Warm_Water_Foot_Bath_Reducing_Level_Fatigue_Insomnia_Chemotherapy_Cancer_Patients.pdf

SSR Institute of International Journal of Life Sciences
ISSN (O): 2581-8740 | ISSN (P): 2581-8732
Shindhe et al., 2023
DOI: 10.21276/SSR-IIJLS.2023.9.6.2
Copyright © 2015–2023| SSR-IIJLS by Society for Scientific Research under a CC BY-NC 4.0 International License Volume 09 | Issue 06 | Page 3374
Study to Assess the Effectiveness of Warm Water Foot Bath on
Reducing Level of Fatigue and Insomnia among Chemotherapy
Cancer Patients
Supreeya P Shindhe1
, Shridhar Pujari1*
, Dileep S Natekar2
, Neelambika Devi G3
, Kariyappa T3
, Sneha G3
, Anu T3
,
Praveen J3
, Seeta C3
1
Professor, Department of Medical-Surgical Nursing, Shri B.V.V.S Sajjalashree Institute of Nursing Sciences,
Bagalkot, Karnataka, India
2
Principal, Department of Community Health Nursing, Shri B.V.V.S Sajjalashree Institute of Nursing Sciences,
Bagalkot, Karnataka, India
3
Student, Department of Medical-Surgical Nursing, Shri B.V.V.S Sajjalashree Institute of Nursing Sciences, Bagalkot,
Karnataka, India
*Address for Correspondence: Shridhar Pujari, Professor, Dept of Medical Surgical Nursing, Shree B.V.V.S Sajjalashree
Institute of Nursing Sciences, Navanagar, Bagalkot, Karnataka, India
E-mail: shridhar291181@gmail.com
Received: 27 Jun 2023/ Revised: 22 Aug 2023/ Accepted: 11 Oct 2023
ABSTRACT
Background: Cancer is a disease caused when cells divide uncontrollably and spread into the surrounding tissue. Changes to DNA
cause cancer. It is one of the most common and largest killer diseases in the world. It usually affects physically, and the disease
can alter one’s perspective on life and personality. Many treatment options are there to treat cancer. Among them, chemotherapy
treatment may have more side effects like lethargy, esophagitis, nausea, vomiting, Fatigue, and insomnia, the most common
problems among chemotherapy patients in India.
Methods: A quasi-experimental study with a sample size of 60, out of which 30 subjects were in the experimental group and 30
were in the control group. A convenient sampling method was used to select the subjects. A structured questionnaire tool was
used to collect the data.
Result: The result of the study showed that, during pre-test in the study group, among 30 subjects 3(10%) had moderate Fatigue,
22(73.33%) had severe Fatigue, 5(16.67%) had worst Fatigue and 12(40%) had moderate insomnia, 18(60%) had severe insomnia
and in control group among 30 subjects, 6(20%) had moderate Fatigue, 13(43.33%) had severe Fatigue, 11(36.67%) had a worst
fatigue, and 14(46.67%) had moderate insomnia, 16(53.33%) had severe insomnia. With post-test, in experimental group,
14(46.67%) had no fatigue, 16(53.33%) had mild fatigue, 14(46.67%) had no insomnia, 16(53.33%) had mild insomnia, and in
control group, 6(20%) had moderate fatigue, 13(43.33%) had extreme fatigue, 11(36.67%) had worst fatigue, and 14(46.67%) had
moderate insomnia, 16(53.33%) had severe insomnia.
Conclusion: The study concluded that clients who were receiving chemotherapy had fatigue and insomnia problems. The Warm
water foot bath therapy is very effective in clients undergoing chemotherapy in reducing Fatigue and insomnia. A positive
correlation between pre-test and post-test was found by using the Mann-Whitney test.
Key-words: Cancer, Chemotherapy, Foot bath, Health, Warm water
INTRODUCTION
How to cite this article
Shindhe SP, Pujari S, Natekar DS, Devi N, et al. Study to Assess the
Effectiveness of Warm Water Foot Bath on Reducing Level of
Fatigue and Insomnia among Chemotherapy Cancer Patients. SSR
Inst. Int. J. Life Sci., 2023; 9(6): 3374-3381.
