Wilkinson, Susie PhD; Lockhart, Karen; Gambles, Maureen; Storey, Lesley PhD
Cancer Nursing: September 2008 - Volume 31 - Issue 5 - p 354-360
Complementary therapies are increasingly being used in hospices and hospitals alongside orthodox treatments in an attempt to improve patients' emotional, spiritual, psychological, and physical well-being. An average of 31% of UK patients with cancer use some form of complementary therapy. Many UK cancer centers, out-patient units, and hospices are providing complimentary services. There is strong anecdotal evidence that complementary therapies assist in the palliation of physical and psychological symptoms. This systematic review examines the research evidence base for the effectiveness of reflexology in cancer care. The study reports the results of a systematic review following the Cochrane principles of systematic reviewing. No meta-analysis was possible. Studies were retrieved from a comprehensive search of electronic databases from their start dates. An initial search was carried out in 2003 and updated in 2005 to 2006. Eligible studies were randomized controlled trials, controlled before and after studies, and interrupted time-series studies. Participants were adults with a diagnosis of cancer, receiving care in any healthcare setting. Interventions were limited to reflexology carried out by a qualified therapist as distinguished from another healthcare professional carrying out a reflexology intervention. Outcome measures were patient-reported levels of physical and psychological indices of symptom distress and quality of life (measured using validated assessment tools).
Complementary therapies are increasingly being used in hospices and hospitals alongside orthodox treatments in an attempt to improve the patients' emotional, spiritual, psychological, and physical well-being.1 In healthcare, reflexology is probably one of the most frequently used complementary therapies.2 Reflexology is defined as the systematic application of pressure to specific reflex points on the feet (or hands) with the intention of promoting homeostasis. Working from the premise that reflex areas in the foot (or hand) are linked to principal organs and glands via energy zones, it is presumed that the application of pressure to these areas releases congestion and promotes the flow of energy.2 By enabling optimum circulation, helping to eliminate toxins, and aiding the major systems of the body (immune, nervous, and glandular), it is purported that the therapy helps to promote and restore balance.3
An average of 31% of UK patients with cancer use some form of complementary therapy.4 Many UK cancer centers, out-patient units, and hospices are providing complimentary services.1 According to the Macmillan Cancer Support, the most common complementary therapies offered are massage, aromatherapy massage, reflexology, relaxation therapy/imagery, hypnotherapy, and acupuncture/acupressure.
There is a strong anecdotal evidence that complementary therapies assist in the palliation of physical and psychological symptoms. This systematic review examines the research evidence base for the effectiveness of reflexology in cancer care.
The objective of this study was to assess the evidence of reflexology in improving physical and psychological well-being in patients with cancer. Specifically, it aimed to determine the following:
whether reflexology reduced physical symptoms such as pain, nausea, fatigue, and constipation,
whether reflexology reduced psychological symptoms such as anxiety, and
whether reflexology improved quality of life and produced any unwanted adverse effects.
The search (summarized in Box 1) was undertaken according to Cochrane principles of systematic reviewing.
The databases which were searched (listed in Box 1) were used to obtain relevant studies for this review. No language restrictions were applied. MeSH keyword terms were modified as necessary for each database searched. The search was not restricted by the application of methodological filters in case this eliminated a number of the "best available" studies, should there not have been any trials which fully met the inclusion criteria.
The review sought the following:
randomized controlled trials (RCTs), controlled before and after studies, and interrupted time-series studies;
adult participants with a diagnosis of cancer receiving care in any healthcare setting;
reflexology carried out by a qualified therapist; and
patient-reported levels of physical and psychological indices of symptom distress and quality of life (measured using validated assessment tools).
One reviewer screened the titles and abstracts and eliminated those which are clearly not relevant to reflexology. Two reviewers then independently screened the remaining titles and abstracts to derive a list of studies potentially eligible for inclusion in the review. When necessary, full copies of studies were retrieved. The full texts of all potentially eligible studies were obtained for independent review by 2 to 4 reviewers. Disagreements regarding inclusion or exclusion were resolved by discussion between the reviewers. Studies that met the inclusion criteria are described in Table 1; studies that were excluded and the reason for their exclusion at this stage are listed in Table 2.
