Factors Predicting Depression Among Cancer Survivors in Integrative Care: A Mixed-Method Design



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Background With the increasing cancer survival rate, depression becomes commonly comorbid among individuals with cancer, needing to involve long-term and integrative healthcare to manage the symptoms. Acupuncture has become increasingly acceptable, showing scientific evidence with clinical benefits to cancer survivors to manage cancer-related distress. Very little research has explained the holistic components of depression in this targeted population integrating perspectives of complementary and alternative medicine and cognitive-behavioral health. This study investigates unique predictors of depression among individuals with cancer seeking acupuncture and explores their coping experiences and help-seeking motivation at the acupuncture clinic. Method A mixed-methods study with an explanatory sequential design was conducted to investigate the study goals. This study was conducted at the American College of Acupuncture and Oriental Medicine (ACAOM). Secondary data from the medical records between 2017 and 2019 were used in the first quantitative phase to identify a unique predictive model of depression among cancer patients, followed by phenomenological approach interviews to explore their coping process and motivation of seeking acupuncture. Results A total of 371 cases were analyzed, including cancer (n = 188, 50.7%) and non-cancer (n = 183, 49.3%) groups. Among the 82 patients with depression, 35 (42.68%) had cancer, and the cancer patients reported lower levels of depression than the non-cancer group (t = -2.410, p = .016). The logistic regression analysis results showed perceived overall health condition, anxiety levels, and current health status served as a unique composite predictive model of depression in the cancer group. The 11 interviews elaborated on those coping strategies with multi-dimensional components, including emotional expression, personal perception of illness-related changes, and the impact of cancer on the social relationship. A desire to have holistic and long-term healthcare motivated them to seek acupuncture treatments while coping with cancer. The trust relationship with an acupuncturist serves as a critical bonding to help them process perception of having cancer and strengthen the function of coping mechanisms. Integrative results highlighted that depressive symptom might appear throughout the journey, even if the symptoms may not meet the clinical diagnosis criteria. Cognitive appraisals are non-stop dynamic processes that significantly influence behavioral and emotional apparencies in the coping process and lead to step into the route of depression. The experiences and beliefs about the effectiveness of acupuncture motivate cancer patients to include acupuncture in their long-term healthcare plans. Implications Integrative cancer care, including acupuncture and psychosocial assessments and interventions, should be planned early in standard oncology care procedures. Guidelines about collaboration with the oriental medicine team in an integrative healthcare facility should be developed in social work curriculum and clinical training to advocate for cancer care reform. Health policy innovation will be beneficial if a friendly community-based integrative cancer care network is built to increase the accessibility for the cancer population. Healthcare insurance policies should consider adding acupuncture under the cover options to enlarge the benefits of delivering holistic long-term care. Future research should conduct clinical trials collaborating with neuropsychology professionals focusing on depression-specific acupuncture points to enhance patients’ engagement in treatment.



Depression, Coping, Cancer survivors, Oncology social work, Integrative cancer care, Acupuncture