Promoting holistic recovery for cancer survivors through enhancing occupational harmony: A case report

Promoting holistic recovery for cancer survivors through enhancing occupational harmony: A case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Promoting holistic recovery for cancer survivors through enhancing occupational harmony: A case report Yijun Liu, Yu Xin, Yexin Zhu, Yaqing Wu, Yujia Mo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8154135/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Oncology rehabilitation requires holistic care that addresses the body, mind, and spirit, yet current treatments are often fragmented. The Model of Occupational Harmony (MOHar) offers a potential framework for supporting comprehensive well-being in cancer survivors. Aims: To illustrate the application of the MOHar in cancer recovery and explore its underlying mechanisms. Material and Methods: A case study was conducted with a female participant diagnosed with both thyroid and breast cancer, who undertook a lifestyle-based intervention grounded in the MOHar. Sleep quality, emotional state, quality of life, and the level of occupational harmony were assessed using scales at baseline, mid-intervention, and post-intervention. Sleep patterns and body weight were recorded daily using sleep diaries and logs. Results: The participant’s recovery began with addressing a fear of insomnia, leading to improved sleep and restored daytime energy. These gains facilitated weight management and physical recovery, culminating in a lifestyle rebuilt and a renewed sense of life purpose. Conclusions: This case demonstrates the successful use of MOHar in supporting holistic cancer rehabilitation, integrating physical, psychological, and spiritual dimensions of recovery. Significance: Highlights how the MOHar fostered comprehensive recovery by mobilising the body’s innate healing capacity through enhancing harmonious human-environmental transactions. cancer rehabilitation holistic care occupational therapy occupational harmony Figures Figure 1 Figure 2 Figure 3 1. Introduction The World Health Organization estimates that in 2022, there were 20.0 million new cases of cancer and 9.7 million deaths from cancer worldwide. Globally, one in five men or women develops cancer during their lifetime, and one in nine men and one in 12 women die from cancer [ 1 ]. This all contributes to its very high disease burden, especially in transitioning countries where cancer incidence is rising rapidly, and mortality rates remain high [ 2 ]. Cancer survivors may retain many residual impacts of the disease and its treatment, which can impact both their physical and mental well-being. For example, cancer survivors exhibit a higher prevalence of conditions such as debility, psychological distress, depression, social isolation, and sleep disturbances compared to the general population [ 3 ]. Lifestyle interventions have been shown to improve cancer survivors’ health and quality of life [ 4 ], thereby lowering the risk of long-term disability, hospitalization, and overall mortality [ 5 ]. Among lifestyle factors, sleep disturbance is one of the most prevalent challenges faced by individuals with cancer, particularly those undergoing chemotherapy [ 6 ]. Previous interventions integrating elements such as physical activity and diet have attempted to address cancer-related fatigue, sleep quality, and overall well-being [ 7 ]. However, their effects on sleep outcomes and psychosocial well-being remain inconsistent, largely due to the lack of a comprehensive approach that acknowledges the holistic nature of daily living [ 8 ]. Cancer management typically involves a multidisciplinary team, including doctors, nurses, therapists, counsellors, and psychologists. While the team-based approach seeks to address multiple facets of cancer recovery, the sub-specialized nature of each professional's practice can limit the capacity to comprehensively view and support the client’s holistic needs [ 9 ]. Occupational therapy (OT) is an essential component of rehabilitation, emphasizing the improvement of a person’s function, encompassing both physical and psychosocial abilities. OT practitioners are unique in the value they place on the mind-body-spirit connection, thereby viewing their clients as holistic beings with complex functional needs [ 10 ]. Cancer rehabilitation is an emerging OT practice area, where OT practitioners have the potential to improve holistic well-being by leveraging self-care as a critical component of daily life and recovery [ 11 – 13 ]. Current evidence shows that OT can improve the quality of life of breast cancer patients, especially their global health, physical health, social health, cognitive function, fatigue, and role function[ 14 , 15 ]. Recently, the Model of Occupational Harmony (MOHar) has been proposed to elucidate the relationship between the orchestration of everyday occupations and health and well-being [ 16 , 17 ]. The model proposed that lifestyle patterns that hold equilibria among three pairs of two-sided occupational characteristics (i.e., physical and mental engagement, quiet and active engagement, individual and social engagement), harmony among five-dimensional occupational engagement (i.e., virtuous engagement, rational engagement, productive engagement, emotional engagement, health maintenance engagement), and coherence across multiple levels (i.e., ontosystem, small-system, medium-system, large-system, chronosystem) of human-environment transactions were essential to health and well-being. This article presents a case report of a client with both thyroid and breast cancer diagnoses, demonstrating how the MOHar was applied to support holistic recovery for cancer survivors, the outcomes achieved, and the underlying mechanisms of recovery. 2. Material and Methods To exemplify the MOHar, a case study method was employed. Case study research is an in-depth investigation of a phenomenon within its real context [ 18 ]. It is applicable to studies in a holistic perspective, capturing the context and complexity of occupational therapy practice [ 19 ]. 2.1. The Participant The participant was selected from clients the first author met through her regular work at a rehabilitation medicine outpatient clinic. While receiving conventional treatment, the client also participated in a larger interventional study applying the MOHar to improve sleep. The interventional study was approved by the ethics committee of Peking University First Hospital (Approval number: 2024Study386). The participant voluntarily agreed to report her recovery case and has signed a written informed consent form for publication. The client, here called Xiaoyao (pseudonym), is a 40-year-old woman residing in a major city in China. She is married and has a 13-year-old son and an 8-year-old daughter. In 2014, at the age of thirty, she was diagnosed with thyroid cancer and underwent a total thyroidectomy and radioactive iodine therapy. Ten years after her initial diagnosis of thyroid cancer, she was diagnosed with breast cancer in August 2024. Xiaoyao is a senior engineer working in a media organization. A four-year history of night-shift work has severely disrupted her sleep-wake cycle, leading to insomnia exacerbated by fear of sleeplessness. After the breast cancer diagnosis, she took a medical leave and had a breast-conserving surgery (post-op pT1N0) followed by adjuvant endocrine therapy and radiotherapy. This treatment regimen caused substantial pain, fatigue, and depressed mood, pushing her near a psychological collapse and significantly worsening her sleep. In addition, she gained weight quickly in three months due to consuming large amounts of highly nutritious food after surgery, which worsened her frailty. Upon completion of the 20th radiotherapy session, she visited the rehabilitation medicine outpatient clinic seeking help to improve her sleep and manage her weight, with the goal of resuming a normal work and life the following year. 2.2. Interventions based on the MOHar The occupational therapy intervention was developed based on the MOHar, a quiescence-based lifestyle program designed to enhance occupational harmony [ 20 ]. The treatment was provided by the first author, the developer of the MOHar, who is a physician trained in both rehabilitation medicine and occupational therapy. On November 1, 2024, Xiaoyao visited the rehabilitation clinic and commenced her course of recovery. The intervention was initiated with the health maintenance dimension. Xiaoyao received training in traditional Chinese sleep methods (quiescence breathing and Kung Fu of sleep) [ 21 ] and dietary guidance to reduce high-fat intake, with daily practice prescribed. At her second visit (Nov 22), she reported improved sleep quality and physical fitness (e.g., cycling/stair climbing) and expressed strong motivation for weight loss. Given her adequate nutritional status and low-energy-expenditure lifestyle (including morning quiescence training during medical leave), she was advised to adopt 16:8 intermittent fasting [ 22 ], restricting meals to lunch and dinner. During the third follow-up (Dec 13), she updated dietary and exercise progress and subsequently enrolled in a six-week Occupational Harmony Sleep Program [ 23 ]. This program provided daily online sleep sessions (pre-bedtime and after waking), peer support groups (including a breast cancer patient subgroup), and personalized lifestyle guidance. By the fourth follow-up (Feb 26, 2025), having achieved sleep improvement and weight loss goals, the focus shifted to work reintegration. To address her workaholic tendency compromising self-care, activities from the virtuous and rational dimensions were introduced: quiescence thinking and reflective journaling to optimize daily prioritization, adjust worldviews, core beliefs and values, and the subsequent behaviour patterns, alongside maintained health maintenance practices as a buffer against occupational stress. From Mar 1 to May 24, 2025, Xiaoyao volunteered in subsequent Occupational Harmony Sleep Program sessions, consistently practicing prescribed quiescence techniques while mentoring new participants through experiential sharing. 