One in four people in the UK is likely to be affected by cancer at some time in their life and, for many, improvements in medical treatments mean that the disease will go into remission. In the UK a reduction of at least 20% of cancer deaths is expected in those under 75 years of age by 2010 (DoH, 2008). Cancer care has dramatically changed over the last three decades with an emphasis on early diagnosis and treatment, and an evidence-based approach to symptom management. Additionally, there is an international emphasis on improving lifestyles to reduce the impact of predisposing factors to cancer, with legislation and health campaigns focused on reducing smoking, obesity and abuse of alcohol and encouraging healthier diets and exercise. The role of reflexologists in assisting people making lifestyle changes is discussed in Chapter 13.

Cancer is not a single disease, but many, with different areas and tissues of the body affected. Diagnosis may follow investigation of unusual lumps, growths, persistent pain, and changes in weight or bleeding. Some cancers are difficult to diagnose and/or patients may be fearful of seeking medical advice. As the disease progresses, secondary growths, or metastases, may occur in other areas of the body. Treatment can include surgery, chemotherapy, radiotherapy, steroids and hormones, with some of these in combination (Watson et al. 2005). If the disease cannot be brought into remission, the focus of medical care is to support the patients to live well, based on the aims of palliative care, which:

A European survey indicated that over 35% of people living with cancer will access complementary therapies, with high expectations of benefits (Molassiotis et al. 2006). When faced with a cancer diagnosis some patients may seek out ‘cures’ and can have unrealistic expectations of treatments. Therapists offering their services must be fully aware that under the Cancer Act, 1939, it is illegal to take sole responsibility for the treatment of people with cancer or to imply or make a promise of ‘cure’. ‘Healing’ as distinct from ‘curing’ must be differentiated when engaging with clients about therapeutic outcomes. For example, a treatment might be a ‘healing’ experience, improve well-being and assisting with symptom management, but makes no discernible difference to disease progression (see Case Study 12.4).

The term ‘resilience’ has been used to describe the ability of people to cope with major life stresses (Hunter 2001). A resilient individual will confront adversity and find a way of coping, surviving and even thriving (Garmezy 1991). The capacity to meet, cope with and overcome adversities can be developed and enhanced, given the right conditions and support. Moorey and Greer (1989), in their work with people who had received a cancer diagnosis, identified and classified the following coping styles:

These styles may be perceived as negative but need not be adhered to rigidly; for example, positive avoidance may be appropriate when spending time being involved with pleasant things and not dwelling on worries or concerns. Stoically accepting one’s situation can also be helpful; it is certainly a way of avoiding or containing anxiety. Anxious preoccupation (going over and over fears/worries) and/or feeling helpless and hopeless will undermine an individual’s ability to cope and can be extremely overwhelming.

In contrast, the fighting spirit has been linked with survivorship, an approach to self-empowerment which is important and of great interest to patients, researchers, disease-specific support groups and therapists alike. This can be more complex than it first seems. For example, women with breast cancer, who have sought out radical and alternative means of staying well and fighting the disease, could be described as taking a heroine’s path, although women whose cancers have progressed can feel devastated for ‘failing’ and guilty for not doing ‘enough’ or not doing it ‘right’ (Gray et al. 1998). Survival strategies such as buying and preparing large quantities of fresh fruit and vegetables for juicing and completely excluding ‘junk food’ may be proactive and positive, but making these changes can be very difficult. Participants in Sinding and Gray’s (2005) study advocated a revised ‘spunky’ approach to cancer survivorship which embraces discussion of fears and concerns, living well, eating healthily, and engaging in therapies, such as reflexology, whilst even enjoying fun activities and ‘naughty but nice’ treats.

Reflexology can provide a nurturing source of support and comfort (see Fig. 12.1) for patients exhibiting these various coping styles. Those who are stoic or taking an avoidance stance may not be the first to turn to complementary therapies – and declining reflexology can be very empowering for them. Those in ‘fighting spirit’ mode may be clamouring to receive reflexology, while health professionals may refer patients who are anxious and preoccupied, or feeling helpless and hopeless, for much needed support. An understanding of coping styles informs our awareness of the varying responses to diagnosis and/or the challenges of treatment and can help therapists working in a cancer unit to accept when someone declines reflexology.

