Journal of pain and symptom management最新文献

{"title":"A Behavioral Intervention to Improve Symptoms After Hematopoietic Cell Transplantation.","authors":"Elizabeth S Ver Hoeve, Beyann Alzoubi, Meredith E Rumble, Lisa Cadmus-Bertram, Mark B Juckett, Natalie S Callander, Peiman Hematti, Erin S Costanzo","doi":"10.1016/j.jpainsymman.2026.04.006","DOIUrl":"10.1016/j.jpainsymman.2026.04.006","url":null,"abstract":"<p><strong>Context: </strong>Fatigue, insomnia, and depression are persistent, burdensome symptoms for patients recovering from hematopoietic cell transplantation (HCT). Restoring Sleep and Energy after Transplant (ReSET) is a novel behavioral intervention designed to alleviate these symptoms by optimizing patients' 24-hr rest-activity patterns.</p><p><strong>Objectives: </strong>The primary aim was to evaluate feasibility and acceptability of ReSET. An exploratory aim was to determine preliminary effect sizes.</p><p><strong>Methods: </strong>This pilot randomized controlled trial compared ReSET to usual care. Participants randomized to ReSET completed three in-person intervention sessions at approximately 3-4, 8 and 12 weeks post-HCT that focused on strategies to improve nighttime sleep and increase non-sedentary daytime activity. All participants wore an actigraphy device (Philips) and completed patient-reported outcome measures (PROMIS sleep disturbance, fatigue, depression) pre-HCT (T0), 9 (T1), and 18 weeks post-HCT (T2). Interviews were conducted at T2. Ability to recruit, retain, and collect complete data from participants and participant engagement with the intervention were the primary measures of feasibility and Y acceptability. Interviews were conducted at T2 to provide supplementary insight regarding participant satisfaction and barriers to completion.</p><p><strong>Results: </strong>Thirty-nine patients were randomized and most (n = 35; 89.7%) completed the study. Most ReSET participants (85%) completed all intervention sessions. PROMs of sleep (η² = .033) and depression (η² = .015) improved over time for participants in ReSET compared to usual care. Those randomized to ReSET also showed improved rest-activity rhythms relative to usual care, including mesor (η² = .044), amplitude (η² = .087) and R-squared (η² = .073) actigraphy indices.</p><p><strong>Conclusion: </strong>ReSET demonstrated feasibility, acceptability, and preliminary promise for intervention efficacy.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Kusa Ikivi': Death as an accomplishment and end-of-life experience of cancer patients in Rwanda.","authors":"Christian R Ntizimira, Deo S Mbonyinkebe, Mary Dunne, Eric L Krakauer","doi":"10.1016/j.jpainsymman.2026.03.019","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.03.019","url":null,"abstract":"<p><strong>Background: </strong>In present-day Rwanda, despite efforts of the Ministry of Health to implement palliative care, end-of-life care, and death are seldom discussed, and many patients die suffering or alone.</p><p><strong>Objectives: </strong>We qualitatively studied end-of-life traditions and attitudes toward end-of-life care in present-day Rwanda that might inform optimization of palliative and end-of-life care.</p><p><strong>Methods: </strong>We conducted qualitative interviews with 29 key informants that were audio recorded, transcribed, translated from Kinyarwanda to English, and analyzed. We also observed patients, family members, and caregivers during the interviews.</p><p><strong>Results: </strong>Three themes emerged from the data analysis: (1) Colonization introduced new meaning and new fear into the experience of dying, (2) There is a perception of death from cancer as a 'bad death,' and (3) Traditional values can and should be reconciled with modern medicine to optimize end-of-life care for Rwandans.</p><p><strong>Conclusion: </strong>The meaning of death and dying in Rwanda has changed radically since the precolonial period. Previously accepted and celebrated in meaningful family gatherings as an accomplishment, death began to evoke fear during colonization when Christianity was imposed. This transition, compounded by the trauma of the 1994 genocide against the Tutsi, appears to have complicated end-of-life care. Optimal care requires not only medical management of disease and symptoms but attention to sociocultural values that promote wellbeing among patients and family members.