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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.
NAME OF THE CANDIDATE
Mrs. DIPA MAJUMDAR
AND ADDRESS
GOUTHAM COLLEGE OF NURSING
MANJUNATH NAGAR,
WEST OF CHORD ROAD,
RAJAJINAGAR,
BANGALORE – 560 010
2.
GOUTHAM COLLEGE OF NURSING
NAME OF THE INSTITUTION
MANJUNATH NAGAR,
WEST OF CHORD ROAD,
RAJAJINAGAR,
BANGALORE – 560 010
3.
4.
COURSE OF THE STUDY AND
M.Sc. NURSING I YEAR
SUBJECT
MEDICAL – SURGICAL NURSING
DATE OF ADMISSION TO
03/06/2009
THE COURSE
5.
A STUDY TO EVALUATE THE
TITLE OF THE TOPIC
EFFECTIVENESS OF FOOT
REFLEXOLOGY MASSAGE ON
PHYSIOLOGICAL AND
PSYCHOLOGICAL WELL BEING
AMONG CANCER PATIENTS IN
SELECTED HOSPITAL AT
BANGALORE
1
6.
BRIEF RESUME OF THE INTENDED WORK.
6.1
NEED FOR THE STUDY:
“Journey of thousand mile’s starts with your feet”
Chinese proverb.
Our bodies are made up of billions of cells that grow, divide, and then die in a
predictable manner. Cancer occurs when something goes wrong with this
system, causing uncontrolled cell division and growth. (1)
According to WHO cancer is a leading cause of death worldwide and the total
number of cases globally is increasing. The number of global cancer death is
projected to increase from 2007 to 2030 (from 7.9 million to 11.5 million
deaths). New cases of cancer in the same period are estimated to jump from
11.3 million in 2007 to 15.5 million in 2030. More than half of all cancer cases
occur in developing countries. (2)
The number of new cancer patients in United states population is expected to
more than double from 1.36 million in 2000 to almost 3.0million in 2050.(3)
Over 800,000 new cases occurring every year and is one of the ten leading
causes of death in India. Cancer incidence in India is estimated to be around 70
– 90 per 1,00,000 population. From the population based registries in India
covering 28 – 30 million population from different parts of the country. The
age adjusted incidence rates vary from 44 – 122 per 1,00,000 population in
males, and 52 – 128 per 1,00,000 females.
Cancer scenario in India is quite alarming with nearly 25 lakh’s patients in the
country currently suffering from the deadly disease according to Indian council
of Medical Research. Every year there is a 10,000 new cancer patients. (4)
There would be about 1.5 lakhs cancer cases in Karnataka and about 35,000
new cancer cases are added to this pool each year. Over 16,000 new cases are
2
registered every year in Kidwai Memorial Institute of Oncology with more
than 20% from neighboring states of Andhra Pradesh and Kerala. (5)
Foot reflexology massage is a “pressure therapy” and involves applying
focused pressure to certain known reflex points located in the foot, which
corresponds to certain others areas in the body.
Reflexology is based on the unsubstantiated belief that each part of each foot is
a mirror site for a part of the body. The big toe for example is considered a
reflex area for the head. Reflexology maps the body with the feet, the right
foot corresponding to the right side of the body and the left foot corresponding
to the left side of the body. The physiological change achieved with the
application of pressure are based on logical relationship that exist between the
skin and the nervous system. The study of reflexology based on anatomy and
physiology of the human body. The principle of reflexology is founded on the
understanding of how the nerves work and what they mean to human body.
Feet contain “reflex buttons” which are connected to all organ and glands.
When these reflex centers are stimulated, they instantly send a surge of new
vigor to the part of the body they are connected to and with no side effects.(6)
Benefit’s of the reflexology treatment include increased circulation, relaxation
and release of tension, nausea, relieve of pain, stiffness, headache, stress,
asthma, constipation, sinusitis and migraine. (7)
Over three fourth of our health problem can be linked to nervous and physical
tension. By reducing stress and tension reflexology improves blood and lymph
circulation, strengthens the function of the immune system, improves
assimilation of nutrition and elimination of toxin and calm the nervous system.
