Tao Wei-Wei, Jiang Hua, Tao Xiao-Mei, Jiang Ping, Sha Li-Yan, Sun Xian-Ce
College of Nursing, Dalian Medical University, Dalian, People's Republic of China.
School of Nursing, Peking University, Beijing, People's Republic of China.
J Pain Symptom Manage. 2016 Apr;51(4):728-747. doi: 10.1016/j.jpainsymman.2015.11.027. Epub 2016 Feb 12.
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.
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.
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.
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.
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.
大多数癌症患者既要承受疾病本身的折磨，又要忍受传统治疗带来的症状。现有关于针灸、推拿、太极拳、气功以及中医五行音乐疗法（TCM-FEMT）对癌症患者临床疗效的文献报道结果存在争议。
本荟萃分析的主要目的是评估针灸、推拿、太极拳、气功以及中医五行音乐疗法对癌症患者各种症状及生活质量（QOL）的影响；同时评估所选试验的偏倚风险。
通过检索电子数据库（通过PubMed和Ovid检索MEDLINE、Cochrane中心、中国知网、中国科学期刊数据库、中国生物医学数据库以及万方数据库）来识别研究。选取2014年10月2日前发表的所有使用针灸、推拿、太极拳、气功或中医五行音乐疗法的随机对照试验（RCT），无论文章是以中文还是英文发表。
我们识别出67项符合纳入标准的随机对照试验（5465例患者）以进行本荟萃分析。分析结果显示，晚期癌症患者生活质量变化方面观察到显著的综合效应，有利于针灸和推拿（Cohen's d：0.21 - 4.55，P < 0.05），而太极拳和气功对乳腺癌幸存者的生活质量没有影响（P > 0.05）。荟萃分析还表明，针灸对包括疼痛、疲劳、睡眠障碍和一些胃肠道不适等不良症状产生了小到中等程度的影响；然而，对潮热频率（Cohen's d = -0.02；95% CI = -1.49至1.45；P = 0.97；I(2) = 36%）和情绪困扰（P > 0.05）未发现显著影响。推拿缓解了胃肠道不适。中医五行音乐疗法降低了抑郁水平。太极拳提高了乳腺癌患者的肺活量。所选随机对照试验中有74.63%存在高偏倚风险。偏倚风险的主要来源是缺乏盲法、分配隐藏和结局数据不完整。
综上所述，尽管本研究中所综述的研究主体存在一些明显局限性，但可以得出一个初步结论，即针灸、推拿、太极拳、气功或中医五行音乐疗法是有益的辅助疗法。该领域未来的研究报告在干预措施的方法和内容以及研究方法方面都应加以改进。