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketamine for Depression in Serious Illness: Evidence, Safety, and Practical Approaches.","authors":"Paul Noufi, Joshua B Borris, Danielle Chammas, Cara L McDermott, Nneka N Ufere, Jason A Webb, Daniel Shalev","doi":"10.1016/j.jpainsymman.2026.04.604","DOIUrl":"10.1016/j.jpainsymman.2026.04.604","url":null,"abstract":"<p><p>Patients with serious illnesses and short prognoses often experience depression and suicidal ideation. Traditional antidepressants are limited by delayed onset, creating a need for rapidly acting therapies. In this Palliative Care Rounds, we examine the evidence for ketamine/esketamine's efficacy as antidepressants, including evidence specific to people with serious illnesses. In psychiatric studies, intravenous ketamine produces rapid (1-24 hours), moderate-to-large antidepressant effects lasting one to two weeks, with a number needed to treat of three in the first week. Esketamine nasal spray demonstrates similar early efficacy and is U.S. Food and Drug Administration-approved for treatment-resistant depression and major depression with suicidal ideation. Evidence in serious illness is limited to several perioperative cancer trials and small open-label studies, which show short-term reductions in depressive symptoms and suicidal ideation but do not address long-term management or maintenance dosing. Safety across serious illness studies is generally favorable, with transient dissociation, hypertension, and somnolence the most common adverse effects; serious adverse events remain rare. Ketamine and esketamine offer the strongest evidence among rapid-acting antidepressants and may be preferred when urgent symptom relief is needed. However, rigorous psychiatric trials in serious illness are lacking. Clinicians should consider prognosis, access to Risk Evaluation and Mitigation Strategies-certified esketamine programs or equivalent regulatory frameworks outside the U.S., and the need for an appropriate maintenance regimen when integrating ketamine into palliative care depression management.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13112849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative Care Awareness and Misconceptions By Sexual Orientation: HINTS 2018 and 2024.","authors":"Jiamin Hu, Young-Rock Hong, Zhigang Xie","doi":"10.1016/j.jpainsymman.2026.04.004","DOIUrl":"10.1016/j.jpainsymman.2026.04.004","url":null,"abstract":"<p><strong>Introduction: </strong>Sexual minority individuals with serious illness experience persistent inequities in end-of-life care compared with their heterosexual counterparts, including reduced access to timely, high-value palliative care (PC). This study examined differences in PC awareness and misconceptions between U.S. sexual minority (lesbian, gay, and bisexual) and heterosexual adults.</p><p><strong>Methods: </strong>We analyzed nationally representative data from the 2018 Health Information National Trends Survey (HINTS) Cycle 2 and the 2024 HINTS 7. Sequential multivariable robust Poisson regression models were used to estimate prevalence ratios (PRs) for PC awareness and misconceptions. Models were progressively adjusted: Model 1 (unadjusted); Model 2 (demographics); Model 3 (demographics and socioeconomic factors); and Model 4 (demographics, socioeconomic, and health-related factors).</p><p><strong>Results: </strong>The final analytic sample included 8,036 respondents, of whom 6.5% self-identified as sexual minorities. The prevalence of PC awareness was 44.5% among sexual minority adults and 39.6% among heterosexual adults (P = 0.29). Although unadjusted differences were not statistically significant, sexual minority adults demonstrated significantly higher PC awareness after adjustment for socioeconomic factors (Model 3: adjusted PR [aPR] = 1.23; 95% CI: 1.03-1.47) and health-related factors (Model 4: Apr = 1.22; 95% CI: 1.02-1.46). Among respondents reporting PC awareness, 20.5% of sexual minority adults and 23.1% of heterosexual adults reported PC misconceptions (P = 0.65), with no significant differences observed across all regression models.</p><p><strong>Conclusions: </strong>After accounting for socioeconomic and health-related differences, sexual minority adults demonstrated higher PC awareness but comparable levels of PC misconception relative to heterosexual adults. Future research should examine mechanisms underlying the PC awareness-utilization gap among sexual minority populations.