출처 : http://www.complementarytherapiesinmedicine.com/article/S0965-2299(13)00195-7/abstract

암환자들을 위한 기공 또는 태극권의 건강이익들: 체계적 문헌고찰과 메타분석

Health benefits of qigong or tai chi for cancer patients : a systematic review and meta-analyses
Yingchun Zeng
Summary

배경
암은 전 세계적으로 죽음으로 이끄는 원인이 되고 있다. 심신(心身) 중재 방법들은 암환자들에 의해 증상을 줄이고 질병과 치료와 관련된 증상들에 더 잘 대처하기 위해 널리 사용되고 있다. 지난 10년 동안 암치료방법으로서 기공/태극권에 관한 많은 무작위 임상실험들이 나오고 있다. 이 연구는 기공/태극권의 암환자의 건강과 관련된 결과에 관한 효과들을 정량적으로 규명하기 위해 목적되었다.

Background
Cancer is a leading cause of death worldwide. Mind-body interventions are widely used by cancer patients to reduce symptoms and cope better with disease- and treatment-related symptoms. In the last decade, many clinical controlled trials of qigong/tai chi as a cancer treatment have emerged. This study aimed to quantitatively evaluate the effects of qigong/tai chi on the health-related outcomes of cancer patients.

방법
5개의 데이터베이스들(Medline, CINAHL, Scopus, the Cochrane Library, 그리고 the CAJ Full-text Database)이 2013년 6월 30일까지 조사되었다. 암환자를 위한 치료 중재로서 기공/태극권의 무작위비교연구(RCTs)가 포함되도록 고려되었다. 이 고찰의 일차적 결과는 암환자들의 삶의 질(QOL), 다른 신체적, 정신적 효과의 변화였다. 이 고찰의 이차적 결과는 기공/태극권 중재의 부작용 보고였다.

Methods
Five databases (Medline, CINAHL, Scopus, the Cochrane Library, and the CAJ Full-text Database) were searched until June 30, 2013. Randomized controlled trials (RCTs) of qigong/tai chi as a treatment intervention for cancer patients were considered for inclusion. The primary outcome for this review was changes in quality of life (QOL) and other physical and psychological effects in cancer patients. The secondary outcome for this review was adverse events of the qigong/tai chi intervention.

결과
592개의 주제를 가진 전체 13건의 무작위배정 임상실험들(RCTs)이 이 고찰 안에 포함되었다. 499개의 주제를 포함한 9건의 RCTs이 건강과 관련된 결과를 위한 효과크기의 통합추정값을 발생시키기 위한 충분한 데이터를 제공하였다. 암 특이 QOL을 위하여 통합 가중평균차이(WMD)는 7.99 [95% 신뢰구간 (CI): 4.07, 11.91; Z score = 4.00, p < 0.0001]이었다. 우울증과 불암감 점수에서 변화에 대한 표준화된 평균차이(SMDs)는 각각 −0.69 (95% CI: −1.51, 0.14;Z score = 1.64, p = 0.10)와 −0.93 (95% CI: −1.80, −0.06; Z score = 2.09, p = 0.04)이었다. 체질량지수와 체성분에서의 변화들에 대한 가중평균차이(WMDs)는 기준치로부터 12주 추가조사까지 각각 −1.66 (95% CI: −3.51, 0.19; Z score = 1.76, p = 0.08)과 −0.67 (95% CI: −2.43, 1.09; Z score = 0.75, p = 0.45)이었다.

