Effect of music therapy on postembolization syndrome in Thai patients with hepatocellular carcinoma: A quasi-experimental crossover study


music therapy
transarterial chemoembolization
abdominal pain
liver neoplasms

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Khuntee, W., Hanprasitkam, K., & Sumdaengrit, B. (2022). Effect of music therapy on postembolization syndrome in Thai patients with hepatocellular carcinoma: A quasi-experimental crossover study. Belitung Nursing Journal, 8(5), 396–404. https://doi.org/10.33546/bnj.2210
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Background: Postembolization syndrome (PES), including abdominal pain, nausea, and vomiting, are complications most severe on the first day after transarterial chemoembolization (TACE). Music therapy has been found to help manage pain. If pain, a cause of nausea and vomiting, can be relieved, then nausea and vomiting should also be reduced.

Objectives: This study aimed to examine the effect of music therapy on PES in patients with liver cancer after receiving TACE.

Methods: This study employed a quasi-experimental crossover design. The study was conducted at the inpatient units of a specialized hospital for cancer in Bangkok, Thailand, from March 2020 to October 2021. Thirty patients with liver cancer were purposively selected based on the pre-determined criteria. A change-over design was used to compare patients’ changes in abdominal pain, nausea, and vomiting from the experimental period to the other control period. During the experimental period, music therapy was administered for 30 minutes on Day 0 after TACE, then twice a day in the morning and evening of Days 1 and 2 after TACE, and in the morning of Day 3 after TACE. During the control period, the patients used silent headphones. Data were analyzed using Wilcoxon signed ranks and Friedman tests.

Results: The participants perceived abdominal pain, nausea, and vomiting at a mild level during all periods. Pain scores in the music therapy period were significantly lower than those in the control period on Days 0, 1, and 2 after TACE (p <0.001, p <0.01, and p <0.001, respectively) and lower than at the baseline (p <0.001). There were no statistically significant differences in nausea and vomiting scores between the music therapy period and the control period on Days 0, 1, and 2 after TACE and no statistically significant differences at the baseline.

Conclusion: Music therapy effectively reduces mild pain among patients with liver cancer experiencing PES. This therapy can be used as a non-pharmacological treatment for nurses and other healthcare professionals in caring for patients with liver cancer.  



Copyright (c) 2022 Wassana Khuntee, Kanitha Hanprasitkam, Bualuang Sumdaengrit

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Declaration of Conflicting Interest

None declared.


The first author was very grateful to advisors and the Ramathibodi School of Nursing for their support and encouragement. In addition, the authors would like to thank professional nurses of the National Cancer Institute, Thailand, for their kind support during data collection. Finally, thankfulness is given to all patients willing to participate in this study.

Authors’ Contributions

WK contributed to study conceptualization and design, manuscript writing, data collection, data analysis, and interpretation. KH and BS contributed to study conceptualization and design, critical revisions for important intellectual content, and language editing. All authors were accountable for each stage of the study and agreed to the final manuscript to be published.

Data Availability

The datasets generated or analyzed during the current study are available from the corresponding author upon reasonable request.


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Ahmed, S., De Souza, N. N., Qiao, W., Kasai, M., Keem, L. J., & Shelat, V. G. (2016). Quality of life in hepatocellular carcinoma patients treated with transarterial chemoembolization. HPB Surgery, 6120143. https://doi.org/10.1155/2016/6120143

Blackburn, H., & West, S. (2016). Management of postembolization syndrome following hepatic transarterial chemoembolization for primary or metastatic liver cancer. Cancer Nursing, 39(5), E1-E18. https://doi.org/10.1097/NCC.0000000000000302

Cao, W., Li, J., Hu, C., Shen, J., Liu, X., Xu, Y., & Ye, Z. (2013). Symptom clusters and symptom interference of HCC patients undergoing TACE: A cross-sectional study in China. Supportive Care in Cancer, 21(2), 475-483. https://doi.org/10.1007/s00520-012-1541-5

Chiengchana, N., & Trakarnrung, S. (2014). The effect of Kodály-based music experiences on joint attention in children with autism spectrum disorders. Asian Biomedicine, 8(4), 547-555. https://doi.org/10.5372/1905-7415.0804.326

