A Parent-Delivered Foot Bath Intervention for Chemotherapy-Related Fatigue in Children with Cancer: A Family-Centered
Özge Eda Karadağ Aytemiz1, Şadiye Dur2, Sermin Dinç3
1Department of Pediatric Nursing, Faculty of Nursing, Koç University, 34450 Istanbul, Türkiye.
Insights
A parent-delivered warm-water foot bath showed no significant difference in reducing chemotherapy-related fatigue in children with Non-Hodgkin Lymphoma. The intervention was safe, feasible, and well-adhered to, but larger trials are needed to confirm efficacy.
Area of Science:
- Pediatric Oncology Nursing
- Complementary and Alternative Medicine
- Quality of Life Research
Background:
- Chemotherapy-related fatigue (CRF) significantly impacts children's quality of life.
- Limited evidence exists for parent-delivered, home-based non-pharmacological interventions for pediatric CRF.
- Family-centered care is crucial in pediatric oncology.
Purpose of the Study:
- To evaluate the effect of a parent-delivered warm-water foot bath on CRF in children aged 7-12 years undergoing chemotherapy.
- To assess the safety, feasibility, and adherence of this home-based intervention.
Main Methods:
- A randomized controlled trial (NCT06529484) involving 61 children with stage 3-4 Non-Hodgkin Lymphoma.
- Children received either a nightly warm-water foot bath intervention or standard care for 7 days post-chemotherapy.
- Fatigue was measured daily using the Oncology Nursing Society Visual Fatigue Scale (ONS-VFS) and the Pediatric Oncology Fatigue Assessment Scale.
Main Results:
- Both groups showed significant daily declines in ONS-VFS scores, indicating fatigue reduction over time.
- No statistically significant between-group differences in fatigue scores were observed on any day.
- The intervention was 100% adhered to, with no adverse events reported.
Conclusions:
- Parent-delivered warm-water foot baths are safe, feasible, and well-accepted in pediatric oncology.
- This study did not demonstrate the superiority of the foot bath intervention over standard care for reducing CRF.
- Larger, adequately powered trials are necessary to definitively determine the efficacy of this intervention.
Abstract:
Background/Objectives: Chemotherapy-related fatigue (CRF) affects 50-80% of children receiving chemotherapy and significantly impairs quality of life. Despite the family-centered care framework guiding pediatric oncology practice, evidence on parent-delivered, home-based non-pharmacological interventions for CRF remains limited. This study aimed to evaluate the effect of a parent-delivered warm-water foot bath on CRF in children aged 7-12 years undergoing chemotherapy. Methods: A two-arm parallel randomized controlled trial (NCT06529484; October 2024-May 2025) was conducted at a university hospital pediatric hematology-oncology outpatient clinic. Sixty-one children with stage 3-4 Non-Hodgkin Lymphoma (intervention, n = 29; control, n = 32) were randomized using computer-generated allocation and sequentially numbered, opaque, sealed envelopes. Following structured family education, parents delivered nightly foot baths (38-40 °C, 20 min) at home for 7 consecutive days after chemotherapy administration. Adherence and fidelity were monitored via a daily WhatsApp communication protocol. Fatigue was assessed daily using the Oncology Nursing Society Visual Fatigue Scale (ONS-VFS; primary outcome) and pre/post analysis using the Pediatric Oncology Fatigue Assessment Scale (child and parent forms). Reporting followed CONSORT 2025. Results: Median ONS-VFS scores declined significantly over the 7 days in both groups (Friedman p < 0.001 for each), from 5 (Day 1) to 2 (Day 7); between-group comparisons showed no statistically significant differences on any day (all p > 0.05). On the Pediatric Oncology Fatigue Assessment Scale, no between-group differences favored the intervention; a single child-report subscale difference favored the control group and is most plausibly attributable to multiple comparisons. Adherence was complete (100%), no adverse events occurred, and all 61 participants completed the protocol. Conclusions: A parent-delivered foot bath is a safe, feasible, and well-accepted family-centered nursing intervention, with complete adherence and no adverse events. This trial was not powered to detect between-group differences and did not demonstrate superiority over standard care; adequately powered trials are needed to determine efficacy.