# Cosmeceuticals and Thalassotherapy: Recovering the Skin and Well-Being after Cancer Therapies
## 4 Thalassotherapy for Improving Well-Being and Post-Onology Recovery
### Thalassotherapy and Post-Onological Recovery
In this review, the authors postulate that hormesis can play a role in the biological effects of balneotherapy, and these effects can be related to non-specific factors such as heat--which induces the heat shock response, and therefore the synthesis and release of heat shock proteins--and also to specific biochemical components such as hydrogen sulfide (H\({}_{2}\)S) in sulfurous water and radon in radioactive water [151]. [PERSON] et al. [155; 156] studied the improvement of the quality of life of breast cancer survivors with 2 weeks of physical and educational intervention in thermal spa centers, concluding that balneotherapy is effective in improving the quality of life and that the effects are maintained for at least 6 months, recommending a second intervention after that time. Furthermore, another study investigated the effectiveness of a warm-water footbath on relieving fatigue and insomnia problems in patients undergoing chemotherapy. Two groups were investigated (control and experimental group) in a longitudinal study design. Women diagnosed with gynecologic cancer and receiving a 4-series platinum chemotherapy regimen were recruited and then followed up for 6 months. They completed fatigue and insomnia items on the 1 st, 2 nd, 4 th, 7 th, and 14 th day after each scheduled chemotherapy. Participants in the experimental group soaked their feet in 41 \({}^{\circ}\)C to 42 \({}^{\circ}\)C warm water for 20 min every evening, starting from the eve of receiving the first chemotherapy, whereas participants in the comparison group did not do so. The results showed that participants in the experimental group reported a significant reduction in fatigue and improvement in sleep quality from the second session of chemotherapy and continued to improve during the study period [157]. Recovery post-breast cancer was also studied; [PERSON] et al. [158] carried out a study with 40 women aged 29-71 years with stage I-III breast cancer who reported arthralgia. The hydrotherapy intervention consisted of 24 sessions 3 days a week over 2 months; each session included 5 min of warm-up, 15-20 min of aerobic exercise, 15 min of mobility exercise, and 20 min of recovery techniques. The results showed that participants experienced a decrease in pressure pain threshold measured in neck, hand, shoulder and leg, as measured by algometry pressure and waist circumference; body mass index and cancer-related fatigue did not show significant improvement [158]. Later on, a randomized controlled trial was conducted by the same research group in breast cancer survivors. They compared two groups of patients: the experimental group followed aquatic exercise in deep water pool and the control group followed the usual care; the intervention group attended aquatic exercise sessions 3 times per week for 8 weeks in a heated deep swimming pool (sessions were 60 min in duration: 10 min of warm-up, 40 min of aerobic and endurance exercises, and 10 min of cool-down exercises). Patients allocated to the usual care group followed the oncologist's recommendations in relation to a healthy lifestyle. Values for fatigue (Piper Fatigue Scale), mood state (Profile of Mood States), and abdominal (trunk curl static endurance test) and leg strength (multiple sit-to-stand test) were collected at baseline, after the last treatment session, and at a 6-month follow-up. Immediately after discharge, the aquatic exercise group showed a large effect size in total fatigue score, trunk curl endurance, and leg strength, but negligible effects in vigor, confusion, and disturbance of mood. At the conclusion of the 6-month follow-up period, the aquatic exercise group maintained large to small effect sizes in fatigue scores, multiple sit-to-stand test, and trunk curl static endurance and negligible effects for the fatigue severity dimension and different scales of the Profile of Mood States. The authors concluded that an aquatic exercise program conducted in deep water was effective for improving cancer-related fatigue and strength in breast cancer survivors [159]. [PERSON] et al.