2.3. Measurements Sleep quality improvement was measured using the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and a Five-dimensional Sleep Index (5D-SI) developed based on the MOHar. Emotional state was measured using Zung's Anxiety Scale and Zung’s Depression Scale. Quality of life was assessed with the SF-36 Health Survey and the Occupational Harmony Questionnaire. The assessments were conducted at baseline, mid-intervention, and post-intervention. Xiaoyao was asked to maintain a daily log of her body weight, measured each morning, and to keep sleep diaries using an online platform before bed and after waking, including recording sleep latency, bedtime/wake-up times, pre-sleep medication use, daytime naps, nighttime awakenings, and morning refreshment levels. The online platform automatically calculated task completion rates, including online sleep training frequency, duration, and video viewing time. Sleep logs were only required during the active training period of the sleep program. 2.4. Data analysis In line with the study's aims, the data analysis involved the following steps. First, the patient’s medical records, examination reports, measurement results, written articles and summaries, and autobiographical materials were gathered. Audio recordings of the participant’s speech in group activity sessions are transcribed, and the therapist–patient communication records are compiled. All these materials are used to build a case record organized by the recovery timeline. Next, the second author condensed the raw data chronologically, identifying key recovery themes and stages through a triangulation of multiple sources of evidence [ 18 ], and organized the original materials under the corresponding phases. Subsequently, the first author reviewed the condensed data to identify meaningful themes and discussed recovery mechanisms with the second author to refine the analysis. The analysis was then reviewed by the fifth author, a PhD candidate in occupational science. Finally, the manuscript was reviewed by all authors and the participant to confirm its trustworthiness. 3. Results 3.1. Overcoming the fear of insomnia Overcoming the fear of insomnia was Xiaoyao's primary concern, and thus, her recovery journey began at this very point. To break the vicious cycle wherein insomnia led to a fear of poor sleep, which in turn made it even more difficult to fall asleep, Xiaoyao was instructed to practice techniques for quiescence breathing each night before bed. A core principle of practicing this exercise was to “resonate with nature” and achieve a state of "without thinking or worrying, completely free from distracting thoughts." Although Xiaoyao was sceptical, believing herself to be a fanciful person whose mind would naturally wander and finding the goal utterly unattainable, she agreed to follow the physician's guidance and encouragement and committed to trying as instructed. After three weeks of practice, Xiaoyao felt that silently reciting the mantra and focusing only on breathing before sleep had indeed significantly improved her sleep quality. Her insomnia symptoms had already alleviated. Describing her training experience vividly, she analogized, "It's like there are two little people in my mind. When one wants to run off and play, the other must quickly pull it back, promptly reining the thoughts in." By her second outpatient visit, Xiaoyao's complexion had become rosy, and she was glowing with vitality. The physician noted the significant improvement in her sleep quality and reinforced this progress with positive and firm feedback, which greatly delighted and encouraged Xiaoyao, solidifying her confidence to persevere. 3.2. Restoring sleep tranquillity and renewing vitality By the sixth week of treatment, Xiaoyao reported noticeable improvement in sleep quality, though it remained vulnerable to environmental influences, and she still experienced occasional difficulty falling asleep. Given her self-described sensitivity and tendency to overthink, external factors and mental chatter continued to affect her rest. During this period, Xiaoyao joined the Occupational Harmony Sleep Program. She engaged actively in group sessions and completed the “Kung Fu of Sleep” online course twice, gaining appreciation for the scientific and cultural foundations of quiescence breathing and its mind–body benefits. Adhering to the program’s principle of “calm the mind before resting the body” and treatment procedure, she established a structured nightly routine involving watching calming videos (featuring soft music, scenes of natural landscapes, and excerpts from traditional Chinese classics), activity review, 10–30 minutes of quiescence breathing practice, and wearable-assisted heart rate monitoring. Each morning, she performed Zhan Zhuang (standing meditation) and Ba Duan Jin exercises, logged her data, and maintained a sleep diary—gradually mastering a cycle of feedforward, execution, recording, feedback, and regimen optimization. By the program’s fifth week, substantial improvement was observed. Xiaoyao no longer feared insomnia, fell asleep quickly, and achieved stable deep sleep. Her total sleep need decreased from 10 hours to 6–7 hours per night, with higher daytime energy and no need for naps. Assessment scales confirmed comprehensive gains (Fig. 1 ). PSQI fell from 6 to 1, ISI from 9 to 3, and SF-36 subscales such as role-physical and role-emotional increased from 0 to 100. After completing the program, she reflected on having internalized a mindset free from distraction, achieving a renewed state of physical and mental well-being that she had “never experienced before.” 3.3. Regaining control of the body and recovering physically In addition to sleep improvement, weight management and physical recovery constituted Xiaoyao’s secondary rehabilitation goals. Prior to her illness, she maintained a moderate weight (~ 60 kg) and enjoyed running, though previous weight-loss attempts had been unsuccessful. During the post-surgical period and radiotherapy, a high-calorie diet combined with inactivity led to a peak weight of 70 kg (BMI 26.5 kg/m²) and comorbidities including hyperlipidaemia, fatty liver, and leukopenia. She expressed strong motivation to lose weight and regain fitness, but lacked confidence due to past failures. Under medical guidance, Xiaoyao adopted a structured weight-loss plan aimed at achieving a BMI of 24 (63.4 kg) through balanced nutrition and controlled dietary intake, combined with graded aerobic and endurance training, with an emphasis on avoiding excessive exertion. Beginning Nov 17, she systematically recorded daily caloric intake, avoided pro-inflammatory foods, and developed varied, palatable low-energy recipes. Her physical regimen included walking, cycling, yoga, and traditional practices such as Zhan Zhuang and Ba Duan Jin, progressively increasing in intensity. Through consistent caloric control and integrated exercise, her weight decreased from 66.9 kg to 57.4 kg by January 26, 2025 (Fig. 2 ). Her new year examinations revealed normalized lipids, glucose, blood pressure, and resolution of fatty liver and haemangioma—her most favourable results in a decade. Reflecting on the process, she noted, “The experience revealed how little food the body truly needs, and the fulfilment gained from mastering self-control over diet and physical conditioning is unparalleled.” 