The Effect of Reflexology on Fatigue in Cancer Patients Receiving Chemotherapy: A Randomized Controlled Trial

Introduction Cancer is considered a major problem in the area of general health (1) and is of great importance since it is the second cause of mortality in the world and the third cause of death in Iran (2). The World Health Organization warned that the cancer wave is on its way and the number of people who are inflicted with this disease reaches 24 million people annually by 2035 (3). In addition, 100 people die due to cancer in Iran every day (4). Cancer patients suffer from several symptoms throughout the diagnosis and treatment process (5). Chemotherapy is used for treating cancer which is associated with several side effects despite prolonging the life of the patient (6). Fatigue is considered one of the most widespread and annoying complications caused by cancer treatment, which is reported in 70-100% of the patients under treatment (7, 8). Damage to bone marrow and the side effects related to the treatment including nausea, vomiting, diarrhea, appetite loss, anemia, and the like are the reasons which cause and intensify fatigue (9). Patients suffering from cancer feel the fatigue more severely and persistently compared to healthy people, and sufficient sleep cannot alleviate the condition (10). The tiredness which is resulted from the disease or its treatments is referred to as cancer-related fatigue (5). The results of a study by Zaighami Mohammadi revealed that the mean fatigue severity before and after three periods of chemotherapy varied significantly (11). According to Steen et al, this fatigue is related to considerably low levels of health-related quality of life (12). Methods which are used to alleviate cancer-related fatigue include pharmacologic and non-pharmacologic interventions (5). The pharmacologic treatment is the most effective way available to the nurses for reducing the fatigue. Further, using non-pharmacological treatment is very important since it reduces fatigue resulted from the side effects or the difference in response to the drug (13). Non-pharmacologic methods include a wide range of techniques which are relatively easy, non-invasive, and cheap and have fewer side effects (14). Massage is known as one of the effective non-pharmacologic treatments for fatigue (15). Nearly 20% of the cancer patients in the Abstract Objectives: Fatigue is one of the most common complications of cancer and its related medications including chemotherapy. The present study aimed to investigate the effects of reflexology on the fatigue in cancer patients receiving chemotherapy. Materials and Methods: The current randomized clinical trial was conducted on 80 cancer patients under chemotherapy in Tohid Medical Center affiliated with Kurdistan University of Medical Sciences in Iran during 2016-2017. The patients were randomly assigned to control and intervention groups in the form of quadruple blocks using the StatsDirect software. The data were collected by a personal information questionnaire and the fatigue severity scale (FSS). After questionnaire administration and collection, foot sole reflexology was performed on the intervention group during four consecutive days each session lasting for 30 minutes. Then, the severity of fatigue was once more measured in the patients of both groups. Results: Based on the results, the mean and standard deviation in the investigated patients, before and after the intervention was 5.538±1.041 and 4.486±1.040 in the intervention group, respectively, indicating that the difference was significant (P = 0.000). In addition, after the reflexology was performed, the mean and standard deviation of the intervention and control groups were 4.486±1.040 and 5.180±1.450, respectively, which demonstrated a significant difference between the two groups in terms of fatigue (P = 0.016). Conclusions: In general, based on the results, reflexology was found to have a positive effect on fatigue in cancer patients who underwent chemotherapy.