Results
A total of 13 RCTs with 592 subjects were included in this review. Nine RCTs involving 499 subjects provided enough data to generate pooled estimates of effect size for health-related outcomes. For cancer-specific QOL, the pooled weighted mean difference (WMD) was 7.99 [95% confidence interval (CI): 4.07, 11.91; Z score = 4.00, p < 0.0001]. The standardized mean differences (SMDs) for changes in depression and anxiety score were −0.69 (95% CI: −1.51, 0.14;Z score = 1.64, p = 0.10), and −0.93 (95% CI: −1.80, −0.06; Z score = 2.09, p = 0.04), respectively. The WMDs for changes in body mass index and body composition from baseline to 12 weeks follow-up were −1.66 (95% CI: −3.51, 0.19; Z score = 1.76, p = 0.08), and −0.67 (95% CI: −2.43, 1.09; Z score = 0.75, p = 0.45) respectively. The SMD for changes in the cortisol level was −0.37 (95% CI: −0.74, −0.00; Z score = 1.97, p = 0.05).

결론
이 연구에서 기공/태극권이 암 특이 삶의 질, 피로, 면역기능과 암환자의 코르티졸 농도에 긍정적 영향을 가졌음을 알 수 있었다.
그러나 이러한 발견들은 확인된 논문의 제한된 숫자와 포함된 실험에서 편향의 높은 위험이 있기 때문에 주의 깊게 이해되어야할 필요가 있다.
암환자에게 기공/태극권이 가능한 치료상의 효과가 있다는 것을 탐구하기 위해 더 많은 엄격한 실험이 필요하다.

Conclusion
This study found that qigong/tai chi had positive effects on the cancer-specific QOL, fatigue, immune function and cortisol level of cancer patients. However, these findings need to be interpreted cautiously due to the limited number of studies identified and high risk of bias in included trials. Further rigorous trials are needed to explore possible therapeutic effects of qigong/tai chi on cancer patients.

참고문헌

References
1.World Health Organization (WHO). Cancer control: knowledge into action. WHO, Geneva, Switzerland; 2013 (http://www.who.int/cancer/modules/en/index.html. [accessed 15.06.13]).
2.US National Cancer Institute. The SEER cancer statistics review, 1975–2010. US National Cancer Institute, Bethesda, MD; 2013 (http://surveillance.cancer.gov/statistics/types/survival.html. [accessed 15.06.13]).
3.Mansky, P., Sannes, T., Wallerstedt, D., Ge, A., Ryan, M., Johnson, L.L. et al, Tai chi chuan: mind-body practice or exercise intervention? Studying the benefit for cancer survivors. Integr Cancer Ther. 2006;5:192–201.

4.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.

5.Pearman, T. Quality of life and psychosocial adjustment in gynecologic cancer survivors. Health Qual Life Outcomes. 2003;1:33.

6.Elkins, G., Fisher, W., Johnson, A. Mind-body therapies in integrative oncology. Curr Treat Options Oncol. 2010;11:128–140.

7.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;119:1690–1698.
8.Horowitz, S. Evidence-based health benefits of qigong. Altern Complement Ther. 2009;15:178–183.
9.Larkey, L., Jahnke, R., Etnier, J., Gonzalez, J. Meditative movement as a category of exercise: implications for research. J Phys Act Health. 2009;6:230–238.
10.Morone, N.E., Greco, C.M. Mind-body interventions for chronic pain in older adults: a structured review. Pain Med. 2007;35:359–375.

11.Jahnke, R., Larkey, L., Rogers, C., Etnier, J., Lin, F. A comprehensive review of health benefits of qigong and tai chi. Am J Health Promot. 2010;24:e1–e25.
12.Abbott, R., Lavretsky, H. Tai chi and qigong for the treatment and prevention of mental disorders. Psychiatr Clin North Am. 2013;36:109–119.
13.Chan, C.L.W., Wang, C.-W., Ho, R.T.H., Ng, S.-M., Chan, J.S.M., Ziea, E.T.C. et al, A systematic review of the effectiveness of qigong exercise in supportive cancer care. Support Care Cancer. 2012;20:1121–1133.
14.Lee, M.S., Chen, K.W., Sancier, K.M., Ernst, E. Qigong for cancer treatment: a systematic review of controlled clinical trials. Acta Oncol. 2007;46:717–722.
15.Lee, M.S., Pittler, M.H., Ernst, E. Is tai chi an effective adjunct in cancer care? A systematic review of controlled clinical trials. Support Care Cancer. 2007;15:597–601.
16.Lee, M.S., Choi, T.-Y., Ernst, E. Tai chi for breast cancer patients: a systematic review. Breast Cancer Res Treat. 2010;120:309–316.
17.The Cochrane Collaboration Review Manager (RevMan) [Computer program]. Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration; 2012.