3.4. Lifestyle rebuilt and redefining the ultimate goal of life Resuming normal work-life balance represented a key recovery goal for Xiaoyao, a 40-year-old senior engineer. Having gradually recovered from severe debility, she began reassessing her previous over-committed work patterns and sleep anxiety linked to night-shift history. She expressed a need to recalibrate her life values and daily rhythm to meet professional responsibilities without compromising health. After health indicators normalized post–Spring Festival, Xiaoyao resumed work but soon reported fatigue, increased daytime sleepiness, and concerns about health regression, despite normal check-up results. In the third week after returning to work, she revisited the rehabilitation outpatient clinic for guidance on achieving a better work–life balance. The physician analysed her occupational engagement profile, recommending strengthened virtuous engagement (e.g., reading Chinese traditional cultural classics like Tao Te Ching and Zuo Wang Lun , quiescence thinking) to reshape life–work perspectives and rational engagement through daily routine reviews to foster behaviour adjustment, particularly her tendency for excessive work immersion. Being encouraged to document her recovery experience to help others, she showed increased motivation and dedication. Xiaoyao resumed pre-sleep routines involving calming videos (Fig. 3 ) and quiet reflection, continually drawing insight from classical texts to prioritize meaningful engagements and reduce distractions. She consciously shifted family dynamics, no longer imposing high standards on her children, and cultivated a harmonious home atmosphere. During a group activity at the sleep program, she shared that she had not only reshaped many of her previous perspectives but had also inspired her family and friends to embrace a healthier lifestyle, achieving a greater sense of physical and mental well-being. She described this as the most rewarding accomplishment in her recovery journey. Currently, Xiaoyao has healthily reintegrated into work with a positive and energetic outlook. She noted that the recovery journey not only resolved insomnia and enabled weight loss but also opened a whole new world in her life and fundamentally altered her perception of life priorities. In her words, “For my family, my very existence is my most important mission.” She has since written an autobiography, hoping to make sense of her first forty years of life, conveying a genuine, free-spirited attitude and an embrace of life’s journey. In recent follow-ups, we learned that Xiaoyao is currently in excellent condition, reporting high well-being, a balanced life, manageable work, and stable sleep and weight. 4. Discussion Xiaoyao’s case demonstrates a notably positive outcome. A patient with two cancer episodes, recent surgery, and radiotherapy reported better subjective perception of well-being than she had in four decades. Such pronounced improvement invites analysis of the contributing factors and their implications. Key elements underpinning this success include a strong therapeutic alliance, a proactive and action-oriented disposition, and consistent adherence to the treatment plan. Consistent self-monitoring and feedback facilitated effective communication between the client and healthcare providers, enhanced the client’s sensitivity to perceived improvements, and reinforced her sense of achievement, thereby supporting sustained adherence to the lifestyle intervention. This pattern aligns with prior evidence that personality factors such as conscientiousness and agreeableness are associated with higher treatment adherence in cancer outpatients [ 24 ]. Notably, her openness to sharing her experience within a group-based sleep program created a supportive loop of mutual encouragement—a feature often emphasized as highly valued in group-based OT interventions for cancer survivors [ 25 ]. Furthermore, because she identifies strongly with traditional Chinese cultural values, the cultural foundation of MOHar resonated deeply with her through therapeutic occupations such as watching calming videos with classics, practicing Kung Fu of sleep, quiescent breathing, and standing meditation. This cultural alignment strengthened her trust in the intervention and facilitated the translation of therapeutic principles into everyday life. As these principles became integrated across work, home, and other personal routines, she developed a greater sense of coherence, which in turn contributed to inner peace and tranquillity, an outcome aligned with culturally resonant OT approaches that integrate client values [ 26 ]. The recovery process lasted nearly seven months and advanced systematically from the psychological to the physiological and spiritual levels. It began with training to clear the mind and halt incessant thinking, thereby breaking the vicious cycle of negative thoughts and overcoming the fear of insomnia. Subsequently, by participating in a sleep program, she connected with a larger collective field, resonating with the group, nature rhythm (i.e., cycle of day-night, seasons, and energy), and classical Taoist wisdom over millennia. This strengthened a unity of self, others, and nature [ 16 , 17 ], which activated her spiritual energy [ 27 ] and resulted in more restful sleep and further renewed vitality. Serving as a pivot, a sound sleep enhanced her body's self-organizing capacity, an innate healing ability to restore homeostatic balance, leading to a series of physiological improvements [ 28 ]. These changes included weight loss, increased physical stamina, and improvement in conditions such as hyperlipidaemia, fatty liver, and haemangioma. Essentially, she regained a sense of control over her body. After returning to work, facing new fluctuations and challenges due to increased workload, she further adjusted her life values and priorities. Writing an autobiography helped her reconsider the meaning of life and clarify her mission, and thus achieve a wholeness of the body, mind, and spirit. Guided by the MOHar, the intervention started from the health maintenance dimension, improving sleep, then progressed to the virtuous dimension, adjusting life beliefs and lifestyles, followed by the rational dimension, enhancing wisdom in handling work and life matters. It further advanced to the productive dimension (contributing to the lives of others) and the emotional dimension (loving life and living in the present). Led by the goal of reshaping life's values, the intervention encompassed all aspects of life. Unlike conventional cancer rehabilitation that often prioritizes physical function or symptom-specific management [ 29 ], MOHar facilitated comprehensive growth by realigning values, habits, behaviours, and mindsets. This systematic progression echoes the core OT tenet of "occupational balance" but extends it by explicitly incorporating spiritual and cultural dimensions—areas increasingly recognized in contemporary OT but not always structurally integrated [ 30 ]. From the perspective of occupational harmony, lifestyle-related diseases result from the disruption in human-environment transactions. Therefore, illness serves as a warning from the body and can also become an opportunity for life transformation in terms of adjusting an individual’s lifestyle and orchestrating human-environment relationships; a breakthrough lies in a correct understanding and a proper mindset in response. This view contributes to the ongoing dialogue on the transactional perspectives in occupational science, which seek to understand behavioural change and continuity, as well as their impact on health outcomes [ 31 ]. Aligning with this perspective, interventions based on the MOHar are characterized by five core principles. First, they adhere to the concept that consciousness guides behaviour, with adjustments progressing systematically from the cognitive to the physical and ultimately the spiritual level. By initially modifying cognition to reshape behavioural patterns, the intervention facilitates profound change at the spiritual level, promoting harmonious human-environment transactions. Second, they emphasize the organic and systemic nature of recovery, recognizing that a recovery process involves multiple facets of life and encompasses needs at the physical, psychological, and spiritual levels. These multidimensional and multilevel needs are naturally interconnected, and their prioritization and sequencing must be carefully managed. Third, a client-led approach is central, leveraging the individual’s innate potential and self-organizing capacity for healing, whether in individual or group contexts. An in-depth understanding of the client's personality traits, values, interests, and cultural beliefs is essential for facilitating their active participation in therapeutic activities. Fourth, the model strategically incorporates team support, offering professional guidance and peer reinforcement to help overcome personal limitations—such as challenges in self-discipline—and creating synergistic effects through social connectivity. Fifth, MOHar focuses on fostering resonance between the mind–body system and the broader natural environment, emphasizing cross-temporal coherence from momentary experiences to the life course as a whole, thereby integrating fragmented states of being and enabling spiritual-level recovery. This case suggests that MOHar offers a structured, culturally resonant approach for facilitating holistic recovery. While further controlled studies are needed, its systematic and multidimensional approach aligns well with current best practices in occupational therapy and cancer rehabilitation and extends them [ 32 ]. By uniting evidence-based OT principles with traditional Chinese wellness philosophy and practice, MOHar merits broader investigation as a viable and potent framework, particularly for populations where cultural and spiritual dimensions are central to health and meaning. Future studies will continue observing the patient’s recovery trajectory and long-term prognosis. The applicability of the MOHar-guided intervention should also be examined in larger and more diverse populations to address the limited statistical power of this case study, and the mechanisms linking occupational harmony with holistic well-being across clinical contexts should be further investigated. Notably, occupational therapy rooted in traditional Chinese wellness culture works well in China but may not be as generalizable in other cultures. However, every culture can discover that enduring and powerful force within its own cultural environment and historical heritage. We envision adapting the MOHar for broader social and cultural contexts. 