|Year : 2022 | Volume
| Issue : 2 | Page : 153-158
Effect of warm water footbath on chemotherapy-induced fatigue among patients with cancer in a selected hospital at Mangaluru
Irene Thakuria1, Sonia D'Souza2, Victoria D'Almeida3
1 M.Sc Nursing Student, Department of Medical Surgical Nursing, Father Muller College of Nursing, Mangaluru, Karnataka, India
2 Associate Professor, Department of Medical Surgical Nursing, Father Muller College of Nursing, Mangaluru, Karnataka, India
3 Professor and Head, Department of Medical Surgical Nursing, Father Muller College of Nursing, Mangaluru, Karnataka, India
|Date of Submission||30-Jan-2021|
|Date of Decision||11-Nov-2022|
|Date of Acceptance||14-Nov-2022|
|Date of Web Publication||10-Jan-2023|
Mrs. Sonia D'Souza
Department of Medical Surgical Nursing, Father Muller College of Nursing, Mangaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Fatigue is experienced by most patients with cancer during chemotherapy. Warm-water footbath is one of the many non-pharmacological interventions which help in reducing chemotherapy-induced fatigue (CIF). This study aimed to assess the effect of warm water-footbath on CIF among patients with cancer. A time-series non-equivalent control group design was adopted. Thirty participants with CIF were selected from a selected hospital at Mangaluru by purposive sampling technique and were assigned to the intervention group (n = 15) and control group (n = 15) by random allocation using the closed envelope method. The pre-interventional CIF scores were assessed using the Piper Fatigue Scale-12. Warm-water footbath intervention was administered to the intervention group for 20 min two times a day with the interval of 6 h for 3 consecutive days. The post-intervention measure was administered 5 min after the second intervention on each day using the same fatigue scale. The same protocol was followed by the control group but no intervention was given. The one-way repeated measure analysis of variance value (F (5,10) = 215.63, P = 0.001) indicates that there was a highly significant difference between the mean pre-interventional and post-interventional scores in the intervention group at various time points. The unpaired t values (t (28) =15.9, P = 0.001) on day 3 showed that there was a highly significant difference in the post-interventional scores between the intervention and control groups. Warm-water footbath is an effective and simple strategy to reduce CIF among participants with cancer-receiving chemotherapy.
Keywords: Chemotherapy-induced fatigue, patients with cancer, warm-water footbath
|How to cite this article:|
Thakuria I, D'Souza S, D'Almeida V. Effect of warm water footbath on chemotherapy-induced fatigue among patients with cancer in a selected hospital at Mangaluru. Indian J Cont Nsg Edn 2022;23:153-8
|How to cite this URL:|
Thakuria I, D'Souza S, D'Almeida V. Effect of warm water footbath on chemotherapy-induced fatigue among patients with cancer in a selected hospital at Mangaluru. Indian J Cont Nsg Edn [serial online] 2022 [cited 2023 Feb 3];23:153-8. Available from: https://www.ijcne.org/text.asp?2022/23/2/153/367494
| Introduction|| |
Fatigue is one of the most frequent complaints reported by patients undergoing chemotherapy. In the majority of studies, 82%96% of those receiving chemotherapy suffer from fatigue during their treatment. Chemotherapy can kill normal cells and cancer cells, which leads to a build-up of cell waste. Cancer forms toxic substances in the body that change the way normal cells work, which can cause or worsen fatigue. Fatigue worsens as the number of chemotherapy cycles increases and causes distressing and disabling symptoms in cancer patients, interfering with their ability to enjoy life and to take care of themselves. It reduces the individual resources of patients, influences their nutritional state and increases morbidity.
Warm-water footbath is a simple and inexpensive therapy which has been accepted for decades as a non-pharmacological intervention for relieving fatigue. When a warm-water footbath is applied for 1520 min, the vasodilation that results improves neutralising acid, killing bacteria and relieving aches and tiredness. It increases nourishment to tissues and calms and relaxes tension. Severe fatigue is a common complaint that nurses come across when caring for patients undergoing chemotherapy. Hence, this research study was undertaken to find out whether an alternative therapy which is cost-effective and simple can help overcome this disabling side effect of chemotherapy.
