The Effect of Foot Reflexology on Chemotherapy-Induced Nausea and Vomiting in Patients With Digestive or Lung Cancer: Randomized Controlled Trial

Abstract

Background Cancer is a chronic disease with an incidence of 24.5 million and 9.6 million deaths worldwide in 2017. Lung and colorectal cancer are the most common cancers for both sexes and, according to national and international recommendations, platinum-based chemotherapy is the reference adjuvant treatment. This chemotherapy can be moderately to highly emetogenic. Despite antiemetic therapy, chemotherapy-induced nausea and vomiting (CINV) may persist. Moreover, cancer patients are increasingly interested in alternative and complementary medicines and have expressed the desire that nonpharmacological treatments be used in hospitals. Among alternative and complementary medicines, foot reflexology significantly decreases the severity of CINV in patients with breast cancer. Objective The primary aim of this study was to assess the benefits of foot reflexology as a complement therapy to conventional treatments regarding the severity of acute CINV in patients with digestive or lung cancer. The secondary objectives assessed were the frequency and severity of delayed CINV, quality of life, anxiety, and self-esteem. Methods This study was conducted between April 2018 and April 2020 in the Hospices Civils de Lyon, France. This was an open-label randomized controlled trial. Participants were randomized into two groups: the intervention group (ie, conventional care with foot reflexology; n=40) and the control group (ie, conventional care without foot reflexology; n=40). Foot reflexology sessions (30 minutes each) were performed on outpatients or inpatients. Eligible participants were patients with lung or digestive cancer with an indication for platinum-based chemotherapy. Results The severity of acute nausea and vomiting was assessed with a visual analog scale during the second cycle of chemotherapy. A significant increase of at least 2 points was observed for the control group (7/34, 21%; P=.001). Across all cycles, the foot reflexology group showed a trend toward less frequent delayed nausea (P=.28), a significantly less frequent consumption of antiemetic drugs (P=.04), and no significant difference for vomiting (P=.99); there was a trend toward a perception of stronger severity for delayed nausea in the control group (P=.39). Regarding quality of life and anxiety, there was no significant difference between the intervention group and the control group (P=.32 and P=.53, respectively). Conclusions This study’s results indicate that foot reflexology provides significantly better management of acute nausea severity and decreased consumption of antiemetic drugs in patients with lung or digestive cancer. In order to fulfill patients’ desires to use nonpharmacological treatments and complementary and alternative medicines in hospitals, foot reflexology could be provided as a complementary intervention to conventional antiemetic drugs. Foot reflexology did not result in adverse effects. To assess the benefits of foot reflexology in routine practice, a larger study with several health care centers would be needed with a cluster randomized controlled trial. Trial Registration ClinicalTrials.gov NCT03508180; https://clinicaltrials.gov/ct2/show/NCT03508180 International Registered Report Identifier (IRRID) RR2-10.2196/17232

Reflexology in oncological treatment – a systematic review

“…Therefore, the evidence is too limited for a conclusion. This also applies to the outcomes of self esteem [22], psychiatric morbidity [23], perceived social support and quality of relationship between caregiver and patient [21], which all presented with insigni cant results. Consequently, re exology presumably is not an effective tool here.…”

“…Tsay et al [9] (n=62, day 2-6 after surgery) did not nd any signi cant differences for anxiety on average over all measurement points but a decrease in symptoms which was signi cantly stronger in the intervention group (β I = -1.12 (0.49); p=0.0231). This also applies to a study by Murat-Ringot et al [22] (n=80) in which re exology was compared with a control group. Patients received four sessions of re exology (30 minutes each) every two to three weeks during chemotherapy infusion depending on the chemotherapy protocol for four cycles.…”

“…Eight studies used active control groups [10,14,18,19,23,24,26,35], while the other six used passive groups [7,21,22,27,28,33].…”

“…Furthermore, signi cantly lower grade 1+ urinary frequency in week 5 (p=0.044) and grade +1 distension in weeks 4 (p<0.000) and 5 (p<0.000) were found for the re exology group compared to control. This study and two other studies [22,33] also measured quality of life using the EORTC-Quality of Life Questionnaires (QLQ)-C30. Uysal et al [14] found signi cantly better results on the function scale for the re exology group compared to control for week 3 (p<0.000) and 5 (p<0.000).…”

“…A signi cant advantage for re exology was found for the subscale of symptom development scale (p=0.000) and distress development (p=0.000) after the 4 th cycle of CTX, while none was found regarding if they experienced symptoms or not. Murat-Ringot et al [22] measured CINV during the second cycle of chemotherapy, asking patients to ll out a VAS before and after the re exology intervention or upon entering and leaving the hospital for the control group respectively. An intention-to-treat analysis was conducted, with patients with missing outcome data being considered as having an increase of >2 on the VAS.…”