When we step a sharp object, a sequence of reflex actions takes place in our
body, muscles with draw the foot and help to rebalance the body, adrenaline is
released and changes occur in the composition of our blood and function of
our internal organs. Reflexology works on a similar (but far less painful)
3
principle. Stimulating the nervous system to invoke response’s in the relevant
part’s of the body. (8)
The therapist applies controlled pressure with thumb and fore fingers in the
cuteneo organ reflex points on the feet. There are 7200 nerve ending in each
foot that corresponds to every part of the body. Nerve endings send message to
the brain about stress or pain found in the body during a reflexology session.
The brain that responds by producing endorphins the body’s natural pain
reliever. The endorphins are then sent through the blood stream to the affected
areas. (9)
A study was conducted on “foot massage: A Nursing intervention to modify
the distressing symptoms of pain and nausea in patients hospitalized with
cancer”. The study shows that reflexology modifies the distressing symptoms
of pain and nausea in patients hospitalized with cancer. 87 patients participated
in the study and
each received a 10 min reflexology foot massage (5
min/foot). The result revealed that treatment produces a significant and
immediate effect on the patients perception of pain, nausea and relaxation. The
use of foot reflexology as a complementary method is recommended as a
relatively simple nursing intervention for patients experiencing nausea or pain
related to cancer experience. The result was positive and the researcher
recommend that further research using longer number of patients in controlled
clinical trail’s into its effectiveness of reflexology in alleviating pain, nausea
and anxiety in the management of these symptom’s by the family at home is
warranted. (10)
A study was conducted on the effect of foot reflexology on anxiety and pain in
patients with breast and lung cancer. The study shows that foot reflexology
alleviated anxiety and pain for 23 patients with breast and lung cancer. This
has an important implication for nursing practice. Reflexology is a simple
technique for human touch which can be performed any where requires no
special equipment, is non invasive and does not interfere with patients
privacy. (11)
4
A foot reflexology is a great way to quickly relax and feel better. Foot massage
a Thai primary self care custom, has been found to enhance blood circulation,
relaxation and one’s own healing power.
In UK Health study 97% of reflexology participants interested in more
sessions. The study titled complementary and Alternative Medicine Pilot
Project. Reflexology was reported as the most popular to continue with. The
score was 87% for complementary and alternative medicine in general but for
reflexology it was 97% of patients who would wish to continue their
treatment.(12)
A study was conducted on impact of reflexology on cancer patients. Twelve
British hospitalized cancer patients were included in the study. Six patients
with different types of tumors were randomly assigned to a reflexology group
and six to a placebo reflexology group. Placebo and reflexology groups
received three 40 minutes session every other day oven a five day period. Only
33% of the placebo group benefited from an improvement in quality of life
compared to 100% of the reflexology group. The study shown improvement in
the
quality
of
life
components:
appearance,
appetite,
breathing,
communication, concentration, constipation, diarrhea, isolation, micturation,
mobility, mood, nausea, pain, sleep and tiredness. The study concluded that
frequency of improvement was greater in the reflexology group not only did
the patients in this study enjoy the intervention, they were also relaxed,
comforted and relieved from symptoms. (13)
Reflexology is a simple non invasive technique which can be performed
anywhere. It does not require any special equipment. Human hand is the
primary tool for used in reflexology, it does not interfere with patients privacy.
It has a good beneficial effects include increased circulation, relaxation, and
release of tension, nausea, relieve of pain, stiffness, headache, stress, asthma,
constipation, sinusitis, and migraine. Based on the above review of literature
and findings the researcher is interested to do the study among cancer patient
to relieve those sysmptoms.
5
6.2
REVIEW OF LITERATURE:
Review of literature is the basis of most of the research projects in various
sciences and humanities. It forms the foundation upon which all future work
will be built.
It provides basis for the selection and formation of the problem, Justify the
need for the study, throws light on the feasibility of the study, providing
methodology for comparison and replication, avoiding obstacles and making
generalization.
