But to you who fear my name, the sun of righteousness

Shall arise with healing in his wings. – Mal.4:2

Cancer is a disease that poses a threat to many aspects of life. Caring for clients with cancer is one of the most significant tasks perturbing health care professionals. One of the most debilitating complications of cancer is moderate to severe pain, calling for aggressive treatment.

Cancer pain management starts with the assessment of physical and psychological components of pain by measurement tools. A lot of empathy and a holistic approach including physical therapy, psychological interventions, neurologic techniques, nerve blocks, counter stimulation techniques and ongoing support are essentially required for effective management of these difficult pain situations, (Chec.et. al ,1994).

As of 2004, world wide the death’s caused by cancer was (7.4 million). The main causes were lung cancer (1.3 million death / year), stomach cancer (803,000 deaths), colorectal cancer (639,000 deaths), liver cancer (610,000), and breast cancer (519,000 deaths).

In the US, about 25% of deaths were caused by cancer and among the lung cancer is the leading (30%). The most commonly occurring cancer in men is prostate cancer and in women is breast cancer (about 25% new cases were reported). But in total figures cancer is s frequent with women as with men. Cancer can occur in children and adolescents, leukemia is the common cancer seen in these age group with the statistics of150 cases per million in US. In the first decades of life the neuroblastoma is the commonly occurring cancer. New cases were found to be 1,529,560 and deaths 569,490.

The magnitude of the problem of cancer in the Indian subcontinent in terms of sheer number is the most alarming. From the population census data for India in 1991, 609,000 new cancer cases were estimated to have been diagnosed in the country. This figure had increased to 806,000 by the turn of the century. The estimated age standardized rates per 100,000 were 96.4 for males and 88.2 for females. The most common cancers found in males were cancers of the lung, pharynx, esophagus, tongue and stomach while among female, cancers of the cervix, breast ovary, esophagus and mouth were common. In 2010 Pernilla reveals in her study that the incidence of esophageal adenocarcinoma has been increasing rapidly than any other caners in many countries since 1970’s.

Cancer

Cancer is a term used for group of symptoms when the cells in a part of a body starts to grow beyond the control. (American Cancer Society, 2010)

Categories of cancer

Carcinoma – that is seen in layers that protect the internal organs

Sarcoma – seen connective tissue and vascular system

Leukemia – cancer in precursor cells of the blood

Lymphoma and myeloma – cancer in the white blood cells.

Central nervous system cancers – cancer in the central nervous system

Cancer and Pain

The most alarming concept of cancer is not the risk of dying as much as the anticipation of continuous and existing pain. The pain is a combination of both physical and biopsychosocial phenomenon.

Pain and cancer are not synonymous

¾ of patients experience pain.

¼ of patients do not experience pain.

Pain in cancer is due to cancer, treatment, cancer / debility, concurrent disorder

Cancer pain and its management

Nursing is a compassionate concern for human beings. It is the heart that understands and the hand that soothes. In 2007 Carcy and Turpin stated that nurses, who accepted the challenges of cancer pain as a clinical problem were studied, are low communicating.

“By Mouth”, the oral route is the preferred route for analgesics, including morphine.

“By clock”, persistent pain requires preventive therapy. This means that analgesics should be given regularly and prophylactic ally.

“By ladder”, use a three step WHO analgesic ladder.

Step 1: Non-narcotics NSAIDS

Step 2: Mild opioids

Step 3: Strong opioids (Morphine)

Use of adjuvant drugs

Alternative and complementary therapies

Alternative and complementary therapies

During the last few decade, patients with cancer have increasingly turned to complementary and alternative medicine (CAM) resources in an attempt to cure cancer, to provide relief from cancer related symptoms , or to improve overall well being and quality of life. The National Centre For Alternative and Complementary Medicine defines “It as a group of diverse medical and health care system, practices and products considered to be part of conventional medicine.

Foot massage

Foot massage is a simple, non-invasive method to help balance the body; it has been described as a natural therapy that requires the application of a specific type of pressure on particular areas of the feet. It is based on the principle that there are reflexes in the feet which correspond to every part of the body. Foot massage serves to relax, improve circulation and promote a general feeling of wellness. (Carlson, 2006)

Foot massage has a positive effect on relieving pain of cancer patients, and also it is one of the caring interventions which has greater benefit to cancer patients not only relieving the distressing symptoms of their disease but also fulfills the basic nedsic need of human touch, one of the five senses (Vora, 1982).

SIGNIFICANCE AND NEED FOR THE STUDY

Pain is one of the most feared consequences of cancer. Estimates indicate that pain is experienced by 25% newly diagnosed cancer patients and by 60% to 90% of patients with advanced cancer by patients. (Bernard et.al.,2007). Much of the suffering due to serious pain including cancer pain can be reduced or eliminated by properly implemented technologies for relief.