Access this article online
http://iijls.com/
Health is a state of complete physical, mental, social well-
being and not merely an absence of disease or infirmity.[1]
A disease is any harmful deviation from an organism's
normal structure or functional state, generally associated
with certain signs and symptoms differing from physical
injury. It may be caused by factors originally from
external such as infectious diseases or internal
dysfunctions such as autoimmune diseases.[2]
Research Article

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DOI: 10.21276/SSR-IIJLS.2023.9.6.2
In human beings," disease" is often used more broadly to
refer to any condition that causes distress, pain,
dysfunction, social problems, and death to the person
afflicted or similar problems for those in contact with the
person. Cancer is a disease in which some body's cells
grow uncontrollably, invade nearby tissue, and spread to
other body parts-changes to DNA [3]
cause cancer. Cancer
can develop in almost any human body region, affecting
age and gender. A quasi-experimental study with a
sample size of 60, out of which 30 subjects were in the
experimental group and 30 were in the control group. A
convenient sampling method was used to select the
chemotherapy clients with Fatigue and insomnia in the
experimental and control group [4]
. Immediately
12,00,000 new cancer cases are diagnosed in India every
year. The risk of developing cancer generally increases
with age.
In 2022, there will be an estimated 1.9 million new
cancer cases diagnosed and 8.08 lakh deaths worldwide.
There are 28 million cancer survivors worldwide [5]
. Rates
are rising as more people live to an old age and as mass
lifestyle changes occur in the developing world. Cancer
management is a team work that involves many
treatment options. The primary treatment goal is to
either altogether remove cancer from the body or
destroy cancer cells that are present in the body. The
most common primary treatment for cancer is surgery [6]
.
The main objective of surgery is to complete the removal
of cancer cells in the body as much as possible. Adjuvant
treatment aims to kill the cancer cells that remain in the
body after the surgery or primary treatment. Palliative
treatment aims to reduce the sign and symptoms caused
by cancer itself. In palliative care, surgery, chemotherapy,
hormonal therapy and radiation therapy can be used.[7]
In
radiation therapy, high-energy rays or protons destroy
cancer cells. Hormones trigger some cancers. Bone
marrow transplantation is also a cancer treatment. It is
also called stem cell transplantation [8]
.
Chemotherapy is treatment by using medicines that
contain potent chemicals to kill growing cancer
cells in the body by destroying cancer cells by stopping
their ability to grow and divide. Chemotherapy drugs are
used alone or in combination to treat a variety of cancers.
Chemotherapy drugs travel through the whole body, so
there may be a chance of damaging healthy cells also.
This is why chemotherapy can cause some side effects [9]
.
Adverse effects of chemotherapy include nausea,
vomiting, Fatigue, insomnia, diarrhea, hair loss, loss of
appetite, fever, pain, mouth sores, constipation, and
bleeding. Late-developing and long-lasting side effects of
chemotherapy are damage to lung tissue, kidney
problems, nerve damage, infertility, peripheral
neuropathy and risk of second cancer [10]
.
Between 80% to 90% of people, it is prevalent among
cancer patients receiving chemotherapy. Apart from
chemotherapy, radiation therapy, immunotherapy,
hormone therapy and surgery, alternative treatments are
needed to treat cancer like talk therapy, meditation,
visualization, reflexology, music therapy, art therapy,
biofeedback, aroma therapy, relaxation techniques,
herbal remedies, massage, acupuncture and exercise
emerges [11]
. Warm water Foot bath therapy is one of the
hydrotherapeutics. Its temperature should be 37-38
degrees Celsius. It is an accomplished way to draw blood
from inflamed and congested body areas.[12]
It improves
peripheral circulation and provides comfort to the
patient. Indications for warm water foot baths are to
reduce foot and leg cramps, eliminate toxins, reduce pain
and muscle cramps, increase circulation, elevate Fatigue,
flu, nausea, insomnia, smooth skin and build immunity
[13]
.
MATERIALS AND METHODS
It was a quasi-experimental study aiming to assess the
effectiveness of fatigue and insomnia levels among clients
receiving chemotherapy at selected hospitals in Bagalkot.
The study's sample size was 60, of which 30 subjects
were in the experimental group and 30 subjects were in
the control group. A convenient sampling method was
used to select the subjects with Fatigue and insomnia.
Study Participants- Clients undergoing chemotherapy
admitted to the Hanagal Shree Kumareshwar Hospital
oncology ward and Research Center Bagalkot, India.
Sample size- The study's sample size was 60, out of
which 30 subjects were in the control group and 30 in
the experimental group.
Settings of study- A study was conducted in the cancer
department of Hanagal Shree Kumareshwar Hospital
and Research Center Bagalkot, India.
Data Collection Instrument- A questionnaire was used
to collect the demographic variables. Athens Insomnia

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DOI: 10.21276/SSR-IIJLS.2023.9.6.2
Scale was used to assess insomnia. Fatigue Self-
Assessment Scale was used to assess the Fatigue.