Many asthma patients seek alternative or adjunctive therapies. One such modality is reflexology, whereby finger pressure is applied to certain parts of the body. The aim of the study was to examine the popular claim that reflexology treatment benefits bronchial asthma. Ten weeks of active or simulated (placebo) reflexology given by an experienced reflexologist, were compared in an otherwise blind, controlled trial of 20+20 outpatients with asthma.
Objective lung function tests (peak flow morning and evening, and weekly spirometry at the clinic) did not change. Subjective scores (describing symptoms,β2 -inhalations, and quality of life) and also bronchial sensitivity to histamine improved on both regimens, but no differences were found between groups receiving active or placebo reflexology. However, a trend in favor of reflexology became significant when a supplementary analysis of symptom diaries was carried out. It was accompanied by a significant pattern compatible with subconscious un-blinding, in that patients tended to guess which treatment they had been receiving.
No evidence was found that reflexology has a specific effect on asthma beyond placebo influence.
Author links open overlay panelS.WrightPh.D., BA (Hons), RGN, RM.(Research Fellow)af1U.CourtneyM.Med.Sc., RGN(Director)bC.DonnellyBN., ITEC. Dip. Reflexology & Aromatherapy. Cert.Ed.T.KennyITEC. Dip. Reflexology, Aromatherapy & Massage. Cert.Ed.C.LavinITEC. Dip. Reflexology, Aromatherapy Massage & Nutrition
Awareness has increased among health-care professionals, patients and the general public of the importance of a holistic approach to cancer care. Psychosocial interventions, including complementary therapies, may help to improve the quality of life (QoL) of people with cancer by helping to reduce the distress associated with the diagnosis and treatment of cancer and by facilitating improved psychological adjustment to the experience of cancer. The following article presents anecdotal findings at ARC Cancer Support Centre Dublin, Ireland, of clients' perceptions of the benefits of reflexology interventions on their QoL. Reflexology interventions were perceived to impact positively upon clients' levels of impairment and functional status, including physical and psychological function, with implications for general health perceptions. The paper discusses how these findings might form the basis of further, more rigorous evaluation of the benefits of reflexology for people with cancer at ARC Cancer Support Centre.
“Reflexology: An intervention for Advanced Breast Cancer”
Completed 2010, NCI grant #R01 CA104883-01A1, $3,127,692,
clinicaltrials.gov identifier #, NTC01577420
Reflexology is safe.
Reflexology is a specialized therapy; it is not foot massage.
Significant improvement in dyspnea (shortness of breath) and ability to function in everyday activities such as walking up a flight of stairs or carry a bag of groceries.
"Home-Based Symptom Management via Reflexology for Breast Cancer patients”
Completed April, 2018, NCI grant #R01 CA157459-01, approx. $3,000,000.
clinicaltrials.gov identifier #, NTC01582971
The total symptom scores showed significant improvement after reflexology. This total symptom improvement was led by the strength of improvements in fatigue and pain. The list of symptoms below were the ones showing improvement in the total symptom score.
Distress or being upset
Shortness of breath
Difficulty remembering things
Lack of appetite
Dry mouth or sore mouth
Numbness and tingling
“Using SMART Design to Improve Symptom Management Strategies Among Cancer Patients”
NCI grant # R01 CA193706
2015-2020. Cancer Clinics in Michigan, Chicago, and Arizona worked with this study. Results available soon-
All three studies were multi-site, longitudinal, randomized clinical trials and funded by the National Institutes of Health.
Gwen Wyatt, PhD, RN, FAAN
Alla Sikorskii, PhD
(Michigan State University, College of Nursing)
Lead Reflexologist 2008-2016, Chicago cancer clinics & 2016-2020, Michigan, Chicago & Arizona cancer clinics: Sarah Preusker.