The Effectiveness of Foot Reflexology Massage in Reducing Cortisol Saliva Levels as a Biomarker of Stress for Patients with Cancer

Abstract

Patients with cancer will experience limitations in meeting their daily needs, including psychological problems such as stress. Stress can be assessed through cortisol saliva as a biomarker of stress. Foot Reflexology will help restore the body's energy balance, stimulate relaxation and endorphins, and reduce stress. To determine the effect of foot reflexology to reduce salivary cortisol levels as a biomarker of anxiety for patients with cancer. Adult patients with cancer in stage II and III hospitalized in a Public hospital in Central Java, Indonesia, were invited. Foot reflexology was given once (40 minutes) a day. Saliva collection was carried out two times a day (30 minutes before intervention) and 15 minutes after intervention. Salivary cortisol levels at baseline and post-intervention were measured and compared to determine the effect of foot reflexology. Data were analyzed using the Wilcox on signed-rank and effect size (ES) test. Fifty-five patients (93.2%) participated in this study. We found that the effect size of foot reflexology was 0.82 (ρ = 0.001) with a mean and standard deviation of salivary cortisol levels at baseline and post-intervention were (9.31 ± 5.45 and 6.17 ± 4.55) respectively. These findings indicated the significant effect of giving Foot Reflexology Massage in reducing salivary cortisol levels. Foot Reflexology massage is proven to have a substantial impact on reducing the Salivary cortisol level as a stress biomarker.

Full text

           
 
    
 
          
The Effectiveness of Foot Relexology Massage in Reducing Cortisol
Saliva Levels as a Biomarker of Stress for Patients with Cancer
        
          
 
          
    
            
    
Article History:
    
    
    
Keywords:








          
         
           
         
           
            
              
           
             
         
          
            
     .   
              ρ
            
     ±   ± 
          
          
             

 
  
 
 
 
 
   

  |  
INTRODUCTION
        
      
       
     
       
      
       
     
      
  et al.    
         
       
        

           
       
         
        
      
      
      
        
      
      
   et al. et al.
     
      
     et al.
 et al.
         
     
     
       
       
      
et al.     
      
         
        
         
   
        
       
        
       
et al.     
     
    
      
       
       
      
    
        
       
        
      
       
       
          
        
      
        
        
      
      
       
    
       
       
        
    
      
    
      
      
et al.      
         
et al.     
      
  et al.
      
       
          
       
       
      
      
       
       
        
     
      
      
        
       
      
      
        
      
        
 
MATERIALS AND METHODS
Subject and Methods
Patient
       
       
       
        
      
       
       
      
     
       
      
      
      
      
      
      
      
   
        

           
Figure 1: Respondent Selection Chart.
       
      
     
   
      
     
       

Figure 2: Change of salivary cortisol.
Intervention
       
       
      
            
      
       
        
        
        
     
       
       
       
     
     
        
     
   
     
      
     
      
      
     
      
    

Measurement, data and specimen collection
         
       
        
      
      
        
µ        
         
      
        
        
       
        
       
         
        

           
Table 1: Demographic Characteristics.
Characteristics f % Mean ±SD
Sex
  
  
Age
    
        ±
   
Min-max Age
  
Income
   
≥   
Type of Cancer
  
   
    
  
   
   
 
Length of Sickness
≤   
   
      ±
Type of therapy
  
    
 oo      
         
        
  
Statistical Analysis
       
       
        
         
        
       
      
        
         

      
       
        
       
        
       
     ρ  
       
    ≤
≤   
Figure 3: Boxplot of cortisol on baseline and
Post Intervention.
        
      
        
       ρ
        

           
Table 2: The effect of foot relexology on salivary cortisol levels in cancer.
Level of Salivary Average Difference Value of Cortisol Saliva Level and Test of Size Effect
ortisol Median (min-max) P-value Z ES
     
   
        ρ            
                    
        
        
       
         
           
          
      
RESULTS AND DISCUSSION
       
       
        
        
        
    
      
      
      
      
       
         
Demographic Characteristics and Distribution
of Cortisol Saliva Levels
          
      
        
        
     
       
       
        
       
      
     
   
      
       
      
      
      
       
   ±     
 ±      
    
       
         
       
     
        
        
       
       
          
      
   
Effects of Massage Foot relection on salivary
cortisol levels
       
          
        
        
         
         
       
       
        
        
       
       
          
       
   
       
    
   ρ  ρ  
       
        
       
         
          
        
       
        
        
         
       
 ρ      
         
        
        

           
     
      
        
  
      
     
       
          
      
        
       
     
      
      
  et al.    
        
        
      
       

Reducing stress by stimulating a relaxation
response
        
      
       
       
         
      
      
      
      
      
       
        
      
     
       
        
        

      
     
      
      
       
       
      
    
       
  et al. et al. 
       
      
       
       
    
      
      
      
      
     
      
  et al.
    
        
        
     
         
     
       
    
       
         
        
        
     
       
        
        
      
       
        
   
Improve mood
       
       
     
         
     
       
      
      
        
        
       
       
     
      
        
      
      et al.

         
      
      
     
       
       
   .    
        

           
      
       
       
         
          
        
     
       
       
      
      
         
   et al.    
      
       
         
       
CONCLUSIONS
        
        
       
       
 
ACKNOWLEDGEMENT
      
        
      
 
Funding Support
       
      
     
     
 
Conlict of Interest
        
   
REFERENCES
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  
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          
       
    Clinical Journal
of Sport Medicine 
        
     The Can-
cer Journal 
    et al.   
    
 The Journal of Pain 
      
     The Cancer
Journal 
      
        
      
     Psycho-
Oncology 
    et al.  
       
       
  Pain Practice 
        
      
American Journal of Nursing Science 
     et al.  
       
      
Experimental and Therapeutic Medicine 

   Aromatherapy: Therapeutic use of
essential oils for esthetic   
  
    et al.  
      
    
Journal of Psychosomatic Research 
     et al.   
      
  Journal of Dental Research

       
      Stress and
Health 
    et al.  
     
      
Psycho Oncology 
       
     
      Comple-
mentary Therapies in Clinical Practice 

       
       
  Cancer Journal 
        

           
      et al.  
      
     
    Complementary Ther-
apies in Clinical Practice 
       
       
       
    
       
    
      
  Asia-Paciic Journal of
Oncology Nursing 
       
     Indian
Journal of Palliative Care 
       
        
 Journal of the National Cancer Insti-
tute Monograph 
      et al.   
        
      
 Psycho Oncology 
        
       
  Japanese Journal of Clinical Oncol-
ogy 
      
      
 Asia-Paciic Journal of Oncology Nursing

    et al.  
        
    European Jour-
nal of Oncology Nursing 
        