Effectiveness of Tai Chi Qi Qong Program for Thai Women with Breast Cancer: A Randomized Control Trial

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Natma Thongteratham
Kanaungnit Pongthavornkamol
Karin Olson
Adune Ratanawichitrasin
Dechavudh Nityasuddhi
Doungrut Wattanakitkrilert


                 Despite their increasing cancer survival rate, many women with breast cancer still live with suboptimal health and quality of life. This randomized control trial aimed to determine the effects of the Tai Chi Qi Qong program on self-esteem, fatigue, cortisol, and quality of life in Thai women with breast cancer. The sample included 30 Thai women with breast cancer who, after treatment completion, routinely visited the breast clinic in a university hospital, Bangkok, Thailand. The participants meeting eligibility criteria were randomly assigned into an experimental group and received the program, in addition to usual care, and the control group received only usual care (n = 15 per group). Data were collected at baseline (T1), 6th week (T2), and 12th week (T3) after program implementation. Instruments for data collection were the Rosenberg Self-Esteem Scale, the Fatigue Symptom Inventory, cortisol, and the Functional Assessment of Cancer Therapy-Breast. Repeated measures ANOVA and ANCOVA were used to test the program efficacy.

             The results revealed that the experimental group had statistically significant improvement in self-esteem, fatigue, cortical, and quality of life compared with control group between 6th week and 12th week after baseline data was controlled. The findings indicated that the Tai Chi Qi Qong is a beneficial program for Thai woman with breast cancer. Nurses should integrate this program in their practice to promote health and quality of life in Thai women with breast cancer. However, future studies are required including a randomized control trial with a larger sample size.

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Thongteratham N, Pongthavornkamol K, Olson K, Ratanawichitrasin A, Nityasuddhi D, Wattanakitkrilert D. Effectiveness of Tai Chi Qi Qong Program for Thai Women with Breast Cancer: A Randomized Control Trial. PRIJNR [Internet]. 2015 Nov. 18 [cited 2022 Oct. 4];19(4):280-94. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/25888
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1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010; 27: 2893-2917.

2. Sankaranarayanan R, Black RJ, Swaminatha R, Prakin DM. In: Sankaranarayanan RJ, Black R, Prakin DM, editors. An overview of cancer survival in developing countries. Cancer survival in developing countries. 1998.

3. Meneses K, Benz R. Quality of life in cancer survivorship: 20 years later. Semin Oncol. 2010; 26(1): 36-46.

4. Sivarux J, Pongthavornkamol K, Wattanakitkrilert D, & Tunticharoensin S. Factors predicting quality of life in Thai breast cancer survivors at 1 year after treatment completion. Thai Cancer Journal. 2012; 32(1): 2-14.

5. Härtl K, Schennach R, Müller M, Engel J, Reinecker H, Sommer H, et al. Quality of life, anxiety, and oncological factors: a follow-up study of breast cancer patients. Psychosomatics. 2010; 51(2): 112-122.

6. Karakoyun-Celik O, Gorken I, Sahin S, Orcin E, Alanyali H, Kinay M. Depression and anxiety levels in woman under follow-up for breast cancer: Relationship to coping with cancer and quality of life. Med Oncol. 2010; 27: 108-113.

7. Bower JE. Behavioral symptoms in patients with breast cancer and survivors. J Clin Oncol. 2008b; 26(5): 768-777.

8. Olson K, Turner AR, Courneya KS, Field C, Man G, Cree M. Possible links between behavioral and physiological indices of tiredness, fatigue, and exhaustion in advanced cancer. Support Care Cancer. 2008; 16: 241-249.

9. Bardwell WA, Ancoli-Israel S. Breast cancer and fatigue. Sleep Med Clin. 2008; 3(1): 61–71.

10. Pongthavornkamol K, Olson K, Soparatanapaisarn N, Chatchaisucha S, Khamkon A, Potaros D, et al. Comparing the meanings of fatigue in individuals with cancer in Thailand and Canada. Cancer Nurs. 2012; 35(5): 1–9.

11. Lueboonthavatchai P. Prevalence and psychosocial factors of anxiety and depression in breast cancer patients. Journal of the Medical Association of Thailand. 2007; 90(10): 2164-2174.

12. Berterö CM. Affected self-respect and self-value: The impact of breast cancer treatment on self-esteem and QOL. Psycho-Oncol. 2002; 11(4): 356-364.

13. Markopoulos C, Tsaroucha AK, Kouskos E, Mantas D, Antonopoulou Z, Karvelis S. Impact of breast cancer surgery on the self-esteem and sexual life of female patients. J Int Med Res. 2009; 37: 182-188.

