Advancing Integrative Oncology: Methodological Refinements in TCM-Informed Lifestyle Research for Chinese Patients With Cancer

To the Editor,

We recently had the opportunity to review the article titled “Diet Habits, Smoking, and Alcohol Consumption Among Chinese Patients with Cancer” published in your esteemed journal. ¹ This study conducted a secondary analysis of cross-sectional survey data from 287 cancer patients at an oncology outpatient clinic in Central China. It examined changes in smoking, alcohol consumption, and dietary habits before and after cancer diagnosis, while pioneering an exploration of how Traditional Chinese Medicine (TCM) beliefs influence cancer patients’ lifestyle behaviors. The purpose of this letter is to appreciate the contributions of this research while discussing areas that require careful interpretation and further exploration.

First, the authors’ investigation of TCM beliefs as an influential factor in Chinese cancer patients’ lifestyle behaviors (smoking, alcohol consumption, and dietary habits) represents a significant strength of this study, deserving commendation. However, we express concern regarding the setting of the entries for this critical variable (TCM beliefs) using only a single-item 0 to 3 point Likert scale, which risks oversimplification and may compromise the generalizability of findings. This limitation likely stems from the secondary use of pre-existing data originally collected by Liu et al. ² Consequently, we recommend that future research incorporate a multidimensional TCM belief scale with refined dimensions—such as theoretical endorsement of TCM principles, health cultivation perspectives, food-as-medicine concepts, and dietary avoidance beliefs—to enhance the authenticity and granularity of TCM belief assessment.

Second, while the integration of yin-yang theory into dietary assessment highlights TCM’s unique perspective, it is noteworthy that the study did not account for patients’ TCM constitutional differences. Merely recording frequency of “yin-yang food intake” without TCM constitutional identification limits analysis of whether “balanced diets” were truly personalized, which constrains the data’s interpretative value. We therefore emphasize that professional TCM practitioners should conduct constitutional assessments using the Classification and Determination of TCM Constitution standard before surveying dietary patterns. ³ This approach would not only enhance data precision on yin-yang dietary indicators but also establish a practical reference for developing integrated dietary protocols tailored to Chinese cancer patients’ constitutions.

Third, while the authors examined potential subgroup differences based on sociodemographic, clinical characteristics, symptom profiles, and TCM beliefs, we contend that additional dimensions—including sociocultural factors (eg, primary family meal planners), health literacy disparities, ⁴ TCM constitutional differentiation, and economic constraints ⁵ —could substantially enrich our understanding of determinants influencing lifestyle behaviors. Incorporating these factors would facilitate the development of tailored lifestyle education and support strategies for Chinese cancer patients.

Finally, as practitioners committed to TCM, we recognize a significant opportunity for our field to contribute within this context. We also once again commend the authors for integrating TCM cultural elements into their study on lifestyle factors affecting Chinese cancer patients, which provides new perspectives and valuable references for integrative oncology management. Future research should build upon these findings to develop further optimized evidence-based interventions that enhance cancer rehabilitation outcomes.

Songhe Chen, M.M
Gulou Subdistrict Community Health Center, Haishu District, Ningbo, Zhejiang, China

Ying Zhang, M.M
Ningbo Hospital of Traditional Chinese Medicine, Zhejiang, China