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Effects of Qigong, Tai Chi, acupuncture, and Tuina on cancer-related fatigue for breast cancer patients: A protocol of systematic review and meta-analysis

Authors:

Abstract

Backgrounds: Cancer-related fatigue (CRF) is one of the most common and disabling outcomes in patients with breast cancer (BC). Traditional Chinese medicine (TCM) nonpharmacological interventions are becoming increasingly popular for cancer treatment and rehabilitation interventions. However, their efficacy and safety remain unclear and there is no systematic review or meta-analysis focusing fully on this issue. We aim to evaluate the effects of representative TCM nonpharmacological interventions, including Qigong, Tai Chi, acupuncture, and Tuina, on CRF in BC patients. Methods: Published randomized controlled trials (RCTs) that assessed the efficacy of these interventions on CRF for BC patients will be included. We will search from the following electronic databases: PubMed, Cochrane Library, EMBASE, MEDLINE, Web of Science, Scopus, PsycINFO, PSYINDEX, CINAHL, China National Knowledge Infrastructure (CNKI), WanFang Database, and Chinese Biomedical Literature Database (CBM). The primary outcomes are the improvement of CRF, which will be evaluated by the Piper Fatigue Scale (PFS), the Functional Assessment of Cancer Therapy (FACT)-Fatigue Scale, Schwartz Cancer Fatigue Scale (SCFS), the Multidimensional Fatigue Inventory (MFI). The secondary outcomes are quality of life and safety. The meta-analysis will be performed using RevMan ver 5.3(Cochrane) statistical software. Results: We will provide more practical results investigating the efficacy of Qigong, Tai Chi, acupuncture, Tuina for BC patients with CRF from several respects including the improvement of fatigue, quality of life, and safety. Conclusions: This review will generate more stronger evidence in BC patients for TCM nonpharmacological interventions, including Qigong, Tai Chi, acupuncture, Tuina, in the treatment of CRF and help to inform clinicians and policymakers. Ethics dissemination: Ethical approval is not necessary because all of the study base in our review will be based on published research. We will submit our results to a peer-reviewed journal. Study registration number: The study is priorly registered through International Platform of Registered Systematic Review and Meta-analysis Protocol on October 2, 2020 (INPLASY 2020100003).
Effects of Qigong, Tai Chi, acupuncture, and
Tuina on cancer-related fatigue for breast cancer
patients
A protocol of systematic review and meta-analysis
Xue Li, MS
a
, Xueqian Wang, MD
a
, Lijun Song, MD
a
, Jiayue Tian, MS
b
, Xuejiao Ma, MS
b
, Qiyuan Mao, MS
b
,
Hongsheng Lin, MD
a,
, Ying Zhang, MD
a
Abstract
Backgrounds: Cancer-related fatigue (CRF) is one of the most common and disabling outcomes in patients with breast cancer
(BC). Traditional Chinese medicine (TCM) nonpharmacological interventions are becoming increasingly popular for cancer treatment
and rehabilitation interventions. However, their efcacy and safety remain unclear and there is no systematic review or meta-analysis
focusing fully on this issue. We aim to evaluate the effects of representative TCM nonpharmacological interventions, including Qigong,
Tai Chi, acupuncture, and Tuina, on CRF in BC patients.
Methods: Published randomized controlled trials (RCTs) that assessed the efcacy of these interventions on CRF for BC patients
will be included. We will search from the following electronic databases: PubMed, Cochrane Library, EMBASE, MEDLINE, Web of
Science, Scopus, PsycINFO, PSYINDEX, CINAHL, China National Knowledge Infrastructure (CNKI), WanFang Database, and
Chinese Biomedical Literature Database (CBM). The primary outcomes are the improvement of CRF, which will be evaluated by the
Piper Fatigue Scale (PFS), the Functional Assessment of Cancer Therapy (FACT)-Fatigue Scale, Schwartz Cancer Fatigue Scale
(SCFS), the Multidimensional Fatigue Inventory (MFI). The secondary outcomes are quality of life and safety. The meta-analysis will be
performed using RevMan ver 5.3(Cochrane) statistical software.
