Journal of Cancer Survivorship

, Volume 12, Issue 2, pp 256–267 | Cite as

Tai Chi and Qigong for cancer-related symptoms and quality of life: a systematic review and meta-analysis

  • Peter M. Wayne
  • M.S. Lee
  • J. Novakowski
  • K. Osypiuk
  • J. Ligibel
  • L.E. Carlson
  • R. Song



This study aims to summarize and critically evaluate the effects of Tai Chi and Qigong (TCQ) mind–body exercises on symptoms and quality of life (QOL) in cancer survivors.


A systematic search in four electronic databases targeted randomized and non-randomized clinical studies evaluating TCQ for fatigue, sleep difficulty, depression, pain, and QOL in cancer patients, published through August 2016. Meta-analysis was used to estimate effect sizes (ES, Hedges’ g) and publication bias for randomized controlled trials (RCTs). Methodological bias in RCTs was assessed.


Our search identified 22 studies, including 15 RCTs that evaluated 1283 participants in total, 75% women. RCTs evaluated breast (n = 7), prostate (n = 2), lymphoma (n = 1), lung (n = 1), or combined (n = 4) cancers. RCT comparison groups included active intervention (n = 7), usual care (n = 5), or both (n = 3). Duration of TCQ training ranged from 3 to 12 weeks. Methodological bias was low in 12 studies and high in 3 studies. TCQ was associated with significant improvement in fatigue (ES = − 0.53, p < 0.001), sleep difficulty (ES = − 0.49, p = 0.018), depression (ES = − 0.27, p = 0.001), and overall QOL (ES = 0.33, p = 0.004); a statistically non-significant trend was observed for pain (ES = − 0.38, p = 0.136). Random effects models were used for meta-analysis based on Q test and I 2 criteria. Funnel plots suggest some degree of publication bias. Findings in non-randomized studies largely paralleled meta-analysis results.


Larger and methodologically sound trials with longer follow-up periods and appropriate comparison groups are needed before definitive conclusions can be drawn, and cancer- and symptom-specific recommendations can be made.

Implications for Cancer Survivors

TCQ shows promise in addressing cancer-related symptoms and QOL in cancer survivors.


