title: 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.
abstract: BACKGROUND
  Most cancer patients suffer from both the disease itself and symptoms induced by conventional treatment. Available literature on the clinical effects on cancer patients of acupuncture, Tuina, Tai Chi, Qigong, and Traditional Chinese Medicine Five-Element Music Therapy (TCM-FEMT) reports controversial results.
  
  
  OBJECTIVE
  The primary objective of this meta-analysis was to evaluate the effect of acupuncture, Tuina, Tai Chi, Qigong, and TCM-FEMT on various symptoms and quality of life (QOL) in patients with cancer; risk of bias for the selected trials also was assessed.
  
  
  METHODS
  Studies were identified by searching electronic databases (MEDLINE via both PubMed and Ovid, Cochrane Central, China National Knowledge Infrastructure, Chinese Scientific Journal Database, China Biology Medicine, and Wanfang Database). All randomized controlled trials (RCTs) using acupuncture, Tuina, Tai Chi, Qigong, or TCM-FEMT published before October 2, 2014, were selected, regardless of whether the article was published in Chinese or English.
  
  
  RESULTS
  We identified 67 RCTs (5465 patients) that met our inclusion criteria to perform this meta-analysis. Analysis results showed that a significant combined effect was observed for QOL change in patients with terminal cancer in favor of acupuncture and Tuina (Cohen's d: 0.21-4.55, P < 0.05), whereas Tai Chi and Qigong had no effect on QOL of breast cancer survivors (P > 0.05). The meta-analysis also demonstrated that acupuncture produced small-to-large effects on adverse symptoms including pain, fatigue, sleep disturbance, and some gastrointestinal discomfort; however, no significant effect was found on the frequency of hot flashes (Cohen's d = -0.02; 95% CI = -1.49 to 1.45; P = 0.97; I(2) = 36%) and mood distress (P > 0.05). Tuina relieved gastrointestinal discomfort. TCM-FEMT lowered depression level. Tai Chi improved vital capacity of breast cancer patients. High risk of bias was present in 74.63% of the selected RCTs. Major sources of risk of bias were lack of blinding, allocation concealment, and incomplete outcome data.
  
  
  CONCLUSIONS
  Taken together, although there are some clear limitations regarding the body of research reviewed in this study, a tentative conclusion can be reached that acupuncture, Tuina, Tai Chi, Qigong, or TCM-FEMT represent beneficial adjunctive therapies. Future study reporting in this field should be improved regarding both method and content of interventions and research methods.
authors.affiliation: College of Nursing, Dalian Medical University, Dalian, People's Republic of China. Electronic address: taoweiwei2003@163.com.
authors.forename: Wei-Wei
authors.initials: WW
authors.lastname: Tao
authors.affiliation: School of Nursing, Peking University, Beijing, People's Republic of China.
authors.forename: Hua
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Beijing Shijitan Hospital, Beijing, People's Republic of China.
authors.forename: Xiao-Mei
authors.initials: XM
authors.lastname: Tao
authors.affiliation: Graduate School, Dalian Medical University, Dalian, People's Republic of China. Electronic address: dywx.2009@163.com.
authors.forename: Ping
authors.initials: P
authors.lastname: Jiang
authors.affiliation: College of Nursing, Dalian Medical University, Dalian, People's Republic of China.
authors.forename: Li-Yan
authors.initials: LY
authors.lastname: Sha
authors.affiliation: College of Public Health, Dalian Medical University, Dalian, People's Republic of China.
authors.forename: Xian-Ce
authors.initials: XC
authors.lastname: Sun
mesh_terms: D015670:Acupuncture Therapy; D019468:Disease Management; D006801:Humans; D008516:Medicine, Chinese Traditional / Q000379:methods*; D009147:Music Therapy / Q000379:methods*; D009369:Neoplasms / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D064906:Qigong; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D026302:Tai Ji
keywords: Acupuncture; Qigong; Tai Chi; cancer; massage; meta-analysis; symptom management