Music and massage for patients undergoing chemotherapy infusion

Music and massage for patients undergoing chemotherapy infusion | 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 Research Article Music and massage for patients undergoing chemotherapy infusion Ana Carolina Barbosa dos Santos Correia, Alida Rosária Silva Ferreia, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5763392/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 Purpose: It has been found that the combination of music and therapeutic massage has positive effects on cancer patients undergoing chemotherapy infusion, therefore, this study evaluates the effects of music and therapeutic massage on pain, quality of life, and well-being of patients undergoing chemotherapy infusion. Method: A randomized, crossover study was conducted with patients over 18 years old with cancer, who were randomly allocated to either receive twenty minutes of therapeutic massage and music by a trained physical therapist in the first three chemotherapy sessions or in the last three. Patients were evaluated using the Visual Analog Scale (VAS) for pain, European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire-30 for quality of life and the Subjective Well-Being Scale for well-being (EBES). Results: Participants (N=54) had better health-related quality of life (p=0.000* and p=0.002*) and improved well-being about life satisfaction (p=0.008* and p=0.000*) at the end of the study intervention. Patients who started the research receiving the intervention had a better index of positive affect and a decrease in fears and anxieties regarding the upcoming oncology treatment (p=0.001*). There were no differences in the reported pain between the groups. Conclusion: The association of music and therapeutic massage promoted an increase in the quality of life related to health and well-being in cancer patients undergoing chemotherapy treatment. Integrative Oncology Physical Therapy Modalities Musculoskeletal Manipulations Complementary Therapy Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Cancer is a serious public health issue worldwide and is one of the leading causes of premature death in most countries [ 1 – 4 ]. The disease not only affects patients but also their families and caregivers, causing physical, psychological, and social impacts that can lead to isolation [ 5 – 7 ]. Even when the symptoms and signs of cancer cease to exist, the negative effects can persist [ 8 , 9 ]. Cancer treatment often involves a combination of methods to increase the chances of cure and preserve the function and esthetics of affected organs. However, these treatments can cause negative side effects that impact the health and well-being of patients, affecting their quality of life [ 10 ]. To minimize these effects and improve the well-being of patients, complementary therapies are increasingly being sought by patients and family members [ 11 – 13 ]. These therapies are not part of conventional medical care but complement it, and involve body practices, natural products, and lifestyle modifications. Integrative cancer medicine is the integration of evidence-based complementary practices with conventional cancer treatments. It is important to assess and use validated complementary techniques and therapies and educate the healthcare team for their accurate implementation [ 14 – 17 ]. Complementary therapies, also known as integrative therapies, can be helpful in improving the quality of life and promoting relief of symptoms caused by cancer treatment [ 18 , 19 ]. These therapies can be used alongside conventional cancer treatment to improve the feeling of well-being and promote relief of symptoms [ 20 ]. Integrative cancer medicine or integrative oncology refers to the integration of evidence-based complementary practices with conventional cancer treatments [ 20 , 21 ]. Music and massage are two complementary practices that can help with the undesirable effects of cancer treatment. They can increase patients' tolerance to treatment and improve their feelings of well-being. The combination of music and massage has been shown to minimize anxiety in cancer patients in palliative care [ 22 ]. Studies have shown that both therapies [ 23 – 26 ] have benefits in minimizing symptoms during cancer treatment when used alone. However, few studies have evaluated the impact of music and massage together during chemotherapy infusion. The present study aims to evaluate the effect of music and massage together on patients undergoing chemotherapy. METHOD This study was conducted in a randomized, parallel, crossover manner, where each patient was randomly assigned to either Group 1 or 2, experiencing the control and intervention moments at different times throughout the study. A properly trained physical therapist conducted the research, which was approved by the Research Ethics Committee of the Federal University of Minas Gerais (CEP/UFMG) (CAAE 15862519.5.0000.5149). The study followed patients over 18 years of age who were diagnosed with cancer and undergoing chemotherapy at the Mater Dei Health Consortium and the Hematology and Oncology Unit - Borges da Costa Unit of Hospital das Clínicas (HC – UFMG). Only those who met the inclusion criteria, agreed to participate, and signed the Informed Consent were included in the study. Patients were informed of the minimal risks associated with the intervention and were assured that any discomfort would be addressed immediately. The exclusion criteria were limited to patients who were unable to physically or cognitively perform the necessary tasks or had signs of deep vein thrombosis in either the upper or lower extremity. Patients were sorted into two groups through a random allocation process. This was done after collecting personal data and conducting a physical therapy assessment. The randomization process was completed in blocks, with six patients per block. The two groups were as follows: Group 1, where the patient received physiotherapy alongside chemotherapy infusion, and Group 2, where the patient only underwent chemotherapy infusion. It should be mentioned that this study was a crossover study, meaning that all patients underwent both proposed treatments. Specific information such as socioeconomic data, history of current illness, disease staging, and symptoms and signs were recorded in a designated study document. Figures 1 and 2 demonstrate the approach and intervention dynamics of each group. During the physical therapy interventions, the expert physiotherapist utilized various manual techniques to ease muscle tension. These included longitudinal kneading maneuvers, circular compressions, and acupressure to reduce muscle tension points. Additionally, patients were offered music of their choice to enhance their experience. The massage interventions were performed on the upper body, including the cervical region, upper trapezius region, and scalp, or on the lower limbs. The duration of each intervention was 20 minutes and was performed during three treatment periods, corresponding to their chemo infusion. Both groups were evaluated at the beginning of the first chemotherapy session and were reevaluated at the third and sixth chemotherapy sessions, which represents a three to four-week interval between each massage/music intervention and evaluation. According to Gosling (2013) [ 27 ], the passive techniques applied by the physical therapist cause rapid analgesia but of short duration, ranging from a few hours to weeks, therefore, no washout period was required. The assessments were conducted using the Visual Analog Scale (VAS) to measure pain, the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire-30 to assess quality of life, and the Subjective well-being scale to evaluate well-being (EBES). Also, At the end of the sixth chemotherapy session, the participants were asked to share their thoughts on the intervention. Their responses were recorded and later transcribed. STATISTICAL ANALYSIS The database used in this study was established using Microsoft Office Excel® program, version 2016. The results were carefully reviewed before being analyzed by the Statistical Package for the Social Sciences for Windows Student Version® (SPSS), version 28.0 program. The significance level adopted for all statistical tests was 5% (p ≤ 0.05). To ensure the normality of the data, the Shapiro‒Wilk test was conducted, and it was found that the dimensions of the subjective well-being scale (EBES) had a normal distribution. As a result, the values are presented as the mean and standard deviation. However, other continuous variables were not normally distributed and are shown as medians and quartiles. For the comparison of groups over time, generalized models were used, which allowed comparisons over time and between groups in the same analysis. Comparisons for well-being (EBES) were performed using the independent samples t-test, while pain comparisons (VAS) and HRQoL (EORCT) were performed using the Mann‒Whitney test, all with a significance level of 5%. Based on our pilot study of 10 cancer patients undergoing chemotherapy, we found a significant difference in HRQoL between Group 1 and Group 2 as assessed by the EORCT instrument. Group 1 had a median of 75 with an IQ of 8, while Group 2 had a median of 58 and an IQR of 33, resulting in an effect size of 0.7. With a confidence interval of 95% and a test power of 80%, our sample size calculation determined that we needed 27 participants in each group, totaling 54 patients. For the qualitative analysis, a "word cloud" was created using the World