14. Mustian KM, Katula JA, Gill DL, Roscoe JA, Lang D, Murphy K. Tai Chi Chuan, health-related quality of life and self-esteem: A randomized trial with breast cancer survivors. Support Care Cancer. 2004; 12: 871-876.

15. 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): 165-176.

16. 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: 608–614.

17. 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. 2013; 19: 38-44.

18. Jin P. Changes in heart rate, noradrenaline, cortisol, and mood during Tai Chi. J Psychosom Res. 1989; 33: 197-206.

19. Jin P. Efficacy of Tai Chi, brisk walking, meditation, and reading in reducing mental and emotional stress. J Psychosom Res. 1992; 36: 361-370.

20.Wang CC, Bannuru R, Rame J, Kupelnick B, Scott T, Schmid C. Tai Chi on psychological well-being: Systematic review and meta-analysis. J Altern Complem Med. 2010; 10(23): 1-16.

21. Pan Y, Yang K, Shi X, Liang H, Zhang F, Fang Q. Tai Chi Chuan Exercise for patients with breast cancer: A systematic review and meta-analysis. Evid Based Complement Alternat Med. 2015; 1-15. https://dx.doi.org/10.1155/ 2015/535237.

22. Sprod LK, Janelsins MC, Palesh OG, Carroll JK, Heckler CE, Peppone LJ, et al. Health-related quality of life and biomarkers in breast cancer survivors participating in tai chi chuan. J Cancer Surviv. 2012; 6: 146-154.

23. Irwin MR, Olmstead R, Breen EC, Witarama T, Carrillo C, Sadeghi N, et al. Tai Chi, cellular inflammation, and transcriptome dynamics in breast cancer survivors with insomnia: A randomized controlled trial. J Natl Cancer Inst Monogr. 2014; 50: 295- 301.

24. 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: 26-30.

25.Yang GY, Wang LQ, Ren J, Zhang Y, Li M-L, Zhu Y-T, et al. Evidence base of clinical studies on tai chi: A bibliometric analysis. PLoS ONE. 2015; 10(3): 1-13.

26. Tongnok S, Panutai S, Pramoch A. Effect of Tai Chi Qigong exercise on memory among the elderly. Nursing Journal. 2007; 34(4): 82-92.

27.Wayne PM, Kaptchuk TJ. Challenges inherent to T’ai Chi research: Part I-T’ai Chi as a complex multicomponent intervention. J Altern Complem Med. 2008a; 14(1): 95-102.

28.Wayne PM, Kaptchuk TJ. Challenges inherent to T’ai Chi research:Part II-T’ai Chi as a complex multicomponent intervention. J Altern Complem Med. 2008b; 14(1): 95-102.

29.Chao YF, Chen SY, Lan C, Lai JS. The cardiorespiratory response and energy expenditure of Tai-Chi-Qui-Gong. Am J Chin Med. 2002; 30(4): 451-461.

30.Ainsworth B, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: An update of activity code and MET intensities. Med Sci Sports Exerc. 2000; 32(9): S498-516.

31. McCain NL, Gray DP, Walter JM, Robins J. Implementing a comprehensive approach to the study of health dynamics using the psychoneuroimmunology paradigm. ANS. 2005; 28(4): 320-332.

32. Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat. 2005; 4: 287-291.

33. Rosenberg M. Society and the adolescent self-image. Princeton, NJ: Princeton University Press. 1965.

34. Vongsirimas N, Sitthimongkol Y, Beeber L, Wirachai N, Sangorn S. The relationship among depressive symptom severity in mothers, gender differences, and depressive symptom in Thai adolescents. Thai J Nurs Res. 2009; 13(3): 167-168.

35. Hann DM, Denniston MM, Baker F. Measurement of fatigue in cancer patients: Further validation of the Fatigue Symptom Inventory. Qual Life Res. 2000; 9: 847-854.

36. Buranaruangrote S, Kasemkitwattana S, Pongthavornkamol K, Keerativitayanant N. Experience and self-management for fatigue in breast cancer patients receiving chemotherapy. Thai Journal of Nursing Council. 2006; 21(2): 47-62.

37. Cella DF, Tulsky PS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The functional assessment of cancer therapy scale: Development and validation of the general measure. Clin Oncol 1993; 11: 570-9.

38. Ratanatharathorn V, Sirilerttrakul S, Jirajaras S, Silpakit C, Maneecharakajorn J, Sailamai P, et al. Quality of life, functional assessment of cancer therapy-general. J Med Assoc Thai. 2001; 84: 1430-1442.

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