5. Conclusions This case presents the first application of the Model of Occupational Harmony in cancer rehabilitation. It demonstrates how occupation-based interventions can facilitate holistic recovery—physical, psychological, and spiritual—and elucidates the mechanisms through which occupational harmony promotes health. The MOHar posits that health arises from equilibrium across several domains, including physical-mental, quiet-active, and individual-social engagement, as well as harmony among five dimensions and multi-level coherence. Beginning with health-related adjustments in diet, sleep, and physical activity, the intervention progressed to the virtuous dimension, rational dimension, and productive dimension, achieving step-by-step multi-level coherence connecting the client with community, nature, history, and traditional Chinese philosophy, leading to a profound transformation of body, mind, and spirit. Future studies should investigate the efficacy of MOHar in larger and more diverse client populations, including comparative effectiveness research with other interventional models. Declarations Acknowledgments: The authors thank Prof. Zhensu She’s guidance on this work and the participant who inspired this case report. Funding Statement: This research was funded by the National High Level Hospital Clinical Research Funding (Youth Clinical Research Project of Peking University First Hospital), grant number 2024YC10. Data Availability Statement: Research data in this article are unavailable due to privacy restrictions. Human Ethics and Consent Statement: The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Peking University First Hospital (protocol code 2024Study386 and approval date 2024/08/05). Written informed consent has been obtained from the participant to publish this paper. References Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-63. doi: 10.3322/caac.21834 Arnold M, Morgan E, Rumgay H, et al. Current and future burden of breast cancer: Global statistics for 2020 and 2040. 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Occupational therapy intervention for cancer patients following hospital discharge: How and when should we intervene? A systematic review. Aust Occup Ther J. 2021;68(6):546-62. doi: 10.1111/1440-1630.12750 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8154135","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":551563360,"identity":"b2046223-1e40-4016-bb3c-8bcc3fc71e24","order_by":0,"name":"Yijun Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIie3LMQuCQBTA8SeBLketTyTqI1y0CH4ZD0GXiEaHiJtubRX6EoHQLAjXYrQKOjf3CaIzh5awa2u4P+/gPbgfgMn0j40gBNggTMDuT01CEVyuTV5RNYUuoWe4eRvqs7wRMUIaMO5cimFSQuxlFNmplRKhShgn6/A7IR2pE4GWKBlHQvVInnXk8Qs5YizR4hrELSEKFFlmrYz8UCZLQVbDZHytWEPS3XR/EIv6vg2me6caJvOChP2G6nWrPfhfNeNO8SYmk8lk+tQT6z4/tjUVDPQAAAAASUVORK5CYII=","orcid":"","institution":"Peking University First Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yijun","middleName":"","lastName":"Liu","suffix":""},{"id":551563361,"identity":"3ca2f7c4-a643-4006-8f4d-352cb5985729","order_by":1,"name":"Yu Xin","email":"","orcid":"","institution":"Peking University","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Xin","suffix":""},{"id":551563362,"identity":"a31652b8-236d-4dde-bf30-6c5b35941201","order_by":2,"name":"Yexin Zhu","email":"","orcid":"","institution":"Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yexin","middleName":"","lastName":"Zhu","suffix":""},{"id":551563363,"identity":"cb7bd9a2-6234-4ce6-94ee-3f8560909733","order_by":3,"name":"Yaqing Wu","email":"","orcid":"","institution":"Peking University First Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yaqing","middleName":"","lastName":"Wu","suffix":""},{"id":551563364,"identity":"43bc12ef-b27e-45e0-8036-3ba12ddbb127","order_by":4,"name":"Yujia Mo","email":"","orcid":"","institution":"University of Southern California","correspondingAuthor":false,"prefix":"","firstName":"Yujia","middleName":"","lastName":"Mo","suffix":""}],"badges":[],"createdAt":"2025-11-19 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13:13:23","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":86779,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8154135/v1/f67cb4cc068615f0fa1b3da2.html"},{"id":97150862,"identity":"8a9ec52f-7fb7-4561-b44d-1663a0f8fea0","added_by":"auto","created_at":"2025-12-01 10:37:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":256044,"visible":true,"origin":"","legend":"\u003cp\u003eXiaoyao's Assessment Scores Change Over Time. (a) PSQI scores change over time; (b) ISI scores change over time; (c) 5D-SI scores change over time; (d) Zung’s Anxiety Scale scores change over time; (e) Zung’s Depression Scale scores change over time; (f) SF-36 scores change over time; (g) Occupational Harmony Questionnaire scores change over time; (h) Daily sleep diaries scores change over time.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8154135/v1/4219f5bfc28d13694951cd10.png"},{"id":97150860,"identity":"f14de7ca-e57d-470e-a1e6-e0560bc61671","added_by":"auto","created_at":"2025-12-01 10:37:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":98026,"visible":true,"origin":"","legend":"\u003cp\u003eXiaoyao's Weight Change Over Time\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8154135/v1/c5d857b8356004241a67cabc.png"},{"id":97150861,"identity":"16a29b90-1542-452f-8267-fe41e74e4e5e","added_by":"auto","created_at":"2025-12-01 10:37:38","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":76095,"visible":true,"origin":"","legend":"\u003cp\u003eXiaoyao's Video Viewing Duration Over Time\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8154135/v1/5ae86c9528dd287dd1440659.png"},{"id":97668256,"identity":"ded710d1-e313-4160-b5f6-cebd34731b9c","added_by":"auto","created_at":"2025-12-08 09:25:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":791347,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8154135/v1/6fdf9194-68e9-4d07-95f1-255a42c3619c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Promoting holistic recovery for cancer survivors through enhancing occupational harmony: A case report","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe World Health Organization estimates that in 2022, there were 20.0\u0026nbsp;million new cases of cancer and 9.7\u0026nbsp;million deaths from cancer worldwide. Globally, one in five men or women develops cancer during their lifetime, and one in nine men and one in 12 women die from cancer [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This all contributes to its very high disease burden, especially in transitioning countries where cancer incidence is rising rapidly, and mortality rates remain high [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCancer survivors may retain many residual impacts of the disease and its treatment, which can impact both their physical and mental well-being. For example, cancer survivors exhibit a higher prevalence of conditions such as debility, psychological distress, depression, social isolation, and sleep disturbances compared to the general population [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLifestyle interventions have been shown to improve cancer survivors\u0026rsquo; health and quality of life [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], thereby lowering the risk of long-term disability, hospitalization, and overall mortality [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Among lifestyle factors, sleep disturbance is one of the most prevalent challenges faced by individuals with cancer, particularly those undergoing chemotherapy [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Previous interventions integrating elements such as physical activity and diet have attempted to address cancer-related fatigue, sleep quality, and overall well-being [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, their effects on sleep outcomes and psychosocial well-being remain inconsistent, largely due to the lack of a comprehensive approach that acknowledges the holistic nature of daily living [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCancer management typically involves a multidisciplinary team, including doctors, nurses, therapists, counsellors, and psychologists. While the team-based approach seeks to address multiple facets of cancer recovery, the sub-specialized nature of each professional's practice can limit the capacity to comprehensively view and support the client\u0026rsquo;s holistic needs [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Occupational therapy (OT) is an essential component of rehabilitation, emphasizing the improvement of a