Cancer and modality contraindications

[mdeflorio]

Working in an outpatient setting. There is alot of controversy concerning the use of modalitites (ultrasound, estim, massage) for those patients with either active or a history of cancer in dealing with the referring physicians. We all want to provide the best care for our patients but without compromising safety. Some colleagues say that all modalities are OK, others say that as long as the patient has been in remission for 5-7 years, others say just not at the cancer site. Any recent literature as to the recent thinking? It seems that the texts make the issue that much more cloudy.

[ali]

I can't refer you to any research studies. I know that typically, most books on any of the modalities list cancer as a contraindication, some as a precaution, for the fear of metastases caused by using the modality. One obvious difficulty in doing the research is how ethically you can use human subjects to test something that may cause their cancer to get worse (and yes, while not a PETA member, I am opposed to the torture of animals in the name of science).

Where I work, we generally shy away from modalities if there is any active cancer present (did you know that technically massage is also contraindicated?), even if the treatment site is distal from the known cancer site. And many of the therapists I know are also cautious about certain modalities even with a past history of cancer.

I do remember several years ago reading an article (online or in a journal, I don't remember) in which a nursing supervisor was discussing the use of modalities by physical therapists to reduce pain in a hospital or ward that specialized in oncology. I remember being surprised, even shocked, that those PTs felt comfortable going against what was in every one of my manuals -- like any health care professional, we are constantly aware of the issue of liability should things not go as planned. I don't remember where this hospital was, possibly in either California or Canada.

I'd be interested as well to see any research about the subject.

[mlb]

You must always put the patients' needs first. Take into consideration the reason for using the modality. Is the patient terminal anyhow and may get some benefit from the use of modalities? Or if the patient is in remission, is the use of modalities worth the risk of mets?

[ali]

I disagree. You must always put legality first, or you lose your license. And a patient's needs will no longer be met by you if you lose your license. If your primary resources say that the modality is contraindicated when a patient has cancer, you are potentially risking your career if you just go ahead and do it. One option here would be having a patient sign a consent form indicating that despite the risks and known statements of contraindication, he/she wishes the treatment to continue. Eventually, a family member could always argue that the patient wasn't in his right mind, and perhaps even your use of the modality on, say, a terminal patient may have hastened his death. And even in that case, is the use of that modality for a temporary relief of a symptom worth the risk that you take with above problems?