Cloud application, which helped to visually represent the frequency of certain words that appeared in the text. After identifying the words and their frequencies, the content analysis technique was used to understand the reports. This technique helped to classify the data into themes or categories. The process followed the sequence proposed by Bardin (2011), which includes pre-analysis, material exploration, and treatment of results and interpretations. Qualitative data were coded according to common themes based on the study by Robison et al. (2016). RESULTS Out of the initial 126 patients who were evaluated between October 2019 and December 2021, only 54 of them were included in the research. Unfortunately, three patients were deemed ineligible during screening, and four others were excluded for failing to sign the informed consent form. Additionally, the COVID-19 pandemic caused data collection to be interrupted, leading to 52 patients being considered lost to follow-up. When the study resumed, thirteen patients had to pause their chemotherapy treatment due to complications, COVID-19 infection, and, ultimately, death. Despite these challenges, the research was able to proceed with the 54 included patients (as shown in Fig. 3 ). The mean age of the patients was 56.8 ± 14.6 years. The majority of the patients were female, accounting for 55.6% of the sample, and had higher education, which was true for 42.6% of the patients. As shown in Table 1 , only 13% of the patients performed regular physical activities. Comorbidities were identified in 64.8% of the patients, with arterial hypertension and diabetes mellitus being the most common ones. In terms of tumors, the most prevalent ones were of the large intestine, rectum, and anus, accounting for 27.8% of the cases, followed by breast tumors, also accounting for 27.8% of the cases. Liver, bile ducts, and pancreas tumors were the third most common, accounting for 11.1% of the cases. Adjuvant chemotherapy was performed in 59.3% of the patients, with the infusion time exceeding four hours for 44.4% of the patients. Most patients had stage III (38.9%) and IV (20.4%) disease, as shown in Table 2 . It is worth noting that both groups were statistically equal for all sociodemographic and clinical characteristics (p > 0.05). Table 1 Sociodemographic characteristics and life habits of cancer patients, Belo Horizonte – MG, 2023 Variable Group 1 (n = 27) Group 2 (n = 27) Chi-square (p value) Age 20 to 29 years 7.4% 7.4% χ2 (1.333;5); p = 0.931 30 to 39 years 7.4% 3.7% 40 to 49 years 11.1% 11.1% 50 to 59 years 29.6% 29.6% 60 to 69 years 22.2% 33.3% ≥ 70 years 22.2% 14.8% Sex Female 59.3% 51.9% χ2 (0.300;1); p = 0.584 Male 40.7% 48.1% Education Incomplete elementary school 22.2% 18.5% χ2 (1.573;3); p = 0.665 Elementary School 18.5% 22.2% High school 11.1% 22.2% University education 48.1% 37.0% Profession Retired 33.3% 33.3% χ2 (2.485;3); p = 0.478 On sickness leave 3.7% 0.0% Unemployed 25.9% 14.8% Active 37.0% 51.9% Marital status Single 14.8% 14.8% χ2 (3.433;3); p = 0.330 Married/Cohabitated 77.8% 70.4% Widower 0.0% 11.1% Divorced 7.4% 3.7% *Group 1 - started with physical therapy + infusion; Group 2 - started with infusion Table 2 Clinical characteristics of cancer patients, Belo Horizonte – MG, 2023 Variable Group 1 (n = 27) Group 2 (n = 27) Chi-square (p value) Diagnosis Esophagus, stomach and duodenum 7.4% 7.4% χ2 (8.267;7); p = 0.310 Head and neck 3.7% 14.8% Colorectal 37.0% 18.5% Liver, bile ducts and pancreas 3.7% 18.5% Breast 33.3% 22.2% Lung 3.7% 7.4% Ovary and uterus 11.1% 7.4% Kidney and bladder 0.0% 3.7% Staging In progress 22.2% 22.2% χ2 (2.913;4); p = 0.572 I 3.7% 11.1% II 14.8% 7.4% III 44.4% 33.3% IV 14.8% 25.9% Comorbidities Yes 66.7% 63.0% χ2 (0.081;1); p = 0.776 No 33.3% 37.0% Radiotherapy Yes 14.8% 14.8% χ2 (0.000;1); p = 1.000 No 85.2% 85.2% Chemotherapy time Up to 2 h 7.4% 7.4% χ2 (0.867;3); p = 0.833 From 2 h 1' to 3 h 14.8% 7.4% From 3 h 1' to 4 h 33.3% 40.7% Over 4 h 44.4% 44.4% Surgery Yes 51.9% 66.7% χ2 (1.227;1); p = 0.268 No 48.1% 33.3% *Group 1 - started with physical therapy + infusion; Group 2 - started with infusion Table 3 presents the median pain scores based on VAS, and the HRQoL scores according to the General Health and Quality of Life Scale of the EORTC QLQ-C30. Meanwhile, Table 4 shows the average scores of well-being based on EBES. Our analysis indicates no significant differences in pain scores between the groups or moments (p > 0.05). However, we found a difference within the groups when analyzing health-related quality of life, particularly in Group 1. Final reassessment showed the highest score, where the scores at moments 0 and intervention were statistically equal and lower than in the control group. In Group 2, the scores at moments 0 and control were the same, but the score increased at the intervention moment, indicating an improvement in HRQoL at the final reassessment. Table 3 Comparison of groups at the three assessment moments for the VAS pain and EORTC QLQ-C30 Scale (domain global health status - health and quality of life), Belo Horizonte - MG, 2023. VAS pain Group 1 Group 2 p value (intergroup) Moment 0 1 (0–6) 0 (0–2) 0.515 Control moment 0 (0–3) 0 (0–1) 0.510 Intervention moment 0 (0–2) 0 (0–0) 0.928 p value (intra group) 0.429 0.999 EORTC QLQ- C30 Moment 0 75 (58.3–83.3) (a) 75 (66.7–91.7) (a) 0.244 Control moment 83.3 (75–100) (b) 75 (66.7–91.7) (a) 0.070 Intervention moment 75 (66.7–83.3) (a) 83.3 (66.7–100) (b) 0.081 p value (intra group) 0.000* 0.002* * There is at least one moment different from the others. Different letters indicate significantly different moments. #Group 1 - started with intervention + infusion; Group 2 - started with infusion; Moment 0 - initial assessment; Control Moment - evaluation after infusion; Intervention Moment - evaluation after physio + infusion Table 4 Comparison of groups at the three evaluation moments for the EBES Scale, Belo Horizonte – MG, 2022 EBES Affection Group 1 Group 2 p value (intergroup) Moment 0 3.5 (0.11) (a) 3.5 (0.11) 0.776 Control moment 3.7 (0.13) (b) 3.6 (0.12) 0.477 Intervention moment 3.7 (0.11) (b) 3.7 (0.13) 0.730 p value (intra group) 0.001* 0.195 EBES Satisfaction Moment 0 3.7 (0.11) (a,b) 3.7 (0.13) (a,b) 0.795 Control moment 3.8 (0.12) (a) 3.6 (0.14) (a) 0.368 Intervention moment 3.6 (0.12) (b) 3.8 (0.13) (b) 0.206 p value (intra group) 0.008* 0.000* EBES General Moment 0 3.5 (0,10) 3.6 (0.11) 0.760 Control moment 3.7 (0,12) 3.6 (0.12) 0.732 Intervention moment 3.6 (0,10) 3.7 (0.12) 0.892 p value (intra group) 0.112 0.702 * There is at least one moment different from the others. Different letters indicate significant differences #Group 1 - started with intervention + infusion; Group 2 - started with infusion; Moment 0 - initial assessment; Control Moment - evaluation after infusion; Intervention Moment - evaluation after physio + infusion The General Well-being Scale (EBES) showed no significant difference between the two groups. However, when examining the affection and satisfaction dimensions separately, it was found that Group 1, which received the intervention and infusion, had a significant increase in their affection scores from moment 0 to the final reassessment (p = 0.001). This improvement was not observed in Group 2 (p = 0.195). In terms of satisfaction, both groups showed a change, with a noticeable difference between the initial assessment and the final reassessment. A difference was observed in the dimension of well-being satisfaction when patients treated in the Borges da Costa and Mater Dei were compared, with the latter having a higher score (p = 0.031) (Table 5 ). Table 5 Comparison of the dimension of well-being satisfaction between patients in both Institutions, Belo Horizonte - MG, 2023 Health care institution Borges da Costa (n = 20) Mater Dei (n = 34) EBES Affection 3.5 (0.46) 3.8 (0.69) 0.179 EBES Satisfaction 3.5 (0.55) 3.9 (0.69) 0.031 EBES General 3.5 (0.45) 3.8 (0.65) 0.099 EVA Pain 0 (0-1.75) 0 (0-1.25) 0.542 EORTC QLQ-C30 70.8 (66.7–100) 83.3 (66.7–91.7) 0.670 Comparison of EBES made by independent t test (Mean (sd)); EVA and EORTC QLQ-C30 by Mann‒Whitney test (Median (Q1 - Q3)) The “word cloud” using the World Cloud application is shown in Fig. 4 . According to the content analysis technique, as a way of appreciating and interpreting the results, some patients’ opinions are presented in Table 6 . Table 6 Qualitative Analysis, Belo Horizonte - MG, 2023 Themes related to patient satisfaction with massage therapy and music and examples of participants Positive impact of massage and music “I truly enjoyed receiving massage and music, relaxing, is not it?!... I truly enjoyed it” “The massage was very good, ..., it was very good. I relaxed” Distraction “I truly enjoyed receiving massages and music… relaxing, it makes me sleepy. I liked it a lot” “... time passed by quickly, I relaxed” Holistic impact of massage and music “... it is very important when we are apprehensive, when we are in pain. It relaxes us, brings us physical comfort and even for the soul, I truly liked it.” “I liked it a lot, it was very good, it helped me a lot, we get down there, it helped me a lot, I liked it a lot.” Improvement of side effects “The massage was very good, it helped my legs and feet. It was very good. I relaxed” “I truly enjoyed this survey and I think it contributed to my overall improvement.” Continuity and Recommendations “I liked it, I felt very good, relaxing, is not it? I want to continue and I recommend it to everyone, for sure.” “I felt very good after the massage, I was