Effectiveness of “Warm Footbath” on fatigue and insomnia in patients undergoing radiotherapy

 

Minu Sharma¹, Mrs. Kamli Prakash², Mrs. Priya JPN³

¹Lecturer, Pal College of Nursing and Medical Sciences, Haldwani, Nainital, Uttarakhand, India

²Associate Professor (Guide) Himalayan College of Nursing, Dehradun, Uttarakhand, India

³Assistant Professor (Co-Guide) Himalayan College of Nursing, Dehradun, Uttarakhand, India

 

ABSTRACT:

Objectives: To assess the effectiveness of warm foot-bath on relieving fatigue in cancer  patients undergoing radiotherapy . To assess the effectiveness of warm foot-bath on relieving insomnia in cancer  patients undergoing radiotherapy . To find correlation between post-test insomnia and post-test fatigue score.  Methodology: A Quantitative research approach was used for the study to assess the effectiveness of Warm Foot Bath in cancer patients undergoing radiotherapy. Quasi - experimental pretest and posttest design was used in the study. The study was conducted in selected cancer hospital, Dehradun, Uttarakhand. Consecutive Sampling technique was used to select the study subjects. Data was collected from 60 cancer patients by using FACIT fatigue scale and Insomnia Severity Index. Results: There was mean increase in the fatigue level in control group and mean decrease in fatigue level in experimental group when warm footbath is given which was found statistically significant at p<0.05. The pre-test insomnia score in control group was 6.47 ±(4.24) which was increased to 13.63 ±(3.03)in post-test. The pre-test insomnia score in experimental group was 8.77±(2.88) which has decreased to 6.47±(5.38) in post-test. Positive correlation was found between fatigue and insomnia. Conclusion:

It is concluded that the warm footbath was effective in reducing fatigue and insomnia in cancer patients undergoing radiotherapy.

 

 

INTRODUCTION:

Cancer is a disease of cell in which the normal mechanism of the control of growth and proliferation has been altered. It is invasive, spreading directly to surrounding tissue as well as to the new site in the body. The global burden of diseases is shifting from communicable diseases to non communicable diseases. The health burden from preventable non communicable diseases, such as cardio vascular diseases, cancer, diabetics and chronic respiratory diseases, is increasing significantly throughout world¹

Based on the GLOBOCAN 2008 estimates, about 12.7 million cancer cases and 7.6 million cancer deaths are estimated to have occurred in 2008; of these, 56% of the cases and 64% of the deaths occurred in the economically developing world. ²

 

Management options for cancer exist with the primary ones including surgery, chemotherapy, radiation therapy and palliative care. Which treatments are used depends upon the type, location and grade of the cancer as well as the person's health and wishes.

 

Radiation therapy involves the use of ionizing radiation in an attempt to either cure or improve the symptoms of cancer. It is used in about half of all cases and the radiation can be from either internal sources in the form of Brachytherapy or external sources. Fatigue is a common symptom of advanced cancer limiting one's activity and affecting the quality of life. Several recent studies have reported an incidence of 30 to 50% insomnia in this group, compared to 15% in the general population.^3,4

 

Helping patients and families, managing side effects is a key nursing responsibility. Unlike the systemic side effects of chemotherapy, radiation side effects are specific to the treatment site. Patients need guidance, education, and support from nurses to navigate the healthcare system and the cancer care continuum. Teaching is a primary responsibility of nursing care for radiation patients. Patients and families must know what to expect, get a chance to ask questions, and have those questions answered to their satisfaction. Patients and families tour the radiation department on designated days to become familiar with the facility and learn about the treatment process.⁵

 

Water has historically been used to treat a variety of illnesses by many cultures, including the ancient Egyptians, Greeks, Romans, Chinese, Indians, Japanese, and classical societies of South America and Mesopotamia. However, the movement involving the use of water as the primary form of treatment originated in Europe and forms the basis of hydrotherapy today.

