Sharp, D.M., Walker, M.B., Chaturvedi, A., Upadhyay, S., Hamid, A., Walker, A.A., . . . Walker, L.G. (2010). A randomized, controlled trial of the psychological effects of reflexology in early breast cancer. European Journal of Cancer, 46, 312–322.

To evaluate the effects of reflexology in comparison with two comparator interventions (reflexology and massage) on cancer-related quality of life, relaxation, mood, and adjustment in women with newly diagnosed early-stage breast cancer

Women were randomized to one of three interventions:

• Intervention 1: reflexology plus self-initiated support (SIS)
• Intervention 2: scalp massage plus SIS (comparator intervention – identical amount of physical and social contact)
• Intervention 3: SIS (comparator intervention – treatment as usual; this was the 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 clinical and research specialist nurse (blinded to treatment allocation) before randomization (week 6 post-surgery), 18 weeks after surgery (primary end point 1), and 24 weeks after surgery (secondary end point). Seventy-five percent of women received all eight sessions of reflexology, and 75.4% received all eight sessions of massage.

• The study reported on a sample of 183 patients: 60 in the reflexology group, 61 in the massage group, and 62 in the SIS group.
• Mean patient age was 59.37 ± 10.46 (range = 32–81) in the reflexology group, 57.70 ± 10.12 (range = 36–76) in the massage group, and 59.36 ± 10.23 (range = 36–77) in the control group.
• All patients were diagnosed with early-stage breast cancer; the sample was 100% female.
• Patients were randomized six weeks after breast surgery (not controlled for treatment type). It appears that most patients were receiving chemotherapy, radiation therapy, or both, but the authors were unable to determine exactly from the sample description.

• Multisite
• Outpatient setting
• United Kingdom

Patients were undergoing the active treatment phase of care.

A randomized controlled trial design was used.

• Functional Assessment of Cancer Therapy (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 (SCID)

There were no significant differences between groups on any measure or demographic variable at baseline. 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 a better quality of life) than those receiving SIS. The difference existed only between massage and SIS. There were no differences among groups in self-reported quality of life as measured by FACT. MRS scores at the primary end point showed that massage and reflexology patients were significantly more relaxed than those randomized to SIS, and total MRS scores for reflexology and massage patients were significantly higher than for SIS patients. At this end point, massage patients were significantly more easygoing than either reflexology or SIS patients. Scores on HADS anxiety and depression did not differ significantly between the three groups. At the second end point (week 24), reflexology patients were significantly more relaxed than SIS patients measured by TOL and MRS. Scores on HADS anxiety and depression did not differ significantly between the three groups.

The authors concluded this was a well-controlled and rigorous study with an adequate sample size. Overall, however, there was low psychiatric morbidity in this sample, and despite the high compliance with the interventions (reflexology and massage), there were really no significant differences in the two end points in the depression scores.

• The study did not include an appropriate control group.
• The study design lacked an attentional control.

Findings do not support effectiveness of reflexology for reduction of depression or anxiety.