Mindfulness and Tai Chi for Sleep, Fatigue, and Pain in Distressed People After Cancer Treatment: A Partially Randomized Patient-Preference Comparative Effectiveness Trial

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Abstract
PURPOSE: Sleep, fatigue, and pain are common symptoms in cancer survivors. Mindfulness-based cancer recovery (MBCR) and Tai Chi/Qigong (TCQ) are beneficial for these conditions, but have not been studied together. The Mindfulness and Tai Chi for Cancer Health (MATCH) study was designed to incorporate innovative design features, including patient choice, while evaluating two interventions for distressed cancer survivors with predefined secondary outcomes, including sleep, fatigue, and pain. METHODS: Participants chose one of the two interventions or chose to be randomly assigned into either intervention, then were further randomly assigned into immediate intervention or waitlist groups. We evaluated the efficacy of MBCR and TCQ, whether participants' choices affected intervention effects, and correlations among changes in sleep, fatigue, and pain. RESULTS: Participants (N = 587) were on average 60.7 years, with multiple types and stages of cancer. At postintervention, compared with waitlist controls, the TCQ group had an average improvement of 1.9 points on the sleep quality scale, which remained statistically significant compared with controls after adjustment for age, sex, cancer stage, and preference ( P = .004). Compared with waitlist controls, both MBCR and TCQ groups had significantly improved fatigue with mean improvements of 3.66 and 3.42 points, respectively (MBCR: P = .036. TCQ: P = .043) and over 1 point of change on pain interference (MBCR: P = .029. TCQ: P = .002). MBCR and TCQ did not differ from one another. Preference status did not affect outcomes. Significant correlations were observed among changes in sleep, fatigue, and pain interference, suggesting mild to moderate associations. CONCLUSION: Compared with waitlist controls, MBCR and TCQ both improved fatigue and pain interference at post-intervention, and TCQ also improved sleep quality. Correlations across outcomes highlight the importance of addressing clusters of cancer symptoms within a whole-person health framework.

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