Literature are related to the following aspects:
1. Studies related to cancer
2. Studies related to foot reflexology therapy
3. Studies related to effectiveness of foot reflexology massage on
cancer patients
4. Studies related to effectiveness of interventional program.
1. Studies related to cancer
An article on “projection of cancer incidence in 5 cities and cancer mortality in
India” says that cancer is the second largest non communicable disease and it
has sizable contribution in the total number of deaths. It is important for the
public health professional to understand the dynamics of cancer incidence for
future strategies. Therefore this paper is attempted with the objective of
projecting number of cancer incidence for five cities namely, Bangalore,
Chennai, Delhi, Bhopal, Mumbai and to estimate the cancer mortality rate for
all India for the year 2008. The data were used from the Indian Council of
Medical Research’s publication of population based cancer registry for the
year 1999 – 2000. The population was calculated from the census report of
1999 and 2001. Causes specific mortality report by the Central Bureau of
Health Intelligence was used for estimating cancer mortality for all India. The
6
age specific rate method is utilized to project number of cancer incidence for
the cities of Bangalore, Chennai, Delhi, Bhopal and Mumbai and to estimate
cancer mortality in 2000 for all India. Results shown about 26.6% increase is
expected in these five cities and 52.68% increase is projected for Delhi which
would mean highest number of cases in Delhi among these five cities within a
span of eight years. And in Mumbai it is expected to have a manginal decline
in the number of cases for the year 2008 (around 3.25%). The age adjusted
analysis indicates that Mumbai is experiencing the higher incidence rate
among the five cities. It is estimated about 50% cancer mortality is reported
from the age group 55 and above years. (14)
An article on psychological problems in cancer care: a brief review of common
problems says that worldwide the number of cancer cases continues to
increase. Newly diagnosed patients often face more advanced and aggressive
therapy as medical advances attempt to provide better survival outcomes.
Success in part from improvement of treatment and from early diagnosis
means that more cancer patients living longer with the diagnosis, common
problems of anxiety, depression, psychosexual and communication issues are
examined. (15)
A study was conducted on expectations of cancer patients regarding treatment
related side effects. In this study sample comprised of 160 newly diagnosed
cancer patient who are planning to undergo either chemotherapy (CT) or
radiotherapy (RT). Ninety patients were from Kamala Nehru Hospital, Bhopal
and 70 were from Jawarahalal Nehru Cancer Hospital and Research Centre,
Bhopal. Sample was taken randomly (every third patients) from the list of
OPD patients who had not initiated the therapy. All the information regarding
demographic data, type of cancer, and type of treatment option e.g.
radiotherapy (RT), chemotherapy (CT) or radio + chemotherapy (RT+CT)
were obtained in a questionnaire prepared by radiologists and oncologists from
Kamala Nehru Hospital, Bhopal. Side effects queried were the most common
side effects usually experienced by cancer patients during the treatment, i.e.
hair loss, vomiting, weight loss, pain, fatigue, sleep problems, depression,
7
burning micturition and mouth ulcer. Each patient was interview prior to
initiation of the therapy to assess the current symptoms due to cancer itself and
expected symptoms regarding treatment related side effects. Patients response
was recorded as “YES” if they certainly expected the side effect to be
developed and “NO” if they certainly did not expect the side effects. The study
result shown that females expected significantly higher number of side effects
than males. Hair loss was the most side effects (77.5%), pain (59%), sleep
problems (59%). With reference to gender fatigue was expected by highest
number of patients in both sexes. The study concluded that most of the cancer
patients expect high number of side effect related to cancer treatment. Proper
counseling education and information regarding treatment options and its side
effects is essential. (16)
2. Studies related to foot reflexology therapy
A study was conducted to find out the efficacy of reflexology in patient with
operative pain after general surgery. Sixty patient of general surgery have been
included in this study. Patients were divided randomly into two groups,
Reflexology group (foot reflexology + required quantity of standard drug) and
control group (standard quantity of standard drug). Standard drug were NSAID
(Diclofenec) + opioids (pethidine and fentanyl). Pain score was measured by
monitoring the strength of pain on visual analog scale. In group I pain has been
measured at the time. Scale of 0,2,6,24 hrs and also (0hr – 20min) (2hrs –
20min) (6hrs – 20min) (24hrs – 20min), 20min is the time interval before and
after therapy. In Group II pain score has been measured only at time interval
0,2,6,24 hrs (0hr has been defined as the time at which patient was shifted to
the recovery room). The results shown a significant decrease of requirement
and quantity of drugs in Group I and also a significant decrease of pain score
in Group I in comparison with Group II. The study concluded that the effect of
foot reflexology causes a significant reduction of requirement of pain killer’s,
Another effect is a significant reduction of pain score in Group I comparison
with Group II in post operative patient. (6)
8
A study was conducted on “Foot Reflexology: An intervention study”. The
goal was to test if foot reflexology affects the well being, voiding, bowel
movement, pain and sleep in women who underwent an abdominal operation.
