The efficacy of Qigong practice for cancer-related fatigue: A systematic review and meta-analysis of randomized controlled trials

https://doi.org/10.1016/j.mhpa.2020.100347Get rights and content

Highlights

  • •

    Effects were aggregated from thirteen randomized trials of 1154 participants.

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    Qigong was accompanied by small-to-moderately sized anti-fatigue effects for cancer patients or survivors.

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    Methodological bias were provided and higher quality RCTs were suggested.

Abstract

Objective

To evaluate clinical trial evidence of the effects of Qigong practice on self-reported fatigue among cancer patients or survivors.

Methods

13 articles published before 31 December 2019 involving 1154 participants were selected according to PICO guidelines in the Cochrane Handbook. Relevant randomized controlled trials (RCTs) were included. Hedges d effect sizes were calculated and random effects models were used to estimate the pooled effects. I2 tests were applied to assess the heterogeneity. Moderating effects were tested by mixed model meta-regression analysis according to moderators derived from participant characteristics, features of Qigong exposure and research design. Study quality was judged using the Wayne Checklist.

Results

Qigong practice relieved cancer-related fatigue by a heterogeneous (I2 = 81.4%) standardized mean effect size 0.46 (95% CI, 0.15 to 0.78, z = 2.89, p = 0.0039). Reductions were larger in participants having elevated fatigue at baseline. Trials with blinded allocation or blinded assessment of participants had larger effects. Qigong had a significant effect on cancer-related fatigue when Qigong was compared with usual care or waitlist control (Hedges d = 0.66, 95% CI, 0.07 to 1.26, p < 0.001), but not when Qigong was compared with Western exercise (Hedges d = 0.46, 95%CI, −0.02 to 0.95, p = 0.06) or no treatment control (Hedges d = 0.10, 95%CI, −0.23 to 0.43, p = 0.60) in sub-analysis.

Conclusion

Qigong practice may have small-to-moderate efficacy for management of cancer-related fatigue, but the limited number of RCTs and methodological flaws in most of the trials make it premature to conclude clinical effectiveness. Further high-quality RCTs are needed to mitigate potential methodological bias.

Section snippets

The literature search

English language articles published before December 31, 2019, were located using Databases of PubMed, Embase, Cochrane Library Database and Web of Science. The reference lists of articles and reviews were also manually searched. The search terms used were: “Qigong”, “qi gong”, “qi”, “chi kung”, “cancer”, “tumour”, “neoplasms”, “tumor”, “fatigue”, “tiredness”, “lassitude”, “random”, “randomized ", “randomized control”, and “randomized controlled trial".

Types of studies

Articles aiming to examine the effects of

Results of the literature search

Our database and manual searches identified 124 (Pubmed 13, Cochrane Library 14, Embase 38, Web of Science 57, manual search 2) potentially relevant articles, of which 26 articles were removed because of the duplicate articles. 98 articles were acquired after screening of title or abstract, of which 56 articles were excluded including 31 reviews, 4 reports, 3 conference abstracts, 18 obviously unmatched research content; 42 articles were further screened after reading the full text, of which 29

Discussion

The cumulative evidence summarized here indicates that Qigong has a moderate, statistically significant, favorable effect on fatigue symptoms. The magnitude of the overall mean effect (Hedges d = 0.46) provides quantitative support for the anti-fatigue effect of Qigong, which is comparable to the effects of other intervention therapies on cancer-related fatigue including Western Exercise of about one-third SD (Cramp & Byron, 2012; Puetz & Herring, 2012), psychostimulants (SMD = 0.28) (Minton,

Limitation

The primary weakness in this review was the small number of trials or effects. The relatively small number of the included studies necessarily limited confidence on the estimated effects for limited sample size. In addition, the participants in the included articles varied clinically in terms of type of cancer as well as the cancer stages. Hence, the results may not be generalized to all cancer patients. Further, although we divided the comparison controls into three groups (usual care or

Conclusion

The summarized evidence tentatively supports that the practice of Qigong is accompanied by small-to-moderately sized anti-fatigue effects for cancer patients or survivors. However, the results should be interpreted with caution because of the limited number of studies and their associated methodological weaknesses. Further studies of rigorously designed RCTs are needed minimize methodological bias and provide stronger tests of the efficacy and effectiveness of Qigong exposure on cancer-related

Declaration of competing interest

The authors declared that they have no conflicts of interest to this work. We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted.

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