Comment on “Traditional Chinese Medicine Combined Group Psychotherapy Experiences Among Colorectal Cancer Survivors: A Secondary Qualitative Analysis”

Dear Editor,

We read with great interest the study by Liu et al. ¹ examining colorectal cancer survivors’ experiences with traditional Chinese medicine combined with online group psychotherapy.

Study Design and Interpretive Framework

The authors applied a secondary qualitative analysis within a single-arm trial, offering an informative view of the patients’ lived perspectives. Nevertheless, embedded design constrains interpretive breadth because participants enter the qualitative component after receiving a structured therapeutic curriculum with predefined TCM and psychological elements. This sequencing yields narratives shaped by the intervention rather than spontaneous experiential accounts. Such conditioning matters clinically; when insights are derived from reflective states fostered by the program itself, the extent to which these perspectives represent baseline psychosocial needs versus intervention-driven reappraisals becomes less clear. Distinguishing authentic pre-existing needs from adaptive responses is essential for designing scalable survivorship pathways. ²

Statistical Validity and Clinical Interpretation

Although the qualitative findings align with previously reported improvements in anxiety, sleep, and fatigue, the absence of a comparator group limits the interpretation of whether thematic patterns correspond to clinically meaningful changes beyond expected postoperative adjustment. Immediate psychological shifts, such as greater acceptance, reduced worry, and increased engagement in self-management, can emerge naturally during the survivorship trajectory. Without triangulation against control narratives, it remains uncertain which patient-reported changes reflect intervention-specific mechanisms and which stem from usual recovery. ³ This distinction carries clinical weight because programs that require specialist-led TCM coaching and mindfulness practice must be justified by benefits exceeding those attainable through lower-resource educational or peer support models.

Data Integrity and Translational Context

The authors offered rich thematic coding; however, they relied on group-session dialogue risks to capture the experiences of individuals reluctant to share sensitive concerns in a public virtual setting. Patients who are socially inhibited, distressed by stigma related to bowel dysfunction, or uncertain about discussing TCM practices may not disclose issues that could influence clinical decision-making. Survivorship care models must account for this group because underreporting of symptom burden can lead to delayed evaluation or missed opportunities for targeted supportive care. Moreover, the broad range of queries regarding herbal preparations, acupressure, and cupping illustrates the complexity of integrating traditional practices into standardized oncology pathways. Without careful clinical governance, patients may divert toward practices unsuitable for their medical status, particularly those at risk of neuropathy, infection, or postoperative complications. ⁴

Clinical Applicability and Individualized Strategy

This study underscores survivors’ need for nuanced guidance, especially regarding bowel function, sleep routines, and emotional resilience. However, the intervention’s reliance on culturally specific frameworks raises questions regarding generalizability. Clinicians must determine which components – mindfulness, structured peer support, lifestyle coaching, or TCM-based approaches – drive the most durable behavioral adjustments. A modular structure that tailors content to individual symptom patterns, literacy levels, and cultural orientations may offer greater clinical value while maintaining accessibility across diverse populations. Blending evidence-based psycho-oncology principles with patient-preferred cultural practices requires clear boundaries to ensure safety and therapeutic consistency.

Conclusion

Liu et al. provided important qualitative insights into survivors’ evolving needs following multimodal supportive care. Further comparative and mixed-methods research can clarify how such culturally informed interventions integrate into broader survivorship frameworks while ensuring clinical rigor and equitable applicability.

Elman Azimov, PhDAzerbaijan Medical University, Baku, Azerbaijan Elmina Gadirova, PhDBaku State University, Azerbaijan Swapan Banerjee, PhD Poornima University, Jaipur, Rajasthan, India