18.in: J.P.T. Higgns, S. Green (Eds.) Cochrane handbook for systematic reviews of interventions, version 5.1.0. The Cochrane Collaboration, ; 2011 ([Available from: www.cochrane-handbook.org, updated march 2011]).
19.Chi, I., Jordan-Marsh, M., Guo, M., Xie, B., Bai, Z. Tai chi and reduction of depressive symptoms for older adults: a meta-analysis of randomized trials. Geriatr Gerontol Int. 2013;13:3–12.
20.Campo, R.A., O’Connor, K., Light, K.C., Nakamura, Y., Lipschitz, D.L., LaStayo, P.C. et al, Feasibility and acceptability of a tai chi chih randomized controlled trial in senior female cancer survivors. Integr Cancer Ther. 2013;12:464–474.
21.Lam, S.W.Y. A randomized, controlled trial of Guolin qigong in patients receiving transcatheter arterial chemoembolisation for unresectable hepatocellular carcinoma [master dissertation]. Hong Kong, China, The University of Hong Kong; 2004.
22.Oh, B., Butow, P.N., Mullan, B.A., Clarke, S.J., Beale, P.J., Pavlakis, N. et al, Effect of medical qigong on cognitive function, quality of life, and a biomarker of inflammation in cancer patients: a randomized controlled trial. Support Care Cancer. 2012;20:1235–1242.
23.Sprod, L.K., Janelsins, M.C., Palesh, O.G., Carroll, J.K., Heckler, C.E., Peppone, L.J. 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.
24.Mustian, K.M., Katula, J.A., Gill, D.L., Roscoe, J.A., 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.
25.Mustian, K.M., Katula, J.A., Zhao, H. A pilot study to assess the influence of tai chi chuan on functional capacity among breast cancer survivors. J Support Oncol. 2006;4:139–145.
26.Janelsins, M.C., Davis, P.G., Wideman, L., Katula, J.A., Sprod, L.K., Peppone, L.J. et al, Effects of tai chi chuan on insulin and cytokine levels in a randomized controlled pilot study on breast cancer survivors. Clin Breast Cancer. 2011;11:161–170.
27.Galantino, M.L., Capito, L., Kane, R.L., Ottey, N., Switzer, S., Packer, L. 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;21:17–22.
28.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;36:459–472.
29.Peppone, L.J., Mustian, K.M., Janelsins, M.C., Palesh, O.G., Rosier, R.N., Piazza, K.M. et al, Effects of a structured weight-bearing exercise program on bone metabolism among breast cancer survivors: a feasibility trial. Clin Breast Cancer. 2010;10:224–229.
30.Rausch, S.M. Evaluating the psychosocial effects of two interventions, tai chi and spiritual growth groups, in women with breast cancer [PhD thesis]. Virginia Commonwealth University, Richmond, VA; 2007.
31.Mishra, S.I., Scherer, R.W., Geigle, P.M., Berlanstein, D.R., Topaloglu, O., Gotay, C.C. et al, Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev. 2012;8:CD007566.
32.Chen, K., Yeung, R. Exploratory studies of qigong therapy for cancer in China. Intergr Cancer Ther. 2002;1:345–370.

33.Wang, F., Man, J.K.M., Lee, E.-O., Wu, T., Benson, H., Fricchione, G.L. et al, The effects of qigong on anxiety, depression, and psychological well-being: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2013;2013