anywhere from 30 to 90 minutes. In these sessions the Reiki practitioner places his or her hands close to or lightly touching the patient's body, using as many as 15 different hand positions. The idea behind Reiki is that the practitioner is able to feel the flow (or lack of flow) of the body's energy (ki) and to free it up so as to facilitate the patient's overall health. Reiki can be a very calming and reassuring therapy for the patient who receives it.
Is Reiki Effective?
The Journal of Alternate and Complementary Medicine recently published a review of 12 clinical trials of Reiki. While nine of these investigators reported positive effects for Reiki, 11 of the 12 studies had serious methodological flaws, such as the lack of a control group and/or a comparison treatment. It is therefore impossible to say whether the reported effects were due to patients' expectations of benefit -- the placebo effect. In another review of research published in the International Journal of Clinical Practice, 205 studies were evaluated and boiled down to nine that were scientifically sound. The most common benefits of Reiki that were reported in these studies was in the area of relieving depression and anxiety. There were no substantiated results for pain relief. Finally, none of these studies has been replicated to show that the results can be reliably repeated.
If Reiki is effective, then, it is most likely to be with respect to patients' overall emotional state. That, of course, matters: Depression and anxiety are two side effects of medical treatments for cancer that are often overlooked.
According to NCCAM, the leading reason why Americans turn to massage therapy as an adjunct to cancer treatment is to help relieve pain. To the extent that massage is effective in relieving the physical aspects of stress (tight muscles, etc.), we could say that massage is also used to relieve stress. And surely treatment for cancer is stressful, for the patient as well as loved ones!
There are a variety of "schools" of massage therapy, but all of them involve the direct manipulation of bodily tissue in one way or another. In addition, the majority of massage therapists I spoke with said they incorporate a variety of techniques in their practice, including the use of pressure, deep muscle massage, body alignment and so on.
Is Massage Therapy Effective?
Keep in mind that we are talking specifically about the use of massage as a complement to cancer treatment, not its effectiveness in general. In a study funded in part by NCCAM, 380 participants were randomly assigned to receive either six 30-minute sessions of actual massage therapy or six three-minute sessions of simple touch therapy that did not include the kinds of methods cited above. Both groups showed significant reductions in reported pain, physical and emotional distress and overall mood. However, these effects were greater for the group that received actual massage therapy.
Two things strike me as important about the above findings. The first is that touch -- any kind of touch -- appears to be beneficial when you are fighting cancer, including the side effects of medical treatments. Second, the fact that these beneficial effects were not sustained after the massage therapy ended suggests that this form of complementary treatment needs to be ongoing as opposed to a one-time intervention.
One final note on massage: A treatment known as manual lymphatic drainage, in which massage is used to move fluid away from areas where lymph vessels are blocked, appears to be effective in reducing lymphedema associated with surgery for breast cancer.
Both Reiki and massage therapy are available to patients who reside (for free) at the Hope Lodge in Boston while they undergo treatment in one of that city's several major cancer centers. However, as people have commented in response to my earlier blog, it is a mistake to assume that a cancer treatment center -- even an expensive or well-known one -- will offer such services. Their availability may reflect in part the bias of the center's administration regarding the effectiveness of complementary treatments. So the best advice I can offer to these patients and their families is to pursue these options on your own if you think they might be worth a try.
Insurance may not cover complementary treatments; on the other hand, they are much less costly than any medical treatment, such as chemotherapy. And some have commented that it may be possible to negotiate rates, especially if several patients get together and seek a discount.
Perhaps as more rigorous research is conducted and reported we will learn more about which complementary treatments do what, and for whom. Surely all of the above symptoms -- anxiety, depression, pain -- complicate cancer treatment. To the extent they can be ameliorated, it makes sense to include them in a comprehensive treatment plan.
The "new grief" that is the result of the transformation of death and dying will affect every one of us eventually, if it hasn't already. Families do best when they approach terminal illness by learning about primary treatment as well as complementary treatment, and bringing both to bear.
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