Cancer is a group of disease characterized by the uncontrolled growth and spread of abnormal cells. Around one third of cancer deaths are due to the 5 leading behavioral and dietary risks such as high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, alcohol use [1]. There is variety of medical interventions to reduce insomnia problem among cancer patients. Water is a basic resource and a primal natural remedy. In all of its states; steam, liquid and ice, water can provide a wide range of treatment for health problems[2]. Sleep is a basic human need: it is a universal biological process common to all people. Historically, sleep was considered a state of unconsciousness. More recently, sleep has come to be considered an altered state of consciousness in which the individuals perception of and reaction to the environment are decreased[3]. Insomnia is defined as a subjective complaint of inadequate nocturnal sleep. It is the most common sleep disorder reported by cancer patients. Although alterations in sleep patterns are endemic among this population, sleep problems are rarely assessed in a typical patients evaluation. Furthermore, patients often fail to mention symptoms to their caregiver, and when sleep is assessed, it is usually in the form of a single question [4]. Hot water footbath provided a good sleep, because it relaxes the body and mind. It works by slightly raising the body temperature and after 15 minutes, it starts to drop slowly. This can promote sleep indirectly [5]. A warm water footbath is a local moist heat application. The findings provide empirical support that a warm water footbath relieves fatigue and insomnia problems of patients undergoing chemotherapy [6]. In cancer, one of those cells stops paying attention to the normal signals that tell cells to grow, stop growing or even to die. Cancer cells stills share many of the same needs and properties of normal cells but they become independent of the controls that make our body function smoothly. The process by which a normal cell changes into one that behaves so abnormally can take a long time and is often triggered by outside influences [7]. Cancer is actually a general term that describes a large group of related diseases very case of cancer is unique, with its own set of genetic changes and growth properties. The many differences between cases of cancer, even of the same organ (i.e. different cases of breast cancer) is one of the main reason that treatment is so difficult despite the differences between different types of cancer, all cancer do share some common features, and these shared properties are the basis for many cancer treatments and research efforts [8]. Hot water bath can help is giving us a good sleep, because it relaxes body mind. Gradual drop of body temperature can feel drowsy and therefore we feel prepared for sleep. Warm footbath is one of the effective methods for inducing sleep. A warm footbath warms the skin, which causes vessels dilation and induces heat dissipation. Intervention that enhances heat dissipation prior to sleep will improve the sleeping pattern of the patients [9]. Sleep provides healing and restorations. Achieving the best possible sleep quality is important for the promotion of good health as well as recovery from the illness. Sleep is a cyclical physiological process that alternates with longer periods of wakefulness. The sleep wake cycle influences and regulates physiology function and behavioral response [10]. Changes to sleep patterns which affect quality of sleep or disrupt a normal sleep cycle are known as sleep disturbances. It is sleep disturbances that have an adverse effect on health and quality of life [11]. The prevalence of insomnia increases with age. In a survey of more than 9000 elderly adults 65 years and older, 28% complained of difficulty initiating sleep, and 42% reported difficulty in both initiating sleep, and maintain sleep. In a study done a general practice more than 50% of elderly patients reported insomnia, 80% of these reporting than insomnia were chronic condition. Women complained of insomnia more than man [12].

Quantitative approach was in this study. A quasi-experimental, post test only control group design was chosen to assess the effect of warm footbath on quality sleep among patients with cancer. The study was conducted in saveetha medical college and hospital. The setting was chosen on the basis of feasibility in term of availability of adequate sample and cooperation extended by the management and other health care team members. Target population of the study is all cancer patients in saveetha medical college and hospital. Patients with cancer who meet the inclusion criteria were selected as the sample for the study. The sample size was 60 cancer patients. 30 cancer patients in experimental and 30 cancer patients in control group. Purposive sample technique was used by the investigator. Inclusion criteria are patients with cancer who are willing to participate in this study. The study includes both men and women. Data was collected using Groningen sleep quality scale and demographic profile of warm footbath on quality of sleep among patients with cancer. The project has been approved by the ethics committee of the institution. Informed consent was obtained from the participants before initiating the study.

The present study results show in the majority of cancer patients in experimental group 12(40%) to the age group of 46-55 years and control group 11(36.6%) to the age group of 56-65 years, male 18 (60%) in experimental group and Female 116(53.3%) in control group, educational status 11(36.6%) and 13 (43.3%) in experimental group and control group, occupational status 17 (56.6%) and 20(66.6%) in experimental and control groups, monthly income 5000-10000 13 (43.3%) in experimental and control groups, stages of cancer 1^st stage 16 (53.3%) in experimental group and 14(46.6%) in control group.

Table 1: shows that the mean value of sleep quality scores among patients with cancer in the experimental and control groups was 5.33 (SD=30.5) and 7.9 (SD=0.188) respectively with mean difference of value -5.19. The t value (-4.30) was significant at p>0.005.

Table 1: This section deals with effect of warm footbath on quality of sleep among patients with cancer in the experimental and control group on fifth day

Table 2: shows that the comparison of mean post test in effect of warm footbath in experimental and control groups. The control group was higher than the experimental group which implies that there was a significant increase a p<0.005 level.

Table 2: This section deals with comparison of mean post test in effect of warm footbath in experimental and control groups

Table 3: The results reveals that in the experimental group in first day 21 (70%) patients had poor sleep. On the fifth day 19 (63.3%) patients had normal sleep. In the control 21 (70%) patients had poor sleep on the first day and 16 (53.3%) patients had on the fifth day.

Table 3: Assessment on quality of sleep among patients with cancer in the experimental and control group on first and fifth day

Figure I: Stages of cancer