Early palliative care, for the support and relief of physical, emotional, social pain, of any suffering related to neoplastic disease or the toxicity of causative cancer therapies, is guaranteed by the Italian Law no. 38/ 2010.   Among the supporting activities, in addition to the indispensable allopathic medical care, there are complementary medicine activities, aimed at the physical, psychological, spiritual sphere, and the control of total pain.

CLINICAL CASE: A female patient, 60 years old, comes to our attention for simultaneous Palliative Care (October 2019), diagnosed with locally advanced pancreatic cancer and candidate for first-line chemotherapy. The patient, since the first cycle of chemotherapy, had complained of continuous nausea and vomiting (2nd), anorexia (2nd) with weight loss of 7 kg in two months (weight detected 65 kg), mild constipation (1st).   

The patient also complained of NRS 8, locoregional algias, for which she took, with little benefit, Fentanyl TTS 75 micrograms/hour every 72 hours and sublingual trans-mucosal Fentanyl 400 micrograms as needed.  Depression of 3°, continuous anxiety and panic attacks for which she had been treated for years.

She is given palliative supportive therapy: antiemetic, steroid, electrolyte rehydrating EV, anxiolytic for OS, and morphine EV with good benefit, but lasting only a few hours. When the symptomatology worsens, a one-hour foot reflexology treatment, one per week, will be associated with the palliative and antalgic infusion, for a duration of 16 weeks, until disease progression, subsequent discontinuation of chemotherapy, and admission to hospice for terminal accompaniment.

Plantar reflexology is an ancient zonal massage, introduced in Italy by Prof. Giuseppe Calligaris, neurologist and university lecturer, and Dr. Nicola Gentile, who published several innovative studies.  It was observed that the nervous system and the skin originate from the outer embryonic leaflet called the 'ectoderm' and having the same origin are intimately connected. Therefore by massaging reflex points in the skin, we also act on the nervous system. We stimulated the reflex points in the foot of the CNS (Central and Peripheral, Sympathetic and Parasympathetic) spinal column and musculature, the endocrine and lymphatic.  The patient, following foot treatments, will have a longer period free of chemotherapy toxic effects than with palliative infusion alone.

With reflexology, rapid results can be achieved in reducing stress, disorders such as hiccups, vomiting, constipation, asthenia, insomnia, depression, and above all pain.  During the last weeks of life in hospice, the patient, in her physical fading, will present a discrete psychological state, no pain. She will report psychological well-being and a desire to perform the rite of marriage with her life partner.  Finally, she died in hospice, without pain or distress, maintaining her individual quality of life, with good quality of death and accompaniment, thanks to terminal palliative support and reflexology support, with control of total pain in compliance with Palliative Care indications and Law 38.