PEP Topic 

Reflexology involves applying pressure to areas of the feet and hands, using the thumb, fingers, and hand on specific zones of the feet or hands that reflect other areas of the body. Pressure is applied to specific areas to create a change in the related part of the body. Reflexology has been evaluated in patients with cancer in the management of pain, anxiety, dyspnea, fatigue, and depression.

Effectiveness Not Established

Research Evidence Summaries

Wyatt, G., Sikorskii, A., Rahbar, M. H., Victorson, D., & You, M. (2012). Health-related quality-of-life outcomes: a reflexology trial with patients with advanced-stage breast cancer. Oncology Nursing Forum, 39, 568–577.

doi: 10.1188/12.ONF.568-577

Study Purpose:

To evaluate the safety and efficacy of reflexology.

Intervention Characteristics/Basic Study Process:

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.

Sample Characteristics:

  • 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

Phase of Care and Clinical Applications:

The study has clinical applicability for late effects and survivorship.

Study Design:

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

Measurement Instruments/Methods:

  • 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.

Nursing Implications:

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.