Foot Reflexology and Ta-VNS for Symptom Management in Head and Neck Cancer During CCRT

This is a three‐arm parallel, repeated‐measures randomized controlled trial conducted inthe otolaryngology outpatient and inpatient settings of Hualien Tzu Chi Hospital.Eligible patients with pathologically confirmed HNC (clinical stage II‐IVA) scheduled toreceive a second cycle of cisplatin‐based CCRT are stratified by CRT dose (<66 Gy vs ≥66Gy) and randomized using a computer‐generated sequence with block size 4 or 8, in a 1:1:1ratio, to the FR group, the ta‐VNS group, or the usual‐care control group; the FR andta‐VNS groups are further randomized to true or sham subgroups. The foot reflexologyintervention is delivered twice weekly for 20 minutes over two weeks and comprises arelaxation phase, a head‐neck/gastrointestinal regulation phase, and acirculation/detoxification phase; the sham condition applies light, non‐specific touch.The ta‐VNS intervention stimulates the left tragus, cymba conchae, and cavum conchae(pulse width 250 µs, 25 Hz, 0.5‐5 mA individualized to a tingling sensation, 30 s on/off)twice weekly for 20 minutes over two weeks; the sham condition stimulates the leftearlobe at 0.5 mA. Auricular acupressure with magnetic beads is self‐administered threetimes daily. Outcomes are assessed at T0 (baseline), T1 (week 1), T2 (week 2), and T3(week 4). Data are analyzed with generalized estimating equation (GEE) models.