Can meditative or relaxation-based interventions manage cognitive impairment in cancer patients?
Date of publication of the systematic review: April 2017
Design
Systematic review of 4 randomized controlled trials (RCTs).
Participants
A total of 290 participants (authors did not report age range and overall male % range) with cognitive impairment among adult patients with cancer.
Intervention
Meditative or relaxation-based interventions with duration ranged from 6 weeks to 10 weeks, 1 session per week.
Comparator
Comparison 1: Meditative or relaxation-based interventions (meditation, qigong or yoga) versus control group on improvement of subjective cognitive function;
Comparison 2: Meditative-based intervention (meditation) versus control group on improvement of subjective cognitive function;
Comparison 3: Meditative or relaxation-based interventions (meditation, qigong or yoga) versus control group on improvement of mental quality of life.
Major Outcomes
Outcome 1: Improvement of subjective cognitive function, measured by FACT-Cog (Functional Assessment of Cancer Therapy-Cognitive Function), EORTC-CF (European Organization for Research and Treatment of Cancer Cognitive Function) and AFI (Attentional Function Index);
Outcome 2: Improvement of mental quality of life, measured by SF-36 and EORTC (European Organization for Research and Treatment of Cancer) QLQ-C30.
Settings
The reviewers did not state whether the study was conducted in in-patient or out-patient settings.
Comparison    Meditative or relaxation-based interventions (meditation, qigong or yoga) versus control group for improvement of subjective cognitive function.
Main Results
Patients in meditation, qigong or yoga groups had resulted in significantly improved subjective cognitive function (pooled weighted mean difference: 5.29, 95% CI: 2.97 to 7.61) compared to control group.
Comparison: Meditation, qigong or yoga versus control group for improvement of subjective cognitive function
Outcome No. of studies (Total no. of participants) Mean improvement of subjective cognitive function (SD)/ No. of participants Heterogeneity test (I2) Pooled WMD (95% CI) Overall quality of evidence*
Intervention Intervention
1 4 (290) Not reported/142 Not reported/148 35% 5.29 ( 2.97 to 7.61) Moderate
Keys: SD= standard deviation; pooled WMD: pooled weighted mean difference; CI: confidence interval.
Comparison    Meditative-based intervention (meditation) versus control group for improvement of subjective cognitive function.
Main Results
Meditation group had resulted in significantly improved subjective cognitive function (pooled weighted mean difference: 10.34, 95% CI: 4.24 to 16.44) compared to control group.
Comparison: Meditation versus control group for improvement of subjective cognitive function
Outcome No. of studies (Total no. of participants) Mean improvement of subjective cognitive function (SD)/ No. of participants Heterogeneity test (I2) Pooled WMD (95% CI) Overall quality of evidence*
Intervention Comparator
1 2 (118) Not reported/58 Not reported/60 21% 10.34 (4.24 to 16.44) Moderate
Keys: SD= standard deviation; pooled WMD: weighted mean difference; CI: confidence interval.
Comparison    Meditative or relaxation-based interventions (meditation, qigong or yoga) versus control group on improvement of mental quality of life.
Main Results
Patients in meditation, qigong or yoga group had resulted in significantly improved mental quality of life (pooled weighted mean difference: 4.10, 95% CI: 1.41 to 6.78) as compared to patients in control group.
Comparison: Meditation, qigong or yoga versus control group for improvement of mental quality of life
Outcome No. of studies (Total no. of participants) Mean improvement of mental quality of life (SD)/ No. of participants Heterogeneity test (I2) Pooled WMD (95% CI) Overall quality of evidence*
Intervention Comparator
2 3 (219) Not reported/107 Not reported/112 0% 4.10 (1.41 to 6.78) Moderate
Keys: SD= standard deviation; pooled WMD: pooled weighted mean difference; CI: confidence interval.
Comparison    Meditative or relaxation-based interventions (meditation, qigong or yoga) versus control group for improvement of subjective cognitive function.
Main Results
Patients in meditation, qigong or yoga groups had resulted in significantly improved subjective cognitive function (pooled weighted mean difference: 5.29, 95% CI: 2.97 to 7.61) compared to control group.
Comparison: Meditation, qigong or yoga versus control group for improvement of subjective cognitive function
Outcome 1
No. of studies (Total no. of participants) 4 (290)
Mean improvement of subjective cognitive function (SD)/ No. of participants Intervention Not reported/142
Intervention Not reported/148
Pooled WMD (95% CI) 5.29 ( 2.97 to 7.61)
Overall quality of evidence* Moderate
Keys: SD= standard deviation; pooled WMD: pooled weighted mean difference; CI: confidence interval.
Comparison    Meditative-based intervention (meditation) versus control group for improvement of subjective cognitive function.
Main Results
Meditation group had resulted in significantly improved subjective cognitive function (pooled weighted mean difference: 10.34, 95% CI: 4.24 to 16.44) compared to control group.
Comparison: Meditation versus control group for improvement of subjective cognitive function
Outcome 1
No. of studies (Total no. of participants) 2 (118)
Mean improvement of subjective cognitive function (SD)/ No. of participants Intervention Not reported/58
Comparator Not reported/60
Pooled WMD (95% CI) 10.34 (4.24 to 16.44)
Overall quality of evidence* Moderate
Keys: SD= standard deviation; pooled WMD: weighted mean difference; CI: confidence interval.
Comparison    Meditative or relaxation-based interventions (meditation, qigong or yoga) versus control group on improvement of mental quality of life.
Main Results
Patients in meditation, qigong or yoga group had resulted in significantly improved mental quality of life (pooled weighted mean difference: 4.10, 95% CI: 1.41 to 6.78) as compared to patients in control group.
Comparison: Meditation, qigong or yoga versus control group for improvement of mental quality of life
Outcome 2
No. of studies (Total no. of participants) 3 (219)
Mean improvement of mental quality of life (SD)/ No. of participants Intervention Not reported/107
Comparator Not reported/112
Pooled WMD (95% CI) 4.10 (1.41 to 6.78)
Overall quality of evidence* Moderate
Keys: SD= standard deviation; pooled WMD: pooled weighted mean difference; CI: confidence interval.
Conclusion
Benefits
Meditation, qigong or yoga had all shown significant impact on improving both subjective cognitive function and mental quality of life among cancer patients with cognitive impairment. For all outcomes, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events were reported.
Link to Original Article
http://www.sciencedirect.com/science/article/pii/S2352013216301983
The synopsis is based on the following article:
Zhang Y, Luo Y, Zeng Y. Meta-analysis of meditative/relaxation-based interventions for cognitive impairment in cancer patient. International Journal of Nursing Sciences. 2017 Apr 26; In Press.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.