Both tai chi and cognitive behavioral therapy may reduce insomnia and inflammation and bolster antiviral defenses in breast cancer survivors, according to a recent study published by Irwin et al in Brain, Behavior, and Immunity.
Background
Chronic insomnia—one of the most prominent symptoms experienced among cancer survivors—often poses significant health concerns, including the risk of inflammatory disease that could increase the risk of cancer recurrence.
About 30% of breast cancer survivors are reported to have insomnia, which is twice the rate of the general population. Although prior research has shown that cognitive behavioral therapy and mind-body interventions such as tai chi may be effective at treating insomnia in this patient population, little is understood about their potential to reverse inflammation caused by insomnia.
Study Methods and Results
In the recent study, the investigators used blood samples collected from a 2017 study at baseline and 2, 3, 6, and 15 months to analyze changes in the inflammation biomarkers of 90 breast cancer survivors receiving either tai chi or cognitive behavioral therapy sessions lasting 120 minutes for a 3-month period between 2008 and 2012.
After a follow-up of 15 months, the investigators discovered that tai chi led to more significant, sustained reductions in inflammation among the participants compared with cognitive behavioral therapy. Analyses of the blood samples demonstrated that the participants in the tai chi group had reduced cellular and genomic markers of inflammation, specifically in plasma interleukin-6, TLR4-stimulated monocyte activation and inflammatory cytokine production, and inflammatory transcriptional profiles. However, the participants in the cognitive behavioral therapy group had greater antiviral gene transcripts that potentially improved the body’s defenses against infections.
Conclusions
“Tai chi can be readily provided in community settings, with minimal cost, and can treat insomnia in adults, older adults, and cancer survivors. Tai chi, as compared [with] cognitive behavioral therapy, has additional advantages in reducing inflammation in breast cancer survivors,” highlighted lead study author Michael Irwin, MD, Professor in the Department of Psychiatry and Behavioral Sciences and Director of the Mindful Awareness Research Center at the University of California, Los Angeles (UCLA) Health, as well as a member of the UCLA Health Jonsson Comprehensive Cancer Center. “Effective treatment of insomnia has potent impacts on the immune system. Tai chi preferentially reduces inflammation as compared [with] cognitive behavioral therapy, whereas cognitive behavioral therapy preferentially improves antiviral viral immunity or resistance to infectious diseases. Further research that examines the combined benefit of tai chi and cognitive behavioral therapy is needed, especially in cancer survivors who are at risk for inflammatory disorders as well as infectious diseases,” he emphasized.
The investigators noted that there were several limitations in the study: the participants were predominantly White, older adults (aged 42–83), and had achieved higher levels of education. They also excluded participants who had coexisting medical conditions. Changes in participants’ sleep-wake cycle and alignment with circadian rhythms may have yielded these inflammatory health benefits. Additionally, access to tai chi may have been limited in some communities, which requires ongoing practice for several days per week compared with cognitive behavioral therapy. As a result, future studies assessing the efficacy of these therapies across different populations may be needed.
The investigators are currently examining the trajectories of inflammatory activation and accelerated aging in breast cancer survivors compared with patients without breast cancer. They hope to identify behavioral and biological targets to help prevent depression as well and other morbidities in cancer survivors.
Disclosure: For full disclosures of the study authors, visit sciencedirect.com.
