Psychological and inflammatory outcomes associated with tai chi interventions in cancer patients: a systematic review

Abstract

Cancer survivorship often includes persistent psychological distress and heightened inflammation that may be interrelated. This systematic review examined whether Tai Chi benefits both domains and explored the potential psycho–immune associations that may connect them. Following PRISMA 2020, we applied Population, Intervention, Comparison, Outcomes, Study design (PICOS) criteria to identify studies of adult patients with cancer that used Tai Chi as the primary intervention and reported psychological outcomes and/or inflammatory biomarkers. Searches and screening yielded 14 eligible records, including randomized trials, controlled clinical trials, and cohort studies. Across breast, lung, and mixed oncology cohorts, Tai Chi was generally associated with improvements in resilience, anxiety, depressive symptoms, and quality of life, with frequent concurrent gains in sleep and fatigue. Several trials reported biologic changes suggestive of reduced physiological stress load, including lower or altered interleukin-6 and tumor necrosis factor, decreased C-reactive protein in some studies, healthier diurnal cortisol rhythms, and improved heart rate variability. Studies that measured both psychological and biological outcomes suggested that symptom relief and biomarker shifts may occur together; however, the available evidence does not establish bidirectional causality or mediation. These findings suggest potential psycho–immune mechanisms in which improvements in resilience, autonomic balance, inflammatory activity, fatigue, and sleep disturbance may be interrelated. Feasibility was high in nurse-led, center-based, and telehealth formats. Heterogeneity in Tai Chi style, dose, and biomarker panels, along with modest sample sizes and limited follow-up, remains the main constraint. Current evidence suggests that Tai Chi appears to be a safe, feasible adjunct based on current evidence for supportive oncology that may be associated with improvements in psychological outcomes and, in some studies, immune-related outcomes, warranting larger, protocol-standardized trials with prespecified mediation analyses.