person\u0026rsquo;s function, encompassing both physical and psychosocial abilities. OT practitioners are unique in the value they place on the mind-body-spirit connection, thereby viewing their clients as holistic beings with complex functional needs [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCancer rehabilitation is an emerging OT practice area, where OT practitioners have the potential to improve holistic well-being by leveraging self-care as a critical component of daily life and recovery [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Current evidence shows that OT can improve the quality of life of breast cancer patients, especially their global health, physical health, social health, cognitive function, fatigue, and role function[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRecently, the Model of Occupational Harmony (MOHar) has been proposed to elucidate the relationship between the orchestration of everyday occupations and health and well-being [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The model proposed that lifestyle patterns that hold equilibria among three pairs of two-sided occupational characteristics (i.e., physical and mental engagement, quiet and active engagement, individual and social engagement), harmony among five-dimensional occupational engagement (i.e., virtuous engagement, rational engagement, productive engagement, emotional engagement, health maintenance engagement), and coherence across multiple levels (i.e., ontosystem, small-system, medium-system, large-system, chronosystem) of human-environment transactions were essential to health and well-being.\u003c/p\u003e\u003cp\u003eThis article presents a case report of a client with both thyroid and breast cancer diagnoses, demonstrating how the MOHar was applied to support holistic recovery for cancer survivors, the outcomes achieved, and the underlying mechanisms of recovery.\u003c/p\u003e"},{"header":"2. Material and Methods","content":"\u003cp\u003eTo exemplify the MOHar, a case study method was employed. Case study research is an in-depth investigation of a phenomenon within its real context [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. It is applicable to studies in a holistic perspective, capturing the context and complexity of occupational therapy practice [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. The Participant\u003c/h2\u003e\u003cp\u003eThe participant was selected from clients the first author met through her regular work at a rehabilitation medicine outpatient clinic. While receiving conventional treatment, the client also participated in a larger interventional study applying the MOHar to improve sleep. The interventional study was approved by the ethics committee of Peking University First Hospital (Approval number: 2024Study386). The participant voluntarily agreed to report her recovery case and has signed a written informed consent form for publication.\u003c/p\u003e\u003cp\u003eThe client, here called Xiaoyao (pseudonym), is a 40-year-old woman residing in a major city in China. She is married and has a 13-year-old son and an 8-year-old daughter. In 2014, at the age of thirty, she was diagnosed with thyroid cancer and underwent a total thyroidectomy and radioactive iodine therapy. Ten years after her initial diagnosis of thyroid cancer, she was diagnosed with breast cancer in August 2024.\u003c/p\u003e\u003cp\u003eXiaoyao is a senior engineer working in a media organization. A four-year history of night-shift work has severely disrupted her sleep-wake cycle, leading to insomnia exacerbated by fear of sleeplessness. After the breast cancer diagnosis, she took a medical leave and had a breast-conserving surgery (post-op pT1N0) followed by adjuvant endocrine therapy and radiotherapy.\u003c/p\u003e\u003cp\u003eThis treatment regimen caused substantial pain, fatigue, and depressed mood, pushing her near a psychological collapse and significantly worsening her sleep. In addition, she gained weight quickly in three months due to consuming large amounts of highly nutritious food after surgery, which worsened her frailty.\u003c/p\u003e\u003cp\u003eUpon completion of the 20th radiotherapy session, she visited the rehabilitation medicine outpatient clinic seeking help to improve her sleep and manage her weight, with the goal of resuming a normal work and life the following year.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Interventions based on the MOHar\u003c/h2\u003e\u003cp\u003eThe occupational therapy intervention was developed based on the MOHar, a quiescence-based lifestyle program designed to enhance occupational harmony [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The treatment was provided by the first author, the developer of the MOHar, who is a physician trained in both rehabilitation medicine and occupational therapy.\u003c/p\u003e\u003cp\u003eOn November 1, 2024, Xiaoyao visited the rehabilitation clinic and commenced her course of recovery. The intervention was initiated with the health maintenance dimension. Xiaoyao received training in traditional Chinese sleep methods (quiescence breathing and Kung Fu of sleep) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and dietary guidance to reduce high-fat intake, with daily practice prescribed.\u003c/p\u003e\u003cp\u003eAt her second visit (Nov 22), she reported improved sleep quality and physical fitness (e.g., cycling/stair climbing) and expressed strong motivation for weight loss. Given her adequate nutritional status and low-energy-expenditure lifestyle (including morning quiescence training during medical leave), she was advised to adopt 16:8 intermittent fasting [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], restricting meals to lunch and dinner.\u003c/p\u003e\u003cp\u003eDuring the third follow-up (Dec 13), she updated dietary and exercise progress and subsequently enrolled in a six-week Occupational Harmony Sleep Program [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This program provided daily online sleep sessions (pre-bedtime and after waking), peer support groups (including a breast cancer patient subgroup), and personalized lifestyle guidance.\u003c/p\u003e\u003cp\u003eBy the fourth follow-up (Feb 26, 2025), having achieved sleep improvement and weight loss goals, the focus shifted to work reintegration. To address her workaholic tendency compromising self-care, activities from the virtuous and rational dimensions were introduced: quiescence thinking and reflective journaling to optimize daily prioritization, adjust worldviews, core beliefs and values, and the subsequent behaviour patterns, alongside maintained health maintenance practices as a buffer against occupational stress.\u003c/p\u003e\u003cp\u003eFrom Mar 1 to May 24, 2025, Xiaoyao volunteered in subsequent Occupational Harmony Sleep Program sessions, consistently practicing prescribed quiescence techniques while mentoring new participants through experiential sharing.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Measurements\u003c/h2\u003e\u003cp\u003eSleep quality improvement was measured using the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and a Five-dimensional Sleep Index (5D-SI) developed based on the MOHar. Emotional state was measured using Zung's Anxiety Scale and Zung\u0026rsquo;s Depression Scale. Quality of life was assessed with the SF-36 Health Survey and the Occupational Harmony Questionnaire. The assessments were conducted at baseline, mid-intervention, and post-intervention.\u003c/p\u003e\u003cp\u003eXiaoyao was asked to maintain a daily log of her body weight, measured each morning, and to keep sleep diaries using an online platform before bed and after waking, including recording sleep latency, bedtime/wake-up times, pre-sleep medication use, daytime naps, nighttime awakenings, and morning refreshment levels. The online platform automatically calculated task completion rates, including online sleep training frequency, duration, and video viewing time. Sleep logs were only required during the active training period of the sleep program.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4. Data analysis\u003c/h2\u003e\u003cp\u003eIn line with the study's aims, the data analysis involved the following steps. First, the patient\u0026rsquo;s medical records, examination reports, measurement results, written articles and summaries, and autobiographical materials were gathered. Audio recordings of the participant\u0026rsquo;s speech in group activity sessions are transcribed, and the therapist\u0026ndash;patient communication records are compiled. All these materials are used to build a case record organized by the recovery timeline. Next, the second author condensed the raw data chronologically, identifying key recovery themes and stages through a triangulation of multiple sources of evidence [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and organized the original materials under the corresponding phases. Subsequently, the first author reviewed the condensed data to identify meaningful themes and discussed recovery mechanisms with the second author to refine the analysis. The analysis was then reviewed by the fifth author, a PhD candidate in occupational science. Finally, the manuscript was reviewed by all authors and the participant to confirm its trustworthiness.