The objectives of the study were to
- Determine the pre-interventional level of chemotherapy-induced fatigue (CIF) among patients with cancer in the intervention and control groups
- Evaluate the effectiveness of warm-water footbath on CIF among patients with cancer in the intervention group
- Compare the post-interventional level of CIF among patients with cancer in the intervention and control groups
- Determine the association between pre-interventional level of chemotherapy-induced fatigue among patients with cancer and the selected demographic variables in the intervention and control groups.
| Methods|| |
A time-series non-equivalent control group design was adopted for the study. The study was conducted from 25th February 2020 to 21st March 2020, in three oncology units such as surgical oncology, radiation oncology and medical oncology of a tertiary hospital in Mangaluru. The inclusion criteria included patients with reproductive and haematological cancer who were receiving chemotherapy, diagnosed with Stages I and II cancer, between the age group of 2070 years and are able to follow the instructions in English or Kannada. The study excluded patients with reproductive and haematological cancer who were unconscious and terminally ill, with diabetic foot ulcer or fracture of legs, having loss of sensation in their legs, skin excoriation over the legs or diagnosed with leukaemia. The sample comprised 30 patients with haematological and reproductive cancer, Stages I and II admitted for chemotherapy. The sample size was calculated based on a previous study.
The sample size for the study was calculated using the formula
Using this formula, the sample size obtained was 11 and adding 20% of the attrition rate, the sample size was 15 in each group, i.e., a total of 30 participants. Purposive sampling was used to select 30 participants and participants were randomly assigned to the interventional group (n1 = 15) and control group (n2 = 15) by the closed envelope method.
Baseline pro forma
It consisted of 11 items for obtaining information regarding age, gender, occupation, history of smoking, family history of cancer, body mass index (BMI), type of cancer, stage of cancer, presence of comorbidity, cycles of chemotherapy and previous experience of CIF.
Piper Fatigue Scale-12
Piper Fatigue Scale-12 (PFS-12) is a standardised tool which measures the level of CIF among the selected subjects. It is a 12-item scale and each item has 11 response categories on a scale of 010 with verbal descriptors anchoring the endpoints. Each scale is scored individually and then aggregated together for an overall score, with higher scores reflecting more CIF. Scores between 1 and 3 are considered mild CIF, 4 and 6 as moderate CIF and 7 and 10 as severe CIF.
The PFS-12 scale has four subscales with three items each, namely behavioural, affective, sensory and cognitive. To calculate the total score the sum of 12 items is divided by 12, and the fatigue is classified as follows: 0 = none, 13 = mild, 46 = moderate and 710 = severe. Permission to use the standardised tool was taken from the author.
Warm-water footbath feedback form
The feedback form was developed by the investigator to collect the opinion of the subjects regarding the warm-water footbath sessions. It consisted of 10 items each with five options that are excellent, very good, good, fair and poor.
Data collection procedure
Baseline characteristics were assessed using the baseline pro forma through an interview method. Pre-interventional CIF was assessed each day before the initial intervention in both groups using PFS-12. After the pre-test, warm-water footbath was administered to the intervention group for 20 min two times a day with the interval of 6 h for 3 consecutive days, at the end of chemotherapy infusion from the 1st day of chemotherapy. The feet were immersed 10 cm above the ankles in an electronic temperature-regulated footbath device. The temperature of the water was set between 41°C and 42°C by adjusting the digital electronic valve. The entire intervention was done at the bedside and the investigator remained with the subjects to ensure no undue discomfort happened at the time of intervention. The post-test was administered 5 min after the second intervention on each day using the same fatigue scale. The same protocol without intervention was followed for the control group. Demographic data of the subjects were analysed using frequency and percentage. The level of CIF among participants was analysed using descriptive statistics and expressed in terms of frequency, percentage, mean and standard deviation (SD). The data were analysed using one-way repeated measure analysis of variance (ANOVA), unpaired t-test and Chi-square test using SPSS software version 16 (SPSS for Windows, Version 16.0. Chicago, SPSS Inc.).
Formal permission was obtained from the institutional ethics committee of the institution before the data collection. Patients were explained about the study and those who gave informed consent were included in the study.
| Results|| |
Less than 50% (7, 47%) of participants in the intervention group and 6 (40%) participants in the control group were in the age group of 5160 years. Fifty-three per cnet of the participants in the intervention group and 40% of participants in the control group were diagnosed with haematological cancer, whereas 47% in the intervention group and 60% in the control group were diagnosed with reproductive system cancer. Forty-seven per cent of participants in the intervention group and 33% of participants in the control group were in the 3rd cycle of chemotherapy [Table 1].
|Table 1: Frequency and percentage distribution of subjects according to their baseline characteristics in the intervention and control group|
Click here to view
Both the intervention and control groups were homogeneous with regard to all demographic variables and pre-interventional CIF scores as analysed by the Chi-square test [Table 2].