Results: We will provide more practical results investigating the efcacy of Qigong, Tai Chi, acupuncture, Tuina for BC patients with
CRF from several respects including the improvement of fatigue, quality of life, and safety.
Conclusions: This review will generate more stronger evidence in BC patients for TCM nonpharmacological interventions,
including Qigong, Tai Chi, acupuncture, Tuina, in the treatment of CRF and help to inform clinicians and policymakers.
Ethics dissemination: Ethical approval is not necessary because all of the study base in our review will be based on published
research. We will submit our results to a peer-reviewed journal.
Study registration number: The study is priorly registered through International Platform of Registered Systematic Review and
Meta-analysis Protocol on October 2, 2020 (INPLASY 2020100003)
Abbreviations: BC =breast cancer, CI =condence interval, CRF =cancer-related fatigue, RCTs =randomized controlled trials,
TCM =traditional Chinese medicine.
Keywords: acupuncture, breast cancer, cancer-related fatigue, meta-analysis, protocol, Qigong, systematic review, Tai Chi,
traditional Chinese medicine nonpharmacological interventions, Tuina
XL and XQW contributed equally to this work and are co-rst authors.
This study is supported by the Special Fund for TCM (201307006).
The funders had no role in the design, execution, or writing of the study.
The authors have no conicts of interest to disclose.
Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
a
Department of Oncology, Guanganmen Hospital, China Academy of Chinese Medical Sciences,
b
School of Graduates, Beijing University of Chinese Medicine, Beijing,
China.
Correspondence: Hongsheng Lin, Department of Oncology, Guanganmen Hospital, China Academy of Chinese Medical Sciences, Xicheng District, Beijing 100053,
China (e-mail: drlinhongsheng@163.com).
Copyright ©2020 the Author(s). Published by Wolters Kluwer Health, Inc.
This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
How to cite this article: Li X, Wang X, Song L, Tian J, Ma X, Mao Q, Lin H, Zhang Y. Effects of Qigong, Tai Chi, acupuncture, and Tuina on cancer-related fatigue for
breast cancer patients: A protocol of systematic review and meta-analysis. Medicine 2020;99:45(e23016).
Received: 2 October 2020 / Accepted: 5 October 2020
http://dx.doi.org/10.1097/MD.0000000000023016
Study Protocol Systematic Review Medicine®
OPEN
1
1. Introduction
Breast cancer (BC) is the most common cancer among women
worldwide. Fortunately, despite the increasing incidence of BC,
development of cancer diagnosis and treatment technology have
made year of survival extended signicantly.
[1]
For breast cancer
survivors, symptom management and rehabilitation are impor-
tant. Roorda study suggests that BC patients generally use of
rehabilitation interventions are greater than age-matched con-
trols.
[2]
Cancer-related fatigue (CRF) is one of the most common
and disabling outcomes reported by BC survivors during and
after treatment.
[3]
More than 80% of BC patients with
standardized treatment have fatigue.
[4]
The National Compre-
hensive Cancer Network (NCCN) denes CRF as a distressing,
persistent, subjective sense of physical, emotional, and/or
cognitive tiredness or exhaustion related to cancer or cancer
treatment that is not proportional to recent activity and interferes
with usual functioning.
[5]
CRF is exacerbated by higher rates of
depression,
[6,7]
sleep disturbance,
[8,9]
and pain,
[6,10]
it is highly
bothersome, interferes with daily activities, and limiting overall
quality of life. Besides, CRF can persist for up to 10 years after
end of treatment.
[11]
It is increasingly demanding to improve
quality of life.
At present, common prevention and treatment agents for CRF
includes psychostimulants, corticosteroids, and erythropoietin.
However, they are not extensively used in clinical because of their
potential serious adverse effects and insignicant efcacy. Other
pharmacologic interventions remain investigational, and some
have even been identied as ineffective.
[5]
Hence, there is growing
interest in nonpharmacological interventions that are safe and
few side effects. Some clinical studies have shown that non-
pharmacological interventions, such as exercise,
[12,13]
nutrition
therapy,
[14,15]
and psychological interventions
[16,17]
are effective
in relieving fatigue for BC patients. The Oncology Nursing
Society considers nonpharmacological interventions as a prom-
ising intervention for CRF,
[18]
and similar recommendations have
been made by the NCCN.
