Comparative effectiveness of traditional Chinese non-pharmacological therapies for chemotherapy-related symptoms in cancer patients: a systematic review and network meta-analysis

BACKGROUND: Chemotherapy-related fatigue, sleep disturbance, and psychological distress significantly impair quality of life (QoL) in cancer patients. Traditional Chinese medicine (TCM) non-pharmacological therapies are increasingly used as supportive care, yet their comparative effectiveness remains unclear. This study aimed to evaluate and compare five TCM-based interventions for improving QoL and emotional well-being in chemotherapy patients. METHODS: A systematic review and network meta-analysis was conducted, including randomized controlled trials (RCTs) published through April 2025. Five TCM-based interventions (acupuncture, auricular therapy, manual acupoint therapy, mind-body exercise therapy, and moxibustion) were evaluated. Primary outcomes included QoL, sleep quality, fatigue, general mood, anxiety, and depression. Effect sizes were calculated as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Treatment ranking was determined using surface under the cumulative ranking curve (SUCRA). RESULTS: Thirty-five RCTs involving 2025 chemotherapy patients were included. Manual acupoint therapy ranked highest for improving QoL (SUCRA 63.4%; SMD vs. control, 2.29; 95% CI, 0.95 to 3.63) and sleep quality (SUCRA 91.9%; SMD vs. auricular therapy, -9.92; 95% CI, -14.83 to -5.01). Mind-body exercise therapy was most effective for enhancing mood (SUCRA 68.0%; SMD vs. control, 0.72; 95% CI, 0.20 to 1.24) and reducing depression (SUCRA 70.8%; SMD vs. control, -0.92; 95% CI, -1.79 to -0.05). Auricular therapy showed the greatest benefit for fatigue (SUCRA 100%; SMD vs. control, -8.13; 95% CI, -10.15 to -6.11) and anxiety (SUCRA 92.9%; SMD vs. control, -1.53; 95% CI, -2.48 to -0.58). CONCLUSION: TCM non-pharmacological therapies demonstrate distinct, symptom-specific efficacy in cancer patients undergoing chemotherapy. Manual acupoint therapy is most effective for QoL and sleep, mind-body exercise therapy for mood and depression, and auricular therapy for fatigue and anxiety. These findings support individualized integration of TCM interventions into supportive cancer care.