calmer, more relaxed, I want to receive more, for sure.” DISCUSSION Patients undergoing chemotherapy for cancer may benefit from complementary therapies like music and therapeutic massage. These therapies have been shown to improve health, reduce pain, and increase overall well-being. The positive effects of these interventions were observed regardless of the phase of treatment and were linked to higher life satisfaction at the end of the study. Interestingly, patients who received the intervention at the beginning of the study reported more positive emotions throughout the overall study period than those who received the intervention only in the last three chemotherapy sessions. This suggests that early intervention can help reduce fears, anxieties, and negative feelings about treatment, while increasing positive feelings like confidence, enthusiasm, and optimism. Patients who participated in the study reported overwhelmingly positive experiences with the complementary therapies, highlighting the potential benefits of these interventions for cancer patients undergoing chemotherapy. According to multiple authors, massage has been found to effectively reduce anxiety in patients undergoing chemotherapy. Additionally, listening to music during chemotherapy has also been shown to have a calming effect on patients, as reported by Chirico et al. Gillen and Biley suggest that this reduction in anxiety may be due to the suppressive action of the sympathetic nervous system, while Blood and Satori (2001) and Beaulieu-Boire et al. (2013) attribute the improvement in mood to the mediation of the amygdala. From a cognitive perspective, music has been described as a therapy that can help patients focus on something pleasant and comforting, allowing them to escape the reality of their disease diagnosis and treatment. Our own qualitative research session supports these findings, with patients reporting similar experiences. The patients' well-being during their chemotherapy sessions varied according to the type of hospital. We found that patients in the Mater Dei facility reported higher levels of life satisfaction than those in the public sector. This may be due to the socioeconomic differences between the two institutions or the chemo infusion room's environment. In the public sector, patients are accommodated in a large, shared room with about ten reclining chairs, a single television, and natural ventilation. In contrast, Mater Dei provides individual, air-conditioned cabins with a reclining chair or hospital bed, a door for privacy, an individual television, and a chair for a companion. Studies have shown that environmental factors, such as lighting and temperature, can influence individuals' behavior and well-being. However, no previous studies have assessed the impact of these characteristics in the chemo-infusion environment for cancer patients. Additionally, private institutions like Mater Dei often provide psychological support for their cancer patients, which has been shown to improve their well-being and quality of life. These factors can significantly impact how patients face adversities throughout their treatment, such as the perception of pain. The study found that pain perception was similar among patients when comparing groups and moments, indicating that music and massage alone were not enough to influence pain perception. However, evidence suggests that combining music with other therapies, such as aromatherapy or massage, can improve pain perception [ 27 , 43 – 47 ]. Personalized playlists, chosen by the patient and listened to in a comfortable and quiet environment for 20 to 30 minutes several times a day, have been shown to significantly reduce pain levels [ 48 , 49 ]. Passive techniques like massage have a documented analgesic effect, but they are short-lived and dependent on the patient's interpretation of manual stimulation [ 27 ]. Patients with higher education reported feeling less pain than those with lower education. Pain is a complex and multidimensional concept influenced by various factors, making evaluation and interpretation difficult. The experience of cancer-related pain can be complicated, with changes in intensity and frequent exacerbations due to various factors. It can be difficult for some patients to express their pain, making it challenging to address effectively. Experts recommend interdisciplinary, targeted, and dynamic management strategies that prioritize patient communication and education. This may involve non-pharmacological, non-invasive approaches like music and massage, as well as pharmaceutical and interventional therapies. In our study, participants reported being highly satisfied with physical therapy treatment and expressed their desire to continue it if possible [ 50 – 56 ]. Therefore, interdisciplinary and dynamic management based on patient communication and education is essential The participants in the study reported being completely satisfied with the physical therapy treatment and expressed interest in continuing the treatment. The present study has some limitations that need to be taken into account. Specifically, the intervention time was quite short, and we didn't investigate the potential early effects of the association of music and massage. Additionally, the reassessment intervals were, on average, between three and four weeks following the medical prescription, which didn't allow us to examine the effects of the treatment over a longer period. Finally, we should also mention that the population we studied was quite heterogeneous, as it included patients with various types of cancer and staging. Nevertheless, despite these limitations, the study provides valuable insights into the potential benefits of music and massage as complementary therapies for cancer patients. CONCLUSION The association of music and massage can have a really positive impact on the quality of life for cancer patients undergoing chemotherapy treatment. Apparently, implementing this therapy in the first few sessions can help to decrease fears, anxieties, and negative feelings about the treatment, while also increasing positive feelings like confidence, enthusiasm, and optimism. It is a non-invasive, safe method that doesn't require any fancy equipment or added costs, so it is easily replicable and further importantly, the patients really enjoyed it. Declarations Author's contribution: conception and design of the study, analysis and interpretation of data, drafting and revising the article, and final approval of the version to be submitted. Conflict of interest declaration: Nothing to declare. Funding: This work was supported by the Coordination for the Improvement of Higher Education Personnel - Brazil (CAPES). Scholarship from 11/2019 to 08/2022. Additionally, Prof. Correia has a research grant from CNPq 303754/2019-2 DATA AVAILABILITY STATEMENT The data supporting this study will be made available by the corresponding author upon request since it contains material that is protected by ethical restrictions, such as the name of patients and their conditions. However, if necessary be, this will be coded and made available, as well as translated into English. 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Available from: 10.1007/s00520-014-2478-7 Gensic ME, Smith BR, LaBarbera DM. The effects of effleurage hand massage on anxiety and pain in patients undergoing chemotherapy. JAAPA. 2017 Feb;30(2):36-38. doi: 10.1097/01.JAA.0000510988.21909.2e. PMID: 28098671. Mao JJ, Wagner KE, Seluzicki CM, Hugo A, Galindez LK, Sheaffer H, et al. Integrating Oncology Massage Into Chemoinfusion Suites: A Program Evaluation. JOP [Internet]. 2017 [cited 2022 Nov 23];13(3):e207–16. Available from: 10.1200/jop.2016.015081 Gosling AP. Mecanismos de ação e efeitos da fisioterapia no tratamento da dor. Rev dor [Internet]. 2012 [cited 2022 Nov 23];13(1):65–70. Available from: 10.1590/s1806-00132012000100012 Bardin L. Análise de conteúdo. Lisboa: Edições 70; 2010. Robison J, Smith C. Therapeutic Massage During Chemotherapy and/or Biotherapy Infusions: Patient Perceptions of Pain, Fatigue, Nausea, Anxiety, and Satisfaction. CJON [Internet]. 2016 [cited 2022 Nov 23];20(2):E34–40. Available from: 10.1188/16.cjon.e34-e40 Post-White J, Kinney ME, Savik K, Gau JB, Wilcox C, Lerner I. Therapeutic Massage and Healing Touch Improve Symptoms in Cancer. Integr Cancer Ther [Internet]. 2003 [cited 2022 Nov 23];2(4):332–44. Available from: 10.1177/1534735403259064 Billhult A, Määttä S. Light pressure massage for patients with severe anxiety. Complementary Therapies in Clinical Practice [Internet]. 2009 [cited 2022 Nov 23];15(2):96–101. Available from: 10.1016/j.ctcp.2008.10.003 Chirico A, Maiorano P, Indovina P, Milanese C, Giordano GG, Alivernini F, et al. Virtual reality and music therapy as distraction interventions to alleviate anxiety and improve mood states in breast cancer patients during chemotherapy. J Cell Physiol [Internet]. 2020 [cited 2022 Nov 23];235(6):5353–62. Available from: 10.1002/jcp.29422 Gillen E, Biley F, Allen D. Effects of music listening on adult patients’ pre-procedural state anxiety in hospital. 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Available from: 10.1177/1477153520921456 Court A, Pearson A, Frewin AD. The effects of exposure to natural light in the workplace on the health and productivity of office workers: a systematic review protocol. JBI Library of Systematic Reviews [Internet]. 2010 [cited 2022 Nov 23];8(16):1–19. Available from: 10.11124/jbisrir-2010-574 Adhvaryu A, Kala N, Nyshadham A. The Light and the Heat: Productivity Co-Benefits of Energy-Saving Technology. Review of Economics and Statistics [Internet]. 