Abstract
Introduction
Breast cancer survivors experience diminished health-related quality of life (HRQOL). We report on the influence of tai chi chuan exercise (TCC) on HRQOL and explore associations between changes in HRQOL and biomarkers.
Methods
Breast cancer survivors (N = 21) were randomly assigned to TCC or standard support therapy (SST) for 12 weeks (three times/week; 60 min/session). Interleukin-6, interleukin-8 (IL-8), insulin-like growth factor-1 (IGF-1), insulin-like growth factor-binding protein (IBFBP)-1, IGFBP-3, glucose, insulin, and cortisol were measured pre- and postintervention. Overall HRQOL and subdomains were assessed at preintervention (T1), midintervention (T2) and postintervention (T3) and biomarkers at T1 and T3.
Results
The TCC group improved in total HRQOL (T1–T2:CS = 8.54, P = 0.045), physical functioning (T1–T2:CS = 1.89, P = 0.030), physical role limitations (T1–T2 CS = 1.55, P = 0.023), social functioning (T1–T3:CS = 1.50, P = 0.020), and general mental health (T1–T2:CS = 2.67, P = 0.014; T1–T3:CS = 2.44, P = 0.019). The SST improved in social functioning (T1–T2:CS = 0.64, P = 0.043) and vitality (T1–T2:CS = 0.90, P = 0.01). There were relationships between changes in IGF-1 and overall HRQOL (r = −0.56; P < 0.05), physical role limitation (r = −0.68; P < 0.05), and social functioning (r = −0.56; P < 0.05). IGFBP-1 changes were associated with physical role limitations changes (r = 0.60; P < 0.05). IGFBP-3 changes were associated with physical functioning changes (r = 0.46; P ≤ 0.05). Cortisol changes were associated with changes in physical role limitations (r = 0.74; P < 0.05) and health perceptions (r = 0.46; P < 0.05). Glucose changes were associated with emotional role limitation changes (r = −0.70; P < 0.001). IL-8 changes were associated with emotional role limitation changes (r = 0.59; P < 0.05).
Discussion/conclusions
TCC may improve HRQOL by regulating inflammatory responses and other biomarkers associated with side effects from cancer and its treatments.
Implications for cancer survivors
TCC may be an intervention capable of improving HRQOL in breast cancer survivors.
Similar content being viewed by others
References
American Cancer Society, Cancer facts and figures 2009.
Sadler IJ, Jacobsen PB. Progress in understanding fatigue associated with breast cancer treatment. Cancer Invest. 2001;19(7):723–31.
Andrykowski MA et al. Use of a case definition approach to identify cancer-related fatigue in women undergoing adjuvant therapy for breast cancer. J Clin Oncol. 2005;23(27):6613–22.
Hermelink K et al. Cognitive function during neoadjuvant chemotherapy for breast cancer: results of a prospective, multicenter, longitudinal study. Cancer. 2007;109(9):1905–13.
Vardy J, Tannock I. Cognitive function after chemotherapy in adults with solid tumours. Crit Rev Oncol Hematol. 2007;63(3):183–202.
Banthia R et al. Fatigued breast cancer survivors: the role of sleep quality, depressed mood, stage and age. Psychol Health. 2009;24(8):965–80.
Kuo H-H et al. Quality of sleep and related factors during chemotherapy in patients with stage I/II breast cancer. J Formos Med Assoc. 2006;105(1):64–9.
Fann JR et al. Major depression after breast cancer: a review of epidemiology and treatment. Gen Hosp Psychiatry. 2008;30(2):112–26.
Lueboonthavatchai P. Prevalence and psychosocial factors of anxiety and depression in breast cancer patients. J Med Assoc Thai. 2007;90(10):2164–74.
Burgess C et al. Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ. 2005;330(7493):702.
Maxwell C, Viale PH. Cancer treatment-induced bone loss in patients with breast or prostate cancer. Oncol Nurs Forum. 2005;32(3):589–603.
Chen Z et al. Osteoporosis and rate of bone loss among postmenopausal survivors of breast cancer. Cancer. 2005;104(7):1520–30.
Newton RU, Galvao DA. Exercise in prevention and management of cancer. Curr Treat Options Oncol. 2008;9(2–3):135–46.
Makari-Judson G, Judson CH, Mertens WC. Longitudinal patterns of weight gain after breast cancer diagnosis: observations beyond the first year. Breast J. 2007;13(3):258–65.
McInnes JA, Knobf MT. Weight gain and quality of life in women treated with adjuvant chemotherapy for early-stage breast cancer. Oncol Nurs Forum. 2001;28(4):675–84.
Ahles TA et al. Neuropsychologic impact of standard-dose systemic chemotherapy in long-term survivors of breast cancer and lymphoma. J Clin Oncol. 2002;20(2):485–93.
Bower JE et al. Fatigue in long-term breast carcinoma survivors: a longitudinal investigation. Cancer. 2006;106(4):751–8.
McTiernan A et al. Adiposity and sex hormones in postmenopausal breast cancer survivors. J Clin Oncol. 2003;21(10):1961–6.
