Home-Based Symptom Management Via Reflexology for Breast Cancer Patients

This project tests the benefits of a home-based intervention of foot reflexology for
improving health-related quality of life (HRQOL) including symptom responses, functioning,
and health perceptions in women treated with chemotherapy for advanced breast cancer.
Reflexology applies a firm walking-motion during sessions and is based on the premise that
the foot has reflexes mirroring organs of the body. Symptom burden is the strongest predictor
of HRQOL for cancer patients. This project brings together expertise from nursing,
reflexology, communication, statistics, and health economics. The primary specific aims, in a
sample of women with advanced breast cancer receiving chemotherapy, are to determine the
effects of a 4-week, home-based reflexology intervention delivered by a friend/family
provider compared to attention control for improvement of:

1. HRQOL including symptoms, functioning, and health perception at study weeks 5 and 11.

The investigators hypothesize that the reflexology group will have better HRQOL
(symptoms, functioning, and health perception) than the attention control group at study
weeks 5 and 11.

2. Multiple symptom responses and times-to-response as determined by weekly symptom
assessments during the 4-week intervention time.

The investigators hypothesize that the reflexology group will have a higher proportion
of symptoms that respond to the intervention and shorter time-to-symptom-responses than
the attention control group.

3. Symptom-related use of unscheduled health services during the 11-week study. The
investigators hypothesize that fewer unscheduled services will be used for symptom
management over the 11-week study period by women receiving reflexology compared to
women in the attention control.

The exploratory aims are to: 1) Explore differences between trial arms in perceptions of
social support due to the family- or friend-delivered reflexology sessions at study weeks 5
and 11; 2) Determine if effects of the reflexology intervention on HRQOL are mediated by
social support; and 3) Use the newly developed NIH PROMIS standardized symptom and
functioning instruments to assess the effects of the reflexology intervention and to compare
the responsiveness of PROMIS instruments and existing instruments designed to measure similar
constructs.

This project has immense potential to make an effective symptom management intervention
accessible to patients in their homes via a friend or family home provider. The investigators
will not only intervene to enhance HRQOL but also to evaluate social support and costs
associated with unscheduled health services. Effective symptom management provides time and
cost savings to clinicians, advances the current state-of-the-science, and promotes adherence
to medical treatment that may ultimately enhance survival.

Inclusion Criteria:

- Age ≥ 21

- Diagnosis of breast cancer, Stage III, IV, or Stage I or II with metastasis or
recurrence

- Able to perform basic ADLs

- Undergoing chemotherapy and/or hormonal therapy for breast cancer

- Able to speak and understand English

- Have access to a telephone

- Able to hear normal conversation

- Cognitively oriented to time, place, and person (determined via nurse recruiter)

Exclusion Criteria:

- Diagnosis of major mental illness on the medical record and verified by the recruiter

- Residing in a nursing home

- Bedridden

- Currently receiving regular reflexology

- Diagnosis of symptoms of deep vein thrombosis or painful foot neuropathy, which will
require medical approval