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Clients with Cancer

by Sree Roy | May 17, 2013
“I admit, and have even been told, that I can be a bit anal when it comes to keeping my salon nice and clean. ­Sanitation was high on my priority list even before I started working with at-risk clients,” says ­SPAtaneity LLC founder Missy Malone, shown here performing a manicure on a client with cancer.

“I admit, and have even been told, that I can be a bit anal when it comes to keeping my salon nice and clean. ­Sanitation was high on my priority list even before I started working with at-risk clients,” says ­SPAtaneity LLC founder Missy Malone, shown here performing a manicure on a client with cancer.

It may seem odd that in the jumble of appointments that befall a woman with cancer — from radiation to chemotherapy to pharmacy medication pick-up — that she would want to add another appointment to her vast to-do list. But, in many cases, an appointment at the nail salon may be just what the doctor ordered.

“We are an ear to listen and chat and laugh. Hand care particularly is soothing and provides a sense of connectedness,” says licensed manicurist Sheila Fredriksen, who developed a class called  Oncology Manicuring 101 and is CEO/founder of natural beauty brand Nontoxique. “Studies have shown that hand holding is the number-one form of intimacy and, for someone going through a challenge such as cancer, the touch alone can be very comforting.”

Indeed, 75% of oncologists consider the non-medical aspects of cancer care to be very important. This is according to a survey commissioned by the Personal Care Products Council Foundation, a charitable organization established by the Personal Care Products Council, the founder of Look Good Feel Better, a public service program that teaches beauty techniques to cancer patients. In that study, 82% of oncologists who have had female patients participate in a support program believe they are extremely or very effective. And nine out of every 10 female cancer patients who have participated in a support program feel that the program lived up to or exceeded their expectations.

A little glitter can go a lon way in making a hospitalized client feel better, ­as evidenced by these lovely rockstar nails created by nonprofit Polished Girlz.

A little glitter can go a lon way in making a hospitalized client feel better, ­as evidenced by these lovely rockstar nails created by nonprofit Polished Girlz.

Plus, manicures and pedicures can help clients observe abnormalities related to the cancer or its treatment, which may be appearing in the hands or feet and that may otherwise have gone unnoticed. “We can be a set of eyes for change they might not otherwise pay attention to or share with their doctor,” Fredriksen says.

Due to some special circumstances such as a compromised immune system (see “5 Common Conditions” on page 3), the bodies of clients with cancer should be treated with special care. But when it comes to caring for your client’s mind and spirit, you should know that your client with cancer most likely just wants to be treated like any other client. The nail salon may be her one moment of normalcy in an otherwise chaotic time. “If a client is an established client, you will know to what degree you can discuss her journey [with cancer], or not.” Fredriksen says. “Maybe she is very spirited and life goes on as usual. If a client is new to you, the best way to determine what you will talk about is to use a client intake form. This is a great way to lead into your educating her about specific needs and finding out what her hobbies and regular activities are that have nothing to do with the cancer. This can help direct conversation toward positive things she loves. This is something that will go far in creating a relaxing experience for her and building a relationship.”

Fredriksen adds that you don’t need to worry about clients with cancer missing their scheduled appointments due to being sick and certainly not more than you worry about that with any other client. “Unless a client is coming in close to treatment administration and it’s understandable she might not be feeling well, I personally recommend treating cancellations as you would for any other client. It’s unlikely that a licensee will see a client after chemo or radiation as she is more likely to be somewhat tired and not feeling well enough, not to mention not approved by her doctor to be coming back in just yet,” Fredriksen says.

Missy Malone is the founder of SPAtaneity LLC in Fort Worth, Texas, a mobile salon that works with patients in hospital oncology and rehab wards including at Baylor Medical Center at McKinney and the Center for Cancer and Blood Disorders at Fort Worth. Malone also opened a SPAtaneity location in the city’s medical district, where she deals with many at-risk clients, many of whom she met in the hospitals. “Prior to working within the medical community, I always knew I wanted to offer natural nail care in an eco-friendly manner. However, it wasn’t until I got the opportunity to render services in the hospital’s oncology ward that I knew I wanted to do more to make these clients’ time with me as relaxing, enjoyable, and memorable as possible,” Malone says

The mission is simple. Malone says, “I know I’m not performing rocket science by any means, but if I’m able to restore my client’s femininity or give someone a sense of normalcy for an hour or so, mission accomplished.”

