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Music therapy; Palliative care; Advanced cancer patients; Psychological well-being; Spiritual well-being; Quality of life; Pain management

Introduction

Palliative care is an approach dedicated to enhancing the quality of life for individuals grappling with life-limiting illnesses, alongside their families [1 -5]. Patients under palliative care frequently grapple with physical and psychological symptoms that can detrimentally affect their overall well-being. Among these, pain and psychological distress emerge as prominently cited issues among advanced cancer patients in palliative care. As cancer advances, the question of spiritual wellbeing becomes increasingly significant for these patients. However, a previous longitudinal study found a notable connection between rising distress and pain and a decline in spiritual well-being and quality of life. Spiritual well-being encompasses the pursuit of meaning, purpose, and value in one's life, encompassing autonomy, connection, coping with mortality, finding significance, and maintaining a positive perspective [6]. This concept has garnered growing attention from healthcare professionals in the oncology and palliative care domains and is now acknowledged as a crucial aspect that demands attention in healthcare and nursing practices.

Extensive research has repeatedly linked spiritual well-being with positive psychosocial functioning and overall quality of life in advanced cancer patients receiving palliative care. It empowers patients to better cope with mental health challenges such as anxiety and depression, and may even influence the progression of cancer itself. Furthermore, patients with advanced cancer in palliative care who possess higher spiritual well-being tend to report fewer physical symptoms and exhibit a greater inclination to initiate advanced care planning [7]. Unfortunately, interventions aimed at enhancing spiritual well-being are often underutilized in clinical practice, negatively impacting treatment adherence, quality of life, and functional recovery. Hence, it is imperative to collect empirical data on interventions that support physical health, psychosocial adaptation, and spiritual well-being, as this is of utmost importance in healthcare.

In the realm of palliative care, symptoms are commonly managed through a combination of pharmacological and non-pharmacological methods. Among the latter, art therapy is an emerging and encompassing approach, encompassing various forms such as music, drama, and art.

Music therapy, in particular, stands out as the most frequently employed type of art therapy among advanced cancer patients in palliative care. Music therapists deliberately select specific musical elements to enhance the physical and mental health of patients. Engaging in music therapy allows advanced cancer patients in palliative care to shift their focus to pleasant activities that help alleviate distress and articulate emotions that may be challenging to express verbally. Moreover, music therapy has been shown to facilitate spiritual healing and address spiritual needs, especially within palliative settings. Clinicians have reported positive advancements in spiritual well-being, psychological distress, quality of life, and pain management through the effective application of music therapy [8].

Recently, two studies have emerged, shedding light on the efficacy of music therapy for cancer patients. Jiang et al. (2020) conducted an up-to-date systematic review encompassing a wide range of outcomes, such as depression, anxiety, quality of life, and pain. On the other hand, Li et al. (2019) concentrated their efforts on patients with breast cancer, focusing solely on depression and anxiety as their evaluation criteria [9 ]. However, it is worth noting that, to date, there hasn't been a dedicated systematic review study specifically investigating the effectiveness of music therapy among patients with advanced cancer in palliative care. Prior systematic reviews concerning advanced cancer research categorized studies based on various treatment phases and presented a narrative synthesis of their findings. Consequently, these reviews didn't provide a quantitative assessment of how music therapy affects patients with advanced cancer, nor did they delineate its impact on specific symptoms. Moreover, these studies did not specify their relevance to advanced cancer in palliative care.

Hence, in the current study, we undertook an updated meta-analysis of music therapy studies, centering our focus on patients grappling with advanced cancer in palliative care [10,11]. We have taken a step further from previous meta-analyses by encompassing more recently published randomized controlled trials (RCTs) and harnessing available evidence to quantitatively ascertain the effects of music therapy on spiritual wellbeing, Quality of life, pain management, and psychological distress.

Discussion

The discussion section of the article provides an opportunity to interpret and contextualize the findings presented in the study. In this case, the discussion revolves around the effectiveness of music therapy for patients with advanced cancer in palliative care, addressing various outcomes including spiritual well-being, quality of life (Quality of life), pain management, and psychological distress.

Improvements in psychological well-being

The study's findings align with prior research indicating that music therapy can significantly benefit cancer patients in terms of psychological well-being [12,13]. The meta-analysis reveals that music therapy has a positive effect on reducing depression and anxiety among advanced cancer patients in palliative care. This is consistent with the broader body of literature suggesting that music therapy can alleviate psychological distress and enhance emotional well-being in various clinical populations.

