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The Journal of Alternative and Complementary Medicine Vol. 24, No. 1, 2018, pp. 62-68

The Effect of Reflexology on the Pain-Insomnia-Fatigue Disturbance Cluster of Breast Cancer Patients During Adjuvant Radiation Therapy

Ricardo Tarrasch, PhD (1), Narin N. Carmel-Neiderman, MD (2), Sarah Ben-Ami, MSc (3), Bella Kaufman, MD (3), Raphi Pfeffer, MD (4), Merav Ben-David, MD (4,5), and Dorit Gamus, MD, PhD (2)

1 The Jaime and Joan Constantiner School of Education, Tel-Aviv University, Tel-Aviv, Israel.
2 Complementary and Integrative Medicine Service, Sheba Medical Center, Ramat-Gan, Israel.
3 Oncology Department, Sheba Medical Center, Ramat-Gan, Israel.
4 Radiation Oncology Department, Sheba Medical Center, Ramat-Gan, Israel.
5 Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Abstract

Objective: To evaluate the effects of reflexology treatment on quality of life, sleep disturbances, and fatigue in breast cancer patients during radiation therapy.

Methods/Subjects:
A total of 72 women with breast cancer (stages 1–3) scheduled for radiation therapy were recruited.
Design: Women were allocated upon their preference either to the group receiving reflexology treatments once a week concurrently with radiotherapy and continued for 10 weeks or to the control group (usual care).
Outcome measures: The Lee Fatigue Scale, General Sleep Disturbance Scale, and Multidimensional Quality of Life Scale Cancer were completed by each patient in both arms at the beginning of the radiation treatment, after 5 weeks, and after 10 weeks of reflexology treatment.

Results:
The final analysis included 58 women. The reflexology treated group demonstrated statistically significant lower levels of fatigue after 5 weeks of radiation therapy (p<0.001), compared to the control group. It was also detected that although the quality of life in the control group deteriorated after 5 and 10 weeks of radiation therapy (p<0.01 and p<0.05, respectively), it was preserved in the reflexology group, which also demonstrated a significant improvement in the quality of sleep after 10 weeks of radiation treatment (p<0.05). Similar patterns were obtained in the assessment of the pain levels experienced by the patients.

Conclusions:
The results of the present study indicate that reflexology may have a positive effect on fatigue, quality of sleep, pain, and quality of life in breast cancer patients during radiation therapy. Reflexology prevented the decline in quality of life and significantly ameliorated the fatigue and quality of sleep of these patients. An encouraging trend was also noted in amelioration of pain levels.

https://www.liebertpub.com/doi/10.1089/acm.2017.0023

Excerpts:

“Complementary and alternative medicine (CAM) therapies are gradually gaining more interest in cancer symptom management.11 More than 50% of cancer patients in Israel use complementary medicine.12"

“Reflexology is also known as ‘zone therapy’ and involves manual stimulation of reflex points on the feet that somatotopically correspond to specific areas and organs of the body. It is based on the theory that all organs are represented by various points on the feet, forming a map of the whole body, and that massaging specific areas of feet can affect corresponding target organs.

“Clinical experience indicated that reflexology might alleviate fatigue and sleep disturbances. The aim of this study was therefore to evaluate the effect of reflexology on fatigue, pain, and QOL in women with breast cancer during adjuvant radiation therapy.”

“Reflexology treatments were administered once a week by a qualified therapist, began concurrently with radiation therapy, and continued for 10 weeks (for up to 4 weeks after the completion of radiation treatments).

“Reflexology treatments were provided by a senior reflexologist, who graduated a 3-year course in one of the colleges accredited by the Israeli Reflexology Association, with 13 years of clinical experience. Treatment sessions followed a structured protocol and included a standardized protocol (20 min) of manipulation of the areas, which represent body organs on plantar areas of the feet using systematic massage horizontally and vertically (a crawling method), and massaging of spleen, stomach, and heart areas in a circular clockwise motion. This protocol was followed by an additional 10 min of individualized approach adapted to each patient, according to her current symptoms and involved manipulations of plantar and dorsal areas of the feet.

“The control group received no additional treatment.”

“While the mechanism of reflexology is still not clear, it shares a common philosophical background with acupuncture and includes some elements of relaxation and massage treatments.”

“To the best of our knowledge, this is the first report on the effect of reflexology on pain-insomnia-fatigue cluster in breast cancer patients during adjuvant radiation therapy. The study had several limitations as follows: the patients were allocated to the experimental and control groups according to their preference and not through a randomization procedure. The two groups however were similar at the baseline in terms of demographics, background diseases, the levels of fatigue and sleep disturbances, QOL, or pain. In addition, due to the lack of an active control group, it may be that the choice of participation in the reflexology group has resulted in some expectations leading to an inherent bias. The sample size was relatively small, but despite the small statistical power, significant improvements in the reflexology group were able to be demonstrated, compared with the control group.”



Comments: the mechanism of reflexology is not merely “still not clear”; it is inconsistent with scientific knowledge, a fact that the authors do not mention.

The authors appear to acknowledge two major problems, that the treatment group was self-selected and that it got additional treatment but the control group did not.  As Edzard Ernst has emphasized, this type of protocol is almost guaranteed to give results favoring the treatment group due to placebo effects.  30 minutes of individualized foot massage might well produce relaxation and distraction from pain.