Comparative effectiveness of various nonpharmacological interventions, including traditional Chinese medicine-based interventions for cancer-related cognitive impairment: a comprehensive network meta-analysis

Abstract

Background

Cancer-related cognitive impairment is a common complication of cancer and its treatment. The effectiveness of traditional Chinese medicine (TCM)-based interventions in improving subjective and objective cognitive functions has not yet been investigated in previous network meta-analyses. This study aimed to evaluate the comparative effectiveness of nonpharmacological interventions including TCM-based interventions and to rank the best option for improving cognitive function among adults with noncentral nervous system cancer.

Methods

PubMed, Embase, ProQuest, Scopus, and China National Knowledge Infrastructure were searched from their inception until May 2024 for relevant randomized controlled trials. A random effects model was used for conducting network meta-analysis. The primary endpoint evaluated the impact of interventions on subjective or objective cognitive function.

Results

In total, 84 randomized controlled trials were included and 15 nonpharmacological interventions were identified with no reported significant adverse events. Tai Chi/Qigong demonstrated the highest probability (standardized mean differences [SMD] = 2.10, 95% confidence interval [CI] = 0.62 to 3.59) of improving subjective cognitive function. Cognitive rehabilitation was ranked the best with the highest probability for improving overall cognitive function (SMD = 1.49, 95% CI = 0.41 to 2.58) and executive function as well as language domains. Acupoint stimulation was the top-ranking approach for enhancing visuospatial and motor function domain (Surface Under the Cumulative Ranking Curve 84.3%, SMD = 0.94, 95% CI = 0.13 to 1.76).

Conclusions

Tai Chi/Qigong demonstrated the highest effectiveness in addressing subjective cognitive complaints. Cognitive rehabilitation was the most effective intervention across various domains including overall objective cognitive function, executive function, and language. Acupoint simulation was the most effective intervention for improving visuospatial and motor domain functions.