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Overcoming the fear of insomnia\u003c/h2\u003e\u003cp\u003eOvercoming the fear of insomnia was Xiaoyao's primary concern, and thus, her recovery journey began at this very point.\u003c/p\u003e\u003cp\u003eTo break the vicious cycle wherein insomnia led to a fear of poor sleep, which in turn made it even more difficult to fall asleep, Xiaoyao was instructed to practice techniques for quiescence breathing each night before bed. A core principle of practicing this exercise was to \u0026ldquo;resonate with nature\u0026rdquo; and achieve a state of \"without thinking or worrying, completely free from distracting thoughts.\" Although Xiaoyao was sceptical, believing herself to be a fanciful person whose mind would naturally wander and finding the goal utterly unattainable, she agreed to follow the physician's guidance and encouragement and committed to trying as instructed.\u003c/p\u003e\u003cp\u003eAfter three weeks of practice, Xiaoyao felt that silently reciting the mantra and focusing only on breathing before sleep had indeed significantly improved her sleep quality. Her insomnia symptoms had already alleviated. Describing her training experience vividly, she analogized, \"It's like there are two little people in my mind. When one wants to run off and play, the other must quickly pull it back, promptly reining the thoughts in.\"\u003c/p\u003e\u003cp\u003eBy her second outpatient visit, Xiaoyao's complexion had become rosy, and she was glowing with vitality. The physician noted the significant improvement in her sleep quality and reinforced this progress with positive and firm feedback, which greatly delighted and encouraged Xiaoyao, solidifying her confidence to persevere.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Restoring sleep tranquillity and renewing vitality\u003c/h2\u003e\u003cp\u003eBy the sixth week of treatment, Xiaoyao reported noticeable improvement in sleep quality, though it remained vulnerable to environmental influences, and she still experienced occasional difficulty falling asleep. Given her self-described sensitivity and tendency to overthink, external factors and mental chatter continued to affect her rest.\u003c/p\u003e\u003cp\u003eDuring this period, Xiaoyao joined the Occupational Harmony Sleep Program. She engaged actively in group sessions and completed the \u0026ldquo;Kung Fu of Sleep\u0026rdquo; online course twice, gaining appreciation for the scientific and cultural foundations of quiescence breathing and its mind\u0026ndash;body benefits. Adhering to the program\u0026rsquo;s principle of \u0026ldquo;calm the mind before resting the body\u0026rdquo; and treatment procedure, she established a structured nightly routine involving watching calming videos (featuring soft music, scenes of natural landscapes, and excerpts from traditional Chinese classics), activity review, 10\u0026ndash;30 minutes of quiescence breathing practice, and wearable-assisted heart rate monitoring. Each morning, she performed Zhan Zhuang (standing meditation) and Ba Duan Jin exercises, logged her data, and maintained a sleep diary\u0026mdash;gradually mastering a cycle of feedforward, execution, recording, feedback, and regimen optimization.\u003c/p\u003e\u003cp\u003eBy the program\u0026rsquo;s fifth week, substantial improvement was observed. Xiaoyao no longer feared insomnia, fell asleep quickly, and achieved stable deep sleep. Her total sleep need decreased from 10 hours to 6\u0026ndash;7 hours per night, with higher daytime energy and no need for naps. Assessment scales confirmed comprehensive gains (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). PSQI fell from 6 to 1, ISI from 9 to 3, and SF-36 subscales such as role-physical and role-emotional increased from 0 to 100. After completing the program, she reflected on having internalized a mindset free from distraction, achieving a renewed state of physical and mental well-being that she had \u0026ldquo;never experienced before.\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.3. Regaining control of the body and recovering physically\u003c/h2\u003e\u003cp\u003eIn addition to sleep improvement, weight management and physical recovery constituted Xiaoyao\u0026rsquo;s secondary rehabilitation goals. Prior to her illness, she maintained a moderate weight (~\u0026thinsp;60 kg) and enjoyed running, though previous weight-loss attempts had been unsuccessful. During the post-surgical period and radiotherapy, a high-calorie diet combined with inactivity led to a peak weight of 70 kg (BMI 26.5 kg/m\u0026sup2;) and comorbidities including hyperlipidaemia, fatty liver, and leukopenia. She expressed strong motivation to lose weight and regain fitness, but lacked confidence due to past failures.\u003c/p\u003e\u003cp\u003eUnder medical guidance, Xiaoyao adopted a structured weight-loss plan aimed at achieving a BMI of 24 (63.4 kg) through balanced nutrition and controlled dietary intake, combined with graded aerobic and endurance training, with an emphasis on avoiding excessive exertion. Beginning Nov 17, she systematically recorded daily caloric intake, avoided pro-inflammatory foods, and developed varied, palatable low-energy recipes. Her physical regimen included walking, cycling, yoga, and traditional practices such as Zhan Zhuang and Ba Duan Jin, progressively increasing in intensity.\u003c/p\u003e\u003cp\u003eThrough consistent caloric control and integrated exercise, her weight decreased from 66.9 kg to 57.4 kg by January 26, 2025 (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Her new year examinations revealed normalized lipids, glucose, blood pressure, and resolution of fatty liver and haemangioma\u0026mdash;her most favourable results in a decade. Reflecting on the process, she noted, \u0026ldquo;The experience revealed how little food the body truly needs, and the fulfilment gained from mastering self-control over diet and physical conditioning is unparalleled.\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.4. Lifestyle rebuilt and redefining the ultimate goal of life\u003c/h2\u003e\u003cp\u003eResuming normal work-life balance represented a key recovery goal for Xiaoyao, a 40-year-old senior engineer. Having gradually recovered from severe debility, she began reassessing her previous over-committed work patterns and sleep anxiety linked to night-shift history. She expressed a need to recalibrate her life values and daily rhythm to meet professional responsibilities without compromising health.\u003c/p\u003e\u003cp\u003eAfter health indicators normalized post\u0026ndash;Spring Festival, Xiaoyao resumed work but soon reported fatigue, increased daytime sleepiness, and concerns about health regression, despite normal check-up results. In the third week after returning to work, she revisited the rehabilitation outpatient clinic for guidance on achieving a better work\u0026ndash;life balance. The physician analysed her occupational engagement profile, recommending strengthened virtuous engagement (e.g., reading Chinese traditional cultural classics like \u003cem\u003eTao Te Ching\u003c/em\u003e and \u003cem\u003eZuo Wang Lun\u003c/em\u003e, quiescence thinking) to reshape life\u0026ndash;work perspectives and rational engagement through daily routine reviews to foster behaviour adjustment, particularly her tendency for excessive work immersion. Being encouraged to document her recovery experience to help others, she showed increased motivation and dedication.\u003c/p\u003e\u003cp\u003eXiaoyao resumed pre-sleep routines involving calming videos (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) and quiet reflection, continually drawing insight from classical texts to prioritize meaningful engagements and reduce distractions. She consciously shifted family dynamics, no longer imposing high standards on her children, and cultivated a harmonious home atmosphere. During a group activity at the sleep program, she shared that she had not only reshaped many of her previous perspectives but had also inspired her family and friends to embrace a healthier lifestyle, achieving a greater sense of physical and mental well-being. She described this as the most rewarding accomplishment in her recovery journey.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eCurrently, Xiaoyao has healthily reintegrated into work with a positive and energetic outlook. She noted that the recovery journey not only resolved insomnia and enabled weight loss but also opened a whole new world in her life and fundamentally altered her perception of life priorities. In her words, \u0026ldquo;For my family, my very existence is my most important mission.\u0026rdquo; She has since written an autobiography, hoping to make sense of her first forty years of life, conveying a genuine, free-spirited attitude and an embrace of life\u0026rsquo;s journey. In recent follow-ups, we learned that Xiaoyao is currently in excellent condition, reporting high well-being, a balanced life, manageable work, and stable sleep and weight.