Tai Chi for Breast Cancer Survivors


Public Health Report : Tai Chi and Breast Cancer Survivors
Author : Eric L. Zielinski


Introduction

According to the American Cancer Society, an estimated 230,000 new cases of invasive breast cancer will be diagnosed among women and about 2,200 cases of breast cancer are expected to occur among men. Affecting women more than 99 percent of the time, it is expected that approximately 40,000 women will die from breast cancer each year. In comparison, only lung cancer accounts for more cancer-related deaths in women. Being such a significant public health risk, conventional treatments are highly aggressive and oftentimes leave survivors in a compromised state of health upon going into remission. The combination of harm done by the cancer itself and by the medical treatment, for instance chemo and radiation therapies, puts breast cancer survivors at a very unique and specific need to recuperate as fast as possible. Offering hope, however, research has shown that mind-body exercises like Tai Chi can greatly aid in this process.

Breast Cancer Survivors

According to the American Cancer Society, breast cancer incidence and death rates generally increase with age. In fact, 95 percent of new cases and 97 percent of breast cancer deaths occur in women 40 years of age and older. It is reported that survival rates for women diagnosed with breast cancer are:

  • 89 percent at 5 years after diagnosis
  • 82 percent after 10 years
  • 77 percent after 15 years

One of the inherent challenges with breast cancer therapies is that once the cancerous cells are removed, there is no guarantee that they will not return. The American Cancer Society states that, “Women with breast cancer are at a 3-to 4-fold increased risk of developing a new primary cancer in the opposite breast. Increased risk is also seen for cancers of the ovary, uterus, lung, colon, rectum, and connective tissue, as well as melanoma and leukemia.”

Moreover, the American Cancer Society states that, “The risk of a second breast cancer is high no matter what treatment is used for the first cancer.” However, depending on age, radiation therapy is expected to increase the risk even more. Specifically, the risk of lung, bone and various connective tissue cancers are significantly increased for women who undergo radiation. Whereas, the risk of developing leukemia is highest in women who undergo chemo and radiation therapy for the treatment of breast cancer.

The reasons for this vary, but an underlying cause – in addition to the inherent damage medical therapies do to the body – is that the determining factors are not addressed in conventional treatments. Common risks are genetic dispositions to cancer, hormonal imbalances and environmental/lifestyle factors. To address the root issue(s), therefore, it is imperative that breast cancer survivors concentrate on immunity-boosting activities such as proper nutrition and mind-body exercises like Tai Chi to help stave off future cancer occurrences.

Conflicting Perspectives

In 2002 Harvard Medical School explored what they considered to be “two conflicting models of how patients experience mind-body therapies; these models frame the design of a clinical trial examining the effects of Qigong (a traditional Chinese movement therapy) on the immune systems of former cancer patients.” Data consisted of ethnographic research and in-depth interviews conducted at the Boston teaching hospital with the Qigong master responsible for the Qigong aspect of the study and biomedical researchers who designed the study. According to the study it was revealed that, “Two fundamentally different understandings of how Qigong is experienced and how that experience may be beneficial” was discovered. The biomedical team saw Qigong as simply a “non-specific therapy which combines relaxation and exercise.” Whereas, the qigong master viewed Qigong “As using specific movements and visualizations to direct mental attention to specific areas of the body. Thus, while the biomedical team frames qigong as a ‘mind-body’ practice, the Qigong master frames it as a ‘mind-in-body’ practice.”

This fundamental difference in how people view Qigong is not simply a semantic issue. Both perspectives carry with it the implications of how physicians, patients and researches approach Tai Chi and Qigong. As Harvard Medical researchers concluded, “Gaps in understanding between researchers and practitioners may be hindering scientific efforts to assess therapies like Qigong;” thus, preventing physicians from recommending Tai Chi regularly to cancer patients and survivors.

Research Showing Tai Chi’s ability to help breast cancer survivors

According to researchers from the University of Rochester Medical Center, Tai Chi as a cancer “intervention may provide benefits to cancer survivors related to physical deconditioning, cardiovascular disease risk, and psychological stress.” The significance of this cannot be stressed enough as the complications of radiation, chemo and hormone therapy often wipe out cancer patients’ immune systems; thereby putting them at high risk for a variety of diseases. Furthermore, cancer patients often experience cachexia – literally meaning “wasting away” – and are in dire need of physical reconditioning to help them live a healthy, vibrant life. In addition to all the physical stressors the body experiences due to cancer many underestimate the psychological burden of this debilitating disease due to the anxiety, depression, and overall stress that accompanies it.

• As it has been well established that breast cancer treatments accelerate bone loss and leads to osteoporosis, University of Rochester Medical Center researchers set out to determine the effect Tai Chi has in managing or reversing this process. The fascinating 2010 pilot study published in Clinical Breast Cancer, compared Tai Chi with standard support therapy on bone loss biomarkers among breast cancer survivors and determined that the Tai Chi group “experienced a greater increase in levels of bone formation…a significant decrease in bone resorption…whereas the women in the support therapy group did not.” Like other studies evaluating its effect on breast cancer survivors, it is clear that Tai Chi clearly benefits people at the cellular level and can even help reverse the damage cancer and harmful cancer treatments do to the body.

