Myers, J.S., Mitchell, M., Krigel, S., Steinhoff, A., Boyce-White, A., Van Goethem, K., . . . Bender, C.M. (2019). Qigong intervention for breast cancer survivors with complaints of decreased cognitive function. Supportive Care in Cancer, 27, 1395–1403.

This purpose of the study is to evaluate the feasibility of conducting a three-arm single-blind RCT of an eight-week intervention to improve objectively and subjectively measured cognitive function in breast cancer survivors reporting cognitive complaints.

The study comprised three groups: (a) Qi-gong (Six Healing Sounds form: combination of diaphragmatic breathing, chanting of six healing sounds, and specific gentle arm movements), (b) gentle exercise (gentle arm movements and postures only), (c) attention control (survivorship-focused support group sessions facilitated by a clinical psychologist). Each group met for eight weekly 60-minute sessions. For both the Qi-gong and gentle exercise groups, participants were given instructions to complete 15-minute practice sessions, twice a day, and keep a log. Feasibility was defined by (a) achieving 45 evaluable patients (15 in each group); (b) 75% or greater adherence to weekly attendance for all groups and twice daily home practice for Qi-gong and gentle exercise; (c) 25% or less attrition. Patient-reported outcomes collected at baseline (T1), 8 weeks (T2), and 12 weeks (T3). Neuropsychological testing at T1 and T3 only.

• N = 36   
• MEAN AGE: 54 years (SD = 11.19) 
• FEMALES: 100%
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: Stage I-III breast cancer, 2 months to 8 years after chemotherapy, 52% were treated with radiation therapy, 34% treated with anti-HER-2 therapy, 78% treated with anti-estrogen therapy 
• OTHER KEY SAMPLE CHARACTERISTICS: 90% Caucasian, 90% non-Hispanic/Latino, 88% post-menopausal, mean = 2.3 (SD = 1.65) years post-chemotherapy

• SITE: Multi-site   
• SETTING TYPE: Multiple settings    
• LOCATION: Kansas, USA

PHASE OF CARE: Transition phase after active treatment

Single-blinded three arm randomized controlled trial (Qi-gong/Gentle Exercise/Attention Control)

• Objective cognitive function: Rey Auditory Verbal Learning Test (RAVLT), F-A-S test, TMT-A/B
• Subjective cognitive function: FACT-Cog (perceived cognitive impairment, perceived cognitive abilities, QOL), PROMIS applied cognition (general concerns, abilities)
• Other: MD Anderson Cancer Symptom Inventory (fatigue, sleep disturbance, distress)

Feasibility (primary aim): 36 evaluable patients at T3 (Qi-gong = 15, gentle exercise = 10, Attention control = 11). Adherence was 44%-67% for weekly sessions and 21%-31% for twice-daily home practice. 28% overall attrition rate. 
Cognitive function (exploratory aim): Improvements in self-reported cognitive function, as measured by the FACT-Cog, were significantly greater in the Qi-gong group versus gentle exercise between T1 and T2 (perceived cognitive impairments subscale: p = 0.01, d = 1.14; perceived cognitive abilities subscale: p = 0.04, d = 0.75). No significant differences in self-reported cognitive function were noted between the groups from T2 and T3. Improvements on objectively measured processing speed (TMT-A) were significantly greater in the Qi-gong group versus gentle exercise between T1 and T3 (p = 0.07, d = 1.21). The attention control group improved more than the gentle exercise on the F-A-S test of verbal fluency between T1 and T3 (p = 0.02, d = 1.14). 

Other: QOL improved for all three groups between T1 and T2. Distress significantly improved in the Qi-gong group compared to the support group (p = 0.05, d = 0.81) between T1 and T2. There was no significant improvement in fatigue or sleep disturbance scores.

This study provides support for the design of large studies to confirm the effectiveness of Qi-gong, which combines mindfulness-based elements with gentle exercise, for the improvement of perceived cognitive function and processing speed.

• Small sample (< 100)
• Findings not generalizable
• Intervention expensive, impractical, or training needs
• Subject withdrawals ≥ 10%  
• Other limitations/explanation: Weekly intervention sessions delivered by group leaders trained in six healing sounds form of Qi-gong require specialized training. 28% overall attrition rate (21% for Qi-gong group, 50% for the gentle exercise group and 0% for the attention control group) suggest that some aspects of the intervention may not be feasible.

Interventions that combine mindfulness and gentle exercise, such as Qi-gong, may be feasible for some patients after chemotherapy for breast cancer and may have benefits in reducing cognitive complaints and improving speed in performing mental tasks. However, larger studies are needed to confirm these findings.