|Table 2: Homogeneity of the subject's baseline characteristics in the intervention and control group|
Click here to view
Both pre-test score and post-test score in the intervention as well as the control groups were reduced over 3 days. The mean CIF score at pre-intervention reduced from 8.1 (SD 0.58) on the 1st day to 5.6 (SD 1.16) on the 3rd day in the intervention group. In the control group, the mean pre-test scores reduced from 7.6 (SD 0.68) on the 1st day to 6.4 (0.48) on the 3rd day. Similarly, The post-test score reduced from 4.0 (SD 1.09) on the 1st day to 1.7 (SD 0.75) on the 3rd day in the intervention and from 6.9 (SD 0.69) on the 1st day to 5.7 (SD 0.58) on the 3rd day in the control group [Table 3].
|Table 3: Mean pre-interventional and mean postinterventional level of chemotherapy-induced fatigue in the intervention and control group at various time points|
Click here to view
The one-way repeated measure ANOVA, (F (5,10) =215.63, P = 0.001) indicates that there was a highly significant difference in the mean pre-interventional and post-interventional CIF scores in the intervention group at various time points. The eta2 value 0.93 indicates a larger effect size of warm-water footbath on CIF patients receiving chemotherapy in the intervention group at various time intervals. This showed that warm-water footbath had a significant effect on reducing the level of fatigue among cancer patients receiving chemotherapy and the effect was not by chance [Table 4].
|Table 4: Comparison of mean pre-test and post-test levels of chemotherapy-induced fatigue in the intervention group at various time points within the group (n=15)|
Click here to view
To identify at what time point the significant difference was present, post hoc Bonferroni correction test was computed and is presented in [Table 5].
|Table 5: Comparison of the effect of the intervention on chemotherapy-induced fatigue at various time points using post hoc Bonferroni correction test in the intervention group|
Click here to view
The data presented in [Table 5] show that there was a highly significant difference (P < 0.01) in mean CIF scores between pre-test and post-test at and across all time points. The difference in mean scores in the control group was not significant.
To find out the significant difference in the mean post-test level of CIF scores among the cancer patients receiving chemotherapy in the intervention and control group, an unpaired t-test was computed. The data presented in [Table 6] show that the calculated t value (t28 = 15.9, P = 0.001) on day 3 is greater than the table value (t28 = 2.048 P < 0.05) which showed that there was a highly significant difference in the post-interventional CIF scores between the intervention and control group. This indicated that a warm-water footbath is effective in reducing the CIF [Table 6].
|Table 6: Comparison of post-interventional chemotherapy-induced fatigue scores in the intervention and control group|
Click here to view
The P values of age (in years), gender, family history of cancer, BMI (Kg/m2), type of cancer, presence of comorbidity, cycles of chemotherapy and previous experience of CIF are >0.05 indicating that there is no significant association between the pre-interventional level of CIF and selected demographic variables in the intervention group and control group.
Participants were comfortable and also expressed a high level of satisfaction towards the administration of the footbath with warm water in their feedback.
| Discussion|| |
In the present study, <50%, 7 (47%) participants in the intervention group and 6 (40%) participants in the control group were in the age group of 5160 years. This study is similar to the findings of the study conducted by Yang et al. to assess the effects of warm-water footbath on relieving fatigue and insomnia of gynaecologic cancer patients on chemotherapy, which revealed that the majority of the participants, 17 (70.9%) in the experimental group and 19 (72.8%) participants in the control group were in the age group of 4160 years.
Soaking and cleansing feet in warm water reduces inflammation and stimulates circulation, bringing congested blood to the dilated vessels in the feet and lower legs improving blood circulation and supplying oxygen to brain cells, thus helping in the elimination of toxins. It stimulates circulation, increases nourishment to the tissues and relaxes tension. It also causes the congested blood to flow towards distant parts of the body and is brought to the dilated vessels of the foot and leg.
The findings of the present study inferred that there is a highly significant difference between the mean pre-intervention and mean post-intervention levels of CIF scores in the intervention group at repeated time intervals (F(5,10) =215.63, P = 0.001). The current study has revealed that there is a significant difference in the mean post-interventional level of CIF (t(28) =8.6, P = 0.001) on day 1, (t28=-18.7, P = 0.001) on day 2 and CIF (t28 = 15.9, P = 0.001) on day 3 between the intervention and control groups.
The present study gives two major insights. 1. The warm-water foot bath reduced fatigue significantly. 2. The significant reduction in the pre-test score [Table 5] also on consecutive days shows the effect of the foot bath on the next day as well. The steady but not so significant decline in the fatigue score in the control group raises questions as to what caused this effect. Does fatigue decline over time without an intervention or whether there were other confounding variables, such as rest or other adjuvant therapies that could have influenced fatigue? This aspect needs to be evaluated.
Similar studies that assessed the effect of warm-water footbath on the level of fatigue among clients with cancer also found the intervention group showed a significant reduction in fatigue while there was minimal change in the control group.,, The presence of a researcher could also have an influence on how patients feel at that time even without intervention.