130 subjects were randomed into 3 groups. For five days they were exposed to
15 min foot reflexology foot/leg massage on talking respectively. Results
shows that women in the foot reflexology groups were more able to void
without problems, after indwelling catheter have been removed than did
women in the comparison group. There was also a tendency in the foot
reflexology group for the indwelling catheter to be removed earlier than in the
other groups. In comparison foot reflexology subjects sleep worse than the
others. The study concluded that foot reflexology showed significant results in
the subjective measures of well being, pain and sleep. (17)
3.
Studies related to effectiveness of foot reflexology massage on cancer
patients.
A study was conducted to prove that reflexology treatment can lead to
significant decrease in anxiety and pain level for breast cancer patient. A group
of 23 lung and breast cancer patients comprised mostly of women oven the age
of 65 received 30 minutes of reflexology by a certified reflexologist with no
other changes made to their medication on schedules. Results shown that
patients reported a significant decrease in anxiety and pain after the
reflexology sessions. The study concluded that reflexology treatment can lead
to significant decrease in anxiety and pain for breast cancer patient. (18)
A study was conducted on how foot reflexology helped women with breast
cancer. In this study 3 types of complementary and alternative therapies
reflexology, guided imagery and remiscene therapy for women receiving
chemotherapy during the last stage of breast cancer. Foot reflexology was
shown to be the most effective complementary and alternative therapy.
Patients experienced a decreased in depression and anxiety and an increase in
quality of life. They were not only given emotional support, but also were able
to benefit from the physical benefits of reflexology, namely to increase
9
circulation, release pain, stress and tension, and to boost the immune system.
Reflexology helps to bring the body back into balance.(19)
A study was conducted on effects of reflexology in decreasing the pain and
anxiety among cancer patients. Eighty six patients with different types of
metastatic cancer and their partners were recruited to participate in the study.
The largest group 23 percent had lung cancer followed by breast, colorectal
head and neck and lymphoma. The mean age of the patient was 58.3 years and
51 percent were female. Patients ware randomly place in experimental and
control group. Partners in the experimental group were taught how to apply
foot reflexology, control group participants received usual care and a 30 min
reading session from their partner. An immediate decrease in pain intensity
and anxiety was seen in patients receiving reflexology. Relief was strongest for
patients with moderate to severe levels of pain. Reflexology is a
complementary and alternative medicine therapy in which manual pressure is
applied to specific points on the feet, thought to correspond with specific
organs on parts of the body. Estimated 90 percent of cancer patients use some
form of alternative therapy such as massage or music therapy, bio feedback,
yoga or acupuncture without side effects found with some medication or
procedure. More than one million new cancer cases will be diagnosed this
year, according to American cancer society. (20)
A study was conducted on effects of foot reflexology on pain in patients with
metastatic cancer. In this study thirty six oncology patients participated. Foot
reflexology was found to have a positive immediate effect for patients with
metastatic cancer who reports pain, although there was no statistical significant
effect at 3 hours after intervention or 24 hours after. The study suggested that
foot reflexology delivered by family in the homes for management of cancer
patient. (21)
A study was conducted on reflexology and healing touch on relieving cancer
symptoms. A total of 113 patients participated in the program. Sixty seven
percent were female. About 60% of the participants were hospitalized for
10
cancer management. A total of 83 healing touch treatment were given to 48
patients, and 113 reflexology treatment were given to 53 patients. 12 patients
had both healing touch and reflexology treatment who received reflexology
reported less pain, nausea, stress, anxiety and depression they also expressed
increased feeling of well being and peace fullness. The study concluded that
reflexology is effective for relieving cancer symptoms.(22)
4
Studies related to effectiveness of interventional programme to other
patients.
