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 function 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 non-central nervous system cancer. Methods PubMed, Embase, ProQuest, Scopus, and CNKI were searched from their inception until May 2024, for relevant randomized controlled trials. A random-effects model was utilized 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 (SMD = 2.10, 95% 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 (SUCRA 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.