Next page: Client Information Questionnaire and What Services to Offer

[PAGEBREAK]Client Information Questionnaire

You should already have a questionnaire for all new clients, as it’s a great way to find out what each specific client is expecting from her services, what problems and preferences she has for her nails, and even what her birthday is (in case you want to send her a card or offer a discount). Make sure to add these questions from the International Pedicure Association (IPA) client questionnaire so you get a heads-up on clients with cancer and other relevant conditions:

> Do you have any current medical or health conditions, such as diabetes, cancer, skin conditions, infections, or contagious disease, or are you undergoing kidney dialysis?

> Do you have any known problems or conditions with your feet or legs? If yes, please provide details including the site of the problem or condition.

> Have you suffered from any recent injuries or illnesses? If yes, please give details.

> Are you taking any medications, whether prescribed by a doctor or over the counter? If yes, please provide details.

> Do you have any allergies to medications or products? If yes, please provide details.

Offer This, Not That

Offer This Not That
Offer natural nail care only. Don’t cut cuticles as they are a line of defense against infection. Filing nails is preferable to cutting. If there are any nail abnormalities, you may even want to skip polish application. Don’t offer nail enhancements, whether they be acrylics, gels, or ­another medium. You don’t want something semi-permanent ­covering up the nails, plus the client’s nails may not be in good ­condition for the removal process.
Offer waterless services. “One of the most common side effects I’ve had to deal with is weak, dry, brittle nails. I offer waterless manicures and pedicures because soaking can cause more dehydration and dryness to skin that’s already fragile,” Malone says. Most of our expert sources we spoke with recommended waterless services; however, the IPA’s executive director Suzanne Foote says that “many products used in place of soaking are very harsh on the skin.” Foote recommends soaking the feet — not in a salt-based foot soak — for no longer than five minutes. Pat the feet dry after soaking.

Autoclave implements. Regarding Fredriksen’s Oncology Manicuring 101 class, she says, “Although we will train you in oncology manicuring once your prerequisites are met, we will not do so without an agreement that an autoclave sterilizer be implemented. Only then can a spa or salon participate in our hospital to spa program and be promoted.” Tools that can’t be put in an autoclave should be thrown away. Don’t cut corners with sanitation, disinfection, and sterilization. ­Clients with cancer are more susceptible to infection than other ­clients, and the consequences of an infection can be disastrous.

Practice other aseptic protocols to protect the client. This means wearing gloves and cleaning surfaces throughout the day, including doorknobs and product bottles. You may want to opt for jet-free basins to ensure every inch is perfectly clean. Don’t eat at your workstation, thereby potentially contaminating it. Go above and beyond state board mandated standards to create a safe environment for clients with cancer.

Mild products are best. The client’s doctor may have recommendations. New product lines are also evolving for clients with cancer that you can investigate. You may also want to carry product lines that donate a portion of their proceeds to fighting cancer. Avoid products with strong smells, which can cause nausea in ­clients with cancer. Avoid harsh exfoliants. There is much controversy over which product ingredients have been linked to cancer; do research to decide what products you are comfortable with.
Create a scent-free environment. “I use candle warmers and meltables. I find the aroma to be less overwhelming,” Malone says. You may want to pass on those morning squirts of perfume around clients with cancer and other chronic conditions.
Offer reflexology, lymphatic massage, and feather massage techniques, if you are trained in the use of these techniques. Don’t massage a client with cancer without the OK from the client’s physician. It can aggravate the side effects of cancer treatment.
Retail products used in the service for at-home care. Clients with cancer may be struggling with dry skin and nails, so a good cuticle oil and a well-researched moisturizer can help them out at home. Don’t let clients with cancer purchase products for their personal at-home use that have harsh ingredients or that you haven’t ­researched well.