Dhand, S., & Gupta, R. (2011). Hepatic transcatheter arterial chemoembolization complicated by postembolization syndrome. Seminars in Interventional Radiology, 28, 207-211. https://doi.org/10.1055/s-0031-1280666

Faculty of Medicine Siriraj Hospital. (2019). Faculty of Medicine, four institutes join forces to present the “Correct cancer fighting policy to reduce incidence reduce disability and deaths from cancer in Thailand” to consider and scrutinize the agenda of the national health assembly. https://www.si.mahidol.ac.th/th/hotnewsdetail.asp?hn_id=2422

Jamnongsilp, O., Thanasilp, S., & Tantikosoom, P. (2016). The effect of symptom management program and auricular acupressure on pain in hepatocellular carcinoma patients undergoing transarterial chemoembolization therapy. Songklanagarind Journal of Nursing, 36(3), 36-55.

Jansing, T. (2019). Fifty years of antiemetic in chemotherapy-induced nausea and vomiting. Isan Journal of Pharmaceutical Sciences, 15(1), 1-20. https://doi.org/10.14456/ijps.2019.1

Jasemi, M., Aazami, S., & Zabihi, R. E. (2016). The effects of music therapy on anxiety and depression of cancer patients. Indian Journal of Palliative Care, 22(4), 455-458. https://doi.org/10.4103%2F0973-1075.191823

Krishnaswamy, P., & Nair, S. (2016). Effect of music therapy on pain and anxiety levels of cancer patients: A pilot study. Indian Journal of Palliative Care, 22(3), 307-311. https://doi.org/10.4103%2F0973-1075.185042

Lan, S.-C., Lin, Y.-E., Chen, S.-C., Lin, Y.-F., & Wang, Y.-J. (2015). Effects of acupressure on fatigue and depression in hepatocellular carcinoma patients treated with transcatheter arterial chemoembolization: A quasi-experimental study. Evidence-Based Complementary and Alternative Medicine, 496485. https://doi.org/10.1155/2015/496485

Leaungsomnapa, Y., & Ngamkham, S. (2013). Attention to pain. The Journal of Prapokklao Hospital Clinical Medical Education Center, 30(1), 83-93.

Lu, H., Zheng, C., Liang, B., & Xiong, B. (2021). Mechanism and risk factors of nausea and vomiting after TACE: A retrospective analysis. BMC Cancer, 21(1), 1-9. https://doi.org/10.1186/s12885-021-08253-1

Mitchell, L. A., & MacDonald, R. A. R. (2006). An experimental investigation of the effects of preferred and relaxing music listening on pain perception. Journal of Music Therapy, 43(4), 295-316. https://doi.org/10.1093/jmt/43.4.295

National Cancer Institute. (2021). Hospital-based cancer registry 2020. https://www.nci.go.th/e_book/hosbased_2563/files/main.pdf

Oken, M. M., Creech, R. H., Tormey, D. C., Horton, J., Davis, T. E., McFadden, E. T., & Carbone, P. P. (1982). Toxicity and response criteria of the Eastern Cooperative Oncology Group. American Journal of Clinical Oncology, 5(6), 649-656.

Pakpoe, R. (2007). Effects of music therapy on stress, nausea, retching, and vomiting among women with gyneccologic cancer chemotherapy [Master’s thesis, Chiang Mai University]. Chiang Mai, Thailand.

Parisuthkul, A., & Yeela, A. (2011). Music therapy. HOCC-PSU. http://hocc.medicine.psu.ac.th/files/khowledge/1january_2011.2.pdf

Patel, N. H., Hahn, D., Rapp, S., Bergan, K., & Coldwell, D. M. (2000). Hepatic artery embolization: Factors predisposing to postembolization pain and nausea. Journal of Vascular and Interventional Radiology, 11(4), 453-460. https://doi.org/10.1016/S1051-0443(07)61377-3

Perwitasari, D. A., Gelderblom, H., Atthobari, J., Mustofa, M., Dwiprahasto, I., Nortier, J. W. R., & Guchelaar, H.-J. (2011). Anti-emetic drugs in oncology: Pharmacology and individualization by pharmacogenetics. International Journal of Clinical Pharmacy, 33(1), 33-43. https://doi.org/10.1007/s11096-010-9454-1

Pfeiffer, E. (1975). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatrics Society, 23(10), 433-441. https://doi.org/10.1111/j.1532-5415.1975.tb00927.x

Poompu, A. (2002). Symptom management of nausea and vomiting induced by chemotherapy in pediatric cancer patients and caregivers [Master’s thesis, Mahidol University]. Nakhon Pathom, Thailand.

