Van Vu, D., Molassiotis, A., Ching, S.S.Y., & Le, T.T. (2017). Effects of qigong on symptom management in cancer patients: A systematic review. Complementary Therapies in Clinical Practice, 29, 111–121.

STUDY PURPOSE: The purpose of this systematic review of the literature was to evaluate the effectiveness of Qigong on symptom management in patients with cancer. Qigong is a complementary therapy with the goal of relaxation involving simple, repeated body posture or movements, breathing exercises, and meditation performed in synchrony.

TYPE OF STUDY: Systematic review

DATABASES USED: PubMed/MEDLINE, CINAHL, Cochrane Library, and PEDRO

YEARS INCLUDED: From 1995 through 12/2015

INCLUSION CRITERIA: RCTs, quasi-experimental with comparison group, and feasibility trials; adults ≥ 18 years of age; cancer diagnosis; receiving care in any healthcare setting; using Qigong during or after cancer treatment versus placebo, usual care, or other intervention to manage symptoms, including patient-reported physical-psychological symptoms reported as continuous or dichotomous and quality of life. 

EXCLUSION CRITERIA: Trials including patients receiving hospice care or were at the end-of-life

TOTAL REFERENCES RETRIEVED: N = 266

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane Collaboration’s Tool for Assessing Risk of Bias (Cochrane Collaboration, 2011) and strength of the evidence were evaluated using the Oxford Centre for Evidence-Based Medicine Levels of Evidence (Oxford Centre for Evidence-Based Medicine, 2009).

FINAL NUMBER STUDIES INCLUDED: N = 22

TOTAL PATIENTS INCLUDED IN REVIEW: 1,751

SAMPLE RANGE ACROSS STUDIES: 20-211

KEY SAMPLE CHARACTERISTICS: Studies were conducted in Hong Kong, China, Taiwan, Malaysia, South Korea, United States, Israel, and Australia. Various cancer diagnoses were included (i.e., breast, prostate, gynecologic, nasopharyngeal, hepatocellular, colon, non-Hodgkin lymphoma, lung cancer, and gastrointestinal cancers) from early in the treatment period through the recovery phase. Median intervention duration was 6 weeks (ranged from 3 to 24 weeks).

PHASE OF CARE: Multiple phases of care     

APPLICATIONS: Elder care

Of the 22 studies that met inclusion criteria, there were 14 RCTs and 8 controlled clinical trials. A high risk of bias was reported in 16 studies (73%) specifically in lack of blinding, allocation concealment, and incomplete outcome data. The efficacy of Qigong was examined for symptom management among patients with various cancers. Effects were described according to primary outcome measures, including physical (e.g., fatigue, sleep disturbances, pain, dyspnea) and psychological (e.g., depression, anxiety) symptoms, and quality of life. For example, 10 studies included a fatigue outcome whereas 3 studies included a sleep disturbance measure. In addition, 19 studies evaluated ≥ 2 outcomes. Results indicated that participants in Qigong groups were significantly improved postintervention compared with the control groups or there were positive trends from pre- to postintervention scores. Protocols used to deliver the interventions varied and included seven types or forms of Qigong. Interestingly, all seven styles of Qigong were effective for ≥ one outcome variable. Secondary outcomes found that Qigong was safe and feasible without unwanted side effects. The majority of outcomes were self-reported, but there were a few significant objective clinical outcomes: muscular strength, range of motion, six-minute walk test, and body mass index.

Results of this systematic review suggest that some of the symptoms were significantly improved in the Qigong group postintervention compared to controls. These somewhat promising results are tempered by some major limitations. There was a high risk of bias related to allocation concealment, lack of blinding, and incomplete outcome data. Limitations pertain to the potential incompleteness of the evidence reviewed. Conclusions regarding superiority of one form of Qigong over another were beyond the scope of this review.

Limited number of studies included

Mostly low quality or high risk of bias studies

High heterogeneity

Low sample sizes

Qigong for improving symptoms in patients with cancer are encouraging in some but not all reported studies in this review. For example, only one out of three studies that evaluated sleep quality reported significant improvement with Qigong. More research is needed before Qigong can be recommended for relief of cancer-related symptoms.