A study was conducted on the effects of foot massage on physiologic
indicators in critically ill patients. The purpose of this research was
to
determine the effect of foot massage on physiological indicators including
pulse, respiration and mean arterial pressure. The hypothesis of this research is
that foot massage decreases the patient’s heart rate, respiratory rate and mean
arterial pressure. This research is a quasi experimental study and a self –
control, clinical trail with repeated measures in which 46 patients with brain
stroke that hospitalized in intensive care unit of Tajrish Shohada hospital are
studies. Using instruments include a stethoscope and a sphygmomanometer
that sphygmomanometer was calibrated before beginning the work.
Information was collected at 4 to 6 pm. For this purpose the physiologic
indicators were controlled and after 10 minute, the samples were undergoing
five minute stroke foot massage, and then in 10 and 30 minute intervals
physiologic indicator were controlled again. Data were analyzed with repeated
measures ANOVA statistical method. Findings showed that pulse rate,
respiratory rate and mean arterial pressure significantly decrease after five
minute foot massage (p<0.001). So that these indicators in 10 minute after foot
massage were less than 10 minute before massage and in 30 minute after foot
massage were less than 10 minute before and 10 minute after foot massage.
Findings show parasympathetic activity after foot massage that result in
alteration in physiologic responses. Decreasing of heart rate, mean arterial
pressure and respiratory rate may shows that patients were more relaxed and
their anxiety was decreased really. So we can decrease anxiety of patient in
11
intensive care unit with using of a simple, low expense and non invasive
method and can stabilize physiologic indicators and decrease effects of vital
signs instability. (23)
A study was conducted on immediate effects of a five minute foot massage on
patients in critical care. Critical care can be considered to be a stressful
environment at both physiological and psychological levels of patients. A five
minute foot massage was offered to 25 patients (68 sessions in total) as a stress
– reduction intervention is described. A quasi-experimental repeated measures
design was used to collect data before, during and after the intervention.
Physiological data (heart rate, mean arterial blood pressure, respirations and
peripheral oxygen saturation) were obtained from the patient bedside
monitoring system. Repeated measures analysis of variance indicated there
was no significant effect from the intervention on peripheral oxygen
saturation. However, a significant decrease in heart rate, blood pressure and
respiration was observed during the foot massage intervention. The study
concluded that foot massage had the potential effect of increasing relaxation as
evidenced by physiological changes during the intervention administered to
critically ill patients in intensive care. (24)
6.3
STATEMENT OF THE PROBLEM:
A study to evaluate the effectiveness of foot reflexology massage on
physiological and psychological well being among cancer patients in selected
hospital at Bangalore.
6.4
OBJECTIVES OF THE STUDY:
1. To assess physiological and psychological wellbeing among cancer
patients.
2. To evaluate the effectiveness of foot reflexology massage on improving
physiological and psychological well being.
3. To find an association between the foot reflexology massage on
physiological and psychological well being with selected demographic
variables.
12
6.5
OPERATIONAL DEFINITIONS:
 Evaluate: Refers to critical appraisal or assessment of physiological
and psychological wellbeing after foot reflexology massage.
 Effectiveness: Refers to the significant difference between pre and
post interventional scores on physiological and psychological
wellbeing after foot reflexology massage.