[5]
Under the circumstance, non-
pharmacological interventions has been gaining more attention
in CRF treatment for BC patients around the world.
In China, TCM nonpharmacological interventions have been
widely applied in management of fatigue. The most commonly
used and internationally recognized methods include Qigong, Tai
Chi, acupuncture, and Tuina.
[1921]
According to the TCM
theory, CRF is one kind of consumptive disease due to disorder of
viscera function and insufciency of Qi and blood, Yin and Yang.
Qigong, Tai Chi, acupuncture, and Tuina have the function of
regulating visceral function, reinforcing Qi and activating blood,
and restoring the balance of Yin and Yang. In addition, numerous
clinical reports from various sources have shown that Qigong,
[22]
Tai Chi,
[23]
acupuncture,
[24]
and Tuina
[25]
are effective for CRF.
They can also alleviate depression,
[26]
sleep disturbance,
[27]
and
pain.
[28]
And these interventions are less likely to have side
effects.
Previous studies have proved the validity of TCM non-
pharmacological interventions on fatigue.
[2931]
But there is no
consensus on CRF in breast cancer. Though some researches
applying Qigong, Tai Chi, acupuncture, and Tuina in BC patients
with CRF have described positive results, others have reported
mixed evidence.
[32]
Hence, our research team is planning a
systematic review and meta-analysis investigating the efcacy of
CRF managements through representative TCM nonpharmaco-
logical interventions, including Qigong, Tai Chi, acupuncture,
and Tuina, to identify the treatment with the better efcacy for
practical consideration for BC patients.
2. Methods
2.1. Eligibility criteria
2.1.1. Types of studies. Randomized controlled trials (RCTs)
will be included without restriction of publication type or
language. Studies should be available in full papers and peer-
reviewed.
2.1.2. Types of participants. Breast cancer patients suffering
from CRF with the following conditions will be included: rstly,
age, sex, race, education status, and types of treatment are not
restricted. Secondly, denite pathological diagnosis of breast
cancer without restrictions related to type and stage. And nally,
breast cancer patients should conform to the diagnosis standards
of CRF, which based on International Statistical Classication of
Diseases and Related Health Problems, 10th revision (ICD-10).
2.1.3. Types of interventions and comparators. Approaches
including Qigong, Tai Chi, acupuncture, and Tuina alone or in
combination, will be reviewed. The control group could be
placebo, blank control, standard care, and other body-based
practices such as exercise techniques, yoga.
2.1.4. Types of outcome measures
2.1.4.1. Primary outcomes. The primary outcomes are certain
common scales which reect fatigue severity. We considered the
following scales: Piper Fatigue Scale (PFS); the Functional
Assessment of Cancer Therapy (FACT)-Fatigue Scale; Schwartz
Cancer Fatigue Scale (SCFS); the Multidimensional Fatigue
Inventory (MFI).
2.1.4.2. Secondary outcomes. The secondary outcome mea-
sures are any quality of life, adverse events.
2.2. Information sources and search strategy
2.2.1. Electronic searches. RCTS are being searched in the
following electronic databases without language and publication
date restrictions: PubMed, Cochrane Library, EMBASE, MED-
LINE, Web of Science, Scopus, PsycINFO, PSYINDEX,
CINAHL, China National Knowledge Infrastructure (CNKI),
WanFang Database, and Chinese Biomedical Literature Data-
base (CBM) until March 2020. Search terms are related to breast
cancer, cancer related fatigue, Qigong, Tai Chi, acupuncture, and
Tuina. The details of the PubMed database search strategy are
shown in Table 1, and similar search strategies will be adopted
for other databases.
2.2.2. Searching other resources. Manual searches will
include reviewing reference lists of identied studies, relevant
reviews, meta-analyses, and journals that have published the
most relevant research articles or reviews. Meanwhile, grey
literature will be searched. The ongoing RCTS will be searched
the WHO International Clinical Trial Registry Platform (ICTRP)
and its Registry Network, and we will contact corresponding
authors to identify extra studies if necessary.
2.3. Study selection
First of all, the titles and abstracts of researches will be
independently examined by 2 review authors to make a
Li et al. Medicine (2020) 99:45 Medicine
2
preliminary selection of potential trails according to our pre-
determined eligibility criteria. Second, full text of all preliminary
selective trials will be downloaded to make sure eligible trials.
