Feasibility of a Reflexology and Guided Imagery Intervention During Chemotherapy: Results of a Quasi-Experimental Study

Gwen Wyatt

Alla Sikorskii

Azfar Siddiqi

Charles Given

complementary and alternative therapies, guided imagery, interventions
ONF 2007, 34(3), 635-642. DOI: 10.1188/07.ONF.635-642

Purpose/Objectives: To evaluate patient characteristics to predict selection and maintenance of a complementary therapy and the feasibility of a randomized clinical trial (RCT) of complementary therapies.

Design: Quasi-experimental, exploratory study, unblinded and nonrandomized.

Setting: A comprehensive cancer center in Michigan.

Sample: 96 patients undergoing chemotherapy, predominantly Caucasian women.

Methods: Consenting patients with caregivers could choose a reflexology, guided imagery, guided imagery plus reflexology, or interview-only group. Patients without caregivers were restricted to guided imagery or interview-only groups. Data on demographics, depression, anxiety, and functional status were collected using established instruments.

Main Research Variables: Quality of life (QOL) and patient characteristics in relation to complementary therapy choice.

Findings: Patients who chose a complementary therapy rather than an interview only tended to be older and in worse health and had higher percentages of lung cancer, late-stage cancers, higher anxiety, depressive symptoms, and physical limitations at baseline. Patients lost from the guided imagery and guided imagery plus reflexology groups had greater symptom severity, depressive symptoms and anxiety, and worse physical and emotional well-being than those lost from the reflexology group.

Conclusions: Patient characteristics influence choice of complementary therapies, highlighting the need for RCTs to evaluate the true effect of complementary therapies on the QOL of patients with cancer. Further research on complementary therapies can help healthcare providers identify patients who are likely to benefit most by addressing nursing-sensitive outcomes.

Implications for Nursing: An RCT of reflexology as a single therapy for females with breast cancer is most feasible compared to other complementary therapies.