 Foot reflexology massage: Refers to a “pressure therapy” and involves
applying focused pressure to certain known reflex points located in the
foot, which corresponds to certain other areas in the body, here it refers
to a technique of deep massage to the soles of the feet to improve
physiological and psychological wellbeing.
 Physiological well being: Refers to normal functioning of the body
with feeling of good health, here it refers to normal level of blood
pressure, heart rate, respiration, decreased intensity of pain.
 Psychological well being: refers to a state of complete happiness of
mind, here it refers to decreased anxiety, depression and provide
relaxation and comfort.
 Cancer Patients: Patients who are having malignant growth in tissues
of the body, here refers to all types of cancer patients admitted in the
selected hospital.
6.6
HYPOTHESIS:
H1: There will be significant difference between pre and post interventional
scores on physiological and psychological wellbeing after foot reflexology
message.
H2: There will be significant association between foot reflexology massage on
physiological and psychological wellbeing with selected demographic
variables.
6.7
ASSUMPTIONS:
 The foot reflexology massage technique may be effective to improve
the physiological & psychological well being among cancer patients.
13
 Physiological and psychological wellbeing may vary with selected
demographic variables.
6.8
DELIMITATIONS:
1. The study is limited to cancer patients admitted in the cancer wards.
2. The study is limited to patients who are conscious and oriented.
7.
MATERIAL AND METHODS:
7.1
SOURCE OF DATA
Cancer patients admitted in selected cancer hospital
at Bangalore.
7.2
METHOD OF COLLECTION OF DATA:
7.2.1
SAMPLING
CRITERIA
INCLUSION
 Chronic cancer patients admitted in hospital.
CRITERIA
 Patients who are willing to participate in the
study.
 Patients of both sexes
 Patients who can read and understand
Kannada & English.
EXCLUSION
 Patients who are unconscious and disoriented
CREITERIA
 Cancer patients with other neurological
disease
 Cancer patients with foot ulcer.
 Cancer patients with fracture leg.
7.2.2
RESEARCH
The research design adopted for the study is pre
DESIGN
experimental design (one group pre test and post test
design)
7.2.3
VARIABLES
Independent Variables: Foot reflexology massage.
UNDER STUDY
Dependent Variables: Blood pressure, heart rate
respiration, pain, anxiety and depression.
7.2.4
7.2.5
SETTING OF
Study will be conducted in selected cancer Hospitals
STUDY:
at Bangalore.
SAMPLING
The investigator will use purposive sampling
14
TECHNIQUE
technique.
7.2.6
SAMPLE SIZE:
The proposed sample size of the study is 40.
7.2.7
TOOL FOR
Section A: The researcher will develop a structured
RESEARCH:
interview schedule to assess the demographic
variables of the samples
Section B:
a) Physiological parameter will be measured and
scored by the investigator.
b) Pain will be measured by pain scale.
Section C: Hamilton Anxiety
and depression
assessment scale will be used to assess anxiety and
depression.
7.2.8
DATA
COLLECTION
1. A prior formal permission will be obtained
from hospital authority.
2. Informed consent will be obtained from the
subject after explaining the purpose of the
study.
3. The pre interventional assessment will be done
by using physiological wellbeing assessment
scale and psychological wellbeing by Hamilton
anxiety and depression assessment scale, on
the first day among cancer patient.
4. Foot reflexology massage therapy will be given
on the same day for 30 min session 5 times in
24 hrs intervals.
5. Post
interventional
assessment
will
conducted after 6 days by using same scales
6. Duration of study is 30 days
15
be
7.2.9
METHOD OF DATA
1. The investigator will analyze the data
obtained by using descriptive study and
ANALYSIS
inferential statistics.
2. Organize
the
data
in
a
master
sheet/computer.
3. Frequencies and percentage for the analysis
of background data.
4. Comparison of pre and post interventional
score of physiological
and psychological
wellbeing will be done by “T” test
5. Relationship
between
physiological
wellbeing and psychological well being will
be done by ‘R’ value
6. Chi
square to identify the association
between variables.