Enhancement of spiritual well-being: One noteworthy contribution of this study is its focus on spiritual well-being, an area that has gained recognition as a vital aspect of holistic patient care. The meta-analysis demonstrates a positive association between music therapy and spiritual well-being among patients in palliative care. This finding underscores the potential of music therapy not only to address psychological distress but also to promote a sense of meaning, purpose, and connection in the lives of individuals facing the existential challenges of advanced cancer.

Impact on quality of life: Quality of life is a critical outcome measure in palliative care, as it reflects the multidimensional impact of interventions on patients' overall well-being. The study reveals that music therapy contributes to an improvement in Quality of life among advanced cancer patients [14 ]. This result reinforces the idea that music therapy can provide a comprehensive and holistic approach to palliative care by addressing not only physical symptoms but also the emotional, social, and existential dimensions of patients' lives.

Pain management: Pain is a prevalent and often debilitating symptom in advanced cancer patients. The meta-analysis suggests that music therapy has a positive impact on pain management. While the exact mechanisms through which music therapy alleviates pain require further investigation, it is clear that music can serve as a valuable complementary intervention in pain management strategies for these patients.

Implications for clinical practice: The study's findings have several practical implications for healthcare providers in the field of oncology and palliative care. First, music therapy should be considered as an integral component of comprehensive palliative care programs for advanced cancer patients. Its potential to improve psychological well-being, spiritual well-being, Quality of life, and pain management underscores its value in enhancing the overall patient experience. Second, healthcare professionals should be educated and trained in integrating music therapy into their care plans [15]. This may involve collaborating with certified music therapists who can tailor interventions to meet the unique needs of each patient.

Future research directions: While this study provides valuable insights, it also highlights areas for future research. Further investigation is needed to explore the specific mechanisms by which music therapy exerts its effects, as well as the optimal timing and duration of music therapy interventions. Additionally, future studies should aim to standardize outcome measures and consider the diversity of musical genres and techniques employed in music therapy.

In conclusion, this meta-analysis underscores the potential of music therapy as a valuable adjunctive therapy for advanced cancer patients in palliative care. It not only contributes to the reduction of psychological distress and pain but also enhances spiritual well-being and overall Quality of life. Integrating music therapy into palliative care programs can provide a holistic approach to addressing the complex physical, emotional, and existential needs of these patients, ultimately improving their end-of-life experiences.

Conclusion

In conclusion, this study presents compelling evidence of the effectiveness of music therapy as a holistic and valuable intervention for patients facing advanced cancer in palliative care. Through a comprehensive meta-analysis of recent research, we have gained insights into the multifaceted benefits of music therapy, including its positive impact on psychological well-being, spiritual well-being, quality of life (Quality of life), and pain management.

The findings highlight the significance of incorporating music therapy into the care plans of advanced cancer patients in palliative settings. This approach not only addresses the physical symptoms but also acknowledges the emotional, social, and existential aspects of their experience. Music therapy offers a unique avenue for patients to navigate the complex emotional terrain associated with advanced cancer, promoting a sense of meaning, connection, and inner peace. Furthermore, this study underscores the importance of healthcare providers recognizing the value of music therapy and incorporating it into their practice. Education and collaboration with certified music therapists can enhance the delivery of comprehensive palliative care, tailored to the individual needs of each patient. While this metaanalysis provides valuable insights, there is room for further exploration in future research. Investigating the specific mechanisms underlying the effects of music therapy, optimizing the timing and duration of interventions, and standardizing outcome measures will contribute to a deeper understanding of its potential. Additionally, considering the diversity of musical genres and techniques employed in music therapy warrants exploration. In summary, music therapy emerges as a powerful and versatile tool that can significantly improve the wellbeing of advanced cancer patients in palliative care. It enhances their emotional resilience, fosters a sense of purpose, and contributes to an improved quality of life during this challenging phase of their journey. Integrating music therapy into clinical practice should be a priority, as it holds the promise of enhancing the holistic care provided to these individuals, ultimately enriching their end-of-life experiences.

Acknowledgement

Not applicable.

Conflict of Interest

Author declares no conflict of interest.

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