• In 2008, researchers from the University of Rochester School of Medicine and Dentistry tested Tai Chi’s ability to improve functional capacity and quality of life (QOL) in breast cancer survivors. To compare Tai Chi to psychosocial support therapy, women who completed breast cancer treatments were randomized to undergo Tai Chi or psychosocial support therapy for 60 minutes a session, three times weekly, for 12 weeks. The study revealed that the Tai Chi group demonstrated significant improvements in functional capacity, including aerobic capacity, muscular strength, and flexibility, as well as QOL; whereas the psychosocial support therapy group showed significant improvements only in flexibility, with declines in aerobic capacity, muscular strength, and QOL. Thus, proving that Tai Chi is effective in helping breast cancer survivors recoup from harmful radiation and chemotherapy treatments in its own right and in comparison to psychosocial therapy.

• In 2013, to test the hypothesis that Tai Chi is a reliable method for relieving the side effects of conventional cancer treatments in breast cancers survivors, University of Hong Kong researchers investigated the effects of qigong exercise on upper limb lymphedema, arterial resistance, and blood flow velocity in survivors with breast cancer and mastectomy. Eleven breast cancer survivors with Tai Chi-type Qigong experience were assigned to the experimental group and 12 survivors of breast cancer without Qigong experience were assigned to the control group. With the average age of 58 and 54 years, respectively, everyone in both groups had breast cancer-related lymphedema. All procedures were completed within one session and the experimental group performed 18 Forms Tai Chi Internal Qigong for approximately 6 minutes while the control group rested for similar duration in a sitting position. All participants were measured on their affected upper limb circumference (by using tape measures), peripheral arterial resistance, and blood flow velocities (using a Doppler ultrasound machine). The circumferences of the affected upper arm, elbow, forearm and wrist decreased after Tai Chi. Regarding vascular outcomes, the resistance index decreased and the maximum systolic arterial blood flow velocity and minimum diastolic arterial blood flow velocity increased significantly after Tai Chi. Researchers concluded, therefore, that “Qigong exercise could reduce conventional cancer therapy side effects such as upper limb lymphedema and poor circulatory status in survivors of breast cancer. However, such effects may be temporary, and further studies must be conducted to explore longer term effects.”

Clinical Breast Cancer published a study in 2011 in which the expressed goal was to “identify differential changes in biological marker profiles for insulin and cytokines” in participants of Tai Chi interventions who were breast cancer survivors. Subsequently, Tai Chi was shown to “be associated with maintenance of insulin levels and changes in cytokine levels that may be important for maintenance of lean body mass in breast cancer survivors.” As it is commonly accepted that “inflammatory cytokines, and insulin and insulin-related signaling molecules may contribute to weight gain and affect cancer recurrence rates and survival; [Tai Chi] exercise can curb cancer- and treatment-related weight gain, increase survival, and reduce levels of insulin and inflammatory cytokines.” Being a pilot study by design, the results are so encouraging, that there is hope that a much larger design will be conducted in an attempt to confirm these results.

• Another pilot study – this one from the journal Supportive Care in Cancer, highlighted Tai Chi’s ability to improve health-related quality of life and self-esteem 6 and 12 weeks after participants started a Tai Chi program in comparison to a psychological support group. Due to it being a pilot, no control group was established. Although the results are probably quite accurate, this study warrants a larger version with controls to be conducted in the future to determine if these results are repeatable.

• To compare Tai Chi to a conventional psychosocial therapy model, University of Rochester School of Medicine and Dentistry researchers published the results of a pilot study in the Journal of Supportive Oncology and proved that, Tai Chi participants “demonstrated significant improvement in functional capacity (specifically aerobic capacity, muscular strength, and flexibility) whereas the [therapy] group showed significant improvement in flexibility only.” Like the pilot study above, since no control group was utilized, a larger randomized control design is needed to substantiate these results.

Medical Studies and Resources

Supportive Care in Cancer
https://link.springer.com/article/10.1007%2Fs00520-004-0682-6

Evidence-Based Complementary and Alternative Medicine
https://www.hindawi.com/journals/ecam/2012/979213/

Evidence-Based Complementary and Alternative Medicine
https://www.hindawi.com/journals/ecam/2013/787169/

Clinical Breast Cancer
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3071508/

Clinical Breast Cancer
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156577/

Journal of Supportive Oncology
https://www.ncbi.nlm.nih.gov/pubmed/

Medicine and Sports Science
https://www.ncbi.nlm.nih.gov/pubmed/18487900


Public Health Report : Tai Chi and Breast Cancer Survivors
Author : Eric L. Zielinski