One day during her palliative care fellowship at the Dana-Farber Cancer Institute, Winnie Suen, MD, had an epiphany as she followed and observed a massage therapist on her rounds through the cancer clinic. Suen watched as the MT worked with a breast cancer patient. The patient’s arm was swollen and tender from treatment, so the therapist gently massaged the limb. After only 10–15 minutes, the grateful patient told the therapist that her pain had decreased and her anxiety was melting away. The response to massage was much better and faster than the results produced by medication—and without side effects.
A physician and assistant professor of medicine at the Boston University School of Medicine, Suen attends to geriatric and palliative care patients at Boston Medical Center (BMC). The palliative care patients she works with have various illnesses, such as cancer, dementia, heart failure, or lung disease. They may not be actively dying, but they are seriously ill and often receive medications for pain.
After witnessing such a positive patient experience, Suen studied to become a licensed massage therapist, graduating from the Cortiva Institute. Her goal then became bringing massage therapy to patients and staff in the hospital. She hopes massage therapy will continue to be seen as a medically beneficial treatment in a hospital setting, largely because she’s seen the positive results.
An Underserved Population
People with a variety of illnesses have turned to massage for relief, and some have sought massage on the advice of a doctor or physical therapist, but even though hospitals across the country are incorporating massage into their treatment protocols more frequently, many people still don’t think of massage as a typical hospital treatment. At BMC, massage therapy is working wonders for low-income, minority patients, improving their quality of life and helping them get through often-difficult treatments.
BMC is a private, nonprofit academic medical center, and was the general city hospital before merging 10 years ago with the Boston University School of Medicine. Today, it is the region’s largest health-care provider to indigent and uninsured patients. The cost-of-living index in Boston is very high, and approximately half of BMC’s patients fall below the poverty line. Half are either uninsured or covered by Medicaid, and nearly 70 percent are minorities. The hospital regularly provides more than $350 million in health- care services each year to patients who are unable to pay.
For the low-income patients at BMC, even the basics of treatment can be cost-prohibitive, and massage therapy has been unaffordable or just unavailable. In situations where it’s all one can do to simply treat an illness, it’s nearly impossible for these patients to even entertain the idea of trying and paying for alternative therapy.
Bringing Massage to the Hospital
Paula Gardiner, MD, was convinced that massage therapy could benefit the patients at BMC. Gardiner is the assistant director of integrative medicine in BMC’s Department of Family Medicine and an assistant professor at the Boston University School of Medicine. For more than 10 years, she has worked to integrate complementary therapies, such as massage therapy, with conventional medicine.
Acting on her convictions, Gardiner shepherded an application for a grant from the Muscular Therapy Institute Foundation. The foundation’s mission is to advance massage therapy by supporting projects that serve the underserved, train massage therapy practitioners in research skills, and further research in the field of massage therapy. Since 2007, the foundation has awarded almost $100,000 to researchers and community service organizations.
Ben Benjamin, PhD, founder of the Muscular Therapy Institute and the foundation, took a tour of BMC and was impressed. “I visited the hospital and was very moved,” Benjamin says. He noted important programs and initiatives, including a food pantry used to feed impoverished women and their families, 25 translators for patients whose first language is not English, staff lawyers to help patients navigate government assistance programs, and clinicians who give books to young patients to encourage literacy. “They are doing good work in the world,” Benjamin says.
“At BMC, massage was generally not available for poor people, and it is not usually covered by health insurance,” Gardiner says. “But regardless of income or skin color, patients can still benefit from massage.” Benjamin agreed, and the foundation granted funding to help bring massage therapy to the hospital’s underserved patients.
Not So Fast
Gardiner knew that to successfully integrate massage therapy into the clinical environment, they had to approach the process like a tortoise—slow and steady. Because massage was not traditionally seen as a therapeutic intervention, getting buy-in from nurses, doctors, and administrators was crucial. The hospital had to work to build awareness among the medical staff about the value of massage therapy.
The most successful way to do this was to let the staff experience firsthand the benefits of massage. Thanks to a private donor, Suen established a massage program that allowed staff members to receive 10-minute chair massages during their shifts. Over the course of a year, janitorial staff, medical students, nurses, pharmacists, and other coworkers received 250 massages. When the staff got a taste of massage and how good they felt afterward, they began to see the benefits of massage for patients.
Another potential barrier of bringing massage to the hospital was culture clash. Training in medicine and massage therapy often takes place in two very different worlds, Gardiner says. The languages spoken by each discipline are vastly different.
And, the environments are different, too. Very little massage therapy training takes place in hospital settings. In most massage training classrooms, there are no cardiac monitors or intravenous poles. At the hospital, the client is a patient and may be in a hospital bed, on an examination table, or in a waiting room.
An Increased Need in Oncology
One population the Muscular Therapy Institute Foundation’s initial grant helped was the group of low-income cancer patients at BMC. The funding allowed massage therapy to be used to help alleviate the symptoms associated with cancer and its treatment.
BMC’s cancer patients deal with not only the considerable physical and mental stress of cancer treatment, but also daunting social and economic challenges. The treatment itself can make a patient sick, requiring ongoing care and several trips back to the hospital. Oncology care magnifies the degree of need.