Irwin ML et al. Relationship of obesity and physical activity with C-peptide, leptin, and insulin-like growth factors in breast cancer survivors. Cancer Epidemiol Biomarkers Prev. 2005;14(12):2881–8.
Tisdale MJ. Cachexia in cancer patients. Nat Rev Cancer. 2002;2(11):862–71.
Oppenheim JJ et al. Properties of the novel proinflammatory supergene “intercrine” cytokine family. Annu Rev Immunol. 1991;9:617–48.
Walter M et al. Interleukin 6 secreted from adipose stromal cells promotes migration and invasion of breast cancer cells. Oncogene. 2009;28(30):2745–55.
The cytokine handbook. 1st ed. 2003, San Diego, CA: Academic Press.
Seruga B et al. Cytokines and their relationship to the symptoms and outcome of cancer. Nat Rev Cancer. 2008;8(11):887–99.
Bower JE et al. Diurnal cortisol rhythm and fatigue in breast cancer survivors. Psychoneuroendocrinology. 2005;30(1):92–100.
Bower JE et al. Fatigue and proinflammatory cytokine activity in breast cancer survivors. Psychosom Med. 2002;64(4):604–11.
Ronson A. Psychological stress in oncology: the role of glucocorticoids. Bull Cancer. 2006;93(7):699–708.
Pollak M. Insulin, insulin-like growth factors and neoplasia. Best Pract Res Clin Endocrinol Metab. 2008;22(4):625–38.
Samani AA et al. The role of the IGF system in cancer growth and metastasis: overview and recent insights. Endocr Rev. 2007;28(1):20–47.
Schernhammer ES et al. Circulating levels of insulin-like growth factors, their binding proteins, and breast cancer risk. Cancer Epidemiol Biomarkers Prev. 2005;14(3):699–704.
Allen NE et al. A prospective study of serum insulin-like growth factor-I (IGF-I), IGF-II, IGF-binding protein-3 and breast cancer risk. Br J Cancer. 2005;92(7):1283–7.
Greep NC et al. The effects of adjuvant chemotherapy on bone density in postmenopausal women with early breast cancer. Am J Med. 2003;114(8):653–9.
Lonning PE. Bone safety of aromatase inhibitors versus tamoxifen. Int J Gynecol Cancer. 2006;16 Suppl 2:518–20.
Peppone LJ 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(3):224–9.
Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.
Chen Z et al. Fracture risk among breast cancer survivors: results from the Women's Health Initiative Observational Study. Arch Intern Med. 2005;165(5):552–8.
Jin P. Efficacy of Tai Chi, brisk walking, meditation, and reading in reducing mental and emotional stress. J Psychosom Res. 1992;36(4):361–70.
Tsai J-C et al. The beneficial effects of Tai Chi Chuan on blood pressure and lipid profile and anxiety status in a randomized controlled trial. J Altern Complement Med. 2003;9(5):747–54.
Irwin MR, Olmstead R, Oxman MN. Augmenting immune responses to varicella zoster virus in older adults: a randomized, controlled trial of Tai Chi. J Am Geriatr Soc. 2007;55(4):511–7.
Tse SK, Bailey DM. T'ai chi and postural control in the well elderly. Am J Occup Ther. 1992;46(4):295–300.
Wolf SL et al. The effect of Tai Chi Quan and computerized balance training on postural stability in older subjects. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies on Intervention Techniques. Phys Ther. 1997;77(4):371–81. discussion 382–4.
Li F et al. An evaluation of the effects of Tai Chi exercise on physical function among older persons: a randomized controlled trial. Ann Behav Med. 2001;23(2):139–46.
Irwin MR, Olmstead R. Mitigating cellular inflammation in older adults: a randomized controlled trial of Tai Chi Chih. Am J Geriatr Psychiatry. 2011 (in press).
Lan C et al. Effect of T'ai chi chuan training on cardiovascular risk factors in dyslipidemic patients. J Altern Complement Med. 2008;14(7):813–9.
Mustian KM, Katula JA, 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(3):139–45.
Mustian KM, Palesh OG, Flecksteiner SA. Tai Chi Chuan for breast cancer survivors. Med Sport Sci. 2008;52:209–17.
Mustian KM et al. Tai Chi Chuan, health-related quality of life and self-esteem: a randomized trial with breast cancer survivors. Support Care Cancer. 2004;12(12):871–6.
Janelsins MC 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(3):161–70.
Spiegel D. Essentials of psychotherapeutic intervention for cancer patients. Support Care Cancer. 1995;3(4):252–6.
Classen CC et al. Supportive-expressive group therapy for primary breast cancer patients: a randomized prospective multicenter trial. Psychooncology. 2008;17(5):438–47.
Acknowledgments
The authors thank the Sally Schindel Cone Foundation (KMM), NCI K07CA120025 (KMM), and NCI R25CA10618 (GRM) for the financial support.
Conflict of interest
The authors have no conflicts of interest to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sprod, L.K., Janelsins, M.C., Palesh, O.G. et al. Health-related quality of life and biomarkers in breast cancer survivors participating in tai chi chuan. J Cancer Surviv 6, 146–154 (2012). https://doi.org/10.1007/s11764-011-0205-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11764-011-0205-7