Jump to a section


    Astin, J.A. (1998). Why patients use alternative medicine. JAMA, 279, 1548-1553.
    Boon, H., Stewart, M., Kennard, M.A., Gray, R., Sawka, C., Brown, J.B., et al. (2000). Use of complementary/alternative medicine by breast cancer survivors in Ontario: Prevalence and perceptions. Journal of Clinical Oncology, 18, 2515-2521.
    Burish, T., Carey, M., Krozely, M., & Greco, F. (1987). Conditioned side effects induced by cancer chemotherapy: Prevention through behavioral treatment. Journal of Consulting and Clinical Psychology, 55, 42-48.
    Burish, T.G., & Jenkins, R.A. (1992). Effectiveness of biofeedback and relaxation training in reducing the side effects of cancer chemotherapy. Health Psychology, 11, 17-23.
    Burish, T.G., Snyder, S.L., & Jenkins, R.A. (1991). Preparing patients for cancer chemotherapy: Effect of coping preparation and relaxation interventions. Journal of Consulting and Clinical Psychology, 59, 518-525.
    Cassileth, B.R. (1999). Complementary therapies: Overview and state of the art. Cancer Nursing, 22, 85-90.
    Cassileth, B.R. (2000). Complementary therapies: The American experience. Supportive Care in Cancer, 8, 16-23.
    Cassileth, B.R., & Vickers, A.J. (2005). High prevalence of complementary and alternative medicine use among cancer patients: Implications for research and clinical care. Journal of Clinical Oncology, 23, 2590-2592.
    Cella, D.F., & Bonomi, A.E. (1994). Manual for the Functional Assessment of Cancer Therapy (FACT) scales and the Functional Assessment of HIV Infection (FAHI) scale, version 3. Chicago: Rush Cancer Institute.
    Davidson, R., Geoghegan, L., McLaughlin, L., & Woodward, R. (2005). Psychological characteristics of cancer patients who use complementary therapies. Psycho-Oncology, 14, 187-195.
    Diefenbach, M.A., Hamrick, N., Uzzo, R., Pollack, A., Horwitz, E., Greenberg, R., et al. (2003). Clinical demographic and psychosocial correlates of complementary and alternative medicine use by men diagnosed with localized prostate cancer. Journal of Urology, 170, 166-169.
    Eisenberg, D., Davis, R., Ettner, S., Appel, S., Rompany, M., & Kessler, R. (1998). Trends in alternative medicine uses in the United States, 1990-1997: Results of a follow-up national survey. JAMA, 280, 1569-1575.
    Feldman, D.E., Duffy, C., DeCivita, M., Malleson, P., Philibert, I., Gibbon, M., et al. (2004). Factors associated with the use of complementary and alternative medicine in juvenile idiopathic arthritis. Arthritis and Rheumatism, 51, 527-532.
    Fonteyn, M., & Bauer-Wu, S. (2005). Using qualitative evaluation in a feasibility study to improve and refine a complementary therapy intervention prior to subsequent research. Complementary Therapies in Clinical Practice, 11, 247-252.
    Guzzetta, C.E. (1996). Alternative therapies: What's the fuss? Nurse Investigator, 3(2), 1-2.
    Harpham, W.S. (2001). Complementary and alternative methods—Alternative therapies for curing cancer: What do patients want? What do patients need? CA: A Cancer Journal for Clinicians, 51, 131-136.
    Hodgson, H. (2000). Does reflexology impact on cancer patients' quality of life? Nursing Standard, 14(31), 33-38.
    Jonas, W.B. (1998). Alternative medicine—Learning from the past, examining the present, advancing to the future. JAMA, 280, 1616-1618.
    Kastner, M., & Burroughs, H. (1996). Alternative healing: The complete A-Z guide to more than 150 alternative therapies. New York: Henry Holt and Company.
    Kolcaba, K., & Fox, C. (1999). The effects of guided imagery on comfort of women with early stage breast cancer undergoing radiation therapy. Oncology Nursing Forum, 26, 67-72.
    Kozachik, S., Wyatt, G.K., Given, C.W., & Given, B. (2006). Patterns of use of complementary therapies among cancer patients and their family caregivers. Cancer Nursing, 29, 84-94.
    Kumar, N.B., Hopkins, K., Allen, K., Riccardi, D., Besterman-Dahan, K., & Moyers, S. (2002). Use of complementary/integrative nutritional therapies during cancer treatment: Implications in clinical practice. Cancer Control, 9, 236-243.
    Lang, S., & Pratt, R.B. (1994). You don't have to suffer: A complete guide to relieving cancer pain for patients and their families. New York: Oxford University Press.
    Lengacher, C.A., Bennett, M.P., Kip, K.E., Gonzalez, L., Jacobsen, P., & Cox, C.E. (2006). Relief of symptoms, side effects, and psychological distress through use of complementary and alternative medicine in women with breast cancer. Oncology Nursing Forum, 33, 97-104.
    Management of Cancer Pain Guideline Panel. (1994). Management of cancer pain: Clinical practice guideline [No. 9]. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service Agency for Health Care, Policy, and Research.
    Montgomery, D.C. (1997). Design and analysis of experiments (4th ed.). New York: John Wiley and Sons.
    Moore, R.J., & Spiegel, D. (2000). Uses of guided imagery for pain control by African American and white women with metastatic breast cancer. Integrative Medicine, 2, 115-126.
    Radloff, L.S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401.
    Richardson, M.A., Sanders, T., Palmer, J.L., Greisinger, A., & Singletary, S.E. (2000). Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. Journal of Clinical Oncology, 18, 2505-2514.
    Rodeheaver, P.F., Taylor, A.G., & Lyon, D.E. (2003). Incorporating patients' perspectives in complementary and alternative medicine clinical trial design. Journal of Alternative and Complementary Medicine, 9, 959-967.
    Spiegel, D. (1993). Living beyond limits: New hope and health for facing life-threatening illness. New York: Time Books.
    Spielberger, C.D., Gorsuch, R.L., Lushene, R., Vagg, P.R., & Jacobs, G.A. (1983). Manual for the State-Trait Anxiety Inventory (Form Y). Palo Alto, CA: Mind Garden Press.
    Stephenson, N., Weinrich, S., & Tavakoli, A. (2000). The effects of foot reflexology on anxiety and pain in patients with breast and lung cancer. Oncology Nursing Forum, 27, 67-72.
    Wyatt, G.K., Friedman, L., Given, C.W., Given, B.A., & Beckrow, K.C. (1999). Complementary therapy use among older cancer patients. Cancer Practice, 7, 136-144.
    Wyatt, G.K., & Friedman, L.L. (1996). Development and testing of a quality-of-life model for long-term female cancer survivors. Quality of Life Research, 5, 387-394.