“One thing about cancer now is that as the medical treatment has improved, some types of cancers have resolved into more chronic diseases,” Gardiner says. “With breast cancer, for example, a woman may get surgery and radiation, or they may go on maintenance medications, and these medications often have side effects.” Cancer survivors who have finished with their initial treatment still may need to come to the hospital for follow-up treatment.
Massage treatments help alleviate symptoms and may increase a patient’s compliance with, and tolerance of, cancer treatments. With the grant funds, an estimated 360 cancer patients have received massage therapy to help alleviate depression, fatigue, nausea, pain, and stress. Many even received massage during chemotherapy.
Massage on Trial
Many cancer patients who are facing chemotherapy first undergo surgery to implant a port, an intravenous device that allows easy access for delivering the chemotherapy. The port goes into the chest wall under the collarbone and is usually removed six months after the end of treatments. The surgery is an invasive procedure, done under a local anesthetic rather than general anesthetic, so the patient is awake and must hold very still. It is often the first surgical procedure in a patient’s treatment for cancer and, not surprisingly, often causes significant anxiety.
During the port placement, patients must keep their heads turned 90 degrees to one side for about an hour. After the procedure, patients often experience headaches, muscle stiffness, and pain in the neck and shoulder for several days. They are usually given pain medications, which can prove to be inadequate.
As part of a grant from the Massage Therapy Foundation, Jennifer Rosen, MD, assistant professor of surgery at BMC, ran a randomized clinical trial to determine whether massage therapy was helpful in reducing anxiety before the port-placement surgery and decreasing pain. The trial served as a feasibility study to see if further research would provide any useful information. “We know intrinsically it can help,” Rosen says, whose specialty is surgical port placement. “But we need a study to prove the positive effects.”
In the study, 60 cancer patients undergoing port-placement surgery, most of them low-income minorities, received either massage therapy or structured attention in the form of empathetic listening. Those who received massage had two 20-minute treatments immediately before and after surgery.
Before the procedure, the patients were asked to rate their levels of anxiety using a standardized measure. They were also asked to rate their levels of pain on a scale of zero to 10, with 10 being the worst.
Massage seemed to be much more beneficial than empathetic listening for reducing anxiety before the procedure. “The results are statistically significant,” Rosen says. “We would like to run a full, clinical trial to study it further and support the provision of massage therapy at the hospital.”
A Different Kind of Touch
A third year of grant money from the Muscular Therapy Institute Foundation is now funding a pilot inpatient palliative care massage program. In palliative care, one goal is to help the patient live the best quality of life possible while enduring serious, chronic, or terminal illness. “If massage can help alleviate pain, provide relaxation, or relieve anxiety without the patient experiencing the side effects that can come with medication, then it’s worth it,” Suen says.
For a couple of hours each week, a massage therapist goes to the inpatient floors, gets a list of patients, and goes to their rooms, asking if they want a massage. The therapist spends 15–30 minutes with a patient and customizes the massage session, perhaps massaging only the hands or feet.
“The patients love it,” Suen says. “Many are older and crave human touch. Not just any touch, but a caring touch.” The kind of touch that a patient usually receives in a hospital can be very clinical, such as drawing blood or inserting an IV. Massage provides a different kind of touch, and the massage therapist says patients are often asleep or resting comfortably by the time the massage ends.
The nurses at BMC also love it. They notice their patients are happier and calmer after a massage. Suen would love to see the massage therapy services increase, if only there were more money. “If I could have a full-time therapist on our team, that would be great,” she says.
It’s Good for Everyone
Patients have described several benefits from the massage therapy they received at BMC. Some said the massage helped them feel more relaxed, soothed, and “loose.” Others reported an improved sense of well-being, more energy, more flexibility, and less muscle tension. Some patients reported that massage reduced their depression, fatigue, nausea, and pain.
Staff members and family caregivers have also benefitted from massage at BMC. One day per week, staff members can get a chair massage on site. The staff massage program at BMC is paid for through private funding rather than grant money.
Suen informally tracked some findings of the staff massage program to see if it was helpful. She asked staff members to rate how they felt before and after massage, and then give feedback. Findings showed that, even after only 10 minutes of chair massage, staff members reported reduced anxiety, pain, and stress, and returned to work with more focus and concentration. Staff members even make a point to sign up for shifts on the days the massage therapist will be there.
“Our staff don’t usually know how to take breaks,” Suen says. “Taking a breather does wonders.”
The Clinical Future of Massage Therapy at BMC
Now, after hundreds of patient and staff massages, BMC is looking to the future. After building momentum, getting staff members and administrators to embrace the concept, studying the effects of massage therapy, and expanding the availability of massage to different segments of their patient population, the team at BMC is eager to continue submitting grant applications.
Gardiner was never in doubt that massage therapy in the hospital setting at BMC would work, and the idea is gaining ground among other area hospitals, including Massachusetts General and Winchester Hospital. “To provide massage therapy to low-income patients, you have to think outside the box about how to pay for it,” she says, “At BMC, we believe that interdisciplinary teams are important for patient care. Working with the massage therapists has been a wonderful addition.”
Ann Ahlers is a Colorado-based writer and editor with experience in nonprofit marketing and communications. She has also worked as a high school English teacher and has held various jobs in the health-care, tourism, and travel industries.
To keep the massage program at BMC sustainable and continue services beyond the extent of the grant monies, BMC joined forces with the Cortiva Institute. Therapists can earn continuing education credits through the program and guest speakers in the course provide massage to cancer patients and their supporters.