Purinai, T. (2013). The development of musical therapy for promotion of well-being for the patients undergone Extracorporal shock wave lithotripsy in Sisaket Hospital. Journal of Nurses' Association of Thailand, North-Eastern Division, 31(4), 144-151.

Sainamthip, P., Kongphanich, C., Prasongsook, N., & Chirapongsathorn, S. (2021). Single dose dexamethasone prophylaxis of postembolisation syndrome after chemoembolisation in hepatocellular carcinoma patient: A randomised, double-blind, placebo-controlled study. World Journal of Clinical Cases, 9(30), 9059-9069. https://doi.org/10.12998%2Fwjcc.v9.i30.9059

Soonthornkul Na Cholburi, J. (2003). Effects of music therapy on anxiety and pain in cancer patients [Master’s thesis, Mahidol University]. Nakhon Pathom, Thailand.

Syrjala, K. L., Cummings, C., & Donaldson, G. W. (1992). Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: A controlled clinical trial. Pain, 48(2), 137-146. https://doi.org/10.1016/0304-3959(92)90049-H

Temtap, S., Udomvisatson, R., & Nilmanat, K. (2017). Effects of shorten bed rest time on back pain and vascular complication in patients with hepatocellular carcinoma receiving transcatheter arterial chemoembolization. Songklanagarind Medical Journal, 35(3), 239-253.

Vuttanon, N., Finnegan, L., Lojanapiwat, B., Sittisombut, S., Meechumnan, C., & Dhatsuwan, J. (2019). Symptom clusters and effects of progressive muscle relaxation in Thai patients with hepatocellular carcinoma undergoing transarterial chemoembolization. Srinagarind Medical Journal, 34(3), 249-255.

Wang, S.-Y., Zhu, W.-H., Vargulick, S., Lin, S. B., & Meng, Z.-Q. (2013). Nausea and vomiting after transcatheter arterial chemoembolization for hepatocellular carcinoma: Incidence and risk factor analysis. Asian Pacific Journal of Cancer Prevention, 14(10), 5995-6000. https://doi.org/10.7314/APJCP.2013.14.10.5995

Wells-Federman, C. L., Stuart, E. M., Deckro, J. P., Mandle, C. L., Baim, M., & Medich, C. (1995). The mind-body connection: The psychophysiology of many traditional nursing interventions. Clinical Nurse Specialist CNS, 9(1), 59-66. https://doi.org/10.1097/00002800-199501000-00017

World Health Organization. (2022). Cancer. https://www.who.int/news-room/fact-sheets/detail/cancer

Xu, L., Wang, S., Zhuang, L., Lin, J., Chen, H., Zhu, X., Bei, W., Zhao, Q., Wu, H., & Meng, Z. (2016). Jian Pi Li Qi decoction alleviated postembolization syndrome following transcatheter arterial chemoembolization for hepatocellular carcinoma: A randomized, double-blind, placebo-controlled trial. Integrative Cancer Therapies, 15(3), 349-357. https://doi.org/10.1177/1534735415617020

Yamvong, C. (1995). Effects of application of Orem’s nursing system on patients’ and relatives’ satisfaction with care and function outcomes in hospitalized elderly patients [Master’s thesis, Mahidol University]. Nakhon Pathom, Thailand.

Zeng, K., Dong, H.-J., Chen, H.-Y., Chen, Z., Li, B., & Zhou, Q.-H. (2014). Wrist-ankle acupuncture for pain after transcatheter arterial chemoembolization in patients with liver cancer: A randomized controlled trial. The American Journal of Chinese Medicine, 42(02), 289-302. https://doi.org/10.1142/S0192415X14500190