Reflexologists who specialise in treating patients with cancer need to consider their own resilience, as ‘burnout’ is a well-recognised phenomenon in cancer and hospice care (Isikhan et al. 2004). Burnout can lead us to distance ourselves from others, to feel physically and emotional unwell, exhausted and demotivated to work. Working with cancer patients can be emotionally challenging. Patients and their relatives need constant emotional support, which can be draining, and sometimes the work may cause therapists’ personal experiences of cancer to be relived or revisited, such as recalling a patient who died or a family member with a similar disease. It is essential to safeguard one’s practice and to incorporate strategies for self-protection, including taking time to reflect on practice experience, noticing personal uneasiness with different situations or tackling concerns which cause challenges at work. Supervision, coaching, mentoring and debriefing sessions can be invaluable, as can reflecting on events and experiences (see Ch. 5). Reflexologists should make arrangements to receive complementary therapies for relaxation and respite, and to develop positive coping strategies to manage personal stress and maintain resilience (Wilson et al., 2007 and Mackereth and Carter, 2006).

Reflexology students and some health professionals may be aware of controversial opinions about the safety of reflexology for people living with cancer and its treatments. Despite some commonly held beliefs, there is no published evidence to suggest that cancer is a contraindication to reflexology. Indeed, it is more often the therapist rather than the therapy that is contraindicated. The UK National Curriculum for Reflexology now asserts that students require knowledge of cancer and its treatments, as well as the skills to adapt treatments safely (O’Hara 2006).

These concerns rest on the belief that reflexology may cause further tissue trauma and even spread cancer, especially in patients with lymphoedema, altered haematological states (i.e. neutropaenia and thrombocytopaenia), neuropathy, deep vein thrombosis and/or metastatic changes. The reflexologist can always engage in some gentle holding or consider working on the hands if the feet are not accessible. The belief that reflexology will ‘spread cancer cells’ is unfounded, given that blood circulation and lymphatic flow are stimulated by everyday activities of daily living, such as taking a bath or walking (Hodkinson, 2001 and Hodkinson et al., 2006). When lymphoedema is present, treatment may be avoided on the affected foot to prevent detrimental tissue pressure, although the non-lymphoedematous foot or hand can be treated (White 2006). Creative approaches to delivering reflexology are described below.

Perhaps the two most undeniable contraindications to reflexology in this client group are those who consciously decline treatment, and those who are unable to consent to treatment. Additionally, patients with resistant infection which may be transferred to the therapist or others may mean that skin-to-skin contact must be limited. It is essential that infection control policies and practices are adhered to at all times, including thorough hand washing and drying before and after contact with each and every patient. In clinical settings, strict adherence to hand washing techniques and the use of alcohol hand-rubbing solutions is closely monitored and subject to spot checks by hospital staff. The practitioner must also take care of his or her posture when providing treatment to patients in bed, in a wheelchair and/or when surrounded by equipment and carers, to avoid working at an awkward angle, which may cause discomfort, pain, injury or even repetitive strain (Pyves & Mackereth 2002).

Some reflexologists believe that handling the patients’ feet and hands will cause them to become contaminated by the residue of cytotoxic drugs on the patients’ skin. Cytotoxic drugs are metabolised by the liver and by-products are excreted in urine and faeces (Dougherty & Bailey 2001), so cross-contamination should not be of concern to reflexologists who do not handle the drugs or patients’ body fluids. Also, there is no evidence of adverse reactions from reflexology for patients receiving chemotherapy. Indeed, the reduced anxiety, improvements in well-being, deep relaxation and decreased nausea and vomiting which result from reflexology treatment far outweigh the small risk of adverse reactions (Grealish et al., 2000, Stephenson and Weinrich, 2000, Smith, 2002 and Quattrin et al., 2006).

Radiotherapy treatment has also been considered a contraindication to receiving reflexology. However, since residual radioactive material is not present in the body following radiotherapy treatment, reflexology is safe for both the patient and the therapist (Faithfull 2001). In the case of treatments and diagnostic procedures involving implanted radioactive material, careful adherence by the reflexologist to the strict rules of contact applied to medical and nursing staff, relatives (especially intimate partners) and carers will eliminate any need for concern.