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JMIR Cancer. 2021 Nov 5;7(4):e25648.
The Effect of Foot Reflexology on Chemotherapy-Induced Nausea and Vomiting in Patients With Digestive or Lung Cancer: Randomized Controlled Trial

Audrey Murat-Ringot (1, 2, 3), Pierre Jean Souquet (1), Fabien Subtil (4 5), Florent Boutitie (4), Marie Preau (3), Vincent Piriou (1, 2)

1 Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.
2 INSERM U1290, Research on Healthcare Performance, Claude Bernard University I, Lyon, France.
3 Groupe de Recherche en Psychologie Sociale EA 4163, Institut de Psychologie, Université Lyon 2, Bron, France.
4 Pôle Santé Publique - Service de Biostatistiques, Hospices Civils de Lyon, Lyon, France.
5 Biometrics and Evolutionary Biology UMR 5558, Claude Bernard University I, Centre national de la recherche scientifique, Villeurbanne, France.

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.

Free full text:
https://cancer.jmir.org/2021/4/e25648/

Excerpts:

"Among the most frequently provided CAMs in private and public oncology centers in European countries [30], foot reflexology seems very interesting. Foot reflexology involves applying pressure to specific areas of the feet, which helps the body restore homeostasis. The premise is that reflex zones in the feet correspond to organs, glands, and systems of the body [31]. Foot reflexology used concomitantly with conventional treatment seems to decrease some side effects induced by chemotherapy; more specifically, this combination improves quality of life [32,33], significantly decreases pain intensity and anxiety in patients with metastatic cancer [34], and significantly improves the perceived pain and anxiety in postoperative patients with gastric cancer and hepatocellular cancer [35]. Moreover, a significant decrease in CINV has been observed in patients with breast cancer receiving chemotherapy and foot reflexology [36,37]...the design of these studies did not provide a high level of evidence, a point underlined by systematic reviews that conclude that there is a necessity to confirm these results by randomized controlled trials (RCTs) [40,41].

"Our primary hypothesis is that foot reflexology performed in association with conventional care will improve the management of acute nausea. Thus, the aim of this RCT is to determine whether foot reflexology provides better control of CINV in patients with lung or digestive cancer who are receiving platinum-based chemotherapy."

"The patients randomized to the intervention group (n=40) received four sessions of foot reflexology (30 minutes each) during chemotherapy infusion every 2 or 3 weeks, according to the chemotherapy protocol. Three qualified reflexologists administered the sessions. The three reflexologists had same skills training approved by the French Federation of Reflexologists. The reflexology chart used in this clinical study is based on the one proposed by Eunice Ingham [31]. The intervention was standardized (Figure 1): to calm nausea and vomiting, the upper and lower digestive reflex points, as well as the metabolism of the smooth muscle reflex points (ie, lymphatic system, kidneys and bladder, lungs, thyroid, and parathyroid), were stimulated. To provide deep relaxation to target anxiety, the diencephalon reflex points, scapular belt reflex points, reflex points of the diaphragm, and reflex points of the spine were stimulated. After each stimulation of the reflex points, relaxation movements were performed [31].

"During the first reflexology session, the reflexologist trained the patients in the foot reflexology group regarding the appropriate zones on the hands to relieve nausea. The reflexologist delivered to the patient a figure illustrating the palmar massage points (Figure 2).

"All patients received standard antiemetic drugs (eg, 5-hydroxytryptamine 3 receptor antagonists, dexamethasone, and/or neurokinin-1 receptor antagonists) in accordance with guidelines [8,13]."

"The benefits of foot reflexology on delayed CINV were assessed using a diary completed every day by patients between the first and fourth cycle of chemotherapy. Every day, the patient assessed the frequency of nausea and vomiting, recording each emetic and nausea episode, and assessed the intensity of the worst nausea and vomiting episodes using a 6-point Likert scale...Patients also recorded all rescue antiemetic medications, which were taken in addition to what was prescribed at baseline to prevent nausea and vomiting.

"At baseline and at the end of the study period, the quality of life, anxiety, and self-esteem of participants were assessed."

"These results, which included both male and female patients, showed that foot reflexology significantly decreased acute nausea in patients with lung or digestive cancer who were receiving chemotherapy."

"However, nausea has a negative impact on patients’ quality of life [12]. This is why the foot reflexology group was taught self-massage to relieve their CINV in a nonmedicinal way, if they desired. The 29% of patients who practiced self-massage all reported that it was effective...we can suggest that self-massage seems to be a promising complementary care treatment to standard antiemetic treatment to improve the management of delayed nausea."



Comments:

As usual, there was no discussion of the fact that reflexology is incompatible with scientific knowledge, or even that it is controversial.

This was the type of study where the treatment group got something added on to usual care, but the control group had no placebo treatment. Thus, any benefits could have arisen from placebo effects plus nonspecific effects of massage. They likely had nothing to do with the use of specific reflex points as guided by reflexology charts.