Reflexology in the management of chemotherapy induced peripheral neuropathy: A pilot randomized controlled trial

Published:November 14, 2017DOI:


      • Chemotherapy induced peripheral neuropathy (CIPN) can limete patient's quality of life functions.
      • Reflexology increases the level of the quality of life functions related CIPN.
      • Reflexology can be recommended to the patients.



      The current experimental study aimed to evaluate the effectiveness of reflexology on the management of symptoms and functions of chemotherapy-induced peripheral neuropathy (CIPN) in cancer patients.


      This study was conducted as a randomized controlled trial in 60 patients (30 experimental and 30 control patients) who had chemotherapy-induced Grade II-IV peripheral neuropathy complaints from July 2013 to November 2015. Data were collected using the patient identification form, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy (EORTC-CIPN-20) form, and BPI (used for related chemotherapy-induced peripheral neuropathy symptoms).


      The majority of the patients were being treated for gastrointestinal or breast cancer and were primarily receiving Eloxatine- or taxane-based treatment. It was found that reflexology applications did not lead to differences in either group in terms of peripheral neuropathy severity and incidence (p > 0.05) and only led to improvement in sensory functions in the experimental group (p < 0.05).


      It was determined that reflexology is not an effective method in the management of patients' activity levels, walking ability etc. and motor, autonomic functions related CIPN, but reflexology is effective method in the management of patients’ sensory functions related CIPN. Key Words: Peripheral neuropathy, reflexology, chemotherapy, EORTC QLQ-CIPN-20, BPI.


