Oncology · Medical Literature
Effects of Neiyanggong on cancer-related fatigue in breast cancer patients undergoing chemotherapy: a randomized controlled trial.
Abstract
This study aimed to develop a dynamic-static combined Neiyanggong intervention for breast cancer patients undergoing chemotherapy and to evaluate its effectiveness in alleviating cancer-related fatigue, with sleep quality assessed as a secondary outcome. A single-center, parallel-group randomized controlled trial was conducted. Seventy-two patients receiving chemotherapy were randomly allocated (1:1) to a Neiyanggong group (n = 36) or a control group (n = 36). The control group received routine treatment and nursing care. The Neiyanggong group additionally practiced a staged progressive dynamic-static Neiyanggong program based on disease-specific characteristics across three chemotherapy cycles. The Piper fatigue scale-revised (PFS-R) and Pittsburgh sleep quality index (PSQI) were assessed at baseline and after each chemotherapy cycle. A significant interaction effect was found for the PFS-R total score (F = 94.810, P < 0.001, η2 = 0.807), indicating a progressive reduction in fatigue over time in the Neiyanggong group. After the third cycle, fatigue scores were significantly lower in the Neiyanggong group compared with the control group (P < 0.05). For the PSQI total score, significant group effects (Wald χ2 = 31.352, P < 0.001), time effects (Wald χ2 = 105.524, P < 0.001), and interaction effects (Wald χ2 = 292.975, P < 0.001) were identified. The Neiyanggong group showed the most notable improvements in sleep latency, sleep efficiency, and daytime dysfunction (P < 0.001). No adverse events occurred, and adherence was high. The findings suggest that the staged progressive dynamic-static combined Neiyanggong intervention is a promising non-pharmacological approach that can effectively reduce cancer-related fatigue and improve sleep quality.
Clinical relevance
Cancer-related fatigue (CRF) and sleep disturbance are among the most debilitating and undertreated symptoms experienced by breast cancer patients during chemotherapy, for which pharmacological options remain limited and often poorly tolerated. This RCT addresses the gap in evidence-based non-pharmacological interventions by evaluating Neiyanggong — a Traditional Chinese Medicine mind-body practice combining dynamic and static qigong elements — adapted specifically for the chemotherapy setting. Given the high prevalence of CRF affecting up to 80–100% of patients on active treatment, oncology clinicians need scalable, safe adjunctive strategies supported by controlled trial data.
Key findings
1. The PFS-R total score demonstrated a significant group × time interaction effect (F = 94.810, P < 0.001, η² = 0.807), indicating a large effect size and progressive, clinically meaningful reduction in cancer-related fatigue across three chemotherapy cycles in the Neiyanggong group. 2. After the third chemotherapy cycle, PFS-R fatigue scores were significantly lower in the Neiyanggong group compared with the control group (P < 0.05), confirming a cumulative benefit with sustained practice. 3. PSQI total scores showed significant group effects (Wald χ² = 31.352, P < 0.001), time effects (Wald χ² = 105.524, P < 0.001), and group × time interaction effects (Wald χ² = 292.975, P < 0.001), demonstrating robust, multi-dimensional sleep quality improvement attributable to the intervention. 4. The most pronounced PSQI subscale improvements in the Neiyanggong group were in sleep latency, sleep efficiency, and daytime dysfunction (all P < 0.001), reflecting gains across both nocturnal architecture and functional daytime performance. 5. The intervention was delivered across three staged, progressive chemotherapy cycles tailored to disease-specific characteristics, with high participant adherence throughout the trial and zero adverse events recorded in either group. 6. The study was a single-center, parallel-group RCT with 1:1 randomization (n = 36 per arm), with the control group receiving standard routine treatment and nursing care, providing a controlled comparator; however, specific between-group mean differences and 95% confidence intervals for PFS-R and PSQI scores were not reported in the abstract.
Practice implications
Oncology teams should consider integrating a structured, staged Neiyanggong (or analogous qigong/mind-body) program as an adjunct to standard supportive care for breast cancer patients beginning chemotherapy, particularly given its favorable safety profile (no adverse events) and high adherence in this trial. The intervention is optimally initiated at the start of chemotherapy and progressed across cycles in alignment with patient performance status, with fatigue and sleep quality formally reassessed using validated tools (PFS-R, PSQI) after each cycle to document response. Pending multicenter replication with longer follow-up and standardized reporting of effect magnitudes and confidence intervals, this approach is appropriate for incorporation into institutional integrative oncology or symptom-management programs as a low-risk, non-pharmacological strategy for CRF and insomnia.