The unclear information or missing data will be replenished by
contacting with the authors. Discrepancies between 2 reviewers
will be resolved through discussion or be arbitrated of a third
reviewer. A Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA) ow chart (Fig. 1) will be used to
describe the entire selection process.
2.4. Date extraction
Information from eligible RCTs will be extracted independently
by 2 authors. Extracted information will include: published
materials: title, authors, publication date, country, study design,
type of control, the number of study groups, and center; the
population: sample size (treatment/control), age, sex, race ratio;
the intervention: duration, frequency, intensity; outcomes and
others: scale tools, evaluation time, outcome details, adverse
events and complications, quality of life. Disagreements will be
resolved through team discussion.
2.5. Risk of bias assessment
Two reviewers will independently assess the risk of study bias
using the Cochrane Collaboration tool, which consists of the
following 6 items: random sequence generation, allocation
concealment, participant and personnel blinding, outcome
assessment blinding, incomplete outcome data, selective report-
ing, and other source of bias. The quality of the reporting will be
categorized into 3 levels: low, unclear, and high risk of bias. Any
disagreement will be decided by 3rd reviewer.
2.6. Dealing with missing data
As for the lacking data, insufcient or vague, we will contact the
corresponding authors by email or telephone to obtain missing
information. If fail, we will only conduct analysis based on
available data and potential impact of the incomplete data will be
analyzed and reported in the summary results.
2.7. Data synthesis and analysis
Meta-analysis will be performed using RevMan ver 5.3
(Cochrane, Oxford, England) statistical software. Relative risk
(RR) will be used when the result is dichotomous variables and
95% condence intervals (CI). For continuous variables, we
will use standardized mean difference (SMD) and 95% CI. Chi-
squared test and I
2
statistic will be used to conrm the
heterogeneity. The former checks for heterogeneity, while the
latter reects the degree of heterogeneity through a specic value.
I
2
of 25%, 50%, and 75%, respectively, indicated low, medium,
and high heterogeneity. If I
2
is >50%, there is considerable
heterogeneity between studies, so a subgroup analysis will be
performed to investigate the potential causes.
2.8. Measures for publication bias
When included studies are >10, funnel plot will be used to
identify the publication bias. Begg and Egger tests will be utilized
to evaluate funnel plot symmetry.
2.9. Evaluation of the level of evidence
Two reviewers will independently evaluate the level of evidence for
outcomes according to the Grading of Recommendations Assessment,
Development and Evaluation (GRADE). There are 4 possible levels:
very low, low, moderate, or high. The level of evidence is determined
by the seriousness of 5 factors: study limitations, inconsistency,
imprecision, indirectness, and publication bias.
2.10. Subgroup analysis
Considering signicant heterogeneity, we plan to carry out a
subgroup analysis. The following items will be considered: age,
and race of patients, types and stage of breast cancer, course of
the intervention.
Table 1
Search strategy for PubMed.
