Effects of Tai Chi Chuan training on the QoL and psychological well-being in female patients with breast cancer: a systematic review of randomized controlled trials

Wenyuan Li, Fengming You, Qiaoling Wang, Yifeng Shen, Jundong Wang, Jing Guo, Wenyuan Li, Fengming You, Qiaoling Wang, Yifeng Shen, Jundong Wang, Jing Guo

Abstract

Background: Tai Chi Chuan (TCC) may have a positive impact on physical and psychological well-being in breast cancer patients, but the evidence remains limited and inconclusive. This systematic review aims to evaluate the effects of TCC on the quality of life (QoL) and psychological symptoms in women patients with breast cancer.

Methods: This review has been registered on PROSPERO (ID: CRD42019141977). Randomized controlled trials (RCTs) of TCC for breast cancer were searched from eight major English and Chinese databases. All trials included were analyzed in accordance with the Cochrane Handbook. The primary outcomes were QoL, anxiety, and depression in patients with breast cancer. Fatigue, sleep quality, cognitive function, and inflammatory cytokine were the secondary outcomes.

Results: Fifteen RCTs involving a total of 1,156 breast cancer participants were included in this review. The methodological quality of included trials was generally poor. The pooled results suggested that TCC-based exercise could significantly improve QoL [standardized mean difference (SMD)=0.35, 95%CI: 0.15-0.55, I 2 = 0, model: fixed, IV], anxiety [weighted mean difference (WMD)=-4.25, 95%CI: -5.88 to -2.63, I 2 = 0, model: fixed, IV], and fatigue (SMD=-0.87, 95%CI: -1.50 to -0.24, I 2 = 80.9%, model: random, DL) compared other controls, with moderate to low certainty of evidence. The improvement of QoL and fatigue by TCC was also clinically meaningful. However, TCC-based exercise failed to show any between-group differences in depression, sleep quality, cognitive function, and inflammatory cytokine. Post-hoc analysis revealed that TCC-based exercise outperformed the other exercise in improving shoulder function with very low certainty of evidence.

Conclusion: Our findings manifested that TCC-based exercise is helpful for improving the QoL, anxiety, and fatigue in patients with breast cancer within the range of comparisons covered in this study. However, the results must be treated with great caution because of the methodological flaws of included trials. Larger, well-designed, and conducted randomized controlled trials with longer follow-up is warranted in the future to evaluate the important outcomes of TCC for breast cancer.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019141977, identifier, CRD42019141977.

Keywords: Tai Chi Chuan; breast cancer; meta-analysis; psychological well-being; quality of life; systematic review.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2023 Li, You, Wang, Shen, Wang and Guo.

Figures

Figure 1
Figure 1
Flow diagram of identification, screening, and systematic review of Tai Chi Chuan training on the QoL and psychological well-being in women patients with breast cancer (60).
Figure 2
Figure 2
Risk of bias of included studies for the systematic review of Tai Chi Chuan training on the QoL and psychological well-being in female patients with breast cancer. (A) Risk of bias graph: the authors assessed each risk of bias item presented as percentages across all included studies. (B) Risk of bias summary: the authors judged each risk of bias item for each included study. +: low risk of bias; −: high risk of bias;?: unclear. The study ID consists of the first author’s surname, the capital initials of the first author’s first name, and the year the first report of the RCTs was published or submitted as dissertation.
Figure 3
Figure 3
Primary outcomes of the systematic review of Tai Chi Chuan training on the QoL and psychological well-being in female patients with breast cancer. (A) TCC-based exercises are superior to the controls on quality of life. (B) No difference between TCC-based exercises and the controls on depression. (C) TCC-based exercises are superior to the controls on anxiety. The weights of trials were provided by random effect model applying DL tau2 estimator. BT, Biggerstaff–Tweedie approximate Gamma model; DL, DerSimonian–Laird estimator of tau2; DL+HKSJ, Hartung–Knapp-Sidik–Jonkman (HKSJ) variance correction to DerSimonian–Laird estimator of tau2; IV, fixed effect inverse variance; SD, standard deviation; SMD, standardized mean difference; TCC, Tai Chi Chuan; IV, fixed effect inverse variance. The study ID consists of the first author’s surname, the capital initials of the first author’s first name, and the year the first report of the RCTs was published or submitted as dissertation.
Figure 4
Figure 4
Secondary and post-hoc outcomes of the systematic review of Tai Chi Chuan training on the QoL and psychological well-being in female patients with breast cancer. (A) TCC-based exercises are superior to other interventions on fatigue when tau2 was calculated by DL estimator in random effect model. Sensitivity analysis using DL + HKSJ as tau2 estimator shows no difference between the two groups. (B) No difference between TCC-based interventions and other interventions on sleep quality. (C) TCC-based exercises are superior to the controls on shoulder function in breast cancer patients. The weights of trials were provided by random effect model applying DL tau2 estimator. BT, Biggerstaff–Tweedie approximate Gamma model; DL, DerSimonian–Laird estimator of tau2; DL+HKSJ, Hartung–Knapp–Sidik–Jonkman (HKSJ) variance correction to DerSimonian–Laird estimator of tau2; SD, standard deviation; SMD, standardized mean difference; TCC, Tai Chi Chuan. The study ID consists of the first author’s surname, the capital initials of the first author’s first name, and the year the first report of the RCTs was published or submitted as dissertation.

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