Frambes, D., Sikorskii, A., Tesnjak, I., Wyatt, G., Lehto, R., & Given, B. (2017). Caregiver-reported health outcomes: Effects of providing reflexology for symptom management to women with advanced breast cancer. Oncology Nursing Forum, 44, 596–605.

To examine the effects delivering reflexology on caregiver (CG) psychological, physical, and social health outcomes (fatigue, anxiety, depression, pain, physical function, sleep disturbances, satisfaction in social roles, and pain interference), and to explore if effect of CG outcomes are moderated by selected CG and/or patient baseline characteristics.

CGs in the intervention group received 4 weeks of training on reflexology. CGs delivered at least one session of reflexology per week for four weeks in a row. The session involved stimulating nine foot reflexes using thumb-walking motion for 15 minutes per foot.

• N = 180   
• AGE: 54
• MALES: 56%  
• FEMALES: 44%
• CURRENT TREATMENT: Combination radiation and chemotherapy, immunotherapy
• KEY DISEASE CHARACTERISTICS: Advanced breast cancer
• OTHER KEY SAMPLE CHARACTERISTICS: Most were employed and had some college education, majority were Caucasian, had access to phone, were able to speak English

• SITE: Multi-site   
• SETTING TYPE: Outpatient    
• LOCATION: Eight cancer centers in central Michigan and Illinois

• PHASE OF CARE: Active anti-tumor treatment
• APPLICATIONS: Elder care, palliative care

This is a secondary analysis of data obtained from a two-group RCT (called Home-Based Symptom Management via Reflexology for Breast Cancer Patients that was conducted 2011-2016). Outcomes assessed at baseline, week 5 (one week after training completion), and week 11 between CG who delivered reflexology to their patients and those who did not.

PROMIS was used to assess the physical, psychological and social health outcomes. The number of reflexology sessions delivered was based on CG self-report through phone calls during the intervention period and from patients at week 11 after the intervention period.

CGs in the intervention group had improvements in fatigue at weeks 5 (p = 0.02) and 11 (p = 0.05). No other differences between the two groups were noted on any other outcomes. No significant association was found between the number of reflexology sessions delivered and any of the outcomes. Gender, patient-caregiver relationship, and caregiver comorbidity possibly moderated effects of reflexology delivery. Being female in the reflexology group moderated the effect of reflexology delivery; they had better physical functioning. Caregivers who were friends with women with breast cancer reported lower levels of depressive symptoms in the reflexology group. The number of comorbidity conditions was negatively associated with satisfaction with social roles in the control group but not in the reflexology group.

Delivering reflexology to patients by their caregivers may decrease caregiving fatigue; caregivers who are friends of patients may benefit (lower depressive symptoms) from delivering reflexology to patients. Female caregivers may potentially have different effects on their physical functioning (better) than male caregivers.

• Risk of bias (sample characteristics)
• Key sample group differences that could influence results
• Intervention expensive, impractical, or training needs
• Subject withdrawals ≥ 10%

Consider involving friends alongside familial caregivers. Caregivers’ fatigue may be improved by caregiver involvement in delivering alternative care measures (reflexology) to their loved ones; no other benefits appear to be gained otherwise.