No. Search items
#1 Breast Carcinoma[Mesh Terms]
#2 breast neoplasms[Title/Abstract]
#3 breast carcinoma[Title/Abstract]
#4 breast carcinomas[Title/Abstract]
#5 breast neoplasms[Title/Abstract]
#6 breast tumor[Title/Abstract]
#7 breast tumour[Title/Abstract]
#8 breast cancer[Title/Abstract]
#9 breast cancers[Title/Abstract]
#10 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 #8 OR #9
#11 fatigue[Mesh Terms]
#12 cancer-related fatigue[Mesh Terms]
#13 fatigue[Title/Abstract]
#14 cancer-related fatigue[Title/Abstract
#15 #11 OR #12 OR #13 OR #14
#16 Qigong[Mesh Terms]
#17 qigong[Title/Abstract]
#18 Baduanjin[Title/Abstract]
#19 Wuqinxi[Title/Abstract]
#20 Tai Chi[Mesh Terms]
#21 Tai Chi[Title/Abstract]
#22 Taiji[Title/Abstract]
#23 Taijiquan[Title/Abstract]
#24 Tai Chi Chuan [Title/Abstract]
#25 Acupuncture[Mesh Terms]
#26 Acupressure[Mesh Terms]
#27 acupuncture[Title/Abstract]
#28 acupressure[Title/Abstract]
#29 acupoint[Title/Abstract]
#30 moxibustion[Title/Abstract]
#31 Tuina[Mesh Terms]
#32 Massage[Title/Abstract]
#33 tuina[Title/Abstract]
#34 massage[Title/Abstract]
#35 #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24
OR #25 OR #26 OR #27 OR #28 OR #29 OR #30 OR #31 OR #32
OR #34 OR #35
#36 randomized controlled trial [Publication Type]
#37 controlled clinical trial [Publication Type]
#38 randomized [Title/Abstract]
#39 randomly [Title/Abstract]
#40 trial [Title/Abstract]
#41 groups [Title/Abstract]
#42 placebo[Title/Abstract]
#43 #36 OR #37 OR #38 OR #39 OR #40 OR #41 OR #42
#44 #10 AND #15 AND #35 AND #43
Li et al. Medicine (2020) 99:45 www.md-journal.com
3
2.11. Sensitivity analysis
Sensitivity analysis will be conducted to eliminate the efcacy of
low quality studies, provided there is signicant heterogeneity
after robust subgroup analysis. The meta-analysis will be
repeated after low-quality studies are removed. We will compare
the results of the 2 meta-analyses and then decide whether to
exclude low-quality studies based on evidence strength, sample
size, and inuence on the pooled estimate. Nonetheless,
sensitivity analysis will not be performed if there is a high risk
of bias in all included studies.
3. Discussion
Due to their efcacy and few adverse effects, TCM non-
pharmacological interventions have been widely recognized and
used in terms of improving the quality of life and symptoms of
cancer patients. For breast cancer patients, fatigue, as a most
common and bothersome symptom, frequently cooccurs with
other symptoms. Consequently, it is especially crucial to
determine the effective treatments with few adverse effects that
can improve fatigue in breast cancer patients. TCM non-
pharmacological interventions have great potential in this
respect.
Now, some possible biological mechanisms for Tai chi,
Qigong, acupuncture, and Tuina of breast cancer related fatigue
have been suggested, such as a decrease of inammatory
cytokines,
[33]
an increase of T-lymphocytes
[34]
and beta-
endorphins,
[35]
and improving immune function.
[36]
But
clinical evidence-based researches of these interventions are
limited. In order to provide more objective evidence of Tai chi,
Qigong, acupuncture, and Tuina for breast cancer related
fatigue, a high-quality systematic review and meta-analysis is
necessary.
Records identified through database
searching
(n= )
Additional records identified through
other sources
(n= )
Records after duplicates removed
(n= )
Records screened
(n= )
Full-text articles assessed for
eligibility
(n= )
Studied included in qualitative
synthesis
(n= )
Studied included in qualitative
synthesis
(meta-analysis)
(n= )
Records excluded
(n= )
IdentificationScreeningEligibilityIncluded
Figure 1. Flow diagram of study selection.
Li et al. Medicine (2020) 99:45 Medicine
4
There are some limitations to this study. First, we have
developed strict inclusion criteria to ensure the quality of
research. However, it may lead to limited number of studies.
Second, we will only include studies published in English or
Chinese due to the language barrier, which might cause
publication bias to some extent. Finally, we only evaluated the
most widely used and representative TCM nonpharmacological
interventions, which may have some limitations in proving the
efcacy of TCM nonpharmacological intervention for breast
cancer related fatigue. In spite of these limitations, this study will
not only help establish a better approach to prevent and treat
CRF in breast cancer patients, but also might have the potential
to improve quality of life for breast cancer patients worldwide.
Author contributions
Conceptualization: Xue Li, Xueqian Wang.
Data curation: Lijun Song, Jiayue Tian.
Investigation: Xuejiao Ma, Qiyuan Mao.
Methodology: Lijun Song, Jiayue Tian, Qiyuan Mao.
Supervision: Ying Zhang, Hongsheng Lin.
Writing original draft: Xue Li, Xueqian Wang.
Writing review & editing: Xue Li.
