Tai Chi

PURPOSE: The goal of this study was to systematically review and synthesize the evidence for Tai Chi and Qigong interventions for supportive cancer care, specifically focusing on five clinical outcomes (fatigue, sleep difficulty, mood, pain, and quality of life), to identify the strengths and gaps in the evidence for theses interventions, and suggest directions for future research.

TYPE OF STUDY: Meta analysis and systematic review

• DATABASES USED: PubMed, CINAHL, Web of Science, and Embase
• YEARS INCLUDED: From inception until January 30, 2017
• INCLUSION CRITERIA: RCTs, prospective non-randomized controlled and prospective non-controlled studies, in English, with cancer as primary disease and Tai Chi and Qigong as the primary interventions. 
• EXCLUSION CRITERIA: Review articles, other intervention, not cancer, outcome unrelated, other language, observational study.

• TOTAL REFERENCES RETRIEVED: 478
• EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane Collaboration Risk of Bias Tool updated 2009; individual domains endorsed with low or high risk of bias; low risk of bias with at least 50% of criteria designates as low risk; high risk of bias when more than 50% of criteria endorsed with high bias or unclear.

• FINAL NUMBER OF STUDIES INCLUDED: 22 for qualitative analysis and 15 for quantitative analysis
• TOTAL PATIENTS INCLUDED IN REVIEW: 1,571
• SAMPLE RANGE ACROSS STUDIES: 12-197
• KEY SAMPLE CHARACTERISTICS: 10 studies included women with breast cancer only, 2 included men with prostate cancer only, 5 studies included mixed solid cancers, and single studies exclusively included patients with lung cancer, non-Hodgkin lymphoma, nasopharyngeal cancer, and gastric cancer.

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Elder care

TCQ interventions varied in content, dosage, duration, and intensity. Of the 22 studies, Tai Chi was applied in 7 studies, Qigong in 10 studies, and Tai Chi and Qigong were explicitly combined in 4 studies. All results based on a random effects model due to statistical heterogeneity. Ten studies pooled for analysis revealed an overall effect size that indicated a beneficial effect of TCQ on fatigue in patients with cancer (Hedges g = − 0.53, 95% CI [−0.97, −0.28], p < 0.001). Six studies pooled for analysis revealed an overall effect size with a beneficial effect of TCQ on sleep difficulty in patients with cancer (Hedges g = − 0.49, 95% CI [−0.89, −0.09], p = 0.018). The overall effect size based on seven studies favored TCQ on depression in patients with cancer (Hedges g = −0.27, 95% CI [−0.44, −0.11], p = 0.001). Four pooled studies suggested that a statistically non-significant trend was in favor of TCQ on cancer-related pain (Hedges g = −0.38, 95% CI [−0.89, 0.12], p = 0.136). Quality of life was assessed with eleven studies and favored TCQ in patients with cancer (Hedges g = 0.33, 95% CI [0.1, 0.56], p = 0.004). Findings from non-RCTs paralleled meta-analysis results. Funnel plots suggest some degree of publication bias.

Findings support that TCQ may be effective in reducing multiple symptoms commonly experienced by cancer survivors. Statistically significant and clinically meaningful medium effect sizes in favor of TCQ were observed for symptoms of fatigue and sleep difficulty. Smaller but statistically significant effect sizes were also observed for QOL and depression, and a non-significant trend in favor of TCQ was observed for pain.

• High heterogeneity
• Low sample sizes

Tai chi and Qigong are mind-body interventions that show promise for reducing cancer-related symptoms, including fatigue, sleep problems, and depression as well as improving quality of life. Evidence from this review comes from a qualitative synthesis as well as a meta-analysis. The review included studies that included patients with different types of cancer.

To evaluate the feasibility of tai chi to improve well-being for women with breast cancer treatment-associated arthralgia

Women met twice weekly for eight weeks for group tai chi under supervision. The program was a gentle, low-impact form of tai chi focusing on body awareness, deep breathing, and weight bearing. Women were provided written information for home practice. Participants were asked to complete journal entries after each tai chi session and home exercise, encouraged to maintain usual activities, and asked to refrain from other exercise during the study. Study measures were obtained at baseline and at the end of 8 weeks.

• N = 12  
• MEAN AGE = 59 years (range = 49-76 years)
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: All had completed initial breast cancer treatment and were post-menopausal, currently free of disease, and on aromatase inhibitors.  
• OTHER KEY SAMPLE CHARACTERISTICS: 91.6% were white, one-third were employed full-time, and 58% had some college education.

• SITE: Single site
• SETTING TYPE: Outpatient   
• LOCATION: New Jersey

PHASE OF CARE: Late effects and survivorship

Single-group observational, mixed-method, feasibility

• Functional Assessment of Cancer Therapy–Breast (FACT-B)
• Brief Pain Inventory
• Hospital Anxiety and Depression Scale (HADS)
• Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-fatigue)
• Qualitative analysis of journal entries

There was a reduction in anxiety from 8.0 to 5.7 (p = .003) and in depression from 5.17 to 2.42 (p = .02). A positive, but non significant, reduction in fatigue and pain occurred. Themes from analysis of qualitative results were improved relaxation and reduced stress, an increase in undisturbed sleep, and perceived value from the group and instructor support. There were no adverse events.

Tai chi participation appears to be feasible for breast cancer survivors and may have positive effects on anxiety and other symptoms.

• Small sample (< 30)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Risk of bias (no appropriate attentional control condition) 
• Risk of bias (sample characteristics)
• Other limitations/explanation: Adherence to sessions is not reported. Sample was limited to women on aromatase inhibitors experiencing pain from arthralgia.

Tai chi sessions are feasible for cancer survivors and may be of benefit. This combination of relaxation and exercise disciplines may be helpful and acceptable to some patients. Study findings here suggest that the supportive nature of instructor-led group sessions contributed to the positive results.