Written by Helen Cooke and the CAM-Cancer Consortium.
Updated October 24, 2016

Reflexology

Does it work ?

In summary, although some of the existing literature indicates improved pain, quality of life, anxiety and breathlessness in cancer patients who receive reflexology, most of these studies 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.7 Evidence is therefore insufficient to document any effectiveness of reflexology. Blinding is associated with considerable difficulties in reflexology research. It is therefore challenging to test the efficacy of this treatment modality.

Systematic reviews

Four systematic reviews including 11 individual trials were assessed for this summary (of the 22 reflexology trials included in the reviews overall, six of the trials did not involve cancer patients and five overlapped).  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 systematic review by Lee et al (2015) investigated the effects of massage therapy on pain in any type of cancer.11 RCTs in English, Chinese and Korean were included if they used the outcome measures Visual Analogue Scale, Brief Pain Inventory, Numeric Rating Scale and Present Pain Inventory. Of the twelve included RCTs, four (n=152) assessed foot reflexology. Results indicated that foot reflexology was significantly more effective in all four studies (standardized mean difference −1.46 [95% CI −2.45 to −0.47];P=0.004). Foot reflexology appeared to be more effective than body or aroma massage. However, methodological shortcomings such as possible selection bias and the small number of long-term studies render this evidence insufficient to suggest that reflexology is an effective long-term care option for patients with cancer pain.

A systematic review (2011) examining the effectiveness of reflexology for treating any medical condition, included five reflexology trials for people with cancer.8 Three trials suggested positive results for quality of life, anxiety and pain and two failed to show convincingly that reflexology is an effective treatment for mood and other cancer-related symptoms. This systematic review did not find convincing evidence that reflexology has health benefits beyond a placebo response for treating any medical conditions.

A systematic review (2010) assessed the effectiveness of reflexology as a symptomatic treatment for breast cancer.9 Four trials met the inclusion criteria. One large randomised controlled trial (RCT) showed a significant difference in quality of life and mood when compared with self-initiated support. Three non-randomised controlled clinical trials suggested favourable effects of reflexology for pain, nausea but were at high risk of bias. The review concluded that collectively the existing evidence does not convincingly show reflexology to be effective for breast cancer care.

Wilkinson et al. (2008) carried out a systematic review based on 5 studies examining the effectiveness of reflexology for symptom relief in patients with cancer.10 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.  

Controlled clinical trials

Four further RCTs15-18 including one pilot RCT16 and one non-randomised trial12 have been published that were not included in the above reviews. For details of these trials please see table 1.

A large (n=385) RCT found significant improvements in physical functioning for the reflexology group compared to the control group, including a reduction in the severity of dyspnoea.15 This study did not find any effectiveness for other health related quality of life indices measured including pain, anxiety and depression for women with advanced stage breast cancer. The reliability of the results is affected by a lack of blinding.

Two studies which demonstrated reductions in pain and anxiety have considerable methodological limitations.12,16 One of the studies12 was small (n=30) and lacked randomisation and the other was a pilot,16 also with a small (n=18) sample size. This small pilot showed both reflexology and Swedish massage (to lower extremities) to be associated with significant changes to salivary cortisol levels, with a slight advantage for reflexology.16

Another RCT which compared the effectiveness of reflexology and aromatherapy, found both interventions to be effective for patients’ self-reported problems/concerns.17 Within group comparisons revealed that both reflexology and massage were associated with statistically significant changes in salivary cortisol and pain. When post-treatment values were compared to the baseline values a slight advantage was indicated for Reflexology

An RCT demonstrated that scalp massage (the active control group), but not reflexology induced a range of potentially beneficial immunological changes.18 

Citation Helen Cooke, CAM-Cancer Consortium. Reflexology [online document]. http://ws.cam-cancer.org/The-Summaries/Manipulative-body-based/Reflexology. October 24, 2016.

References

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  2. Pitman, V and MacKenzie, K. Reflexology: A practical approach (1997). Stanley Thornes. ISBN: 0-7487-2867-8.
  3. Association of Reflexologists UK website: http://www.aor.org.uk/, accessed 10 August 2016.
  4. Tsay S, Chen H, Chen S, Lin H, Lin K. Effects of reflexotherapy on acute postoperative pain and anxiety among patients with digestive cancer. Cancer Nursing. 2008; 31(2): 109-15.
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  6. Molassiotis A et al. Use of complementary and alternative medicine in cancer patients: a European survey. Annals of Oncology 2005; 16: 655-653
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  8. Ernst E, Posadzki P, Lee MS. Reflexology: an update of a systematic review of randomised clinical trials. Maturitas 2011; 68(2):116-120.
  9. Kim JI, Lee MS, Kang JW, Choi dY, Ernst E. Reflexology for the symptomatic treatment of breast cancer: a systematic review. Integrative Cancer Therapies 2010; 9(4):326-330.
  10. Wilkinson S, Lockhart K, Gambles M, Storey L. Reflexology for symptom relief in patients with cancer. Cancer Nursing. 2008; 31 (5): 354-62. 
  11. Lee SH, Kim JY, Yeo S, Kim SH, Lim S. Meta-Analysis of Massage Therapy on Cancer Pain. Integrative cancer therapies. 2015;14(4):297-304.
  12. Quattrin R, Zanini A, Buchini S, Turello D, Annunziata MA, Vidotti C, Colombatti A, Brusaferro S. Use of reflexology foot massage to reduce anxiety in hospitalized cancer patients in chemotherapy treatment: methodology and outcomes. J Nurs Manag. 2006; 14(2): 96-105.
  13. Berenson SC. Management of cancer pain with complementary therapies. Oncology (Williston Park) 2007; 21(Suppl 4):10-22.
  14. White AR, Williamson J, Hart A, Ernst E. A blinded investigation into the accuracy of reflexology carts. Complement Ther Med. 2000; 8(3):166-172.
  15. Wyatt GA. Sikorskii MH, Rahbar D, Victorson and You M. Health-related quality-of-life outcomes: a reflexology trial with patients with advanced-stage breast cancer. Oncology nursing forum. 2012 39, 568-577 DOI: 10.1188/12.ONF.568-577
  16. Hodgson NA and Lafferty D. Reflexology versus Swedish Massage to Reduce Physiologic Stress and Pain and Improve Mood in Nursing Home Residents with Cancer: A Pilot Trial. Evidence-Based Complementary and Alternative Medicine. 2012. Article ID 456897, 5 pages, 2012. doi:10.1155/2012/456897
  17. Dyer J, Thomas K, Sandsund C and Shaw C. Is reflexology as effective as aromatherapy massage for symptom relief in an adult outpatient oncology population? Complement Ther Clin Pract 2013 19(3): 139-146.
  18. Green VL, Alexandropoulou A, Walker MB, Walker AA, Sharp DM, Walker LG and Greenman J. Alterations in the Th1/Th2 balance in breast cancer patients using reflexology and scalp massage. Experimental and therapeutic medicine 2012. 1, 97-108 DOI: 10.3892/etm_00000018
  19. Reflexology in Europe Website: http://reflexology-europe.org Accessed 3rd October 2016