2020 [cited 2022 Nov 23];102(4):779–92. Available from: 10.1162/rest_a_00886 Peralta A, Fernández-Caballero A, Latorre JM. Determining the ambient influences and configuration of optimised environments for emotional wellbeing of older adults. Ergonomics [Internet]. 2021 [cited 2022 Nov 23];64(9):1146–59. Available from: 10.1080/00140139.2021.1909756 Galway K, Black A, Cantwell M, Cardwell CR, Mills M, Donnelly M. Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients. Cochrane Database of Systematic Reviews. 2012 [cited 2022 Nov 23]; (11). Available from: 10.1002/14651858.cd007064 Gabriel I, Creedy D, Coyne E. A systematic review of psychosocial interventions to improve quality of life of people with cancer and their family caregivers. Nurs Open [Internet]. 2020 [cited 2022 Nov 23];7(5):1299–312. Available from: 10.1002/nop2.543 Lingens SP, Schulz H, Bleich C. Evaluations of psychosocial cancer support services: A scoping review. PLoS ONE [Internet]. 2021 [cited 2022 Nov 23];16(5):e0251126. Available from: 10.1371/journal.pone.0251126 Garza-Villarreal EA. Music-Induced Analgesia in Chronic PainConditions: A Systematic Review and MetaAnalysis. Pain Phys [Internet]. 2017 [cited 2022 Nov 23];7(20;7):597–610. Available from: 10.36076/ppj/2017.7.597 Johnson AJ, Kekecs Z, Roberts RL, Gavin R, Brown K, Elkins GR. Feasibility of Music and Hypnotic Suggestion to Manage Chronic Pain. International Journal of Clinical and Experimental Hypnosis [Internet]. 2017 [cited 2022 Nov 23];65(4):452–65. Available from: 10.1080/00207144.2017.1348858 Bradt J, Dileo C, Myers-Coffman K, Biondo J. Music interventions for improving psychological and physical outcomes in people with cancer. 2021 [cited 2022 Nov 23];2022(9). Available from: 10.1002/14651858.cd006911.pub4 Deng C, Xie Y, Liu Y, Li Y, Xiao Y. Aromatherapy Plus Music Therapy Improve Pain Intensity and Anxiety Scores in Patients With Breast Cancer During Perioperative Periods: A Randomized Controlled Trial. Clinical Breast Cancer [Internet]. 2022 [cited 2022 Nov 23];22(2):115–20. Available from: 10.1016/j.clbc.2021.05.006 Davenport TE. How should we interpret measures of patients' fear of movement, injury, or reinjury in physical therapist practice? J Orthop Sports Phys Ther. 2008 Oct;38(10):584-5. doi: 10.2519/jospt.2008.0109. PMID: 18827331. Chai PR, Carreiro S, Ranney ML, Karanam K, Ahtisaari M, Edwards R, et al. Music as an Adjunct to Opioid-Based Analgesia. J Med Toxicol [Internet]. 2017 [cited 2022 Nov 23];13(3):249–54. Available from: 10.1007/s13181-017-0621-9 American Music Therapy Association (AMTA). Scope of Music Therapy Practice [Internet]. Musictherapy.org. 2015 [cited 2022 Nov 23]. Available from: https://www.musictherapy.org/about/scope_of_music_therapy_practice/ Navarro García MA, Irigoyen Aristorena MI, De Carlos Alegre V, Martínez Oroz A, Elizondo Sotro A, Indurain Fernández S, et al. Evaluación del dolor postoperatorio agudo tras cirugía cardiaca. Enfermería Intensiva [Internet]. 2011 [cited 2022 Nov 23];22(4):150–9. Available from: 10.1016/j.enfi.2011.04.002 López-Alfaro MP, Echarte-Nuin I, Fernández-Sangil P, Moyano-Berardo BM, Goñi-Viguria R. Perception of pain in post-surgical patients in intensive care units. Enfermería Intensiva (English ed) [Internet]. 2019 [cited 2022 Nov 23];30(3):99–107. Available from: 10.1016/j.enfie.2018.12.001 American Society of Anesthesiologists Task Force on Acute Pain Management. Practice Guidelines for Acute Pain Management in the Perioperative Setting. 2012 [cited 2022 Nov 23];116(2):248–73. Available from: 10.1097/ALN.0b013e31823c1030 Puntillo KA, Max A, Timsit J-F, Vignoud L, Chanques G, Robleda G, et al. Determinants of Procedural Pain Intensity in the Intensive Care Unit. The Europain® Study. Am J Respir Crit Care Med [Internet]. 2014 [cited 2022 Nov 23];189(1):39–47. Available from: 10.1164/rccm.201306-1174OC Ahlers SJ, van Gulik L, van der Veen AM, van Dongen HP, Bruins P, Belitser SV, et al. Comparison of different pain scoring systems in critically ill patients in a general ICU. Critical Care [Internet]. 2008 [cited 2022 Nov 23];12(1):R15. Available from: 10.1186/cc6789 Kemp HI, Bantel C, Gordon F, Brett SJ, Laycock HC. Pain Assessment in INTensive care (PAINT): an observational study of physician-documented pain assessment in 45 intensive care units in the United Kingdom. Anaesthesia [Internet]. 2017 [cited 2022 Nov 23];72(6):737–48. Available from: 10.1111/anae.13786 Maindet C, Burnod A, Minello C, George B, Allano G, Lemaire A. Strategies of complementary and integrative therapies in cancer-related pain—attaining exhaustive cancer pain management. Support Care Cancer [Internet]. 2019 [cited 2022 Nov 23];27(8):3119–32. Available from: 10.1007/s00520-019-04829-7 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. 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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-5763392","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":399986530,"identity":"1b893ad0-f34f-4f1c-ae50-b7372caccc16","order_by":0,"name":"Ana Carolina Barbosa dos Santos Correia","email":"","orcid":"","institution":"UFMG: Universidade Federal de Minas Gerais","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"Carolina Barbosa dos Santos","lastName":"Correia","suffix":""},{"id":399986531,"identity":"1dff692c-959d-47ab-8d89-500278b3c1ff","order_by":1,"name":"Alida Rosária Silva Ferreia","email":"","orcid":"","institution":"UFMG: Universidade Federal de Minas Gerais","correspondingAuthor":false,"prefix":"","firstName":"Alida","middleName":"Rosária Silva","lastName":"Ferreia","suffix":""},{"id":399986532,"identity":"9cea608d-6a39-4d5c-b7f5-a7da8468f359","order_by":2,"name":"Maria Isabel Toulson Davisson Correia","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYBACNjAqgPISGGx4GNiBDB6CWgzgWtJ4GJgJaGFA0cLAcJiBoBY+/sPPHnwwYJDnlz778MGDmvMy/M3MxyTeMNjJ6TbgsEIizdxwhgGD4cy+dGODhGO3eSQOs6VJzmFINjY7gEsLg5k0jwFDgsEZNjaJBLbbPAbMPEARhgOJ23Bp4T/+TfoPRAv7j4R/54jQwpBjJs0AtYUhse0AEVokcsoNe0B+6WFjlkjsSwb5JdlyjgFuv8j3H9/24EcFMMR42Bg//vhmZ8/f3nzwxpsKOzlcWqDgP7qAATZVo2AUjIJRMAqIBQAv3EkslxqOyQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-3503-4302","institution":"Universidade Federal de Minas Gerais Faculdade de 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15:28:28","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":112071,"visible":true,"origin":"","legend":"\u003cp\u003eDynamics of the approach and intervention of Group 2\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5763392/v1/815cdf98095dc32705e5834f.png"},{"id":73781816,"identity":"5bcd4878-c043-40af-a4e9-48c63d9a6c28","added_by":"auto","created_at":"2025-01-14 15:28:28","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":45260,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of patient selection, screening and inclusion, Belo Horizonte – MG, 2023.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5763392/v1/8fd508436fcb15c9f58eae83.png"},{"id":73781824,"identity":"30d488d1-4ace-4559-9d89-5224b6118908","added_by":"auto","created_at":"2025-01-14 15:28:28","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":458196,"visible":true,"origin":"","legend":"\u003cp\u003eWord cloud encompassing the qualitative assessments of patients’ perceptions\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5763392/v1/99e01d48ce933afeddf6ebde.png"},{"id":81330129,"identity":"07a8f23f-718e-4911-9467-e01de2e2fe0a","added_by":"auto","created_at":"2025-04-24 21:03:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1529997,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5763392/v1/b5674f03-d71d-4fb2-b7aa-db34714d629b.pdf"}],"financialInterests":"","formattedTitle":"Music and massage for patients undergoing chemotherapy infusion","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eCancer is a serious public health issue worldwide and is one of the leading causes of premature death in most countries [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The disease not only affects patients but also their families and caregivers, causing physical, psychological, and social impacts that can lead to isolation [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Even when the symptoms and signs of cancer cease to exist, the negative effects can persist [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCancer treatment often involves a combination of methods to increase the chances of cure and preserve the function and esthetics of affected organs. However, these treatments can cause negative side effects that impact the health and well-being of patients, affecting their quality of life [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. To minimize these effects and improve the well-being of patients, complementary therapies are increasingly being sought by patients and family members [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These therapies are not part of conventional medical care but complement it, and involve body practices, natural products, and lifestyle modifications. Integrative cancer medicine is the integration of evidence-based complementary practices with conventional cancer treatments. It is important to assess and use validated complementary techniques and therapies and educate the healthcare team for their accurate implementation [\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eComplementary therapies, also known as integrative therapies, can be helpful in improving the quality of life and promoting relief of symptoms caused by cancer treatment [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. These therapies can be used alongside conventional cancer treatment to improve the feeling of well-being and promote relief of symptoms [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Integrative cancer medicine or integrative oncology refers to the integration of evidence-based complementary practices with conventional cancer treatments [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMusic and massage are two complementary practices that can help with the undesirable effects of cancer treatment. They can increase patients' tolerance to treatment and improve their feelings of well-being. The combination of music and massage has been shown to minimize anxiety in cancer patients in palliative care [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Studies have shown that both therapies [\u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] have benefits in minimizing symptoms during cancer treatment when used alone. However, few studies have evaluated the impact of music and massage together during chemotherapy infusion. The present study aims to evaluate the effect of music and massage together on patients undergoing chemotherapy.