Tai Chi Qigong Meta-analysis Cancer Fatigue Quality of life 



This study was supported by grants to PMW from the National Center for Complementary and Integrative Health/National Institutes of Health (K24AT009282) and the Osher Center for Integrative Medicine. MSL was supported by a grant from Korea Institute of Oriental Medicine (K17111). LEC holds the Enbridge Research Chair in Psychosocial Oncology, co-funded by the Canadian Cancer Society Alberta/NWT Division and the Alberta Cancer Foundation. RS was supported by a grant from the National Research Foundation of Korea’s Ministry of Education (2013R-1A-1A-2065536).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study formal consent is not required. This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Society AC. Cancer treatment and survivorship facts and figures 2016–2017. In Cancer treatment and survivorship facts and figures 2016–2017 (editor ed.^eds.). City: Am Cancer Soc; 2016.Google Scholar
  2. 2.
    Loscalzo M, Clark K, Pal S, Pirl WF. Role of biopsychosocial screening in cancer care. Cancer J. 2013;19(5):414–20. Scholar
  3. 3.
    Novy DM, Aigner CJ. The biopsychosocial model in cancer pain. Curr Opin Support Palliat Care. 2014;8(2):117–23. Scholar
  4. 4.
    Richtig E, Trapp M, Kapfhammer HP, Jenull B, Richtig G, Trapp EM. The importance of a biopsychosocial approach in melanoma research. Experiences from a single-center multidisciplinary melanoma working group in Middle-Europe. Acta Derm Venereol. 2016;96(217):51–4. Scholar
  5. 5.
    Chaoul A, Milbury K, Sood AK, Prinsloo S, Cohen L. Mind–body practices in cancer care. Curr Oncol Rep. 2014;16(12):417. Scholar
  6. 6.
    Danhauer SC, Addington EL, Sohl SJ, Chaoul A, Cohen L. Review of yoga therapy during cancer treatment. Support Care Cancer. 2017;25(4):1357–72. Scholar
  7. 7.
    Klein PJ, Schneider R, Rhoads CJ. Qigong in cancer care: a systematic review and construct analysis of effective qigong therapy. Support Care Cancer. 2016;24(7):3209–22. Scholar
  8. 8.
    Fulop NJ, Ramsay AI, Vindrola-Padros C, Aitchison M, Boaden RJ, Brinton V, et al. Reorganising specialist cancer surgery for the twenty-first century: a mixed methods evaluation (RESPECT-21). Implement Sci. 2016;11(1):155. Scholar
  9. 9.
    Zeng Y, Luo T, Xie H, Huang M, Cheng AS. Health benefits of qigong or tai chi for cancer patients: a systematic review and meta-analyses. Complement Ther Med. 2014;22(1):173–86. Scholar
  10. 10.
    Song R, Grabowska W, Park M, Osypiuk K, Vergara-Diaz GP, Bonato P, et al. The impact of Tai Chi and Qigong mind–body exercises on motor and non-motor function and quality of life in Parkinson’s disease: a systematic review and meta-analysis. Parkinsonism Relat Disord. 2017;41:3–13. Scholar
  11. 11.
    Kwekkeboom KL, Cherwin CH, Lee JW, Wanta B. Mind-body treatments for the pain–fatigue–sleep disturbance symptom cluster in persons with cancer. J Pain Symptom Manag. 2010;39(1):126–38. Scholar
  12. 12.
    Wayne PM, Kaptchuk TJ. Challenges inherent to t'ai chi research: part II—defining the intervention and optimal study design. J Altern Complement Med. 2008;14(2):191–7. Scholar
  13. 13.
    Wayne PM, Kaptchuk TJ. Challenges inherent to t'ai chi research: part I—t'ai chi as a complex multicomponent intervention. J Altern Complement Med. 2008;14(1):95–102. Scholar
  14. 14.
    Payne P, Fiering S, Leiter JC, Zava DT, Crane-Godreau MA. Effectiveness of a novel qigong meditative movement practice for impaired health in flight attendants exposed to second-hand cigarette smoke. Front Hum Neurosci. 2017;11:67.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Yan JH, Pan L, Zhang XM, Sun CX, Cui GH. Lack of efficacy of tai chi in improving quality of life in breast cancer survivors: a systematic review and meta-analysis. Asian Pac J Cancer Prev. 2014;15(8):3715–20. Scholar
  16. 16.
    Pan Y, Yang K, Shi X, Liang H, Zhang F, Lv Q. Tai chi chuan exercise for patients with breast cancer: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2015;2015:535237.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Tao WW, Jiang H, Tao XM, Jiang P, Sha LY, Sun XC. Effects of acupuncture, Tuina, tai chi, qigong, and traditional Chinese medicine five-element music therapy on symptom management and quality of life for cancer patients: a meta-analysis. J Pain Symptom Manag. 2016;51(4):728–47. Scholar
  18. 18.
    Chuang TY, Yeh ML, Chung YC. A nurse facilitated mind-body interactive exercise (Chan-Chuang Qigong) improves the health status of non-Hodgkin lymphoma patients receiving chemotherapy: randomised controlled trial. Int J Nurs Stud. 2017;69:25–33. Scholar
  19. 19.
    Larkey LK, Roe DJ, Smith L, Millstine D. Exploratory outcome assessment of qigong/tai chi easy on breast cancer survivors. Complement Ther Med. 2016;29:196–203. Scholar
  20. 20.
    McQuade JL, Prinsloo S, Chang DZ, Spelman A, Wei Q, Basen-Engquist K, et al. Qigong/tai chi for sleep and fatigue in prostate cancer patients undergoing radiotherapy: a randomized controlled trial. Psychooncology. 2016;Google Scholar