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        • American Cancer Society
        Peripheral neuropathy caused by chemotherapy, 2015.
        • Argyriou A.A.
        Incidence ve characteristics of peripheral neuropathy during oxaliplatin-based chemotherapy for metastatic colon cancer.
        Acta Oncol. 2007; 46: 1131-1137
        • Arıkan F.
        Effect of massage therapy on peripheral neuropathy and life quality of colorectal cancer with patient receiving.
        (PhD Thesis) Erciyes Üniversitesi Sağlık Bilimleri Enstitüsü Doktora Tezi, Kayseri2013
        • Ben-Horin I.
        • Kahan P.
        • Ryvo L.
        • Inbar M.
        • Lev-Ari S.
        • Geva R.
        Acupuncture and reflexology for chemotherapy-induced peripheral neuropathy in breast cancer.
        Integr. Cancer Ther. 2017; 16: 258-262
        • Bhatnagar B.
        • Pelser C.
        • Gilmore S.
        • Tait N.
        • Bao T.
        Acupuncture and low dose gabapentin effectively treat paclitaxel induced peripheral neuropathy ve prevent chemotherapy dose reduction.
        Altern. ve Integr. Med. 2013; 2: 1-3
        • Biedrzycki B.A.
        Peripheral neuropathy.
        in: Brown C.G. A Guide to Oncology Symptom Management. ONS Pittsburgh, Pennsylvania2010: 405-419
        • Can G.
        (Onkoloji Hemşireliğinde Kanıta Dayalı Semptom Yönetimi Konsensus'07)in: Can G. Enç N. Akaya S. Evidence-Based Symptom Management in Oncology Nursing’07. Mavi İletişim Danışmanlık AŞ Medikal Yayıncılık, İstanbul2008: 157-169
        • Cleeland C.S.
        • Ryan K.M.
        Pain assessment: global use of the brief pain inventory.
        Ann. Acad. Med. Singap. 1994; 23: 129-138
        • Cleeland C.S.
        The brief pain inventory user guide – online.
        • Cunningham J.E.
        Case report of a patient with chemotherapy-induced peripheral neuropathy treated with manual therapy (massage).
        Support Care Cancer. 2011; 19: 1473-1476
        • Dalal K.
        • Maran V.B.
        • Pveey R.M.
        • Tripathi M.
        Determination of Efficacy of Reflexology in Managing Patients with Diabetic Neuropathy: a Randomized Controlled Clinical Trial, Evidence-based Complementary Ve Alternative Medicine.
        2014 (Jan (9))
        • Dicle S.
        • Karayurt O.
        • Dirimese E.
        Validation of the Turkish version of the brief pain inventory in surgery.
        Pain Manag. Nurs. 2009; 10: 107-113
        • Domenico G.D.
        Beard's Massage Principle Ve Practice of Soft Tissue Manipulation. Soft Tissue Manipulation in Complementary/alternative Medicine in Texas.
        Saunders Elsevier, 2007: 294-309
        • Donald G.K.
        • Tobin I.
        • Stringer J.
        Evaluation of acupuncture in the management of chemotherapy-induced peripheral neuropath.
        Acupunct. Med. 2011; 29: 230-233
        • Ho E.Y.
        • Roblew J.S.
        Cultural resources for health participation: examining biomedicine, acupuncture, and massage therapy for HIV-related peripheral neuropathy.
        Health Commun. 2011; 26: 135-146
        • Ihn-Sook J.
        Effect of self-foot reflexology on peripheral blood circulation ve peripheral neuropathy in patients with diabetes mellitus.
        J. Korean Acad. Nurs. 2006; 13: 225-234
        • Ju-Hyeon J.
        • Ju-Hee N.
        • Gi-Suk K.
        • Young-Eun L.
        • Sun-Young Y.
        • Hyun-Ju L.
        • Yu-Mi S.
        • Young-Sun L.
        Characteristics ve quality of life in gynecologic cancer patients with chemotherapy-induced peripheral neuropathy.
        Korean J. Women Health Nurs. 2013; 19: 201-210
        • Kannarkata G.
        • Lasher E.E.
        • Schiff D.
        neurologic complications of chemotherapeutic agents.
        Curr. Opin. Neurology. 2008; 2: 719-725
        • Köksoy S.
        The knowledge level and using of complementary and alternative therapies of the doctors, nurses and midwife who working at hospitals.
        (Master’s Thesis) Mersin Üniversitesi Sağlık Bilimleri Enstitüsü Hemşirelik Anabilim Dalı Yüksek Lisans Tezi, Mersin2008
        • Kurt S.
        • Can G.
        Reflexology and application areas.
        Sağlıkla Derg. 2013; 3: 54-55
        • Kurt S.
        • Ünsar S.
        Assessment of symptom control in patients with cancer in Northwestern Turkey.
        Eur. J. Oncol. Nurs. 2011; 15: 137-144
        • Nicholas P.K.
        • Kemppainen J.K.
        • Canaval G.E.
        • Corless I.B.
        • Sefcik E.F.
        • Nokes K.M.
        Symptom management ve self-care for peripheral neuropath in HIV/AIDS.
        AIDS Care. 2017; 19: 179-189
        • Önsüz Ü.
        efficiency of the interventions practiced by patients in the management of peripheral neuropathy occurring in cancer patients administered with taxan-based treatment.
        (Master’s Thesis) İstanbul Üniversitesi. Sağlık Bilimleri Enstitüsü Hemşirelik Anabilim Dalı İç Hastalıkları Hemşireliği Yüksek Lisans Tezi, İstanbul2015
        • Ovayolu Ö.
        • Seviğ Ü.
        • Ovayolu N.
        • Sevinç A.
        The effect of aromatherapy ve massage administered in different ways to women with breast cancer on their symptoms ve quality of life.
        Int. J. Nurs. Pract. 2013; 20: 1-10
        • Park H.J.
        Chemotherapy induced peripheral neuropathic pain.
        Korean J. Anesthesiol. 2014; 67: 4-7
        • Postma T.J.
        The development of an EORTC quality of life questionnaire to assess chemotherapy-induced peripheral neuropathy: the QLQ-CIPN20.
        Eur. J. Cancer. 2005; 11: 1135-1139
        • Saklı K.
        • Demir-Zencirci A.
        Nursing interventions of chemotherapy induced peripheral neuropathy and neuropathic pain in patients receiving taxanes and platino: a literature review.
        Hemşirelikte Araştırma Geliştirme Derg. 2013; 1: 61-73
        • Schroeder S.
        • Meyer-Hamme G.
        • Epplee S.
        Acupuncture for chemotherapy-induced peripheral neuropath (CIPN): a pilot study using neurography.
        Acupunct. Med. 2012; 30: 4-7
        • Se Young L.
        • Yun H.H.
        • Oh Nam O.
        • Eun J.K.
        • In G.K.
        • Moon Sook H.
        • Myung Sook C.
        The effects of foot reflexology on peripheral neuropathy, symptom distress, anxiety and depression in cancer patients treated with oxaliplatin.
        Asian Oncol. Nurs. 2012; 12: 305-313
        • Soutar G.
        Reflexology for Hands and Feet.
        (Translation, Evyapan T.)third ed. Arkadaş Yayınevi, Ankara2012: 8-26
        • Stephenson N.
        • Weinrich S.P.
        • Tavakoli A.S.
        The effects of foot reflexology on anxiety ve pain in patients with breast ve lung cancer.
        Oncol. Nurs. Forum. 2000; 27: 67-72
        • Tabur H.
        • Basaran E.B.Z.
        Introduction to Reflexology.
        first ed. Kitapdostu Yayınları, İzmir2009: 11-140
        • The Ministry of Health of Turkey
        Cancer of the war department, cancer statistics 2016.
        Date: 2016
        Date accessed: February 2, 2016
        • Tuğay N.
        Massage techniques.
        in: İnci Y. Refleksoloji (Reflexology). Öz Baran Ofset, Ankara2010: 184-193
        • Ünal E.
        • Akan O.
        • Üçler S.
        Effects of diabetes mellitus on neurological disorders.
        Ok Meydanı Tıp Derg. 2015; 31: 45-51
        • Wampler M.A.
        • Hamolsky D.
        • Hamel K.
        • Melisko M.
        • Topp K.S.
        Case report: painful peripheral neuropathy following treatment with docetaxel for breast cancer.
        Clin. J. Oncol. Nurs. 2005; 9: 189-193
        • Wilhelm Z.A.
        Kitap Matbaacılık, İstanbul2003
        • Wong R.
        • Sagar S.
        Acupuncture treatment for chemotherapy-induced peripheral neuropathy – a case series.
        Acupunct. Med. 2006; 24: 87-91
        • World Health Organization Programmes and Projects
        Cancer (WHO), World cancer report 2016.
        Date: 2016
        Date accessed: February 10, 2016
        • Yıldırım Y.K.
        (Onkoloji Hemşireliğinde Kanıta Dayalı Semptom Yönetimi)in: Can G. Evidence-Based Symptom Management in Oncology Nursing. 3P Pharma Publication Planing, İstanbul2007: 81-99