Content validity and reliability of data collection
instruments- The five nursing experts curtained the tool's
content validity. The socio-demographic questionnaire
was corrected as per the suggestions. Standardized tools
such as the Athens insomnia and Fatigue self-assessment
scales were used.
Data collection procedure- Obtained formal permission
from the Principal of B.V.V.S Sajjalshree Institute of
Nursing Sciences and the Medical and Nursing
Superintendent of the Hanagal Shree Kumareshwar
Hospital and Research Centre Bagalkot. The researcher
proceeded with the data collection, obtaining the written
consent. The investigator selected subjects from
Hanagal Shree Kumareshwar Hospital oncology
department and Research Centre Bagalkot, India.
The Athens insomnia and fatigue self-assessment scales
assessed the experimental and control groups. The
investigator provided a warm water foot bath for about
15 minutes for the study group by singing the warm
water at 36-38 degrees Celsius. The researcher
conducted the intervention from 5 am to 6 am. The
researcher selected 15 subjects each week for 4 weeks.
Statistical Analysis- The obtained data was entered in
MS Excel sheet data was edited for accuracy and
completeness. The categorical responses were presented
with numerical codes. The data was illustrated with
frequency and percentage distribution tables and
diagrams. Fatigue and insomnia are described with
arithmetic mean, mean rank, and standard deviation.
Binary logistic regression analysis, Mann-Whitney, and
chi-square test were used to determine the association
and difference between Fatigue and insomnia among
cancer patients receiving chemotherapy.
Ethical Clearance- An ethical clearance certificate was
obtained and enclosed from the ethical committee of
B.V.V.S Sajjalashree Institute of Nursing Sciences,
Bagalkot. Written consent was to be obtained from the
patients receiving chemotherapy participating in the
study. Anonymity and confidentiality regarding the data
and identification of patients were maintained.
RESULTS
As per the result age in the experimental group 7
(23.33%) of them belongs to the age group between 21-
40 years, 11(36.67%) of subjects present to the age group
between 41-60 years, 11 (36.67%) of the subjects belongs
to the age group between 61–80 years, 1(3.33%) of them
belongs to the age group of above 80 years. In the
control group, 1(3.33%) of them belongs to the age group
between 21-40 years, 10(33.33%) of them belong to the
age group between 41–60 years, 14(46.67%) of them
belong to the age group between 61-80 years, 5(16.67%)
of them belongs to the age group of >80 years. It showed
as per gender in the experimental group, 18(60%) were
females, 12(40%) were males. In control group
11(36.67%) were males, 19(63.33%) were females.
Clients receiving chemotherapy according to duration of
illness 14(46.67%) had 13-24 months, and 9(30%) had 25-
36 months of duration. In control group 13(43.33%) had
0-12 months of duration, 12(40%) had 13-24 months of
duration, and 2(6.67%) had 25-36 months of duration,
3(10%) had more than 37 months of duration. Description
of patients receiving chemotherapy according to their co-
morbidity shows that in the study group, 6(20%) had
diabetes mellitus,6(20%) had high blood pressure,
18(60%) had other conditions. Description of patients
receiving chemo according to their cycle of chemotherapy
shows that in study group 1(3.33%) had first cycle of
chemotherapy, 9(30%) had a second cycle of chemo,
14(46.67%) had a third cycle of chemo 6(20%) had above
7 cycles. In control group 4(13.33%) had first cycle of
chemo, 12(40%) had second cycle of chemo, 8(26.67%)
had third cycle of chemo, 6(20%) had above 7 cycles of
chemotherapy.
Table 1: Represents the description of socio-demographics and clinical variables of patients receiving chemo
Demographic and clinical
variables
Study group (n=30) Control group (n=30)
F % F %
Age
• 21-40 yrs
07 23.33 1 3.33
• 41-60 yrs 11 36.67 10 33.33

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DOI: 10.21276/SSR-IIJLS.2023.9.6.2
• 61-80 yrs
• >80 yrs
11
01
36.67
3.33
14
05
46.67
16.67
Gender
• Male
• Female
12
18
40
60
11
19
36.67
63.33
Place of residence
• Rural
• Semi-rural
• Urban
12
08
10
40
26.67
33.33
21
06
03
70
20
10
Religion
• Hindu
• Christian
• Muslim
24
02
04
80
6.67
13.33
25
0
05
83.33
0
16.67
Type of family
• Joint
• Nuclear
• Broken
15
10
05
50
33.33
16.67
12
18
0
40
60
0
Marital status
• Married
• Unmarried
• Widow/widowed
19
3
08
63.33
10
26.67
20
0
10
66.67
0
33.33
Education
• Illiterate
• Primary
• Secondary
• Graduate and others
10
8
9
3
33.33
26.67
30
10
19
11
0
0
63.33
36.67
0
0
Type of diet
• Vegetarian
Non-vegetarian
10
20
33.33
66.67
17
13
56.67
43.33
Duration of illness
• 0-12months.