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Li et al. Medicine (2020) 99:45 www.md-journal.com
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... Most of the clinical studies indicate that about 80% of BC patients have depression or distress, a sense of physical, emotional, and/or cognitive tiredness or exhaustion due to the treatment of chemo and radiotherapy [50]. This stress also exacerbates mammary tumor growth and limiting the overall quality of an individual's life. ...
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... e subgroup results showed that doing Tai Chi for more than 40 min had a better effect on CRF improvement among breast cancer patients. A previous metaanalysis showed that Qigong and Tai Chi had a positive effect on relieving fatigue of breast cancer patients [34]; Larkey et al. [9] conducted Tai Chi intervention in breast cancer patients for 12 weeks and found that their persistent fatigue symptoms relieved; Cao Xin [35] et al. conducted mindfulness training interventions in breast cancer patients and found that the CRF levels of the observation group during the fourth chemotherapy and the sixth chemotherapy were both lower than those of the second chemotherapy. Jin Cuifeng et al. [36] also found that the longer intervention, the better the intervention effect of yoga on cancer-related fatigue of breast cancer patients. ...
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Qigong has been a tool in the Traditional Chinese Medicine [TCM] toolbox for thousands of years. Tai chi is another related tool that is of more recent origin. Although these two types of moving meditation-type exercises have been widely known and used in China and other parts of Asia, they have become more popular as supplementary therapies for a wide range of ailments in the west only more recently. The present article reviews the results of the application of tai chi and qigong to the treatment of cancer patients. Several studies have found that the addition of tai chi or qigong to the treatment of cancer can result in significant improvement in the areas of depression, fatigue, sleep quality, anxiety, and overall quality of life.
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Background: Although medical requirements are urgent, no effective intervention has been proven for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). To facilitate the development of new therapeutics, we systematically reviewed the randomized controlled trials (RCTs) for CFS/ME to date. Methods: RCTs targeting CFS/ME were surveyed using two electronic databases, PubMed and the Cochrane library, through April 2019. We included only RCTs that targeted fatigue-related symptoms, and we analyzed the data in terms of the characteristics of the participants, case definitions, primary measurements, and interventions with overall outcomes. Results: Among 513 potentially relevant articles, 55 RCTs met our inclusion criteria; these included 25 RCTs of 22 different pharmacological interventions, 28 RCTs of 18 non-pharmacological interventions and 2 RCTs of combined interventions. These studies accounted for a total of 6316 participants (1568 males and 4748 females, 5859 adults and 457 adolescents). CDC 1994 (Fukuda) criteria were mostly used for case definitions (42 RCTs, 76.4%), and the primary measurement tools included the Checklist Individual Strength (CIS, 36.4%) and the 36-item Short Form health survey (SF-36, 30.9%). Eight interventions showed statistical significance: 3 pharmacological (Staphypan Berna, Poly(I):poly(C12U) and CoQ10 + NADH) and 5 non-pharmacological therapies (cognitive-behavior-therapy-related treatments, graded-exercise-related therapies, rehabilitation, acupuncture and abdominal tuina). However, there was no definitely effective intervention with coherence and reproducibility. Conclusions: This systematic review integrates the comprehensive features of previous RCTs for CFS/ME and reflects on their limitations and perspectives in the process of developing new interventions.
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Objective: An increasing number of studies have shown the anti-depressive effect of qigong. However, its underlying mechanism remains poorly understood. This study aims to systematically review and meta-analyze existing literature on the mechanism of qigong in reducing depression. Method: The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials of qigong were searched from PsycINFO, PubMed, Embase, ScienceDirect, and Academic Search Premier from inception to December 2018. Studies which involved depression and any neurophysiological or psychological mechanisms as outcomes were included. Publication bias was tested before conducting meta-analysis. Two independent raters were involved for the entire review process. Results: A total of nine studies were identified which covered both neurophysiological and psychological mechanisms. Among these selected studies, seven were involved in meta-analysis, which suggested that qigong was effective in alleviating depression (standardized mean difference, SMD = −0.27, p < 0.05, I 2 = 27%). A significant effect was also found for diastolic blood pressure (SMD = −1.64, p < 0.05, I 2 = 31%). However, no significant effect was found for cortisol level and systolic blood pressure. Conclusions: This review shows that qigong is effective in reducing depression through activating the parasympathetic nervous system. Future studies with higher quality of research methodology with less selection and attrition bias should be conducted to unravel the possible anti-depressive effect of qigong.