 

METHODOLOGY:

The study was conducted in a Cancer Research Institute with outpatient radiotherapy department. 60 patients who were undergoing external beam radiotherapy drawn as sample which were selected through consecutive sampling technique by assessing ECOG (Eastern Cooperative Oncology Group) performance status 0-2.

 

Investigator taken first 30 samples in experimental group and second half in control group. Data were collected between December 2013 to January 2014. Informed written consent were obtained from participants of the study after explaining the purpose of the study.

 

On day 7 of radiotherapy fatigue and insomnia were assessed by giving Functional Assessment of Chronic Illness Therapy (FACIT) fatigue scale and Insomnia Severity Index (ISI) to participants to score their fatigue and insomnia respectively. Instruction followed by demonstration on warm foot bath was given to participants in experimental group and a handout was also given to them. Participants were instructed to do the warm foot bath daily for 20 minutes before going to bed and to keep the record of it in the diary provided by investigator. Investigator sent the message reminder daily through SMS.

 

Patient in control group were also given giving Functional Assessment of Chronic Illness Therapy (FACIT) fatigue scale and Insomnia Severity Index on day 7 to score their fatigue and insomnia but not given any intervention. On day 14 of radiotherapy FACIT scale was given to participants to score their fatigue and again on day 21 of radiotherapy Fatigue and Insomnia scales were given to participants to score their fatigue and insomnia.

 

Figure 1 Method of warm foot bath

 

Table  1. Sociodemographic characteristics of study participants (n=60)

S.No	Characteristic		Control group(n1 =30)	Experimental group(n2 =30 )	Chi 2	p value
			F	F
1	Age	20-40 years 41-60 years 61 years and above	01 14 15	04 18 08	4.430	0.10
2.	Gender	Male Female	12 18	13 17	0.069	0.793
3.	Educational status	Illiterate Primary Secondary Graduate and above	16 06 05 03	12 08 03 07	2.95	0.398
4.	Employed	Yes No	10 20	06 24	1.364	0.243
5.	Marital status	Unmarried Married Divorced / Widow	- 21 09	01 23 06	1.691	0.429
6.	Monthly family income	< 5000 5001 – 10,000 10,001-15,000 > 15,001	14 08 05 03	18 04 03 05	2.833	0.418
7.	Type of family	Nuclear family Joint family	15 15	23 07	4.593	0.032
8.	Place of residence	Urban Rural	12 18	09 21	0.659	0.417
9.	Presently taking sleeping pills	Yes No	- 30	04 26	2.411	0.121
10.	Any chronic illness other then cancer	No Yes	13 17	05 25	5.079	0.024
11.	Intake of milk before going to bed	Yes No	20 10	17 13	0.635	0.426
12.	Consumption of alcohol	Yes No	05 25	04 26	-	1.00
13.	Habit of smoking	Yes No	11 19	08 22	0.693	0.405

 

 

Table 2: Clinical Profile of cancer patients undergoing radiotherapy  (n=60)  

 

Effectiveness of warm foot-bath on fatigue in cancer patients undergoing radiotherapy

Table 3: Comparison of fatigue score^# in the control and experimental groups receiving radiotherapy (n=60)

*Independent sample‘t’ test                                      †Repeated measure ANOVA

^#Higher score denotes less fatigue;  lower score denotes more fatigue

 

Data Analysis:

Sociodemographic characteristics were described using frequency and percentage.  Trial version of Statistical Package for social science 16.0 was used to analyze the data. Inferential statistics involved comparison of both group by independent t test , ANOVA, Chi–square test  and Spearman co-relation test.

 

RESULTS:

Sociodemographic characteristic of study participants are described in Table 1. There was no significant difference between control group and experimental group in terms of sociodemographic characteristics. Table 2 describes the clinical data of patients undergoing radiotherapy in terms of diagnosis out of 60 patients, 19 (31.6%) were having head and neck cancers. 15(25%) patients were having breast cancer it is second most prevalent cancer . Nine (15%) patients were suffering from cervical cancer followed by seven patients (11.7%) suffering from lung cancer 10 patients (16.7%) were

having cancer of Esophagus, Urinary Bladder, Gallbladder , GE Junction,  Stomach, Prostate, and Penis.