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"They're exhausted\": Hospice Staff Views on Caring for Patients and Families Impacted By Dementia.","authors":"Lauren J Hunt, Matthew E Growdon, Alexander K Smith, Noam Margalit, Krista L Harrison","doi":"10.1016/j.jpainsymman.2026.04.003","DOIUrl":"10.1016/j.jpainsymman.2026.04.003","url":null,"abstract":"<p><strong>Context: </strong>Medicare's Hospice Benefit was originally designed for cancer care, but now over half of hospice patients have dementia. To optimize hospice for people living with dementia (PLWD) and their caregivers, we must understand what hospice professionals view as the most important challenges and facilitators to caring for this population.</p><p><strong>Objective: </strong>To assess hospice professionals' perspectives on hospice care for patients and families impacted by dementia.</p><p><strong>Methods: </strong>Semi-structured interviews with multidisciplinary hospice professionals in 3 hospice agencies in California. We used inductive and deductive thematic analysis; deductive analyses were grounded in the socioecological model.</p><p><strong>Results: </strong>32 participants were included (9 nurses, 5 home health aides, 3 social workers, 3 chaplains, 2 NPs, 2 MDs, 9 leaders; 22% male, average age 45). Participants highlighted how challenges and facilitators spanned the socioecological domains, including hospice-specific issues as well as the broader context of the dementia experience. Challenges Individual-level: The prolonged decline of PLWD drained family's physical, emotional, and financial resources. Community/policy-level: Patient and family needs were unmet by local facility capacity and the clinical course of PLWD was a poor fit with hospice eligibility criteria. Facilitators Individual-level: Clinicians' positive attitudes emphasizing dignity of PLWD informed expert communication intended to develop connection and trust. Community/policy-level: Care coordination across systems supported patients along the continuum of decline.</p><p><strong>Conclusion: </strong>Optimizing hospice for patients and families impacted by dementia requires addressing both hospice-specific practice and policy, as well as broader dementia care infrastructure.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chatbot Responses to Frequently Asked Questions About Cannabis and Its Use for Cancer Symptoms.","authors":"Min Ji Kim, Donald I Abrams, Ilana M Braun, Amy A Case, Mellar P Davis, Kimberson Tanco, Mark S Wallace, Christopher M Manuel, Eduardo Bruera, David Hui","doi":"10.1016/j.jpainsymman.2026.04.002","DOIUrl":"10.1016/j.jpainsymman.2026.04.002","url":null,"abstract":"<p><strong>Context: </strong>Chatbots are increasingly used by the public, but their performance in answering questions about complex health topics, such as cannabis, is unknown.</p><p><strong>Objectives: </strong>To evaluate responses of three popular chatbots regarding cannabis and its use for cancer-related symptoms.</p><p><strong>Methods: </strong>We asked ChatGPT, Google Gemini, and Microsoft Co-Pilot to answer questions about cannabis derived from the Centers for Disease Control website and American Society of Clinical Oncology guidelines regarding cannabis. Responses were collected on February 6, 2025. Six physicians with expertise in this field scored responses for accuracy and comprehensiveness (0-10 scale). Reliability of references was scored separately (0-10 scale). Readability was assessed using Flesch-Kincaid Grade Level, Flesch Reading Ease scores.</p><p><strong>Results: </strong>Mean accuracy scores (SD) for ChatGPT, Gemini, and Co-Pilot were 9.0 (1.8), 8.8 (2.3), and 8.3 (2.3), respectively. Co-Pilot significantly underperformed in accuracy compared to ChatGPT (mean difference -0.62, 95% CI: -1.11, 0.14; P = 0.008). Mean comprehensiveness scores (SD) for ChatGPT, Gemini, and Co-Pilot were 8.1 (2.2), 8.5 (2.2), and 7.2 (2.4), respectively. ChatGPT and Gemini performed better than Co-Pilot in comprehensiveness (mean difference Co-Pilot vs. ChatGPT: -0.88 [95% CI: 1.34, -0.42; P < 0.001]; mean difference Co-Pilot vs. Gemini: -1.28 [95% CI: -1.74, -0.82; P < 0.001]). Inaccurate or misleading statements regarding cannabis formulations and symptom benefits were identified, with missing information on adverse effects and drug interactions. Gemini had the lowest reliability (4.1). Readability among all chatbots was poor.