The American Cancer Society Projects treat over 15,000 new cancer cases each year and pain is most common in patients with far advanced disease. The pain occurs when tumor infiltrates or compresses normal tissue and is most common in patients with advanced malignancies.( Burton,2006)

The future of nursing promises to convey feelings of caring and comfort through the aspect of evidence based practice. Pain assessment is a critical component in managing pain. Pain is multi-factorial and includes sensory, affective behavioural, cognitive, socio-cultural and physiologic components. In 1999 The American Pain Society created the phase “Pain: The fifth vital sign” to increase awareness of pain assessment among health care professionals.

The relief of pain is always a priority for nursing action. The pain relieving measure in nursing care includes maintaining a comfortable position, providing comfort device, administering complementary therapies such as relaxation, aroma therapy, music therapy, guided imagery, etc., among these therapies, foot massage has got greater potential to be used by all nurses in the multidisciplinary pain management programme. Foot massage is one among the few natural therapies which has got its evidence in patient care and is implemented by all health professionals in order to attain a holistic approach in patient care.

Caring is nursing and nursing is caring.(Leiniger,1984).it is every nurses prime responsibility to render care to the chronically ill patients suffering from pain. The nurse should look for the promotion of health, prevention, management and rehabilitation.

An empirical study was conducted by the nurses at the school, from the School of Nursing, Division of Science and Design, University of Canberra, Australia on the use of foot massage as a part of nursing care in patients hospitalized with cancer. 87 patients participated in the study and each received a ten minutes foot massage (5 minutes per foot). The patient’s perception of pain was measured using visual analog scale. The results revealed that the intervention produced a significant and immediate effect and is a simple nursing intervention for patients experiencing nausea or pain related to the cancer experience. (Grealish,et. al. 2000).

A study was conducted in East Carolina by the nurses in the school of Nursing, Green Ville USA to measure the effect of foot reflexology on pain in patients with metastatic cancer. 36 oncology inpatients participated in the study and each received a foot massage. The foot massage was found to have a positive immediate effect for patients with metastatic cancer, who reports pain. (Stephenson et.al,2003).

The complementary therapies such as massage, reflexology, acupressure, herbal remedies, and aromatherapy are rising in popularity among patients and health care professionals and increasingly being used in palliative care to improve the quality of life of patients.

Considering the above facts the investigator implements this complementary intervention as a non-pharmacological measure and also as a means for increasing human touch, a basic human need. It also renders an opportunity to convey a feeling of caring to alleviate the pain and providing a sootiness to enhance the relaxation effect as well as provide a sense of satisfaction among clients with advanced cancer.

STATEMENT OF THE PROBLEM

A study to evaluate the effectiveness of foot massage in minimizing pain perception and selected associated symptoms among clients with advanced cancer in selected hospital, Trivandrum.

OBJECTIVES

To assess the level of pain perception and selected associated symptoms among the experimental group and control group before giving the foot massage.

To assess the level of pain perception and selected associated symptoms among the experimental group and control group after giving the foot massage.

To find out the difference between the level of pain perception and selected associated symptoms among the experimental group and control group after the foot massage.

RESEARCH HYPOTHESIS

H1There is no association between the foot massage in minimizing pain perception and selected associated symptoms among clients with advanced cancer.

OPERATIONAL DEFINITIONS

Effectiveness

In this study, effectiveness refers to the outcome of foot massage in terms of minimization of pain perception and selected associated symptoms among clients with advanced cancer

Foot massage

In this study, foot massage refers to the complementary technique by which both feet of the clients with advanced cancer are held at comfortable position, given massage to the dorsum and plantar surface of the feet following a sequence of 15 steps to attain a relaxation response for 25-30minutes.

Pain Perception

In this study, pain perception refers to an unpleasant sensation perceived by the client with advanced cancer which is measured by the numerical pain intensity scale.

Selected Associated Symptoms

In this study selected associated symptoms refers that changes in physical and psychological parameters due to pain which is measured by the symptom assessment scale.

Clients with advanced cancer

In this study, it refers that the clients who have been diagnosed with III and IV stage of advanced cancer receiving palliative care.

ASSUMPTIONS

There will be a significant minimization of pain perception and selected associated symptoms among clients with advanced cancer after foot massage.

The pain perception will be different from each individual.

The prevalence of symptoms will be associated with the intensity of pain.

DELIMITATIONS

The study was limited only to clients who are in III and IV stage of cancer.

The study was conducted on less number of subjects in one setting which limits the generalization.

PROJECTED OUTCOME

Application of foot massage among clients with advanced cancer will help to bring about a significant physical and physiological effect that enhances support, comfort and relaxation.