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Purpose Sleep disturbance and cancer-related fatigue (CRF) are among the most commonly reported symptoms associated with breast cancer and its treatment. This study identified symptom cluster groups of breast cancer patients based on multidimensional assessment of sleep disturbance and CRF prior to and during chemotherapy. Methods Participants were 152 women with stage I–IIIA breast cancer. Data were collected before chemotherapy (T1) and during the final week of the fourth chemotherapy cycle (T2). Latent profile analysis was used to derive groups of patients at each timepoint who scored similarly on percent of the day/night asleep per actigraphy, the Pittsburgh Sleep Quality Index global score, and the five subscales of the Multidimensional Fatigue Symptom Inventory-Short Form. Bivariate logistic regression evaluated if sociodemographic/medical characteristics at T1 were associated with group membership at each timepoint. Results Three groups (Fatigued with sleep complaints, Average, Minimal symptoms) were identified at T1, and five groups (Severely fatigued with poor sleep, Emotionally fatigued with average sleep, Physically fatigued with average sleep, Average, Minimal symptoms) at T2. The majority of individuals in a group characterized by more severe symptoms at T1 were also in a more severe symptom group at T2. Sociodemographic/medical variables at T1 were significantly associated with group membership at T1 and T2. Conclusions This study identified groups of breast cancer patients with differentially severe sleep disturbance and CRF symptom profiles prior to and during chemotherapy. Identifying groups with different symptom management needs and distinguishing groups by baseline sociodemographic/medical variables can identify patients at risk for greater symptom burden.
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Purpose of Review Qigong and Tai Chi are two increasingly popular mind-body interventions with the potential to address the multifaceted needs of cancer survivors. The aim of this updated review and meta-analysis was to quantitatively evaluate the treatment effects of Qigong/Tai Chi on cancer survivors since 2014. Recent Findings There were statistically significant and clinically meaningful effects in favor of Qigong/Tai Chi interventions for symptoms of fatigue and sleep quality. There were positive trends, but not statistically significant effects, observed for anxiety, stress, depressive symptoms, and overall quality of life (QOL). Cancer-related cognitive impairment is a common complaint among cancer survivors that has received increasing attention in this area in recent years. Summary Qigong/Tai Chi in cancer care shows great promise with short-term effects in treating many cancer-related symptoms. Further methodologically sound trials with longer follow-up periods and more active control conditions are required, before definitive conclusions can be recommended for cancer patients.
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Throughout the cancer continuum, patients are faced with the cancer- and treatment-related side effects that can have a negative impact on their overall quality of life. Cancer-related fatigue (CRF) and sleep deficiency are among the symptoms that patients and their caregivers most often experience. An increasing body of literature suggests that a strong correlation between CRF and sleep deficiency exists, indicating that they may be reciprocally related and that they may have similar underlying etiology. This paper aims at bringing together the opinions of leading cancer control (i.e., CRF and sleep) and oncology experts in order to increase the understanding of CRF and sleep deficiency’s assessment, associated symptom clustering, symptom burden shared by caregivers, and CRF and sleep deficiency management in the cancer care context.
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Objectives: Integrative therapies have been incorporated increasingly into health and wellness in the United States in recent decades. Their potential benefits are under evaluation in various situations, including pain and symptom relief for cancer patients and survivors. This pilot study evaluated whether combining two integrative complementary approaches augments a patient's benefit by reducing postoperative stress, pain, anxiety, muscle tension, and fatigue compared with one integrative complementary approach alone. Design: Patients undergoing autologous tissue breast reconstruction were randomly assigned to one of two postoperative complementary alternative therapies for three consecutive days. All participants were observed for up to 3 months. Subjects: Forty-two participants were recruited from January 29, 2016 to July 11, 2018. Interventions: Twenty-one participants were randomly assigned to massage alone and 21 to massage and acupuncture. Outcome measures: Stress, anxiety, relaxation, nausea, fatigue, pain, and mood (score 0-10) were measured at enrollment before surgery and postoperative days 1, 2, and 3 before and after the intervention. Patient satisfaction was evaluated. Results: Stress decreased from baseline for both Massage-Only Group and Massage+Acupuncture Group after each treatment intervention. Change in stress score from baseline decreased significantly more in the Massage-Only Group at pretreatment and posttreatment (p = 0.03 and p = 0.04). After adjustment for baseline values, change in fatigue, anxiety, relaxation, nausea, pain, and mood scores did not differ between groups. When patients were asked whether they would recommend the study, 100% (19/19) of Massage-Only Group and 94% (17/18) of Massage+Acupuncture Group responded yes (p = 0.49). Conclusion: No additive beneficial effects were observed with addition of acupuncture to massage for pain, anxiety, relaxation, nausea, fatigue, and mood. Combined massage and acupuncture was not as effective in reducing stress as massage alone, although both groups had significant stress reduction. These findings indicate a need for larger studies to explore these therapies further.