• 13-24months.
• 25-36months.
• >37 months
7
14
09
0
23.33
46.67
30
0
13
12
2
3
43.33
40
6.67
10
Co-morbidity
• Diabetes
• Hypertension
• Stroke
• Others
6
6
0
18
20
20
0
60
3
7
0
20
10
23.33
0
66.67
Cycle of chemotherapy
• 1
• 2
• 3
• >7
1
9
14
6
3.33
30
46.67
20
4
12
8
6
13.33
40
26.67
20

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DOI: 10.21276/SSR-IIJLS.2023.9.6.2
Occupation
• Government worker
• Private worker
• Self worker
• Unemployment
04
9
8
9
13.33
30
26.67
30
2
7
11
10
6.67
23.33
33.67
33.33
Family income
•less than 5000
•Rs.5001-10000
•Rs.10001-20000
•More than Rs.20000
0
15
10
5
0
50
33.33
16.67
3
15
10
2
10
50
33.33
6.67
Table 2 shows that in the experimental group, for
insomnia, considering per gender, the chi–square was
0.01 and the B value was 0.33 at the significant value
0.65. Considering the place of residence, chi–square
value was 0.18 and the B value 0.13 at a significant value
0.71. As per religion, the chi-square was 0.10 and the B
value 0.13 at a significant value 0.71. Considering the
type of family, the chi-square value was 0.01 and the B
value is 0.13 at a significant value of 0.51. As per marital
status, the chi-square was 0.16 and the B value is 0.73 at
significant value 0.10.
Regarding education, the chi-square value was 0.22 and
the B value 0.65 at a significant value of 0.08.
Considering the type of diet, the chi-square was 0.14 and
the B value 0.13 at a significant value 0.03. As per the
duration of illness, the chi-square value was 0.03, and B
value 0.49 at p-value 0.33. As per co-morbidity, the chi-
square value 0.02 and the B value 0.25 at p-value 0.38.
As per the cycle of chemotherapy, the chi-square value
was 0.01, and the B value is 0.14 at the p-value of 0.75.
As per occupation, the chi-square value is 0.007 and the
B value is 0.160 at p-value of 0.65. As per family income,
the chi-square value is 0.02 and the B value is 0.40 at p-
value 0.41. Table 2 shows that in the control group for
insomnia, considering the gender, the chi-square was
0.01 and the B value 0.50 at p-value 0.51. Considering
the place of residence, the chi-square value was 0.21 at
p-value 0.36.
Regarding religion, the chi-square was 0.01 and the B
value 0.32 at p-value 0.51. Considering the type of
family, the chi-square value was 0.12 and the B value
1.55 at p-value 0.06. As per marital status, the chi-square
was 0.01 and the B value 0.40 at p-value 0.60. Regarding
education, the chi-square value was 0.00 and the B value
0.07 at p-value 0.91. Considering the type of diet, the
chi-square was 0.01 and the B value 0.51 at p-value 0.49.
As per the duration of the illness, the chi-square value
was 0.11 at p-value 0.92. As per the cycle of
chemotherapy, the chi-square was 0.18 and the p-value
was 0.91. Considering the co-morbidity, the chi-square
value was 0.07 at p-value 0.37. Regarding the
occupation, the chi-square was 0.12 at p-value 0.84. As
per family income, the chi-square value was 0.19 at p-
value 0.33.
Table 2: Association between the post-test level of insomnia among patients receiving chemotherapy in the study
and control group with selected demographic and clinical variables
Demographical clinical
variables
Study group (n=30) Control group (n=30)
R
square
B
value
P
value
R
square
B
value
p-value
Gender 0.01 0.33 0.65 0.01 0.50 0.51
Place of residence 0.18 0.13 0.71 0.21 - 0.63
Religion 0.10 0.13 0.71 0.01 0.32 0.51

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Typeoffamily 0.01 0.13 0.51 0.12 1.55 0.06
Marital status 0.17 0.73 0.10 0.01 0.40 0.60
Education 0.22 0.65 0.08 0.01 0.07 0.91
Type of diet 0.14 0.13 0.03 0.01 0.51 0.49
Duration of illness 0.03 0.49 0.33 0.11 - 0.92
Cycle chemotherapy 0.01 0.14 0.75 0.18 - 0.91
Co-morbidity 0.02 0.25 0.38 0.07 - 0.34
Occupation 0.01 0.16 0.65 0.12 - 0.84
Family income 0.02 0.40 0.41 0.19 - 0.33
Table 2 reveals that there is non-significant association
(p<0.05) between the post-test level of pain among
patients receiving chemotherapy in the experimental
and control group with their selected demographic
variables such as age, gender, place of residence,
educational status, economic status, religion, type of
family, dietary pattern, duration of illness, cycle of
chemotherapy, co-morbidity, occupation, and family
income at p<.05 level. Hence, hypothesis H2 is not
accepted.