\u003c/p\u003e"},{"header":"METHOD","content":"\u003cp\u003eThis study was conducted in a randomized, parallel, crossover manner, where each patient was randomly assigned to either Group 1 or 2, experiencing the control and intervention moments at different times throughout the study. A properly trained physical therapist conducted the research, which was approved by the Research Ethics Committee of the Federal University of Minas Gerais (CEP/UFMG) (CAAE 15862519.5.0000.5149). The study followed patients over 18 years of age who were diagnosed with cancer and undergoing chemotherapy at the Mater Dei Health Consortium and the Hematology and Oncology Unit - Borges da Costa Unit of Hospital das Cl\u0026iacute;nicas (HC \u0026ndash; UFMG). Only those who met the inclusion criteria, agreed to participate, and signed the Informed Consent were included in the study. Patients were informed of the minimal risks associated with the intervention and were assured that any discomfort would be addressed immediately. The exclusion criteria were limited to patients who were unable to physically or cognitively perform the necessary tasks or had signs of deep vein thrombosis in either the upper or lower extremity.\u003c/p\u003e \u003cp\u003ePatients were sorted into two groups through a random allocation process. This was done after collecting personal data and conducting a physical therapy assessment. The randomization process was completed in blocks, with six patients per block. The two groups were as follows: Group 1, where the patient received physiotherapy alongside chemotherapy infusion, and Group 2, where the patient only underwent chemotherapy infusion. It should be mentioned that this study was a crossover study, meaning that all patients underwent both proposed treatments. Specific information such as socioeconomic data, history of current illness, disease staging, and symptoms and signs were recorded in a designated study document. Figures\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e demonstrate the approach and intervention dynamics of each group.\u003c/p\u003e \u003cp\u003eDuring the physical therapy interventions, the expert physiotherapist utilized various manual techniques to ease muscle tension. These included longitudinal kneading maneuvers, circular compressions, and acupressure to reduce muscle tension points. Additionally, patients were offered music of their choice to enhance their experience. The massage interventions were performed on the upper body, including the cervical region, upper trapezius region, and scalp, or on the lower limbs. The duration of each intervention was 20 minutes and was performed during three treatment periods, corresponding to their chemo infusion. Both groups were evaluated at the beginning of the first chemotherapy session and were reevaluated at the third and sixth chemotherapy sessions, which represents a three to four-week interval between each massage/music intervention and evaluation. According to Gosling (2013) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], the passive techniques applied by the physical therapist cause rapid analgesia but of short duration, ranging from a few hours to weeks, therefore, no washout period was required.\u003c/p\u003e \u003cp\u003eThe assessments were conducted using the Visual Analog Scale (VAS) to measure pain, the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire-30 to assess quality of life, and the Subjective well-being scale to evaluate well-being (EBES). Also, At the end of the sixth chemotherapy session, the participants were asked to share their thoughts on the intervention. Their responses were recorded and later transcribed.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSTATISTICAL ANALYSIS\u003c/h2\u003e \u003cp\u003eThe database used in this study was established using Microsoft Office Excel\u0026reg; program, version 2016. The results were carefully reviewed before being analyzed by the Statistical Package for the Social Sciences for Windows Student Version\u0026reg; (SPSS), version 28.0 program. The significance level adopted for all statistical tests was 5% (p\u0026thinsp;\u0026le;\u0026thinsp;0.05). To ensure the normality of the data, the Shapiro‒Wilk test was conducted, and it was found that the dimensions of the subjective well-being scale (EBES) had a normal distribution. As a result, the values are presented as the mean and standard deviation. However, other continuous variables were not normally distributed and are shown as medians and quartiles. For the comparison of groups over time, generalized models were used, which allowed comparisons over time and between groups in the same analysis. Comparisons for well-being (EBES) were performed using the independent samples t-test, while pain comparisons (VAS) and HRQoL (EORCT) were performed using the Mann‒Whitney test, all with a significance level of 5%.\u003c/p\u003e \u003cp\u003eBased on our pilot study of 10 cancer patients undergoing chemotherapy, we found a significant difference in HRQoL between Group 1 and Group 2 as assessed by the EORCT instrument. Group 1 had a median of 75 with an IQ of 8, while Group 2 had a median of 58 and an IQR of 33, resulting in an effect size of 0.7. With a confidence interval of 95% and a test power of 80%, our sample size calculation determined that we needed 27 participants in each group, totaling 54 patients.\u003c/p\u003e \u003cp\u003eFor the qualitative analysis, a \"word cloud\" was created using the World Cloud application, which helped to visually represent the frequency of certain words that appeared in the text. After identifying the words and their frequencies, the content analysis technique was used to understand the reports. This technique helped to classify the data into themes or categories. The process followed the sequence proposed by Bardin (2011), which includes pre-analysis, material exploration, and treatment of results and interpretations. Qualitative data were coded according to common themes based on the study by Robison et al. (2016).\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eOut of the initial 126 patients who were evaluated between October 2019 and December 2021, only 54 of them were included in the research. Unfortunately, three patients were deemed ineligible during screening, and four others were excluded for failing to sign the informed consent form. Additionally, the COVID-19 pandemic caused data collection to be interrupted, leading to 52 patients being considered lost to follow-up. When the study resumed, thirteen patients had to pause their chemotherapy treatment due to complications, COVID-19 infection, and, ultimately, death. Despite these challenges, the research was able to proceed with the 54 included patients (as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe mean age of the patients was 56.8\u0026thinsp;\u0026plusmn;\u0026thinsp;14.6 years. The majority of the patients were female, accounting for 55.6% of the sample, and had higher education, which was true for 42.6% of the patients. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, only 13% of the patients performed regular physical activities. Comorbidities were identified in 64.8% of the patients, with arterial hypertension and diabetes mellitus being the most common ones. In terms of tumors, the most prevalent ones were of the large intestine, rectum, and anus, accounting for 27.8% of the cases, followed by breast tumors, also accounting for 27.8% of the cases. Liver, bile ducts, and pancreas tumors were the third most common, accounting for 11.1% of the cases. Adjuvant chemotherapy was performed in 59.3% of the patients, with the infusion time exceeding four hours for 44.4% of the patients. Most patients had stage III (38.9%) and IV (20.4%) disease, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. It is worth noting that both groups were statistically equal for all sociodemographic and clinical characteristics (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics and life habits of cancer patients, Belo Horizonte \u0026ndash; MG, 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGroup 1 (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup 2 (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eChi-square\u003c/p\u003e \u003cp\u003e(p value)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20 to 29 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e7.