"Qigong Show" — MQ for Cancer Patients

Abstract & Commentary

By Russell H. Greenfield, MD, Editor

Synopsis: Results of this randomized clinical trial strongly suggest that Medical Qigong (MQ) can help people with cancer improve their quality of life (QOL) and lessen specific cancer- or treatment-related symptoms. The authors propose that MQ works in part by attending to the emotional and psychological well-being of the patient in addition to their physical health. Lack of a placebo sham group and high dropout rates negatively influence confidence in the authors' conclusions.

Source: Oh B, et al. Impact of medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients: A randomized trial. Ann Oncol 2009 Oct 30; Epub ahead of press; doi:10.1093/annonc/mdp479.

The stress and angst associated with a diagnosis and the treatment of cancer are well accepted, but the optimal means with which to address the emotional and spiritual complications of such a life-altering experience have yet to be fully determined. Interventions such as yoga and meditation techniques have been explored and the results have been encouraging, but the wider the array of available stress-management options, the better the chance a given individual will identify the path best suited for them. The authors of the current study hail from both Australia and the United States (Dana-Farber Cancer Institute), and the lead author is an expert in Qigong. These researchers set out to assess the use of MQ to improve QOL in cancer patients as compared with usual care.

Volunteers were recruited through their doctors' offices at any of three large university teaching hospitals. Initially, trained recruiters approached eligible patients in the waiting room (81 subjects enrolled); in a later phase of the trial, eligible subjects were simply mailed an invitation to participate (another 81 subjects enrolled). Participants had a wide range of types and stages of cancer, but could not have known brain metastases (average age was 60 years at baseline, and the most common form of cancer was breast followed by colorectal). Subjects attended an information session, completed an initial QOL survey, had blood drawn, and were randomized to either MQ or control groups. Randomization was stratified to treatment at baseline (currently undergoing treatment or completed treatment).

The MQ program was comprised of two supervised 90-minute sessions per week for a total of 10 weeks at the hospital in which the person was being treated. The MQ program was developed by the lead author and designed to focus on the needs of cancer patients in general. Anywhere from seven to 20 subjects were present in class at any given time. The sessions began with 15 minutes of discussion around health issues, and were followed by 30 minutes of stretching and specific movements in the standing position, and then 15 minutes of specific movements while seated. Subjects then engaged in 30 minutes of meditation that included breathing exercises and visualization. Subjects were also encouraged to practice MQ daily for 30 minutes at home, and were given diaries in which to document their home practice regimens. Control subjects were given the opportunity to practice Qigong at trial's end.

Overall QOL was measured using the Functional Assessment of Cancer Therapy-General (FACT-G), which includes four subscales assessing physical, emotional, social, and functional well-being, with higher scores reflecting better QOL. Fatigue was assessed using the Functional Assessment of Cancer Therapy-Fatigue (FACT-F), where higher scores reflect greater fatigue. Mood status was determined with the Profile of Mood State total score, with higher scores reflecting more negative mood states. In addition, serum C-reactive protein was monitored serially because some data suggest that chronic inflammation is associated with cancer progression and possibly survival. Measurements were obtained at baseline and 10 weeks post-intervention in both intervention and control subjects.

Only 68% and 65% of MQ and control group subjects, respectively, finished the trial. Completers attended an average of eight MQ sessions, but only half completed and turned in their diaries. Members of the MQ group reported greater improvements in QOL than those in the standard care group, together with greater improvements in fatigue and mood disturbance (including tension and anxiety, depression, lack of vigor, and fatigue but not on subscales of anger and hostility, or confusion). C-reactive protein levels also declined significantly in the intervention group. No adverse events were reported. The authors concluded that MQ may help improve overall QOL and mood status, as well as reduce cancer- and treatment-related symptoms, and reduce inflammation in people with cancer.

Commentary

Large numbers of cancer patients are using select complementary and alternative therapies as adjuncts to conventional medical care, often without telling their doctors about it. While many reasons have been proposed to explain this phenomenon, one theme that rings true is that attention to the deep emotional and spiritual wounds and scars associated with cancer treatment is often relegated to tertiary importance, or lower, in most hospitals and cancer treatment centers. Attention to physical health is typically excellent but if, as many espouse, humans are indivisible systems where balance is paramount to good health, then equal effort needs to be applied toward the maintenance of emotional and spiritual health. The authors of this study are careful to point out that the positive results of MQ for cancer patients can be understood within this framework of mind/body medicine, and minimized discussion of the possible mechanism of action for MQ from traditional Chinese medical energetic theory.

Blinding of participants was of course not possible due to the nature of the intervention, but some methodological weaknesses do come to the fore, especially the high attrition rates. The authors rightfully explain this may be due to the fact that people with all stages of cancer were included in the trial. Another concern is the lack of a placebo sham group, which would help distinguish between benefits that could be ascribed to personal attention and group interaction as opposed to the specifics of MQ practice. In addition, the volunteer status of the participants could certainly invite bias. The specific postures employed were not identified in the paper, information that could have been useful.

Previous studies of mind/body therapies have also suggested promise in the setting of cancer care. These data, including those on MQ, are even more compelling when one considers that the interventions can be performed in groups.

Results of the study by Oh et al strongly suggest that MQ deserves consideration in the treatment plan for people undergoing treatment for cancer. The strength of the researchers' findings suggest not only statistical significance, but also the potential for measurable clinical improvement.