Tai chi and mindfulness practices may help patients with cancer get some relief from fatigue, pain, and sleep problems, a new clinical trial suggests.

The study, of nearly 600 participants, found that both practices lessened fatigue and the impact of pain on daily life vs a waitlist control. Tai chi also boosted sleep quality to a small degree.

The findings, published in the Journal of Clinical Oncology, come from a partially randomized trial — where participants were allowed to choose either tai chi or mindfulness practices, if they had a preference.

Both interventions appeared helpful, though the effects on symptoms were generally mild, said senior researcher Linda E. Carlson, PhD, a professor of oncology at the University of Calgary Cumming School of Medicine in Calgary, Alberta, Canada.

Still, sleep issues, fatigue, and pain are not only highly prevalent during and after cancer treatment but also “notoriously difficult to treat,” Carlson pointed out.

And it’s a plus, she told Medscape Medical News, that these approaches are nonpharmacologic as many patients with cancer want to avoid taking more pills.

Other experts agreed, saying that while learning and practicing tai chi or mindfulness is a time commitment, some patients may find it’s time well spent.

Putting Mindfulness to the Test

The study was a sub-analysis of the Mindfulness and Tai Chi for Cancer Health (MATCH) clinical trial, which tested two interventions for cancer survivors who were suffering from distress: a tai chi/qigong program tailored to people with cancer, and mindfulness-based cancer recovery (MBCR) — a version of mindfulness-based stress reduction adapted for people with cancer. Sleep, fatigue, and pain were predefined secondary outcomes.

The MATCH trial involved 587 participants (75% women; mean age, 61 years) who’d completed treatment for various cancers, including breast, prostate, gastrointestinal (GI), gynecologic, lung, and skin cancers. About half had early-stage disease.

Participants were allowed to choose between tai chi and MBCR if they had a preference; otherwise, they were randomly assigned to one or the other. All participants were then randomly assigned to immediate intervention or a waitlist control group.

The 9-week MBCR program included weekly in-person group meetings and home practice (yoga and meditation) for 45 min/d. The yoga component involved gentle postures intended to serve as a moving meditation.

The tai chi program followed the protocol used in studies based at Harvard Medical School and incorporated elements common to both tai chi and qigong: flowing rhythmic movements, breath awareness, and cognitive skills such as focused attention.

The tai chi group also met weekly, for 11 weeks (though the total contact time was the same as in the MBCR program). Participants practiced daily at home, with the help of videos. Both intervention groups had the opportunity to attend a weekend retreat.

Due to the COVID pandemic, the trial’s final cohort had their programs delivered entirely over Zoom.

Small but Noticeable Changes

The researchers used three established scales to look at how sleep, fatigue, and pain symptoms changed with the interventions, then translated the point differences on the scales to whether it represented a minimal clinically important difference — changes a patient would notice.

When it came to sleep quality, the tai chi group showed a statistically significant change: On average, their scores on the Pittsburgh Sleep Quality Index dipped by 1.9 points vs the waitlist group, which remained significant after adjustment for age and other factors (P = .004).

However, that didn’t quite translate into a minimal clinically important difference, which would be 2.5-3 points, according to Carlson. MBCR, meanwhile, had no significant impact on sleep.

Carlson said the limited effects on sleep quality were not actually surprising. Trial participants were screened for distress, not sleep problems specifically, and on average they didn’t have a high level of sleep disturbance to start.

Both interventions did help with fatigue, though. Compared with the control group, scores improved by about 3.7 points with MBCR (P = .030) and 3.4 points with tai chi (P = .043). Those changes met the definition of a minimal clinically important difference for this scale, which is 3-4 points.

As for pain issues, both intervention groups reported improvements in pain interference, or how symptoms affect daily life. On average, those scores improved by over 1 point with both tai chi and mindfulness vs waitlist — which hit the mark for a minimal clinically important difference.

One surprise: The researchers had hypothesized that participants who chose their interventions would fare better than those who were assigned. But outcomes did not differ between those groups.

Support for a ‘Gentle’ Option

Overall, the benefits seen in the trial were modest, said Fumiko Chino, an associate professor of radiation breast oncology at the University of Texas MD Anderson Cancer Center in Houston.

However, she told Medscape Medical News, “that doesn’t mean individual people wouldn’t get bigger benefits.”

Chino, who was not involved in the research, said that while tai chi and mindfulness programs do require a time investment, they offer patients “another tool” to help address common, and often co-existing, symptoms.

Louisa Liu, MD, an assistant professor of GI medical oncology at City of Hope in Duarte, California, agreed.

The study “adds to a solid and growing body of evidence supporting both practices for fatigue, pain, and sleep,” Liu told Medscape Medical News.

She highlighted the use of a waitlist control group as a strength as it allowed the researchers to distinguish “real treatment effects” from natural improvements over time.

In general, Liu said, tai chi is gentle enough to be accessible for many patients undergoing cancer treatment who can’t tolerate more vigorous exercise. It can also give people something proactive to do, which may help anxiety, she added.

Carlson noted that while the trial used programs specifically tailored for people with cancer, standard tai chi practices and MBSR could be suitable alternatives.

Carlson, Chino, and Liu had no relevant disclosures.