7.3
DOES
THE
STUDY
REQUIRE
ANY
INVESTIGATIONS
OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER
HUMAN OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY,
Yes, the study will be conducted among cancer patients admitted in
selected cancer hospital at Bangalore.
7.4
HAS ETHICAL CLEARANCE BEEN OBTAINED FROM THE
HOSPITAL AUTHORITIES OF THE PARTICULAR INSTITUTION IN
CASE OF 7.3?
Yes, informed consent will be obtained from the institution authorities
and subjects. Privacy, confidentiality and anonymity will be guarded.
Scientific study will be maintained with honesty and impartiality.
8.
LIST OF REFERENCES.
16
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http://coloncancer.about.com/od/glosaries/g/cancer.html.
2. WHO/ Are the number of cancer cases increasing or decrease, 1st April
2008, http://www.who.int/features/9a/15/en/index.html
3. Mathew. J. Hayat, The oncologist, Vol. 21, No. 1, 20 – 37, Jan 2007
doi:10.1634/the oncologist. 21 – 1 – 20.
4. K. Uma Devi, current status of gynecological cancer in India, journal of
gynecologic oncology, June 16 2009
5. Kidwai Memorial Institute of oncology, Hospital based cancer registry,
http://kidwai.kar.nic.in/statistics.html.
6. Sweta Chowdhury. A study on “Reflexology reduce the requirement and
quality of pain killer after genera surgery”, June 2004. www.altmedor.com.
7. Ninnart, Foot reflexology massage: A healing touch, 10th Feb 2006, Vol
22, No. 21 http://www.thaiwaysmagazine.com /thai article/2221 foot
reflexology.
8. Philip green, reflexology, 18th Nov 2007 http://www.reflexology.co.uk
9. Reflexology overview, http://www.focusonhealing.com/overview.html.
10. Grealish, L. Lomanny A, Whiteman, B. “Reflexology used for cancer
patients”. Cancer nurse 2000. June; 23 (3): 237 – 43.
11. Stephenson. N. L., Weinrich. S.P and Tavakoli A. S/. “The effect of foot
reflexology on anxiety and pain in patients with breast and lung cancer”,
oncol nurse forum 2000, Jan – Feb; 27 (1): 67 – 72
12. The
Department
of
Health
social
services
and
public
safety,
complementary and alternative medicines pilot project, Northern Ireland,
May 2008. http://reflexology.suite101.com/article.cfm
13. Hodgson. H. “Does reflexology impact on cancer patients quality of life?”.
Apr 2000 Nursing Standard, 14, 31 pp. 33 - 38.
17
http://www.reflexology.research.com
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mortality in India, Indian journal of cancer, 2008, Dec 3, 45: 4 – 7.
http://www.indiajcancer.com/test.asp? 2008/45/1/4/40639.
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psychosocial problems in cancer care, vol 4, page 323 – 331 31st Oct 2003.
http://www.interscience.wiley.com
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expectation of cancer patients regarding treatment related side effect in
Bhopal, Indian Journal of community medicine, Vol. 32, Page: 69 – 70,
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1999 1:38-40; http://www.reflexology-research.com/nurse.html
18. Group conducted research: School of Nursing, East Carolina University,
Greenville, NC, 2000, http://www.restoreinc.com/iupuireflexology/reflexologyresearch.html
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http://reflexology.suite101.com/artcile.com breast cancer and reflexology.
20. Dr. Stepensons, sole to sole reflexology, oncology nursing forum, Jan
2007, Vol. 34, n-5, http://www.soletosoulreflexology.com/research.html.
21. Nancy Stephenson, A pilot study on the effect of foot reflexology on pain
in patients with metastatic cancer, Science direct 5 November 2003,
http://www.science direc.com/science
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a Complementary Therapy Internship Program on an Inpatient oncology
unit, Oncology Nursing Forum, March/April 2003, Volume 30, Number 2.
http://www.reflexologyresearch.com
23. Imanie, Moshtaqe Eshq Z, The effects of foot massage on physiological
18
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