Reflexology

To evaluate the effects of reflexology compared to the effects of massage or usual care on the cancer-related quality of life, relaxation, mood, and adjustment of women with newly diagnosed early breast cancer

Women were randomized to one of three interventions: reflexology plus self-initiated support (SIS), scalp massage plus SIS, or SIS (treatment-as-usual control group). Patients receiving reflexology or massage received eight one-hour sessions at weekly intervals for eight weeks, beginning seven weeks after surgery. Patients were assessed by a nurse who was blinded to treatment allocation. Assessments occurred before randomization (week 6 after surgery), 18 weeks after surgery, and 24 weeks after surgery.

• The sample was composed of 183 patients. Sixty patients were in the reflexology group, 61 were in the massage group, and 62 were in the SIS group.
• In the reflexology group, mean patient age was 59.37 years (SD = 10.46 years); the age range was 32–81. In the massage group, mean patient age was 57.70 years (SD = 10.12 years); the age range was 36–76. In the control group, mean patient age was 59.36 years (SD = 10.23 years); the age range was 36–77.
• All patients were female.
• All patients had early-stage breast cancer.
• Patients were randomized six weeks after breast surgery. Randomization was not controlled for treatment type. The reeport suggests that most participants were receiving chemotherapy, radiation therapy, or both; the sample description does not make type of treatment clear.

• Multisite
• Outpatient
• United Kingdom

Phase of care: active treatment

Randomized controlled clinical trial

• Functional Assessment of Cancer Therapy-Breast (FACT-B)
• Trial Outcome Index (TOI)
• Mood Rating Scale (MRS)
• Hospital Anxiety and Depression Scale (HADS)
• Complementary Therapies Questionnaire (CMQ)
• Structured Clinical Interview for DSM-IV-TR disorders (SCID-IV-TR)

• At baseline authors noted no significant difference between groups on any measure or demographic variable.
• At the primary end point (week 18), TOI scores for the three groups differed significantly: Massage patients had significantly higher scores on the TOI (indicating better quality of life) than those receiving SIS (p < 0.03). MRS scores at the primary end point showed that massage and reflexology patients were significantly more relaxed (p < 0.0005) than were SIS patients.
• HADS scores did not differ significantly among the three groups.
• At the second end point (week 24), reflexology patients were significantly more relaxed (p < 0.02), according to TOI, than were SIS patients.

At the two end points, authors noted no significant differences in depression scores. This indicated that neither intervention had any impact on depression or anxiety.

• The study had a risk of bias due to no appropriate attentional control.
• Subjects had low levels of symptoms of interest, which may have affected the ability of the interventions to demonstrate impact.

Findings do not support the effectiveness of reflexology as a means of reducing depression or anxiety.

To evaluate the safety and efficacy of reflexology.

Patients were randomly assigned to one of three groups:  reflexology, lay foot manipulation, or the control. Certified reflexology providers administered the reflexology intervention in four weekly, 30-minute sessions. Foot manipulation providers were laywomen trained in the procedure. The laywomen delivered foot manipulation according to the relexology schedule. The control group received standard care. Study data were collected at baseline and at 5 and 11 weeks after randomization. Reflexologists and foot manipulation providers collected data after sessions at the planned time points.

• The study was comprised of 243 women with breast cancer.
• Mean age was 55.7 years.
• Most patients had stage III or IV breast cancer, and 79.67% had metastatic disease.
• The majority (83%) of patients were Caucasian, 65% were married or partnered, and 35% were employed. Educational level varied across the groups.
• Patients were excluded if they were in hospice care at the time of study entry.

• Multisite
• United States

The study has clinical applicability for late effects and survivorship.

The study was a three-group, single-blind, randomized, controlled trial.

• Short Form Health Survey (SF-36) Physical Functioning Subscale
• Functional Assessment of Cancer Therapy–Breast (FACT-B)
• Brief Fatigue Inventory (BFI)
• Brief Pain Inventory (BPI)
• State-Trait Anxiety Inventory (STAI)

At baseline, scores regarding anxiety and depression, according to the Center for Epidemiologic Studies Depression Scale (CESD), differed significantly (p < 0.01) across study groups. No differences were found regarding quality of life and symptoms of depression, anxiety, pain, or nausea. Those receiving reflexology reported lower levels of dyspnea than did the other two groups (p ≤ 0.02). Patients getting foot manipulation from laywomen had lower fatigue scores than did the controls (p < 0.01). Further analysis showed that the effect on fatigue was mediated by changes in dyspnea. Eleven percent of those in the foot manipulation group and 10% of those in the reflexology group did not complete all the sessions. The intervention had no adverse effects.

The findings suggested that reflexology may improve the symptoms of dyspnea and that foot manipulation may help reduce fatigue in women with advanced-stage breast cancer. The authors noted no effect of reflexology or foot manipulation on pain, anxiety, symptoms of depression, or nausea.

• The study had important baseline sample and group differences.
• The study had a risk of bias due to the lack of blinding.
• The findings were not generalizable; the study was underpowered in regard to detecting planned differences in patient outcomes.

The findings did not indicate that reflexology and foot manipulation affected pain, anxiety, symptoms of depression, or nausea among women with advanced breast cancer. The study demonstrated that these interventions are safe for the type of patients who participated. Reflexology and foot manipulation are low-risk interventions that may be helpful to some patients. Laypeople and caregivers could be taught these techniques, which may provide a meaningful way for these people to be involved in symptom management.