</p><p><strong>Conclusion: </strong>Despite overall high accuracy and comprehensiveness scores, chatbots made some misleading, inaccurate statements or missed information. For now, their answers should be interpreted with caution.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychotherapeutic Techniques for Dyspnea in Cancer and Chronic Illness: Systematic Review.","authors":"Jun Kako, Kohei Kajiwara, Masamitsu Kobayashi, Yoshiyasu Ito, Kanako Ichikura, Yoshinobu Matsuda, Takashi Yamaguchi","doi":"10.1016/j.jpainsymman.2026.03.021","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.03.021","url":null,"abstract":"<p><strong>Context: </strong>Psychotherapeutic interventions show promise for managing dyspnea in patients with cancer and other serious illnesses, but evidence synthesis has been limited by substantial heterogeneity. Additionally, the characteristics of interventional delivery remain poorly understood.</p><p><strong>Objective: </strong>This systematic review examined the characteristics of psychotherapeutic techniques-mindful breathing, progressive muscle relaxation, meditation, and guided imagery-to inform standardization, clinical application, and digital development.</p><p><strong>Methods: </strong>We searched PubMed, CINAHL, CENTRAL, and Scopus from inception through 17 January 2025 for quantitative interventional studies evaluating these techniques for dyspnea in adults. Two reviewers independently screened the studies and extracted data on the delivery methods, session structure, provider requirements, and self-practice components. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT).</p><p><strong>Results: </strong>Forty-two studies were included, mindful breathing (n=5), progressive muscle relaxation (n=11), meditation (n=4), guided imagery (n=2), and multicomponent interventions (n=20). Substantial heterogeneity in intervention delivery was identified, even within the same technique, including session duration, frequency, provider training, and home practice components. Psychotherapeutic techniques were predominantly delivered through multicomponent interventions (20/42 studies), most frequently combined with education, breathing techniques (16 studies each), and exercise (11 studies). Most studies met only one to three of the five MMAT criteria, indicating early-stage evidence development.</p><p><strong>Conclusions: </strong>Psychotherapeutic techniques for dyspnea demonstrate substantial delivery heterogeneity and are predominantly integrated into multicomponent programs. Future research should distinguish the core from adaptable components, integrate psychotherapeutic techniques with education and self-management strategies, and employ rigorous designs with standardised reporting to advance this clinically relevant field.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative Care for Immigrants With Cancer in the United States: A Roadmap to Equitable Care.","authors":"Jessica Zhuo, Cheryl Tolomeo, Anissa Kurani, Meaghan Burke, Stephanie Wang, Alice Feng, Yueao Zhang, Edward Christopher Dee, Christopher T Su","doi":"10.1016/j.jpainsymman.2026.03.018","DOIUrl":"10.1016/j.jpainsymman.2026.03.018","url":null,"abstract":"<p><p>Across the U.S., immigrants with cancer, especially those who are undocumented or from low-income backgrounds, encounter significant barriers to accessing quality palliative care. Despite cancer comprising over one-third of global palliative care needs, immigrant patients are often excluded from essential services due to lack of insurance, immigration status, limited English proficiency, and culturally discordant care models. These challenges contribute to delayed diagnoses, inadequate symptom management, and lower quality of end-of-life care. This narrative review identifies both patient-level and systemic barriers and offers a four-part roadmap to address them. First, care models that prioritize cultural humility and respectful curiosity should be implemented through targeted training programs and workforce diversification. Second, community-based palliative care programs should be expanded through partnerships with trusted local organizations, bringing services directly into immigrant communities. Third, successful state-level innovations can be scaled, like California's Senate Bill 1004 and Illinois' Health Benefits for Immigrant Adults and Seniors. Finally, the routine use of patient-reported symptom tracking can improve diagnosis and guide treatment decisions. Drawing on data from national surveys, state-level policy evaluations, and peer-reviewed research on palliative care disparities, this review presents actionable strategies to ensure that all patients receive high-quality palliative care, regardless of their immigration status.