  21. 21.
    Thongteratham N, Kanaungnit P, Olson K, Adune R, Dechavudh N, Doungrut W. Effectiveness of Tai Chi Qi Qong program for Thai women with breast cancer: a randomized control trial. Pac Rim Int J Nurs Res. 2015;19:280–94. 215pGoogle Scholar
  22. 22.
    Vanderbyl BL, Mayer MJ, Nash C, Tran AT, Windholz T, Swanson T, et al. A comparison of the effects of medical qigong and standard exercise therapy on symptoms and quality of life in patients with advanced cancer. Support Care Cancer. 2017;25(6):1749–58. Scholar
  23. 23.
    Zhang LL, Wang SZ, Chen HL, Yuan AZ. Tai chi exercise for cancer-related fatigue in patients with lung cancer undergoing chemotherapy: a randomized controlled trial. J Pain Symptom Manag. 2016;51(3):504–11. Scholar
  24. 24.
    Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535, jul 21 1. Scholar
  25. 25.
    Furlan AD, Pennick V, Bombardier C, van Tulder M, Editorial Board CBRG. 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine (Phila Pa 1976). 2009;34(18):1929–41. Scholar
  26. 26.
    Wayne PM, Berkowitz DL, Litrownik DE, Buring JE, Yeh GY. What do we really know about the safety of tai chi?: a systematic review of adverse event reports in randomized trials. Arch Phys Med Rehabil. 2014;95(12):2470–83. Scholar
  27. 27.
    Cochrane handbook for systematic reviews of interventions. In Cochrane handbook for systematic reviews of interventions (Editor ed.^eds.). City; 2011.Google Scholar
  28. 28.
    Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5(1):13. Scholar
  29. 29.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. Scholar
  30. 30.
    Campo RA, Agarwal N, LaStayo PC, O'Connor K, Pappas L, Boucher KM, et al. Levels of fatigue and distress in senior prostate cancer survivors enrolled in a 12-week randomized controlled trial of qigong. J Cancer Surviv. 2014;8(1):60–9. Scholar
  31. 31.
    Campo RA, O'Connor K, Light KC, Nakamura Y, Lipschitz DL, Lastayo PC, et al. Feasibility and acceptability of a tai chi chih randomized controlled trial in senior female cancer survivors. Integr Cancer Ther. 2013;12(6):464–74. Scholar
  32. 32.
    Chen Z, Meng Z, Milbury K, Bei W, Zhang Y, Thornton B, et al. Qigong improves quality of life in women undergoing radiotherapy for breast cancer: results of a randomized controlled trial. Cancer. 2013;119(9):1690–8. Scholar
  33. 33.
    Larkey LK, Roe DJ, Weihs KL, Jahnke R, Lopez AM, Rogers CE, et al. Randomized controlled trial of qigong/tai chi easy on cancer-related fatigue in breast cancer survivors. Ann Behav Med. 2015;49(2):165–76. Scholar
  34. 34.
    Loh SY, Lee SY, Murray L. The Kuala Lumpur qigong trial for women in the cancer survivorship phase-efficacy of a three-arm RCT to improve QOL. Asian Pac J Cancer Prev. 2014;15(19):8127–34. Scholar
  35. 35.
    Mustian KM, Palesh OG, Flecksteiner SA. Tai chi chuan for breast cancer survivors. Med Sport Sci. 2008;52:209–17. Scholar
  36. 36.
    Oh B, Butow P, Mullan B, Clarke S. Medical qigong for cancer patients: pilot study of impact on quality of life, side effects of treatment and inflammation. Am J Chin Med. 2008;36(03):459–72. Scholar
  37. 37.
    Oh B, Butow P, Mullan B, Clarke S, Beale P, Pavlakis N, et al. Impact of medical qigong on quality of life, fatigue, mood and inflammation in cancer patients: a randomized controlled trial. Ann Oncol. 2010;21(3):608–14. Scholar
  38. 38.
    Robins JL, McCain NL, Elswick RK Jr, Walter JM, Gray DP, Tuck I. Psychoneuroimmunology-based stress management during adjuvant chemotherapy for early breast cancer. Evid Based Complement Alternat Med. 2013;2013:372908.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Fong SS, Ng SS, Luk WS, Chung LM, Wong JY, Chung JW. Effects of qigong training on health-related quality of life, functioning, and cancer-related symptoms in survivors of nasopharyngeal cancer: a pilot study. Evid Based Complement Alternat Med. 2014;2014:495274.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Galantino ML, Capito L, Kane RJ, Ottey N, Swizer S. The effects of tai chi and walking on fatigue and body mass index in women living with breast cancer: a pilot study. Rehabil Oncol. 2003;21:17–21.Google Scholar
  41. 41.
    Huang SM, Tseng LM, Chien LY, Tai CJ, Chen PH, Hung CT, et al. Effects of non-sporting and sporting qigong on frailty and quality of life among breast cancer patients receiving chemotherapy. Eur J Oncol Nurs. 2016;21:257–65. Scholar
  42. 42.
    Lee EO, Chae YR, Song R, Eom A, Lam P, Heitkemper M. Feasibility and effects of a tai chi self-help education program for Korean gastric cancer survivors. Oncol Nurs Forum. 2010;37(1):E1–6. Scholar
  43. 43.
    Lee TI, Chen HH, Yeh ML. Effects of chan-chuang qigong on improving symptom and psychological distress in chemotherapy patients. Am J Chin Med. 2006;34(01):37–46. Scholar
  44. 44.
