Reflexology

In summary, although some of the existing literature indicates improved quality of life in cancer patients who receive reflexology, these studies have either not been reproduced or have considerable methodological limitations. Such limitations were also pointed out by the authors of a narrative review aiming to understand the state of research on massage (including reflexology) for cancer patients in order to propose improved research designs for future studies 15. Evidence is therefore insufficient to document any effectiveness of reflexology. Blinding is associated with considerable difficulties in reflexology research. It is therefore not possible to test the efficacy of this treatment modality.

Systematic reviews

Three systematic reviews were assessed for this summary. Very few trials could be included in the reviews and all studies had significant methodological limitations. It is, based on these reviews, not possible to draw conclusions about the efficacy or effectiveness of reflexology.

A Cochrane systematic review (2004) 12 which assessed the available evidence for non-invasive interventions for improving well-being and quality of life in patients with lung cancer, included a single trial for reflexology 5 and concluded that reflexology showed some positive, but short-lasting effects on anxiety. The authors concluded the quality of this study was low and research of higher methodological quality in this area is needed.

Wilkinson et al. (2008) carried out a systematic review examining the effectiveness of reflexology for symptom relief in patients with cancer 13. The authors concluded that, due to methodological limitations of the included publications, it was not possible to determine the effectiveness of reflexology in alleviating physical and psychological symptoms or in improving quality of life, nor to identify adverse side effects. The review was carried out according to Cochrane principles for systematic reviews.

Another systematic review (Ernst et al. 2009) examining the effectiveness of reflexology for treating any medical condition, included three reflexology trials for people with cancer 14. Two trials suggested positive results and the third failed to show convincingly that reflexology is an effective treatment. All three studies had methodological limitations, which hamper the generalisability of the results. This systematic review did not find convincing evidence that reflexology has health benefits beyond a placebo response.

Controlled clinical trials

Eight controlled clinical trials considered the effectiveness of reflexology for cancer patients 4-5,11,16-20. Four out of these 5,17,19-20 were included in the already presented systematic reviews. Results of the remaining four are presented here.

In a recently published randomised controlled trial, 183 women with early breast cancer who have undergone surgery, were randomized either to self-initiated support plus reflexology treatment, self-initiated support plus scalp massage group (control for physical and social contact), or self-initiated support alone 11. Massage, but not reflexology, was found to be significantly better than self-initiated support alone at 18 weeks post-surgery on the Trial Outcome Index. Reflexology and massage were both better than self-initiated support alone for relaxation measured on the Mood Rating Scale. Reflexology, but not massage was better than self-initiated support alone at the secondary end-point, 24 weeks post-surgery.

A recent trial investigated the benefits of partner-delivered reflexology to a group of patients (n=86) with mixed metastatic cancer 16. The intervention group reported 30% less pain and 60% less anxiety compared to the control group. A major limitation of this study includes a considerable risk of bias, as the primary author of the study provided the reflexology instruction and administered the pain and anxiety scales. Moreover, treatment was delivered by partners rather than fully qualified reflexologists, hence, conclusions can not be drawn about the effectiveness of reflexology in regular practice.

A randomised-controlled trial investigating the effectiveness of foot reflexology as adjuvant therapy for postoperative patients (n=61) with gastric cancer and hepatocellular cancer found reduced pain and anxiety, as well as reduced use of opioid analgesics, compared to a control group receiving usual pain management 4. The study was limited by the small sample size and lack of a credible control group.

Another small non-randomised controlled trial demonstrated a benefit for chemotherapy-related anxiety in hospitalised cancer patients (n=30) 18. The lack of randomisation, small number of participants and the fact that reflexology treatment was provided by a student nurse rather than by a fully qualified reflexologist, reduced the reliability of the results.