Chen, Z., Meng, Z., Milbury, K., Bei, W., Zhang, Y., Thornton, B., . . . Cohen, L. (2013). Qigong improves quality of life in women undergoing radiotherapy for breast cancer: results of a randomized controlled trial. Cancer, 119, 1690–1698.

To evaluate whether patients with breast cancer undergoing radiotherapy (RT) who practiced qigong would report better quality of life, less fatigue, and less sleep disturbance than did patients in a control group.

Patients were randomly assigned to a group that received a qigong intervention or to a wait-list control group. Patients were assigned to cohorts to prevent group contamination during the study. Each week, the qigong group participated in five classes lasting 40 minutes each during RT. These patients received printed materials and a DVD of the qigong program. Patients were encouraged to practice qigong techniques on their own. The intervention included relaxation breathing, meditation, walking in a circle while breathing in sync with arm movement, and self-massage. The control group received standard care. Assessments were performed at baseline, in the middle of the RT schedule, during the last week of RT, and at one and three months after treatment.

• The sample was comprised of 95 participants (100% female).
• Mean age was 45 years (range 25–62).
• All participants had breast cancer.
• Most participants had stage II or stage III disease.
• All participants had undergone mastectomy or lumpectomy.
• Of the participants in both groups, 78% were receiving 25 RT fractions.
• Most participants were married, and 52.5% had some college or higher education.

• Single site
• Multiple settings
• China and the United States

Participants were undergoing the active antitumor treatment phase of care.

The study was a randomized, controlled trial.

• Brief Fatigue Inventory (BFI)
• Center for Epidemiologic Studies Depression (CESD) Scale 
• Pittsburgh Sleep Quality Index (PSQI)
• Functional Assessment of Cancer Therapy-General (FACT-G)
• Salivary cortisol samples taken for two consecutive days at waking, 45 minutes after waking, 45 minutes later, eight hours later, and at bedtime

• Time had a significant effect in reducing depression, with a significantly greater effect in the qigong group (p = 0.05); however, no significant differences were observed between groups at any time point.
• Participants with low measures of depression symptoms at baseline showed no significant differences in fatigue, regardless of group. At the end of the study, of participants who had had high measures of depression symptoms at baseline, those in the qigong group had measures of fatigue that were significantly lower (p < 0.05; 2.93 versus 4.19) than those in the control group.
• No differences were observed between groups in sleep quality, and there was no interaction of depression symptoms with sleep measures.
• One-third of participants attended 100% of the sessions and 78.3% attended more than 50% of the sessions. Attendance ranged from five to 30 sessions.
• Sessions involved one to 10 people at a time.
• No differences were observed between groups in regard to cortisol measures.

Practicing qigong appears to be beneficial in reducing fatigue and depression during RT and appears to be of most benefit to women with high measures of depression symptoms.

• The study had a small sample size, with less than 100 participants.
• The study had risks of bias due to no blinding and no appropriate attentional control condition.
• Adherence varied. No information was provided regarding participants' qigong practice outside the treatment group.
• The study was inconclusive in regard to the effectiveness of qigong itself versus the potential effect of the group activity involved in the qigong intervention.
• Follow-up time was limited.

Qigong, a type of mind-body discipline, appears to have benefit in reducing fatigue and depression over time, particularly among women who have high measures of depression symptoms. Effects were not seen until after RT completion.