    Reid-Arndt SA, Matsuda S, Cox CR. Tai chi effects on neuropsychological, emotional, and physical functioning following cancer treatment: a pilot study. Complement Ther Clin Pract. 2012;18(1):26–30. Scholar
  45. 45.
    Fong SS, Ng SS, Lee HW, Pang MY, Luk WS, Chung JW, et al. The effects of a 6-month tai chi qigong training program on temporomandibular, cervical, and shoulder joint mobility and sleep problems in nasopharyngeal cancer survivors. Integr Cancer Ther. 2015;14(1):16–25. Scholar
  46. 46.
    Galantino ML, Callens ML, Cardena GJ, Piela NL, Mao JJ. Tai chi for well-being of breast cancer survivors with aromatase inhibitor-associated arthralgias: a feasibility study. Altern Ther Health Med. 2013;19(6):38–44.PubMedGoogle Scholar
  47. 47.
    Tufanaru C, Munn Z, Stephenson M, Aromataris E. Fixed or random effects meta-analysis? Common methodological issues in systematic reviews of effectiveness. Int J Evid Based Healthc. 2015;13(3):196–207. Scholar
  48. 48.
    Hilfiker R, Meichtry A, Eicher M, Nilsson BL, Knols RH, Verra ML, et al. Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis. Br J Sports Med. 2017:bjsports-2016-096422.
  49. 49.
    Chan CL, Wang CW, Ho RT, Ng SM, Chan JS, Ziea ET, et al. A systematic review of the effectiveness of qigong exercise in supportive cancer care. Support Care Cancer. 2012;20(6):1121–33. Scholar
  50. 50.
    Chandwani KD, Ryan JL, Peppone LJ, Janelsins MM, Sprod LK, Devine K, et al. Cancer-related stress and complementary and alternative medicine: a review. Evid Based Complement Alternat Med. 2012;2012:979213.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Lee MS, Chen KW, Sancier KM, Ernst E. Qigong for cancer treatment: a systematic review of controlled clinical trials. Acta Oncol. 2007;46(6):717–22. Scholar
  52. 52.
    Larkey LK, Roe DJ, Weihs KL, Jahnke R, Lopez AM, Rogers CE, Oh B, Guillen-Rodriguez J. Randomized controlled trial of qigong/tai chi easy on cancer-related fatigue in breast cancer survivors. Ann Behav Med. 2014.Google Scholar
  53. 53.
    Wayne PM, Manor B, Novak V, Costa MD, Hausdorff JM, Goldberger AL, et al. A systems biology approach to studying tai chi, physiological complexity and healthy aging: design and rationale of a pragmatic randomized controlled trial. Contemp Clin Trials. 2013;34(1):21–34. Scholar
  54. 54.
    Garland SN, Carlson LE, Stephens AJ, Antle MC, Samuels C, Campbell TS. Mindfulness-based stress reduction compared with cognitive behavioral therapy for the treatment of insomnia comorbid with cancer: a randomized, partially blinded, noninferiority trial. J Clin Oncol. 2014;32(5):449–57. Scholar
  55. 55.
    Furmaniak AC, Menig M, Markes MH. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev. 2016;9:CD005001.PubMedGoogle Scholar
  56. 56.
    Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncology. 2016;25(7):750–9. Scholar
  57. 57.
    Shahriari M, Dehghan M, Pahlavanzadeh S, Hazini A. Effects of progressive muscle relaxation, guided imagery and deep diaphragmatic breathing on quality of life in elderly with breast or prostate cancer. J Educ Health Promot. 2017;6:1.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Charalambous A, Giannakopoulou M, Bozas E, Marcou Y, Kitsios P, Paikousis L. Guided imagery and progressive muscle relaxation as a cluster of symptoms management intervention in patients receiving chemotherapy: a randomized control trial. PLoS One. 2016;11(6):e0156911. Scholar
  59. 59.
    Nunes DF, Rodriguez AL, da Silva Hoffmann F, Luz C, Braga Filho AP, Muller MC, et al. Relaxation and guided imagery program in patients with breast cancer undergoing radiotherapy is not associated with neuroimmunomodulatory effects. J Psychosom Res. 2007;63(6):647–55. Scholar
  60. 60.
    Cameron LD, Booth RJ, Schlatter M, Ziginskas D, Harman JE. Changes in emotion regulation and psychological adjustment following use of a group psychosocial support program for women recently diagnosed with breast cancer. Psychooncology. 2007;16(3):171–80. Scholar
  61. 61.
    Bower JE, Irwin MR. Mind-body therapies and control of inflammatory biology: a descriptive review. Brain Behav Immun. 2016;51:1–11. Scholar
  62. 62.
    Wang N, Zhang X, Xiang YB, Li H, Yang G, Gao J, et al. Associations of tai chi, walking, and jogging with mortality in Chinese men. Am J Epidemiol. 2013;178(5):791–6. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Peter M. Wayne
    • 1
  • M.S. Lee
    • 2
  • J. Novakowski
    • 1
  • K. Osypiuk
    • 1
  • J. Ligibel
    • 3
  • L.E. Carlson
    • 4
  • R. Song
    • 5
  1. 1.Osher Center for Integrative MedicineHarvard Medical School and Brigham and Women’s HospitalBostonUSA
  2. 2.Clinical Research DivisionKorea Institute of Oriental MedicineDaejeonRepublic of Korea
  3. 3.Zakim Center for Integrative Therapies and Healthy LivingDana Farber Cancer InstituteBostonUSA
  4. 4.Cumming School of MedicineUniversity of CalgaryCalgaryCanada
  5. 5.College of NursingChungnam National UniversityDaejeonRepublic of Korea

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