DISCUSSION
It was a quasi-experimental study to evaluate the
effectiveness of warm water foot baths in reducing
Fatigue and insomnia among cancer patients receiving
chemotherapy. 11(36.67%) subjects were in the age
group between 41-60 years and 7 (23.33%) people were
between 21-40 years. In a similar study, 13 (43.33%)
members were in the age group between 41-60 years
and 10(33.33%) were 21-40 years [14]
. 12(40%) were
females and 18(60%) were males compare to previous
research study 12(40%) were male and 21(70%) were
female [15]
. 12(40%) were from rural area and 8(26.67%)
semi-rural area. In a similar research study, 11(36.66%)
subjects were from rural areas and 13(43.33%) were
from semi-rural areas [16]
. 24(80%) were belonged to
Hindu religion and 02(6.67%) were Christians. In a similar
research study, 14(46.66%) were from the Hindu religion
and 16(53.33%) were Christians [17]
. 15(50%) belonged to
joint family and 5(16.67%) were from broken family. In a
previous research study, 10(33.33%) were from joint
families and 2(6.66%) were from broken families [18]
. 19
(63.33%) were married and 3(10%) were unmarried.
Whereas in a similar research study, 23(76.66%) were
married and 4 (13.33%) were unmarried [19]
. 10(33.33%)
were illiterate and 3(10%) graduates. In a similar
research study, 13(43.33%) subjects were graduates [20]
.
20(66.67%) were vegetarian and 10(33.33%) were
nonvegetarian. In a similar research study, 18 (60%) were
vegetarian and 12(40%) were non-vegetarian [21]
. 7
(23.33%) subjects suffered from illness for 12 months
and 9(30%) were for 13-24 months. In a similar research
study 16(53.33%) were suffering with illness for 12
months and 11(36.66%) for 13-24 months [22]
. 6(20%)
subjects have diabetes mellitus and 18(60%) had other
diseases. In a similar research study, 7(23.33%) had
diabetes and 10(33.33%) had other chronic disorders [23]
.
14(46.67%) subjects were on third cycle of
chemotherapy and 1(3.33%) were receiving their first
cycle. In a research study 7(23.33%) were on second
cycle and 19(63.33%) were on first cycle [24]
4(13.33%)
were government workers and 9(30%) were unemployed
[25]
.
A significant association was found between the type of
diet and insomnia after the implementation of an
intervention. There was no significant association

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between socio-demographic factors and pain or
insomnia among patients receiving chemotherapy.
CONCLUSIONS
Finally concluded, most of the client’s undergoing chemo
have Fatigue and insomnia. As per my study, a warm
water footbath effectively reduces Fatigue and insomnia.
The study recommends that the following studies be
undertaken to strengthen warm water foot baths as a
good remedy for lowering Fatigue and insomnia among
chemotherapy patients.
Simple measures can be effective in optimum patient
care. Hence, a warm water footbath can be adapted as a
routine measure of care in cancer hospitals. Warm water
footbaths can be part of the health care of patients
undergoing chemotherapy. Other simple care measures
should be tested to ease the difficulties encountered by
chemotherapy patients.
Source of Funding
Rajiv Gandhi University of Health Sciences, Karnataka,
Bangalore, India.
CONTRIBUTION OF AUTHORS
Research concept-Dr. Dileep Natekar, Dr. Shridhar.Pujari
Research design- Dr. Shridhar Pujari
Supervision- Dr. Shridhar Pujari
Materials- Dr. Shridhar Pujari
Data collection-Ms. Supreeya Shindhe
Data analysis and Interpretation- Ms. Supreeya Shindhe
Literature search- Ms. Supreeya Shindhe
Writing article-Ms. Supreeya Shindhe
Critical review- Dr Shridhar Pujari
Article editing- Dr Shridhar Pujari
Final approval- Dr Dileep Natekar
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