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"5\" nameend=\"c6\" namest=\"c5\" rowspan=\"6\"\u003e \u003cp\u003eχ2 (1.333;5); p\u0026thinsp;=\u0026thinsp;0.931\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30 to 39 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e7.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40 to 49 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e11.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50 to 59 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e29.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60 to 69 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e22.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;70 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e22.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e59.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e \u003cp\u003eχ2 (0.300;1); p\u0026thinsp;=\u0026thinsp;0.584\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e40.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncomplete elementary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e22.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"3\" nameend=\"c6\" namest=\"c5\" rowspan=\"4\"\u003e \u003cp\u003eχ2 (1.573;3); p\u0026thinsp;=\u0026thinsp;0.665\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElementary School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e18.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e11.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e48.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProfession\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"3\" nameend=\"c6\" namest=\"c5\" rowspan=\"4\"\u003e \u003cp\u003eχ2 (2.485;3); p\u0026thinsp;=\u0026thinsp;0.478\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOn sickness leave\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e25.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e37.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eχ2 (3.433;3); p\u0026thinsp;=\u0026thinsp;0.330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMarried/Cohabitated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eWidower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e*Group 1 - started with physical therapy\u0026thinsp;+\u0026thinsp;infusion; Group 2 - started with infusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of cancer patients, Belo Horizonte \u0026ndash; MG, 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChi-square\u003c/p\u003e \u003cp\u003e(p value)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEsophagus, stomach and duodenum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eχ2 (8.267;7); p\u0026thinsp;=\u0026thinsp;0.310\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead and neck\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColorectal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver, bile ducts and pancreas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOvary and uterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKidney and bladder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStaging\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn progress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eχ2 (2.913;4); p\u0026thinsp;=\u0026thinsp;0.572\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ2 (0.081;1); p\u0026thinsp;=\u0026thinsp;0.776\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRadiotherapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ2 (0.000;1); p\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChemotherapy time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUp to 2 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eχ2 (0.867;3); p\u0026thinsp;=\u0026thinsp;0.833\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrom 2 h 1' to 3 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrom 3 h 1' to 4 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOver 4 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ2 (1.227;1); p\u0026thinsp;=\u0026thinsp;0.268\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e*Group 1 - started with physical therapy\u0026thinsp;+\u0026thinsp;infusion; Group 2 - started with infusion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the median pain scores based on VAS, and the HRQoL scores according to the General Health and Quality of Life Scale of the EORTC QLQ-C30. Meanwhile, Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the average scores of well-being based on EBES. Our analysis indicates no significant differences in pain scores between the groups or moments (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, we found a difference within the groups when analyzing health-related quality of life, particularly in Group 1. Final reassessment showed the highest score, where the scores at moments 0 and intervention were statistically equal and lower than in the control group. In Group 2, the scores at moments 0 and control were the same, but the score increased at the intervention moment, indicating an improvement in HRQoL at the final reassessment.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of groups at the three assessment moments for the VAS pain and EORTC QLQ-C30 Scale (domain global health status - health and quality of life), Belo Horizonte - MG, 2023.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS pain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value (intergroup)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoment 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.515\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl moment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.510\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention moment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0\u0026ndash;0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.928\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep value (intra group)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEORTC QLQ- C30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoment 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75 (58.3\u0026ndash;83.3) \u003csub\u003e(a)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (66.7\u0026ndash;91.7) \u003csub\u003e(a)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.244\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl moment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83.3 (75\u0026ndash;100) \u003csub\u003e(b)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (66.7\u0026ndash;91.7) \u003csub\u003e(a)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention moment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75 (66.7\u0026ndash;83.3) \u003csub\u003e(a)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.3 (66.7\u0026ndash;100) \u003csub\u003e(b)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep value (intra group)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e* There is at least one moment different from the others. Different letters indicate significantly different moments.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e#Group 1 - started with intervention\u0026thinsp;+\u0026thinsp;infusion; Group 2 - started with infusion; Moment 0 - initial assessment; Control Moment - evaluation after infusion; Intervention Moment - evaluation after physio\u0026thinsp;+\u0026thinsp;infusion\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of groups at the three evaluation moments for the EBES Scale, Belo Horizonte \u0026ndash; MG, 2022\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEBES Affection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value (intergroup)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoment 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.5 (0.11) \u003csub\u003e(a)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.5 (0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.776\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl moment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.7 (0.13) \u003csub\u003e(b)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6 (0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.477\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention moment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.7 (0.11) \u003csub\u003e(b)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.7 (0.