Abstract
Dear Editor,
We sincerely thank Azimov, Gadirova, and Banerjee for their thoughtful commentary on our secondary analysis and qualitative study. We appreciate the opportunity to address their insightful points and further clarify our study’s contents, results, and directions for future research.
We agree that the single-arm, post-intervention qualitative design presents inherent limitations in distinguishing pre-existing psychosocial needs from intervention-driven reappraisals. Our study was nested within an original Phase I clinical trial primarily which focused on the feasibility and preliminary efficacy of the online Traditional Chinese Medicine (TCM) psychological supportive group (TCM-eRhab program). 1 The qualitative component of the current study aimed explicitly to explore the lived experiences and perceived meanings participants derived from the intervention itself, rather than to document baseline needs. We acknowledge that comparative designs are invaluable for attributing causal mechanisms and are actively planning a randomized controlled trial to build upon these foundational findings.
Regarding the absence of a control group for thematic triangulation, this is a recognized constraint of secondary qualitative analysis embedded within a single-arm feasibility study. Our prior quantitative paper reported significant reductions in anxiety, depression, and fear of recurrence using validated scales, providing a complementary evidence strand. 2 Currently, our research team is conducting a phase II randomized controlled trial on TCM-eRab with a wait-list control group to provide higher level of evidence. 3 The qualitative findings richly contextualize how and why participants perceived benefits, offering hypotheses about mechanisms of change—such as culturally resonant reframing and peer normalization of symptoms—that can be formally tested in future comparative research.
The commentators rightly highlight the potential for underreporting of sensitive concerns in a group setting. We mitigated this through multiple strategies: (1) ensuring participants of confidentiality and data anonymization; (2) structuring sessions to build trust gradually; and (3) observing that as group cohesion strengthened, participants increasingly shared intimate challenges (eg, stoma-related anxieties, bowel dysfunction). Nevertheless, individual in-depth interviews in future work could indeed capture a more comprehensive spectrum of experiences, including those of more reticent individuals.
Concerning clinical governance and safety in integrating TCM practices, all TCM guidance and self-management techniques (eg, acupressure, dietary advice) were provided by licensed TCM practitioners specializing in oncology. These were standardized, evidence-informed, and emphasized contraindications. Participant queries were addressed in real-time by these clinicians, ensuring safety and preventing inappropriate self-application.
Finally, we concur that the cultural specificity of our intervention raises important questions about generalizability. The intervention was intentionally designed to be culturally congruent for Chinese patients, leveraging TCM’s holistic, narrative-based framework to enhance engagement and acceptability. This cultural alignment appears to be a key facilitator of the observed “foundational outlook transformation.” Future research should explore which core components (eg, peer support, mindfulness, lifestyle coaching) are universally effective and which require cultural adaptation for different populations from other country and culture background.
In conclusion, we view our study as a crucial first step in developing a complex, culturally sensitive intervention. The commentators’ valuable insights reinforce the importance of rigorous comparative and mixed-methods research to establish efficacy, identify active ingredients, and ensure the safe, equitable, and effective integration of such holistic approaches into global survivorship care frameworks.
