Overview
A 12-week Sequential Multiple Assignment Randomized Trial (SMART) exploring how reflexology and meditative practices can be tailored to improve symptom management in patients undergoing treatment for solid tumor cancers.
Purpose
The goal of this research was to establish effective sequencing of complementary therapies using decision rules that adapt to individual patient needs.
Funding
National Cancer Institute (1 R01 CA193706)
Background
Tailored symptom management interventions allow care to better reflect individual patient experiences. This study focuses on therapies delivered at home, supported by informal caregivers, to improve accessibility and outcomes.
Methods
• 471 patient-caregiver dyads enrolled
• 12-week SMART trial design
Weekly symptom tracking using MD Anderson Symptom Inventory (MDASI)
Initial randomization:
- Reflexology
- Meditative practices
- Control
At 4 weeks:
- Non-responders re-randomized
- Either continue or add alternate therapy
Study Design
Four decision pathways were evaluated:
Reflexology for 8 weeks
Reflexology → add meditation after 4 weeks
Meditation for 8 weeks
Meditation → add reflexology after 4 weeks
Results
No significant differences across the four decision rules at weeks 8 or 12
One exception: lower symptom severity at week 8 in one comparison (p = .04)
Response rates after 4 weeks:
Reflexology: 45%
Meditation: 46%
Conclusion
Both reflexology and meditative practices are effective options for symptom management.
Adding an additional therapy for patients who do not initially respond does not appear to significantly improve outcomes.
Collaborating Institutions
Michigan State University – College of Nursing
Department of Statistics and Probability
Department of Epidemiology and Biostatistics
Department of Psychiatry
Northwestern University Feinberg School of Medicine
University of Arizona College of Nursing