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.730\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep value (intra group)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEBES Satisfaction\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoment 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.7 (0.11) \u003csub\u003e(a,b)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.7 (0.13) \u003csub\u003e(a,b)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.795\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl moment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.8 (0.12) \u003csub\u003e(a)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6 (0.14) \u003csub\u003e(a)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.368\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention moment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.6 (0.12) \u003csub\u003e(b)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.8 (0.13) \u003csub\u003e(b)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.206\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep value (intra group)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.008*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEBES General\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoment 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.5 (0,10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6 (0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.760\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl moment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.7 (0,12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6 (0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.732\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention moment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.6 (0,10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.7 (0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep value (intra group)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e* There is at least one moment different from the others. Different letters indicate significant differences\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e#Group 1 - started with intervention\u0026thinsp;+\u0026thinsp;infusion; Group 2 - started with infusion; Moment 0 - initial assessment; Control Moment - evaluation after infusion; Intervention Moment - evaluation after physio\u0026thinsp;+\u0026thinsp;infusion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe General Well-being Scale (EBES) showed no significant difference between the two groups. However, when examining the affection and satisfaction dimensions separately, it was found that Group 1, which received the intervention and infusion, had a significant increase in their affection scores from moment 0 to the final reassessment (p\u0026thinsp;=\u0026thinsp;0.001). This improvement was not observed in Group 2 (p\u0026thinsp;=\u0026thinsp;0.195). In terms of satisfaction, both groups showed a change, with a noticeable difference between the initial assessment and the final reassessment.\u003c/p\u003e \u003cp\u003eA difference was observed in the dimension of well-being satisfaction when patients treated in the Borges da Costa and Mater Dei were compared, with the latter having a higher score (p\u0026thinsp;=\u0026thinsp;0.031) (Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the dimension of well-being satisfaction between patients in both Institutions, Belo Horizonte - MG, 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth care institution\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBorges da Costa\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMater Dei (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEBES Affection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.5 (0.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.8 (0.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEBES Satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.5 (0.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.9 (0.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEBES General\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.5 (0.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.8 (0.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEVA Pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0-1.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0-1.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.542\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEORTC QLQ-C30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70.8 (66.7\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.3 (66.7\u0026ndash;91.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.670\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eComparison of EBES made by independent t test (Mean (sd)); EVA and EORTC QLQ-C30 by Mann‒Whitney test (Median (Q1 - Q3))\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe \u0026ldquo;word cloud\u0026rdquo; using the World Cloud application is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eAccording to the content analysis technique, as a way of appreciating and interpreting the results, some patients\u0026rsquo; opinions are presented in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQualitative Analysis, Belo Horizonte - MG, 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes related to patient satisfaction with massage therapy and music and examples of participants\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive impact of massage and music\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;I truly enjoyed receiving massage and music, relaxing, is not it?!... I truly enjoyed it\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;The massage was very good, ..., it was very good. I relaxed\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDistraction\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;I truly enjoyed receiving massages and music\u0026hellip; relaxing, it makes me sleepy. I liked it a lot\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;... time passed by quickly, I relaxed\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHolistic impact of massage and music\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;... it is very important when we are apprehensive, when we are in pain. It relaxes us, brings us physical comfort and even for the soul, I truly liked it.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;I liked it a lot, it was very good, it helped me a lot, we get down there, it helped me a lot, I liked it a lot.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImprovement of side effects\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;The massage was very good, it helped my legs and feet. It was very good. I relaxed\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;I truly enjoyed this survey and I think it contributed to my overall improvement.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContinuity and Recommendations\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;I liked it, I felt very good, relaxing, is not it? I want to continue and I recommend it to everyone, for sure.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;I felt very good after the massage, I was calmer, more relaxed, I want to receive more, for sure.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003ePatients undergoing chemotherapy for cancer may benefit from complementary therapies like music and therapeutic massage. These therapies have been shown to improve health, reduce pain, and increase overall well-being. The positive effects of these interventions were observed regardless of the phase of treatment and were linked to higher life satisfaction at the end of the study. Interestingly, patients who received the intervention at the beginning of the study reported more positive emotions throughout the overall study period than those who received the intervention only in the last three chemotherapy sessions. This suggests that early intervention can help reduce fears, anxieties, and negative feelings about treatment, while increasing positive feelings like confidence, enthusiasm, and optimism. Patients who participated in the study reported overwhelmingly positive experiences with the complementary therapies, highlighting the potential benefits of these interventions for cancer patients undergoing chemotherapy.\u003c/p\u003e \u003cp\u003eAccording to multiple authors, massage has been found to effectively reduce anxiety in patients undergoing chemotherapy. Additionally, listening to music during chemotherapy has also been shown to have a calming effect on patients, as reported by Chirico et al. Gillen and Biley suggest that this reduction in anxiety may be due to the suppressive action of the sympathetic nervous system, while Blood and Satori (2001) and Beaulieu-Boire et al. (2013) attribute the improvement in mood to the mediation of the amygdala. From a cognitive perspective, music has been described as a therapy that can help patients focus on something pleasant and comforting, allowing them to escape the reality of their disease diagnosis and treatment. Our own qualitative research session supports these findings, with patients reporting similar experiences.\u003c/p\u003e \u003cp\u003eThe patients' well-being during their chemotherapy sessions varied according to the type of hospital. We found that patients in the Mater Dei facility reported higher levels of life satisfaction than those in the public sector. This may be due to the socioeconomic differences between the two institutions or the chemo infusion room's environment. In the public sector, patients are accommodated in a large, shared room with about ten reclining chairs, a single television, and natural ventilation. In contrast, Mater Dei provides individual, air-conditioned cabins with a reclining chair or hospital bed, a door for privacy, an individual television, and a chair for a companion. Studies have shown that environmental factors, such as lighting and temperature, can influence individuals' behavior and well-being. However, no previous studies have assessed the impact of these characteristics in the chemo-infusion environment for cancer patients. Additionally, private institutions like Mater Dei often provide psychological support for their cancer patients, which has been shown to improve their well-being and quality of life. These factors can significantly impact how patients face adversities throughout their treatment, such as the perception of pain.