Next page: 5 common conditions and how to handle them

[PAGEBREAK]5 Common Conditions

Whether caused by the cancer itself or by the side ­effects of chemotherapy and other treatments, clients with cancer may showcase some of these special conditions. Here’s how to handle them.

1. Lymphedema (swelling caused by lymph accumulating in the tissues)
Get a doctor’s permission before massaging a client with lymphedema. You don’t want to move the lymph around in a way that causes negative effects. Massage requires modification in both techniques and pressure, so a ­special class on lymphatic massage (which generally involves very light effleurage stroking up the leg toward the heart only) is recommended. Janet McCormick, vice president of education and managing partner at the ­MediNail ­Learning Center, adds that clients with ­lymphedema should not be soaked during a pedicure.

2. Dryness and sensitivity of the skin
Many physicians treating cancer recommend specific prescription or over-the-counter moisturizing and healing ­lotions and other treatments. “If there are no recommendations, the tech needs to seek out unscented and gentle products with highly humectant ingredients,” McCormick says.

3. Peripheral neuropathy (nerve damage)
Clients suffering from peripheral neuropathy may not be able to tell you if you are hurting them or even if you knick them. If you use hot towels for treatments, Fredriksen recommends letting towels cool down a bit or using cool towels altogether. She also cautions you to be gentle with your touch. “Surprisingly what doesn’t seem painful to you might be painful to them,” Fredriksen says.

4. Dry or brittle nails
Perform a waterless service. Use a file with a gentle grit. Use a gentle cuticle oil on the nails. If you notice other abnormalities of the nails, have the client check with her doctor if polish is OK for her nails and what prep work (if any) is acceptable.

5. Compromised immune system
Go above and beyond with your cleanliness standards. Don’t use any invasive techniques such as trimming cuticles or cutting calluses. Sterilize all implements using an autoclave or throw them away after one use. Wipe down with disinfectant all surfaces the client may come into contact with from the desk to the chairs to the reception desk to the light switches.

A Note on Doctors’ Notes
Many doctors will inform clients when beauty services are off limits during cancer treatments and will give them the green light when hand and foot services are OK. But that’s not always the case. If a client tells you she’s going through treatment and is unsure if her doctor OK with her having a service, Fredriksen offers this advice: Explain to the client it’s your policy to have a doctor’s note on file to verify that treatments are allowed. If a client has to bring a note, offer her an upgrade on her next visit or a gift card she can use toward another spa service, such as a facial, especially if you have staff trained in oncology esthetics.

What If a Client Loses Her Battle?

Sam Rivenbark, a nail tech at East Coast Acrylic in Edenton, N.C., provides mani-pedi house calls to ­clients with cancer as part of a community service program called The Mani-Cure Project. Even if a ­client loses her battle with cancer, you can still ­offer one more nail service. “Not only should you go to the funeral but I would also offer my services to the ­family,” Rivenbark says. “Some techs may not be able to due to clients’ families’ beliefs, but others will give you the name of the funeral director and home so you can make sure even in their final resting that their nails are as amazing as they were.”

Next page: Continuing education classes

[PAGEBREAK]

Continuing Education Classes

Want to learn more? These classes geared toward beauty professionals will help you safely service clients with cancer.

Oncology Manicuring 101
Run by: beauty brand Nontoxique
You’ll learn: A foundational introduction to working with ­clients with cancer, including knowledge, modules, products, home care, business integration, and a ready-to-go hospital to spa “Cancer Care Package” to start outreach immediately.
More information: www.nontoxique.com

The Advanced Nail Technician Certificate Program (ANT-C)
Run by: MediNail Learning Center
You’ll learn: How to work safely, especially on clients such as those with cancer and other chronic conditions, including ­service precautions. The class also discusses how to convince podiatrists and other physicians to refer their patients to ­salons. The learning center also offers a Medical Nail ­Technician Program, which instructs you on how to work in a podiatry office.
More information: www.medinails.com

Monthly Educational Webinars
Run by: International Pedicure Association (IPA)
You’ll learn: IPA webinars on infection control will help you properly handle at-risk clients such as those with cancer. The IPA also plans to offer a webinar specifically on servicing ­clients with cancer. The current webinar is always highlighted on www.pedicureassociation.org.
More information: E-mail info@pedicureassociation.org for a webinar invitation.

