HOUSTON - Researchers from The University of Texas MD Anderson Cancer Center have found qigong, an ancient mind-body practice, reduces depressive symptoms and improves quality of life in women undergoing radiotherapy for breast cancer.
The study, published in the journal Cancer, is the first to examine qigong in patients actively receiving radiation therapy and include a follow-up period to assess benefits over time. Even though individual mind-body practices such as meditation and guided imagery appear to reduce aspects of distress and improve quality of life, questions remain about their effectiveness when conducted in conjunction with radiation therapy.
"We were also particularly interested to see if qigong would benefit patients experiencing depressive symptoms at the start of treatment," said Lorenzo Cohen, Ph.D., professor in MD Anderson's Departments of General Oncology and Behavioral Science and director of the Integrative Medicine Program. "It is important for cancer patients to manage stress because it can have a profoundly negative effect on biological systems and inflammatory profiles."
For the trial, Cohen, the corresponding author, and his colleagues enrolled 96 women with stage 1-3 breast cancer from Fudan University Shanghai Cancer Center in Shanghai, China. Forty-nine patients were randomized to a qigong group consisting of five 40-minute classes each week during their five-to-six week course of radiation therapy, while 47 women comprised a waitlist control group receiving the standard of care.
The program incorporated a modified version of Chinese medical qigong consisting of synchronizing one's breath with various exercises. As a practice, qigong dates back more than 4,000 years when it was used across Asia to support spiritual health and prevent disease.
Participants in both groups completed assessments at the beginning, middle and end of radiation therapy and then one and three months later. Different aspects of quality of life were measured including depressive symptoms, fatigue, sleep disturbances and overall quality of life.
Results show benefits emerged over time
Patients in the qigong group reported a steady decline in depressive symptom scores beginning at the end of radiation therapy with a mean score of 12.3, through the three month post-radiation follow-up with a score of 9.5. No changes were noted in the control group over time.
The study also found qigong was especially helpful for women reporting high baseline depressive symptoms, Cohen said.
"We examined women's depressive symptoms at the start of the study to see if women with higher levels would benefit more," Cohen said. "In fact, women with low levels of depressive symptoms at the start of radiotherapy had good quality of life throughout treatment and three months later regardless of whether they were in the qigong or control group. However, women with high depressive symptoms in the control group reported the worst levels of depressive symptoms, fatigue, and overall quality of life that were significantly improved for the women in the qigong group."
As the benefits of qigong were largely observed after treatment concluded, researchers suggest qigong may prevent a delayed symptom burden, or expedite the recovery process especially for women with elevated depressive symptoms at the start of radiotherapy.
Cohen notes the delayed effect could be explained by the cumulative nature of these modalities, as the benefits often take time to be realized.
Future research needed
The authors note several limitations to the study, including the absence of an active control group making it difficult to rule out whether or not the effects of qigong were influenced by a patient's expectations or simply being a light exercise. Additionally, the homogeneity of the group, Chinese women at a single site, limits the ability of applying the results to other populations.
According to the authors, the findings support other previously reported trials examining qigong benefits, but are too preliminary to offer clinical recommendations. Additional work is needed to understand the possible biological mechanisms involved and further explore the use of qigong in ethnically diverse populations with different forms of disease.
This work was supported through National Cancer Institute grants R21CA108084, U19CA121503 and CA016672. The authors have no conflicts of interest to report.
In addition to Cohen, MD Anderson authors on the paper include: Zhongxing Liao, M.D., Department of Radiation Oncology; Qi Wei, Integrative Medicine Program and Kathrin Milbury, Ph.D., Department of Behavioral Science. Other authors include Zhen Chen, M.D., Jiayi Chen, M.D., Zhiqiang Meng, M.D., Ph.D., Wenying Bei, M.D., Ying Zhang, Xiaoma Guo, Luming Liu, M.D., Ph.D., all of Fudan University Cancer Hospital; Jennifer McQuade, M.D., Hospital of the University of Pennsylvania; Clemens Kirschbaum, Ph.D., Dresden University of Technology; and Bob Thornton, Merck & Co., Inc (on MD Anderson staff when research was conducted).
About MD Anderson
The University of Texas MD Anderson Cancer Center in Houston ranks as one of the world's most respected centers focused on cancer patient care, research, education and prevention. MD Anderson is one of only 40 comprehensive cancer centers designated by the National Cancer Institute. For nine of the past 11 years, including 2012, MD Anderson has ranked No. 1 in cancer care in "Best Hospitals," a survey published annually in U.S. News & World Report.