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Purpose: Pain, fatigue, and distress are common among patients with cancer but are often underassessed and undertreated. We examine the prevalence of pain, fatigue, and emotional distress among patients with cancer, as well as patient perceptions of the symptom care they received. Patients and methods: Seventeen Commission on Cancer-accredited cancer centers across the United States sampled patients with local/regional breast (82%) or colon (18%) cancer. We received 2,487 completed surveys (61% response rate). Results: Of patients, 76%, 78%, and 59% reported talking to a clinician about pain, fatigue, and distress, respectively, and 70%, 61%, and 54% reported receiving advice. Sixty-one percent of patients experienced pain, 74% fatigue, and 46% distress. Among those patients experiencing each symptom, 58% reported getting the help they wanted for pain, 40% for fatigue, and 45% for distress. Multilevel logistic regression models revealed that patients experiencing symptoms were significantly more likely to have talked about and received advice on coping with these symptoms. In addition, patients who were receiving or recently completed curative treatment reported more symptoms and better symptom care than did those who were further in time from curative treatment. Conclusion: In our sample, 30% to 50% of patients with cancer in community cancer centers did not report discussing, getting advice, or receiving desired help for pain, fatigue, or emotional distress. This finding suggests that there is room for improvement in the management of these three common cancer-related symptoms. Higher proportions of talk and advice among those experiencing symptoms imply that many discussions may be patient initiated. Lower rates of talk and advice among those who are further in time from treatment suggest the need for more assessment among longer-term survivors, many of whom continue to experience these symptoms. These findings seem to be especially important given the high prevalence of these symptoms in our sample.
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Background: Insomnia is a common and debilitating disorder experienced by cancer survivors. Although cancer survivors express a preference for using nonpharmacological treatment to manage insomnia, the comparative effectiveness between acupuncture and Cognitive Behavioral Therapy for Insomnia (CBT-I) for this disorder is unknown. Methods: This randomized trial compared 8 weeks of acupuncture (n = 80) and CBT-I (n = 80) in cancer survivors. Acupuncture involved stimulating specific points on the body with needles. CBT-I included sleep restriction, stimulus control, cognitive restructuring, relaxation training, and education. We measured insomnia severity (primary outcome), pain, fatigue, mood, and quality of life posttreatment (8 weeks) with follow-up until 20 weeks. We used linear mixed-effects models for analyses. All statistical tests were two-sided. Results: The mean age was 61.5 years and 56.9% were women. CBT-I was more effective than acupuncture posttreatment (P < .001); however, both acupuncture and CBT-I produced clinically meaningful reductions in insomnia severity (acupuncture: -8.31 points, 95% confidence interval = -9.36 to -7.26; CBT-I: -10.91 points, 95% confidence interval = -11.97 to -9.85) and maintained improvements up to 20 weeks. Acupuncture was more effective for pain at the end of treatment; both groups had similar improvements in fatigue, mood, and quality of life and reduced prescription hypnotic medication use. CBT-I was more effective for those who were male (P < .001), white (P = .003), highly educated (P < .001), and had no pain at baseline (P < .001). Conclusions: Although both treatments produced meaningful and durable improvements, CBT-I was more effective and should be the first line of therapy. The relative differences in the comparative effectiveness between the two interventions for specific groups should be confirmed in future adequately powered trials to guide more tailored interventions for insomnia.