Reflexology involves the application of pressure to specific zones, on the feet and hands, that reflect other areas of the body. Using the thumb, fingers, or hand on these zones creates a change in the related body part. In patients with cancer, researchers have evaluated the effect of reflexology on pain, anxiety, dyspnea, fatigue, and depression.
Quattrin, R., Zanini, A., Buchini, S., Turello, D., Annunziata, M.A., Vidotti, C., . . . Brusaferro, S. (2006). Use of reflexology foot massage to reduce anxiety in hospitalized cancer patients in chemotherapy treatment: Methodology and outcomes. Journal of Nursing Management, 14, 96–105.
To reduce anxiety caused by chemotherapy (not the diagnosis)
The intervention was reflexology foot massage in hospitalized patients undergoing their second or third cycle of chemotherapy (30-minute foot massage on both feet by an RN student). The Spielberger State-Trait Anxiety Inventory was administered before and after reflexology and 24 hours post-reflexology.
The study reported on a sample of 30 patients: 15 in the control group and 15 in the reflexology foot massage group.
Italian research hospital
Spielberger State-Trait Anxiety Inventory
There was an average decrease of 7.9 points on the state-anxiety scale in the treatment group (p < 0.0001) after the short time frame (immediate decrease in anxiety).
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:
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.
Patients were undergoing the active treatment phase of care.
A randomized controlled trial design was used.
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.
Findings do not support effectiveness of reflexology for reduction of depression or anxiety.
Stephenson, N.L., Swanson, M., Dalton, J., Keefe, F.J., & Engelke, M. (2007). Partner-delivered reflexology: Effects on cancer pain and anxiety. Oncology Nursing Forum, 34, 127–132.
To test the effectiveness of reflexology delivered by partners in patients with cancer
An initial reflexology session of 30 minutes was provided in the hospital setting. The session included relaxing techniques, 15 minutes of reflexing areas of the feet corresponding to areas of the patient’s reported pain and body parts where cancer or pain was located. The final five minutes were used to reflex the entire area of the feet. Partners were taught how to perform a reflexing protocol and provided with associated written materials. Partners practiced the technique on the investigator or the patient and were given feedback on the technique. Signs and symptoms of deep vein thrombosis were reviewed to alert partners to avoid foot reflexology in that situation. Patients in the control group received usual care plus special attention for 30 minutes, consisting of reading a selection of the patient’s choice to the patient. Study data were obtained pre- and postintervention.
A randomized controlled trial design was used.
In the total sample, there were no significant differences between groups in pain outcome measures. In patients with higher baseline pain levels (≥ 5), significant differences were found in favor of the reflexology group in analysis of variance (p = 0.001, eta2 for effect size = 0.12). Patients in the reflexology group had significant reduction in anxiety, with a 62% reduction from baseline to postintervention in those receiving reflexology versus 23% reduction in controls. Among those with higher levels of anxiety (≥ 5), significant differences were found in favor of reflexology (p = 0.001, eta2 = 0.13).
Partner-delivered reflexology was associated with reduction in pain and anxiety compared to controls. The intervention appeared to be most effective in patients with higher levels of pain and anxiety.
Findings suggest that foot reflexology can be helpful for patients with cancer in reducing anxiety and perception of pain in the short term. Study findings suggest that partners can be taught to provide this type of intervention. Addition of partner-delivered reflexology might be a useful adjunct for anxiety and pain control; however, trained individuals need to be available to provide the teaching or the actual intervention. Involvement of caretakers in patient care with this type of approach might be a useful way to empower patients and caregivers.
Tsay, S.L., Chen, H.L., Chen, S.C., Lin, H.R., & Lin, K.C. (2008). Effects of reflexotherapy on acute postoperative pain and anxiety among patients with digestive cancer. Cancer Nursing, 31(2), 109–115.
To investigate the effects of foot reflexology on pain and anxiety in patients undergoing surgery for digestive cancer
Patients were randomly assigned to the intervention group or a control group that received usual care. The intervention consisted of 20 minutes of foot reflexology using a standard protocol. A nurse certified to deliver this treatment provided it on day 2 after surgery, between one and three hours after the patient had received a dose of pain medication. Pain and anxiety were assessed at baseline and on postoperative day 5. A research assistant blinded to the randomization collected data. In the intervention group, pain was assessed before and after the intervention.
Randomized single-blind controlled trial
Foot reflexology as provided in this study may be helpful in reducing postoperative pain.
This type of intervention may be helpful in managing pain in postoperative patients. The relationship between anxiety and pain suggests that efforts to reduce anxiety may affect patients’ perceptions of pain.
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.
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 has clinical applicability for late effects and survivorship.
The study was a three-group, single-blind, randomized, controlled trial.
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 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.