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical Management of Headaches in Patients With Primary and Secondary Brain Tumors.","authors":"Megan E H Still, Joy Burke, Jennifer Robblee, Surabhi Ranjan, Nestor Galvez-Jimenez, Rachel S F Moor, Akanksha Sharma, Lalanthica Yogendran, Cara Siegel, Christine Lu-Emerson, Marianne Karam, Andrew Dhawan, Joshua A Budhu, Elizabeth Coffee, Erin M Dunbar, Denise Leung, David Schiff, Katherine B Peters, Ashley P Ghiaseddin","doi":"10.1016/j.jpainsymman.2026.03.017","DOIUrl":"10.1016/j.jpainsymman.2026.03.017","url":null,"abstract":"<p><strong>Purpose: </strong>Headaches in patients with brain tumors can be multifaceted and difficult to treat, significantly affecting quality of life.</p><p><strong>Methods: </strong>We conducted a narrative synthesis of the literature to discuss the most common causes of and treatments for headache associated with brain tumors.</p><p><strong>Results: </strong>Although increased intracranial pressure due to space-occupying lesions may be the pain driver in some instances, many patients experience secondary headaches that should be treated based on their primary characteristics, such as migraine or tension-like headache. Similarly, the location of tumors can affect pain type, inciting nerve, meningeal, or skull pain, and secondary headaches may also be induced by treatment effects from entities such as posterior reversible encephalopathy syndrome PRES or radiation necrosis.</p><p><strong>Conclusions: </strong>All these headache phenotypes should be treated based on symptoms and pain driver, with a focus on a wholistic approach incorporating both pharmacologic and nonpharmacologic options to improve the quality of life of patients with brain tumors.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five-Element Music and VR for Pain and Psychological Distress in Advanced Cancer: A Randomized Trial.","authors":"Jingjing Song, Yang Zhao, Zijia Zeng, Xu Dong, Chunliu Hou, Xinyue Wang, Yonghe Liu, Junnan Zhao, Yan Li","doi":"10.1016/j.jpainsymman.2026.03.020","DOIUrl":"10.1016/j.jpainsymman.2026.03.020","url":null,"abstract":"<p><strong>Context: </strong>Pain and psychological distress are common and debilitating symptoms in patients with advanced cancer. Non-pharmacological interventions such as Five-Element Music therapy and virtual reality (VR) have shown promise in improving symptom management, but their combined effects remain unclear.</p><p><strong>Objectives: </strong>This study aimed to evaluate the clinical effectiveness of the combination of Five-Element Music and VR in improving pain, anxiety, depression, and sleep quality in cancer patients, as well as its impact on serum β-endorphin (β-EP) and 5-hydroxytryptamine (5-HT) levels, providing an innovative non-pharmacological therapy for cancer patients.</p><p><strong>Methods: </strong>In this randomized controlled trial, 66 patients were allocated to an experimental group (standard care plus Five-Element Music and VR) or a control group (standard care only). The intervention comprised daily 12-minute sessions over seven consecutive days. Outcomes were analyzed using mixed-design analysis of variance (mixed ANOVA), with time (baseline vs. postintervention) as the within-subject factor and group allocation as the between-subject factor.</p><p><strong>Results: </strong>Significant time × group interaction effects were found for pain intensity (NRS), anxiety (SAS), depression (SDS), sleep quality (PSQI), and serum 5-HT. The experimental group showed significantly greater improvements over time compared to the control group in all primary and secondary outcomes (P < .05). Although serum β-EP levels increased in both groups over time (P < .001), no significant interaction effect was found. Partial eta squared values indicated moderate to large effect sizes for outcomes with significant interactions.</p><p><strong>Conclusions: </strong>The combination of Five-Element Music and VR significantly improved pain, anxiety, depression, and sleep quality in patients with advanced cancer, and modulated serum 5-HT levels. These findings support the feasibility and potential efficacy of using this non-pharmacological intervention to manage symptoms in cancer care.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}