This study measured post-intervention fatigue on the same days of intervention. Long-term positive effects have also been reported in another study conducted by Farnia and Rahmanian on the effect of warm footbath on fatigue among diabetic older adults. The results revealed that 2 weeks after the intervention, the difference between the experimental and control groups was significant at (P = 0.001).
In the present study, there was no significant association of age, family history of cancer, BMI (kg/m2), type of cancer, presence of comorbidity, cycles of chemotherapy, previous experience of CIF between the pre-interventional level of CIF and selected demographic variables in the intervention and control groups.
These findings are supported by the study conducted by Devasirvadam and Priya on the effect of warm water footbath on the level of fatigue among clients with cancer. The findings showed that there was no significant association between age, gender, educational status, occupation, stage of cancer, duration of illness, modality of treatment and number of radiation cycles and level of fatigue among clients with cancer in the experimental group at P > 0.05.
| Conclusion|| |
The present study proved that there was a significant level of reduction in CIF. Warm-water footbath is a simple intervention which can be easily administered in both clinical and home settings. Therefore, this method can be used as an appropriate option to reduce or prevent CIF in patients with cancer. It is thus concluded that footbath is an effective and simple strategy to reduce CIF among patients with cancer receiving chemotherapy. The study also proved to be an enriching experience for the investigator. The satisfaction of the participants and the cooperation of the patients motivated the investigator. Warm-water footbath can be considered a non-pharmacological, safe and side effect of free, cost-effective, easy to administer intervention in reducing CIF in patients with cancer. It can be considered as routine care and nurses can teach the caregivers regarding the benefits of a warm-water footbath so that they could perform it after the discharge in their home settings.
Education for nursing students is primarily aimed at improving the quality of patient care. Students can be motivated to learn the assessment of the level of fatigue among cancer patients. Nurse educators can motivate students to learn the effectiveness of a warm-water footbath in reducing CIF as an independent nursing intervention.
- The small sample size and the short duration of the data collection limit the generalisation of the study findings. Further studies in larger population may give more information on the effect of warm foot bath
- Confounding variables have to be evaluated in detail.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Iop A, Manfredi AM, Bonura S. Fatigue in cancer patients receiving chemotherapy: An analysis of published studies. Ann Oncol 2004;15:712-20.
Bower JE. Cancer-related fatigue – Mechanisms, risk factors, and treatments. Nat Rev Clin Oncol 2014;11:597-609.
Bower JE, Bak K, Berger A, Breitbart W, Escalante CP, Ganz PA, et al
. Screening, assessment, and management of fatigue in adult survivors of cancer: An American Society of Clinical oncology clinical practice guideline adaptation. J Clin Oncol 2014;32:1840-50.
Pereira AC, Sebastian S. Effectiveness of hot water foot bath therapy in reduction of temperature among children (6-12 years) with fever in selected hospitals at Mangaluru. IJAR 2018;4:86-92.
The Healing Benefits of Foot Baths: Beyond Ultimate Tranquility; 2018. Available from: http://www.somanovo.com
. [Last accessed on 2020 Apr 22].
Cuesta-Vargas AI, Férnandez-Lao C, Cantarero-Villanueva I, Castro-Sánchez AM, Fernández-de-Las Peñas C, Polley MJ, et al
. Psychometric properties of the QuickPIPER: A shortened version of the PIPER Fatigue Scale. Eur J Cancer Care (Engl) 2013;22:245-52.
Yamamoto K, Aso Y, Nagata S, Kasugai K, Maeda S. Autonomic, neuro-immunological and psychological responses to wrapped warm footbaths – A pilot study. Complement Ther Clin Pract 2008;14:195-203.
Yang HL, Chen XP, Lee KC, Fang FF, Chao YF. The effects of warm-water footbath on relieving fatigue and insomnia of the gynecologic cancer patients on chemotherapy. Cancer Nurs 2010;33:454-60.
Shafeik HF, Abdelaziz SH, ElSharkawy SI. Effect of warm water foot bath on fatigue in patients undergoing hemodialysis. Int J Nurs Didactics 2018;8:26-32.
Soumya S. Effectiveness of footbath therapy on fatigue among patients with chronic renal failure in selected hospitals at Managalore. Int J Sci Res 2014; 3:27-36.
Devasirvadam D, Priya R. Effect of warm water footbath on level of fatigue among clients with cancer at selected cancer center in Neyoor. American J Adv Nur Res 2016; 3:66--69. Available from: http://www.mcmed.us/downloads/1462942620(ajanr).pdf
. [Last accessed on 2020 Apr 22].
Farnia F, Rahmanian M. Effect of warm foot bath on fatigue among diabetic older adults. Elder Health J 2019;5:102-7.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]