Abstract
To the editor,
We read with great interest the recent publication by Gu et al., titled “Efficacy of Chinese Medicine on Postoperative Rehabilitation of Non-Small Cell Lung Cancer (NSCLC), a Randomized Controlled Study,” in Integrative Cancer Therapies. 1 This randomized controlled trial (RCT) presents an innovative comparison between Chinese medicine combined with Liuzijue exercises and standard treatment in the postoperative rehabilitation of NSCLC patients, providing valuable clinical evidence for optimizing rehabilitation strategies. However, upon closer examination, we believe there are several methodological concerns that require further scrutiny, as they may influence the accuracy and persuasive power of the results.
Firstly, a major concern arises from the unequal intensity and supervision of the rehabilitation protocols between the intervention and control groups. While the control group was instructed to independently practice breathing exercises, the intervention group received Liuzijue exercises under the guidance of a specialized physical therapist. This disparity introduces potential confounding factors, as the observed improvements, particularly in objective measures such as reduced complication rates (20% vs 44.44%) and increased 6-minute walk test (6MWT) distances (Δ97.42 vs Δ40.87), may reflect the added physical rehabilitation rather than the effects of the Chinese herbal decoction or Liuzijue exercises alone. It is critical to clarify the individual contribution of each intervention to prevent overestimating the efficacy of the combined regimen.
Secondly, the absence of blinding and placebo control exacerbates this issue. Many of the primary and secondary outcomes are patient-reported outcomes, which are vulnerable to performance bias and placebo effects. The high-contact nature of the intervention, involving both novel herbal treatments and direct therapist guidance, could influence patient expectations and potentially inflate subjective reports of improvement. This introduces uncertainty in interpreting quality of life improvements and complicates attributing these changes solely to the intervention.
Third, the primary outcome of quality of life, assessed using the QLQ-C30, showed no significant difference in the “General QoL” subscale between the groups (P = .585). However, the authors highlight improvements in “Role Functioning” and “Social Functioning” in the intervention group. While these results are promising, the selective reporting of these subscales may obscure a more nuanced understanding of the overall impact on quality of life.
Furthermore, we recommend that future research adopt more refined experimental designs, such as multi-arm trials with blinding and placebo controls. This would enable a more rigorous evaluation of the individual components of the intervention and their respective contributions to patient recovery. 2 Such studies would enhance the evidence base and ensure the broader applicability of these interventions in clinical practice.
In conclusion, this study provides clinical evidence for the use of Chinese medicine in the postoperative rehabilitation of non-small cell lung cancer. However, certain limitations remain, and addressing these issues could enhance the precision and persuasiveness of the results.
