What the Evidence Says About Tai Chi in Cancer Care

By Jyothirmai Gubili, MS, Eugenie Spiguel, MSN, ANP-BC, and Shelly Latte-Naor, MD

What the Evidence Tells Us

Results from clinical trials in non-cancer populations suggest that tai chi practice improves strength, balance, flexibility, and mobility (https://doi.org/10.1186/s40035-022-00280-7); decreases pain (https://doi.org/10.1097/md.0000000000017099); and lowers the risk of falls (https://doi.org/10.1177/0733464817703004) and fractures (https://doi.org/10.1093/geront/gnz006). 

In oncology settings, a large systematic review (22 randomized controlled trials involving 1,410 cancer survivors) found that people who regularly practice tai chi (https://doi.org/10.1007/s00520-019-04911-0) (three to five times per week) have lower overall cancer-related fatigue (standard mean difference = –0.37, 95% CI = –0.70, –0.04) and cortisol levels (mean difference = −0.09, 95% CI = −0.16, −0.02) and better limb function because of improved coordination between muscles and joints (standard mean difference = –1.19, 95% CI = 0.63, 1.75). Importantly, compliance was high and no adverse effects were reported.

Tai chi may also help alleviate insomnia associated with cancer and its treatments. In a trial of 90 breast cancer survivors randomized to three months of tai chi or cognitive behavioral therapy for insomnia (CBT-I) (weekly two-hour sessions), tai chi was statistically noninferior to CBT-I (https://doi.org/10.1200/jco.2016.71.0285) (p < 0.01 at 3 months, p < 0.01 at 6 months, and p = 0.02 at 15 months). Both groups also had significant improvements in fatigue and depression (https://doi.org/10.1200/jco.2016.71.0285), and the tai chi group had reduced expression of genes encoding proinflammatory mediators (https://doi.org/10.1093/jncimonographs/lgu028) compared to the CBT-I arm (p = 0.001).

In another study that evaluated the effects of tai chi on symptom clusters in breast cancer, 69 patients were randomized to eight weeks of usual care or two 60-minute tai chi sessions per week. Tai chi practice significantly reduced (https://doi.org/10.1016/j.ejon.2022.102202) fatigue (p < 0.001), sleep disturbance (p < 0.001), and depression (p = 0.006) and improved quality of life (p = 0.032) postintervention and at the four-week follow-up.

Because of the evidence supporting tai chi for various cancer-specific symptoms and overall quality of life, the National Comprehensive Cancer Network guidelines (https://nccn.org/) recommend it as an adjunctive therapy to lower fatigue, improve sleep, and as an exercise therapy.

Tai chi’s suspected mechanisms of action include increasing immunity biomarkers (https://doi.org/10.1093/rheumatology/kem151) and decreasing cellular inflammatory responses and expression of genes encoding proinflammatory mediators. It’s also been shown (https://doi.org/10.1186/s40035-022-00280-7) to improve motor function by promoting brain network function and neurotransmitter metabolism and by decreasing vulnerability to dopaminergic degeneration. More studies are currently evaluating (https://clinicaltrials.gov/ct2/results?term=tai%20chi&cond=cancer&cntry=US&Search=Apply&recrs=a&age_v=&gndr=&type=&rslt=) the modality in cancer populations.

What Oncology Nurses Need to Know

Growing evidence suggests that patients who practice tai chi can have a variety of physical and psychological benefits. Tai chi is a low-impact activity performed at a slow and controlled pace, amenable to patients of all age groups because of its gentle movements. It can also be modified for patients with limited mobility. Many hospitals, cancer centers, and community and senior centers offer tai chi classes from experienced instructors. Oncology nurses can help to educate patients about the safety and efficacy of tai chi and guide them in beginning its practice.