Certified Master Pedicurist (CMP) 4-Day Program; Infection ­Control 1-Day Program
Run by: North American School of Podology
You’ll learn: The CMP program includes information on the ­implications of chronic illnesses on pedicures, diseases and disorders of the skin and nails, and sanitation, disinfection, and sterilization. The Infection Control class covers proper ­cleaning and disinfecting of foot baths, disinfectant ingredients, microbiology, and personal protective equipment. ­Higher-level classes are also offered: Comprehensive Foot and Leg Evaluation; Advanced Skin and Nail Pathology, ­Diabetic Foot Syndrome; Residence Practicum; and Enhance Your Massage Techniques.
More information: www.northamericanschoolofpodology.com

Next page: Volunteer Organizations

[PAGEBREAK]

Beauty Bus provides free beauty and grooming services to chronically or terminally ill men, women, and children and their caregivers. Beauty Bus recently began compensating beauty professionals for their time during in-home visits in order to shorten the wait time for clients and recruit more beauty professionals to join in the organization in fulfilling its mission.

Beauty Bus provides free beauty and grooming services to chronically or
terminally ill men, women, and children and their caregivers. Beauty Bus recently began compensating beauty professionals for their time during in-home visits in order to shorten the wait time for clients and recruit more beauty professionals to join in the organization in fulfilling its mission.

Volunteer Organizations


Look Good, Feel Better
What it is: A non-medical, brand-neutral public service program that teaches beauty techniques to cancer patients to help them manage the appearance-related side effects of cancer treatment. All volunteer ­beauty professionals are trained and certified by the Personal Care Products Council Foundation, the American Cancer Society, and the Professional Beauty Association | National Cosmetology Association at local, statewide, and national workshops.
Service area: across the United States, plus available in many other countries (for a complete list, visit www.lookgoodfeelbetter.org/programs/international-programs)
More information: www.lookgoodfeelbetter.org


Beauty Bus Foundation
What it is: Its mission is to deliver dignity, hope, and respite to chronically or terminally ill men, women, and children and their caregivers through beauty and grooming services and pampering products. Volunteer training sessions cover Beauty Bus policy and history, the ­diseases the foundation services, and information on what to expect as a volunteer. Other recent educational events have included a session with nail tech and esthetician Karen Hodges, a cancer “thriver” who spoke about her research and experience from the perspective of both a beauty professional and patient.
Service area: in-home services in California’s Los Angeles, Orange, and Ventura Counties; one-time “pop-up salons” for 2013 will include ­Chicago, New York, Las Vegas, and Massachusetts.
More information: www.beautybus.org



Polished Girlz
What it is: It brings sparkle to the lives of girls with special needs or frequent hospitalizations by bringing the trendiest nail art parties to them, while teaching them the importance of hand washing to reduce infection rates and repeated hospital admissions. Volunteers as young as 8-years-old are accepted. Training in four modules — ­etiquette, hand washing, compassionate care, and how to polish — is provided to volunteers.
Service area: across the United States, plus Canada, Australia, Kuwait, and South Africa (additional volunteers especially needed in Atlanta and Kansas City, Mo.)
More information: www.polishedgirlz.org


The Mani-Cure Project
What it is: Started by a nail tech with a family history of cancer, it ­provides in-home nail services to women with cancer.
Service area: Chowan County, N.C.
More information: manicureproject@yahoo.com; www.facebook.com (search “East Coast Acrylic,” the name of founder Sam Rivenbark’s nail business) 

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