Sharp, D.M., Walker, M.B., Chaturvedi, A., Upadhyay, S., Hamid, A., Walker, A.A., … Walker, L.G. (2010). A randomised, 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 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.