\u003c/p\u003e \u003cp\u003eThe study found that pain perception was similar among patients when comparing groups and moments, indicating that music and massage alone were not enough to influence pain perception. However, evidence suggests that combining music with other therapies, such as aromatherapy or massage, can improve pain perception [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan additionalcitationids=\"CR44 CR45 CR46\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Personalized playlists, chosen by the patient and listened to in a comfortable and quiet environment for 20 to 30 minutes several times a day, have been shown to significantly reduce pain levels [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Passive techniques like massage have a documented analgesic effect, but they are short-lived and dependent on the patient's interpretation of manual stimulation [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Patients with higher education reported feeling less pain than those with lower education. Pain is a complex and multidimensional concept influenced by various factors, making evaluation and interpretation difficult. The experience of cancer-related pain can be complicated, with changes in intensity and frequent exacerbations due to various factors. It can be difficult for some patients to express their pain, making it challenging to address effectively. Experts recommend interdisciplinary, targeted, and dynamic management strategies that prioritize patient communication and education. This may involve non-pharmacological, non-invasive approaches like music and massage, as well as pharmaceutical and interventional therapies. In our study, participants reported being highly satisfied with physical therapy treatment and expressed their desire to continue it if possible [\u003cspan additionalcitationids=\"CR51 CR52 CR53 CR54 CR55\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Therefore, interdisciplinary and dynamic management based on patient communication and education is essential The participants in the study reported being completely satisfied with the physical therapy treatment and expressed interest in continuing the treatment.\u003c/p\u003e \u003cp\u003eThe present study has some limitations that need to be taken into account. Specifically, the intervention time was quite short, and we didn't investigate the potential early effects of the association of music and massage. Additionally, the reassessment intervals were, on average, between three and four weeks following the medical prescription, which didn't allow us to examine the effects of the treatment over a longer period. Finally, we should also mention that the population we studied was quite heterogeneous, as it included patients with various types of cancer and staging. Nevertheless, despite these limitations, the study provides valuable insights into the potential benefits of music and massage as complementary therapies for cancer patients.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe association of music and massage can have a really positive impact on the quality of life for cancer patients undergoing chemotherapy treatment. Apparently, implementing this therapy in the first few sessions can help to decrease fears, anxieties, and negative feelings about the treatment, while also increasing positive feelings like confidence, enthusiasm, and optimism. It is a non-invasive, safe method that doesn't require any fancy equipment or added costs, so it is easily replicable and further importantly, the patients really enjoyed it.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor\u0026apos;s contribution:\u0026nbsp;\u003c/strong\u003econception and design of the study, analysis and interpretation of data, drafting and revising the article, and final approval of the version to be submitted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest declaration:\u0026nbsp;\u003c/strong\u003eNothing to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis work was supported by the\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eCoordination for the Improvement of Higher Education Personnel - Brazil (CAPES). Scholarship from 11/2019 to 08/2022. Additionally, Prof. Correia has a research grant from CNPq 303754/2019-2\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDATA AVAILABILITY STATEMENT\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting this study will be made available by the corresponding author upon request since it contains material that is protected by ethical restrictions, such as the name of patients and their conditions. However, if necessary be, this will be coded and made available, as well as translated into English.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eInstituto Nacional de C\u0026acirc;ncer Jos\u0026eacute; Alencar Gomes da Silva. Estimativa 2020: incid\u0026ecirc;ncia de c\u0026acirc;ncer no Brasil / Instituto Nacional de C\u0026acirc;ncer Jos\u0026eacute; Alencar Gomes da Silva. Rio de Janeiro: INCA; 2019.\u003c/li\u003e\n\u003cli\u003eJemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer Statistics, 2009. 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Available from: 10.1097/ncc.0b013e318231daf0\u003c/li\u003e\n\u003cli\u003eVrettos I, Kamposioras K, Kontodimopoulos N, Pappa E, Georgiadou E, Haritos D, et al. Comparing Health-Related Quality of Life of Cancer Patients under Chemotherapy and of Their Caregivers. The Scientific World Journal [Internet]. 2012 [cited 2022 Nov 23];2012:1\u0026ndash;9. Available from: 10.1100/2012/135283\u003c/li\u003e\n\u003cli\u003eObaidi, J, Al-Atiyyat, N. Quality of Life among Primary Caregivers of Women with Breast Cancer: A Review. Middle East Journal of Cancer, 2013; 4(2): 45-49.\u003c/li\u003e\n\u003cli\u003eHeydarnejad MS, Hassanpour DA, Solati DK. Factors affecting quality of life in cancer patients undergoing chemotherapy. Afr Health Sci. 2011 Jun;11(2):266-70. PMID: 21857860; PMCID: PMC3158510.\u003c/li\u003e\n\u003cli\u003eCleeland CS, Zhao F, Chang VT, Sloan JA, O\u0026rsquo;Mara AM, Gilman PB, et al. 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Available from: 10.1164/rccm.201306-1174OC\u003c/li\u003e\n\u003cli\u003eAhlers SJ, van Gulik L, van der Veen AM, van Dongen HP, Bruins P, Belitser SV, et al. Comparison of different pain scoring systems in critically ill patients in a general ICU. Critical Care [Internet]. 2008 [cited 2022 Nov 23];12(1):R15. Available from: 10.1186/cc6789\u003c/li\u003e\n\u003cli\u003eKemp HI, Bantel C, Gordon F, Brett SJ, Laycock HC. Pain Assessment in INTensive care (PAINT): an observational study of physician-documented pain assessment in 45 intensive care units in the United Kingdom. Anaesthesia [Internet]. 2017 [cited 2022 Nov 23];72(6):737\u0026ndash;48. Available from: 10.1111/anae.13786\u003c/li\u003e\n\u003cli\u003eMaindet C, Burnod A, Minello C, George B, Allano G, Lemaire A. Strategies of complementary and integrative therapies in cancer-related pain\u0026mdash;attaining exhaustive cancer pain management. Support Care Cancer [Internet]. 2019 [cited 2022 Nov 23];27(8):3119\u0026ndash;32. Available from: 10.1007/s00520-019-04829-7\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":"Integrative Oncology, Physical Therapy Modalities, Musculoskeletal Manipulations, Complementary Therapy","lastPublishedDoi":"10.21203/rs.3.rs-5763392/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5763392/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eIt has been found that the combination of music and therapeutic massage has positive effects on cancer patients undergoing chemotherapy infusion, therefore, this study evaluates the effects of music and therapeutic massage on pain, quality of life, and well-being of patients undergoing chemotherapy infusion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eA randomized, crossover study was conducted with patients over 18 years old with cancer, who were randomly allocated to either receive twenty minutes of therapeutic massage and music by a trained physical therapist in the first three chemotherapy sessions or in the last three. Patients were evaluated using the Visual Analog Scale (VAS) for pain, European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire-30 for quality of life and the Subjective Well-Being Scale for well-being (EBES).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eParticipants (N=54) had better health-related quality of life (p=0.000* and p=0.002*) and improved well-being about life satisfaction (p=0.008* and p=0.000*) at the end of the study intervention. Patients who started the research receiving the intervention had a better index of positive affect and a decrease in fears and anxieties regarding the upcoming oncology treatment (p=0.001*). There were no differences in the reported pain between the groups.\u003cstrong\u003e Conclusion: \u003c/strong\u003eThe association of music and therapeutic massage promoted an increase in the quality of life related to health and well-being in cancer patients undergoing chemotherapy treatment.\u003c/p\u003e","manuscriptTitle":"Music and massage for patients undergoing chemotherapy infusion","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-14 15:28:23","doi":"10.21203/rs.3.rs-5763392/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":"f09d5ad2-c6c0-47b2-85c7-6312118bedc7","owner":[],"postedDate":"January 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-24T20:55:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-14 15:28:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5763392","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5763392","identity":"rs-5763392","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}