\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eXiaoyao\u0026rsquo;s case demonstrates a notably positive outcome. A patient with two cancer episodes, recent surgery, and radiotherapy reported better subjective perception of well-being than she had in four decades. Such pronounced improvement invites analysis of the contributing factors and their implications.\u003c/p\u003e\u003cp\u003eKey elements underpinning this success include a strong therapeutic alliance, a proactive and action-oriented disposition, and consistent adherence to the treatment plan. Consistent self-monitoring and feedback facilitated effective communication between the client and healthcare providers, enhanced the client\u0026rsquo;s sensitivity to perceived improvements, and reinforced her sense of achievement, thereby supporting sustained adherence to the lifestyle intervention. This pattern aligns with prior evidence that personality factors such as conscientiousness and agreeableness are associated with higher treatment adherence in cancer outpatients [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNotably, her openness to sharing her experience within a group-based sleep program created a supportive loop of mutual encouragement\u0026mdash;a feature often emphasized as highly valued in group-based OT interventions for cancer survivors [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Furthermore, because she identifies strongly with traditional Chinese cultural values, the cultural foundation of MOHar resonated deeply with her through therapeutic occupations such as watching calming videos with classics, practicing Kung Fu of sleep, quiescent breathing, and standing meditation. This cultural alignment strengthened her trust in the intervention and facilitated the translation of therapeutic principles into everyday life. As these principles became integrated across work, home, and other personal routines, she developed a greater sense of coherence, which in turn contributed to inner peace and tranquillity, an outcome aligned with culturally resonant OT approaches that integrate client values [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe recovery process lasted nearly seven months and advanced systematically from the psychological to the physiological and spiritual levels. It began with training to clear the mind and halt incessant thinking, thereby breaking the vicious cycle of negative thoughts and overcoming the fear of insomnia. Subsequently, by participating in a sleep program, she connected with a larger collective field, resonating with the group, nature rhythm (i.e., cycle of day-night, seasons, and energy), and classical Taoist wisdom over millennia. This strengthened a unity of self, others, and nature [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], which activated her spiritual energy [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] and resulted in more restful sleep and further renewed vitality. Serving as a pivot, a sound sleep enhanced her body's self-organizing capacity, an innate healing ability to restore homeostatic balance, leading to a series of physiological improvements [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. These changes included weight loss, increased physical stamina, and improvement in conditions such as hyperlipidaemia, fatty liver, and haemangioma. Essentially, she regained a sense of control over her body. After returning to work, facing new fluctuations and challenges due to increased workload, she further adjusted her life values and priorities. Writing an autobiography helped her reconsider the meaning of life and clarify her mission, and thus achieve a wholeness of the body, mind, and spirit.\u003c/p\u003e\u003cp\u003eGuided by the MOHar, the intervention started from the health maintenance dimension, improving sleep, then progressed to the virtuous dimension, adjusting life beliefs and lifestyles, followed by the rational dimension, enhancing wisdom in handling work and life matters. It further advanced to the productive dimension (contributing to the lives of others) and the emotional dimension (loving life and living in the present). Led by the goal of reshaping life's values, the intervention encompassed all aspects of life. Unlike conventional cancer rehabilitation that often prioritizes physical function or symptom-specific management [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], MOHar facilitated comprehensive growth by realigning values, habits, behaviours, and mindsets. This systematic progression echoes the core OT tenet of \"occupational balance\" but extends it by explicitly incorporating spiritual and cultural dimensions\u0026mdash;areas increasingly recognized in contemporary OT but not always structurally integrated [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFrom the perspective of occupational harmony, lifestyle-related diseases result from the disruption in human-environment transactions. Therefore, illness serves as a warning from the body and can also become an opportunity for life transformation in terms of adjusting an individual\u0026rsquo;s lifestyle and orchestrating human-environment relationships; a breakthrough lies in a correct understanding and a proper mindset in response. This view contributes to the ongoing dialogue on the transactional perspectives in occupational science, which seek to understand behavioural change and continuity, as well as their impact on health outcomes [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAligning with this perspective, interventions based on the MOHar are characterized by five core principles. First, they adhere to the concept that consciousness guides behaviour, with adjustments progressing systematically from the cognitive to the physical and ultimately the spiritual level. By initially modifying cognition to reshape behavioural patterns, the intervention facilitates profound change at the spiritual level, promoting harmonious human-environment transactions. Second, they emphasize the organic and systemic nature of recovery, recognizing that a recovery process involves multiple facets of life and encompasses needs at the physical, psychological, and spiritual levels. These multidimensional and multilevel needs are naturally interconnected, and their prioritization and sequencing must be carefully managed. Third, a client-led approach is central, leveraging the individual\u0026rsquo;s innate potential and self-organizing capacity for healing, whether in individual or group contexts. An in-depth understanding of the client's personality traits, values, interests, and cultural beliefs is essential for facilitating their active participation in therapeutic activities. Fourth, the model strategically incorporates team support, offering professional guidance and peer reinforcement to help overcome personal limitations\u0026mdash;such as challenges in self-discipline\u0026mdash;and creating synergistic effects through social connectivity. Fifth, MOHar focuses on fostering resonance between the mind\u0026ndash;body system and the broader natural environment, emphasizing cross-temporal coherence from momentary experiences to the life course as a whole, thereby integrating fragmented states of being and enabling spiritual-level recovery.\u003c/p\u003e\u003cp\u003eThis case suggests that MOHar offers a structured, culturally resonant approach for facilitating holistic recovery. While further controlled studies are needed, its systematic and multidimensional approach aligns well with current best practices in occupational therapy and cancer rehabilitation and extends them [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. By uniting evidence-based OT principles with traditional Chinese wellness philosophy and practice, MOHar merits broader investigation as a viable and potent framework, particularly for populations where cultural and spiritual dimensions are central to health and meaning. Future studies will continue observing the patient\u0026rsquo;s recovery trajectory and long-term prognosis. The applicability of the MOHar-guided intervention should also be examined in larger and more diverse populations to address the limited statistical power of this case study, and the mechanisms linking occupational harmony with holistic well-being across clinical contexts should be further investigated. Notably, occupational therapy rooted in traditional Chinese wellness culture works well in China but may not be as generalizable in other cultures. However, every culture can discover that enduring and powerful force within its own cultural environment and historical heritage. We envision adapting the MOHar for broader social and cultural contexts.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThis case presents the first application of the Model of Occupational Harmony in cancer rehabilitation. It demonstrates how occupation-based interventions can facilitate holistic recovery\u0026mdash;physical, psychological, and spiritual\u0026mdash;and elucidates the mechanisms through which occupational harmony promotes health. The MOHar posits that health arises from equilibrium across several domains, including physical-mental, quiet-active, and individual-social engagement, as well as harmony among five dimensions and multi-level coherence. Beginning with health-related adjustments in diet, sleep, and physical activity, the intervention progressed to the virtuous dimension, rational dimension, and productive dimension, achieving step-by-step multi-level coherence connecting the client with community, nature, history, and traditional Chinese philosophy, leading to a profound transformation of body, mind, and spirit. Future studies should investigate the efficacy of MOHar in larger and more diverse client populations, including comparative effectiveness research with other interventional models.