 

Table 3 depicts the fatigue score in control group and in experimental group. Repeated measure ANOVA test was performed to find significant difference between mean fatigue score at day 7, 14 and 21 of radiotherapy and the obtained p value was <0.01 which was statistically significant at p <0.05 level. There was significant difference in mean fatigue score between three level of assessment (p<0.01). Table 4, 5 Post-hoc test (LSD) was performed to find the difference in mean fatigue score and result is depicted there was significant increase in fatigue level from day 7 of radiotherapy to day 21 of radiotherapy in control group. While there was significant decrease in fatigue level from day 7 of radiotherapy to day 21 of radiotherapy in experimental group.

 

Table 4: Post-hoc analysis of fatigue score of cancer patients in control group undergoing radiotherapy between each observation    n=60

*Post-hoc test (LSD)

 

Table 5: Post-hoc analysis of fatigue score of cancer patients in experimental group undergoing radiotherapy between each observation   (n=60)

*Post-hoc test (LSD)

 

 

 

Effectiveness of warm foot-bath on insomnia in cancer patients undergoing radiotherapy

Table 6: Severity of insomnia before and after warm foot bath (WFB)   (n=60)

 

Table 7: Comparison of pre-test and post-test insomnia score of cancer patients undergoing radiotherapy (n = 60)

* Paired sample t test, ‘t’ = 2.05  at df = 29 and p = 0.05

 

Table 6 describes in experimental group after intervention of Warm Foot Bath (WFB) the patient’s severity of insomnia was reduced. Table 7 show the pre-test insomnia score in control group was 6.47±2.88 which was increased to 13.63± 3.03 in post-test. The mean difference was 7.16 ± 4.08.  While insomnia score in experimental group was 8.77± 4.24 which has decreased to 5.47±5.38 in post-test. The mean difference was 3.30±4.08.

 

Correlation between post-test insomnia and post-test fatigue score:

There was strong negative correlation between post-test fatigue score and post-test insomnia score r = -0.871, p = 0.001 at 5% level of significance  But as the fatigue score increases, there is fall in fatigue and as the insomnia score decreases, there is decrease in insomnia.

 

DISCUSSION:

Fatigue is not routinely evaluated in cancer patients, however the patient receiving radiotherapy are highly affected by fatigue and insomnia. The implication of warm footbath reduced the fatigue and insomnia caused due to the affect of radiotherapy.

 

CONCLUSION:

Warm foot bath is effective in reducing fatigue and insomnia in cancer patient undergoing radiotherapy. Additional research is needed to better understand other co morbid symptoms in patients undergoing radiotherapy.

 

REFERENCE:

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2.       Jemal A, Bray F, Melissa M. Ferlay J, Ward E, Forman D. Global Cancer Statistics. [online] 2011 Feb [cited 2011Nov 18]; 61 [2] Available from : http://onlinelibrary.wiley. com/doi/10.3322/caac.20107/pdf

3.       Narayanan V, Koshy C. Fatigue in Cancer. IJPC [online] 2009 Jan [cited 2013 Oct 19]; 15(1) :19–25. Available from : http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2886215/

4.       Vachani C .Sleep Problems (Insomnia) in the Cancer Patient. [online] 2011 Sep 14 [cited 2013 Nov 17]. Available from: http://www.oncolink.org/coping/article1.cfm?id=70

5.       Ruppert R. Radiation therapy. American nurses today [online] 2011 Jan; 6 [1]: 24-29. Available from: http://www.americannursetoday.com/assets /0/434/436/440/7360/ 7376/7378/7400/9b6771dd-50ac-4496-90d5-4d7bf3952e2c.pdf

 

 

Received on 18.04.2016           Modified on 20.04.2016

Accepted on 25.04.2016           © A&V Publication all right reserved