Letter to the Editor Re: Improving chemotherapy-induced peripheral neuropathy in cancer patients using a combined qigong and self-administered acupressure intervention: a randomized controlled trial

We read with great interest the original article by Cheung et al. (2025) investigating the effects of a combined qigong and self-administered acupressure intervention on chemotherapy-induced peripheral neuropathy (CIPN) in cancer patients.¹ The authors provide compelling evidence that a 16-week multimodal mind-body intervention leads to significant improvements in self-reported CIPN severity, physical performance, and health-related quality of life, with sustained benefits at the 12-week follow-up. While this study makes a valuable contribution to the non-pharmacological management of CIPN, we wish to highlight several methodological and clinical considerations that may help contextualize the findings and inform future research and implementation.

The authors rightly note that patient-reported outcomes (PROs), particularly the FACT/GOG-Ntx subscale, are central to CIPN assessment given their clinical relevance and responsiveness. The observed mean reduction of 3.86 points in the intervention group exceeds the established minimal important difference of 3.3-4.4 points, underscoring the clinical meaningfulness of the intervention. However, the lack of significant change in objective neurophysiological measures (sensory nerve action potential amplitude and sensory nerve conduction velocity via DPNCheck) warrants careful interpretation. Although the authors attribute this to possible insufficient statistical power, it may also reflect the known discrepancy between subjective symptoms and electrophysiological findings in CIPN, as structural nerve damage may persist even when symptoms improve. Future studies should consider incorporating additional objective measures such as quantitative sensory testing or corneal confocal microscopy, which may offer greater sensitivity to small-fiber neuropathy—a common component of CIPN.

From a clinical perspective, the intervention’s design—integrating Baduanjin qigong with acupressure at six key acupoints—is both pragmatic and theoretically grounded in traditional Chinese medicine meridian theory. The high adherence and satisfaction rates reported (e.g. 81.5% self-practice compliance) suggest strong acceptability among participants, which is critical for the translation of mind-body interventions into real-world settings. However, the absence of an active control group (e.g. sham acupressure or light exercise) limits the ability to fully attribute observed effects to the specific components of the intervention. Placebo effects, attention, and self-efficacy associated with group-based mind-body practices are known to influence PROs. Future trials should include active comparators to isolate the specific effects of qigong and acupressure.

Mechanistically, the authors hypothesize complementary actions of acupressure (e.g. improving local circulation, modulating neurotrophic factors) and qigong (e.g. reducing inflammation, enhancing central nervous system regulation). Although plausible, these mechanisms were not directly measured. Incorporating biomarkers such as serum levels of nerve growth factor,² pro-inflammatory cytokines (e.g. IL-6, TNF-α),³ or heart rate variability⁴ (as a proxy of autonomic function) in future studies could provide deeper insights into the neuroimmunological pathways involved.

Finally, the modest attenuation of treatment effects at the 28-week follow-up (e.g. reduced effect size for CIPN severity) highlights the challenge of sustaining benefits without ongoing practice. This is consistent with many behavioral interventions and underscores the need for booster sessions or digital health tools (e.g. video-guided practice, mobile reminders) to support long-term adherence. Additionally, future research should explore the intervention’s efficacy in more diverse populations, including non-Chinese and those with acute CIPN during active chemotherapy.

In conclusion, Cheung et al. have delivered a well-conducted randomized controlled trial that supports the integration of qigong and self-acupressure into CIPN management. Their work paves the way for larger, mechanism-informed trials and implementation studies to optimize the delivery and sustainability of this promising non-pharmacological approach.