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgments: The authors thank Prof. Zhensu She\u0026rsquo;s guidance on this work and the participant who inspired this case report.\u003c/p\u003e\n\u003cp\u003eFunding Statement: This research was funded by the National High Level Hospital Clinical Research Funding (Youth Clinical Research Project of Peking University First Hospital), grant number 2024YC10.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData Availability Statement: Research data in this article are unavailable due to privacy restrictions.\u003c/p\u003e\n\u003cp\u003eHuman Ethics and Consent Statement: The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Peking University First Hospital (protocol code 2024Study386 and approval date 2024/08/05). Written informed consent has been obtained from the participant to publish this paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-63. doi: 10.3322/caac.21834\u003c/li\u003e\n \u003cli\u003eArnold M, Morgan E, Rumgay H, et al. Current and future burden of breast cancer: Global statistics for 2020 and 2040. Breast. 2022;66:15-23. doi: 10.1016/j.breast.2022.08.010\u003c/li\u003e\n \u003cli\u003eWright LE, Sudheendra PK. Evidence for the benefits of lifestyle medicine interventions in breast cancer survivorship. Oncologist. 2025;30(7). doi: 10.1093/oncolo/oyae303\u003c/li\u003e\n \u003cli\u003eCharalampopoulou M, Tamiolaki EE, Tryfonopoulos D, et al. The impact of lifestyle medicine on quality of life in female breast cancer survivors: A systematic review. 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Effects of sleep interventions on cancer-related fatigue and quality of life in cancer patients: A systematic review and meta-analysis. Support Care Cancer. 2022;30(4):3043-55. doi: 10.1007/s00520-021-06563-5\u003c/li\u003e\n \u003cli\u003eNg ZX, Ong MS, Jegadeesan T, et al. Breast cancer: Exploring the facts and holistic needs during and beyond treatment. Healthcare (Basel). 2017;5(2). doi: 10.3390/healthcare5020026\u003c/li\u003e\n \u003cli\u003eAmerican Occupational Therapy Association. Occupational therapy practice framework: Domain and process (4th ed.). Am J Occup Ther. 2020:7412410010p1-p87\u003c/li\u003e\n \u003cli\u003ePergolotti M, Williams GR, Campbell C, et al. Occupational therapy for adults with cancer: Why it matters. Oncologist. 2016;21(3):314-9. doi: 10.1634/theoncologist.2015-0335\u003c/li\u003e\n \u003cli\u003eBaxter MF, Newman R, Longpr\u0026eacute; SM, et al. Occupational therapy\u0026rsquo;s role in cancer survivorship as a chronic condition. Am J Occup Ther. 2017;71(3):7103090010P1-P7. doi: 10.5014/ajot.2017.713001\u003c/li\u003e\n \u003cli\u003eWallis A, Meredith P, Stanley M. Cancer care and occupational therapy: A scoping review. Aust Occup Ther J. 2020;67(2):172-94. doi: 10.1111/1440-1630.12633\u003c/li\u003e\n \u003cli\u003eHe K, Jiang J, Chen M, et al. Effects of occupational therapy on quality of life in breast cancer patients: A systematic review and meta-analysis. Medicine (Baltimore). 2023;102(31):e34484. doi: 10.1097/md.0000000000034484\u003c/li\u003e\n \u003cli\u003edos Santos Pereira A, Miller A, Akinyemi AO. Bridging the gap: Advancing occupational therapy in cancer recovery for better outcomes. J Med Surg Public Health. 2025;6:100196. doi: 10.1016/j.glmedi.2025.100196\u003c/li\u003e\n \u003cli\u003eLiu Y, Zemke R, Liang L, et al. Model of Occupational Harmony: A Chinese Perspective on Occupational Balance. Ann Int Occup Ther. 2021;4(4):e228-e35. doi:10.3928/24761222-20210601-08\u003c/li\u003e\n \u003cli\u003eLiu Y, Zemke R, Liang L, et al. Occupational harmony: Embracing the complexity of occupational balance. J Occup Sci. 2021;30(2):145-59. doi: 10.1080/14427591.2021.1881592\u003c/li\u003e\n \u003cli\u003eRK Y. Case Study Research and Applications Design and Methods. 6th ed: Los Angeles: SAGE publications; 2018.\u003c/li\u003e\n \u003cli\u003eMcQuaid L, Thomson K, Bannigan K. Case study research: Building the occupational therapy evidence base one case at a time. Scand J Occup Ther. 2023;30(4):435-43. doi: 10.1080/11038128.2022.2039758\u003c/li\u003e\n \u003cli\u003eLiu Y. The model of occupational harmony: an eastern perspective on occupational balance to promote health and well-being[Manuscript submitted for publication].Department of Rehabilitation Medicine, Peking University First Hospital. 2025.\u003c/li\u003e\n \u003cli\u003eChen T. Chen Tuan Ji [Collected Works of Chen Tuan]. 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Am J Occup Ther. 2020;74(4):7404205010p1-p13. doi: 10.5014/ajot.2020.036855\u003c/li\u003e\n \u003cli\u003eMu\u0026ntilde;oz JP. Culturally responsive caring in occupational therapy. Occup Ther Int. 2007;14(4):256-80. doi: 10.1002/oti.238\u003c/li\u003e\n \u003cli\u003eMilton G. Energy therapies. In: Dunning T, editor. Complementary therapies and the management of diabetes and vascular disease: A matter of balance. 27. 1st ed: WILEY; 2006. p. 179-210.\u003c/li\u003e\n \u003cli\u003eShe Z-S, Ni Z. Renti Fuza Xitong Kexue Tansuo [An exploration of the complex systems science of the human body]. Beijing: Chinese Science Publishing \u0026amp; Media Ltd.; 2012.Chinese.\u003c/li\u003e\n \u003cli\u003eStout NL, Santa Mina D, Lyons KD, et al. A systematic review of rehabilitation and exercise recommendations in oncology guidelines. CA: A Cancer Journal for Clinicians. 2021;71(2):149-75. doi: 10.3322/caac.21639\u003c/li\u003e\n \u003cli\u003eMetzger S, Beasley J, Marheineke J, et al. Occupational therapists\u0026apos; perceptions on addressing spirituality: A cross sectional survey. Open J Occup Ther. 2024;12(2):1-10. doi: 10.15453/2168-6408.2177\u003c/li\u003e\n \u003cli\u003eFritz H, Cutchin MP. The transactional perspective on occupation: A way to transcend the individual in health promotion interventions and research. J Occup Sci. 2017;24(4):446-57. doi: 10.1080/14427591.2017.1366354\u003c/li\u003e\n \u003cli\u003eTaylor S, Keesing S, Wallis A, et al. Occupational therapy intervention for cancer patients following hospital discharge: How and when should we intervene? A systematic review. Aust Occup Ther J. 2021;68(6):546-62. doi: 10.1111/1440-1630.12750\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cancer rehabilitation, holistic care, occupational therapy, occupational harmony ","lastPublishedDoi":"10.21203/rs.3.rs-8154135/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8154135/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Oncology rehabilitation requires holistic care that addresses the body, mind, and spirit, yet current treatments are often fragmented. The Model of Occupational Harmony (MOHar) offers a potential framework for supporting comprehensive well-being in cancer survivors.\u003c/p\u003e\n\u003cp\u003eAims: To illustrate the application of the MOHar in cancer recovery and explore its underlying mechanisms.\u003c/p\u003e\n\u003cp\u003eMaterial and Methods: A case study was conducted with a female participant diagnosed with both thyroid and breast cancer, who undertook a lifestyle-based intervention grounded in the MOHar. Sleep quality, emotional state, quality of life, and the level of occupational harmony were assessed using scales at baseline, mid-intervention, and post-intervention. Sleep patterns and body weight were recorded daily using sleep diaries and logs.\u003c/p\u003e\n\u003cp\u003eResults: The participant’s recovery began with addressing a fear of insomnia, leading to improved sleep and restored daytime energy. These gains facilitated weight management and physical recovery, culminating in a lifestyle rebuilt and a renewed sense of life purpose.\u003c/p\u003e\n\u003cp\u003eConclusions: This case demonstrates the successful use of MOHar in supporting holistic cancer rehabilitation, integrating physical, psychological, and spiritual dimensions of recovery.\u003c/p\u003e\n\u003cp\u003eSignificance: Highlights how the MOHar fostered comprehensive recovery by mobilising the body’s innate healing capacity through enhancing harmonious human-environmental transactions.\u003c/p\u003e","manuscriptTitle":"Promoting holistic recovery for cancer survivors through enhancing occupational harmony: A case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-01 10:37:34","doi":"10.21203/rs.3.rs-8154135/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"922f57f7-6116-4038-a6d2-f946c7024f83","owner":[],"postedDate":"December 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-04T17:08:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-01 10:37:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8154135","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8154135","identity":"rs-8154135","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}