Introduction

Cancer ranks as the second leading cause of death, representing one of the greatest public health challenges, with statistics indicating a growing increase in incidence and mortality globally each year [1]. It is estimated that the lifetime risk of developing any type of neoplasm is 40% for men and 38% for women, and this global burden also significantly impacts healthcare systems [2].

Although more than one hundred types of malignant neoplasms have been identified, certain anatomical sites show higher prevalence depending on gender. Among men, prostate cancer is the most common, followed by cancers of the colon and rectum, lung, stomach, and oral cavity. Among women, breast cancer predominates, followed by cancers of the colon and rectum, cervix, lung, and thyroid, in decreasing order of incidence [3].

Cancer staging is determined by the tumor-node-metastasis (TNM) system, which assesses the extent of the disease by considering tumor size and characteristics, lymph node involvement, and the presence of metastases, allowing identification of the spread of malignant lesions. Based on this assessment, neoplasms are classified into stages ranging from zero, when confined to the site of origin, to four, when there is dissemination to adjacent tissues or distant organs [4].

Staging is, therefore, a fundamental step in the diagnostic process, as it guides and standardizes therapeutic approaches. The main treatment modalities include surgery, chemotherapy, and radiotherapy, which are usually employed in combination, although they may occasionally be used alone [5].

A cancer diagnosis can evoke intense suffering encompassing emotional, physical, and social dimensions [2]. In this context, it is characterized as a feared and impactful moment in an individual’s life, affecting not only the diagnosed person but also their involved family circle. Among the most recurrent feelings are the fear of death, disease recurrence, anxieties about treatment, changes in affective bonds, and the economic implications that often accompany the illness process [6].

Psychological distress is a broad construct encompassing negative emotions and feelings that can impair an individual’s overall functioning and interfere with daily activities. This condition may distort self-perception and the understanding of one’s environment, manifesting through sadness, anxiety, inattention, and other symptoms related to mental health. Among individuals with cancer, psychological distress tends to have multidimensional repercussions, affecting financial, family, sexual, spiritual, and social aspects of life.

Consequently, patients undergoing chemotherapy frequently experience multiple adverse effects that compromise their well-being [7]. Evidence indicates that individuals with cancer may present with more than ten concurrent symptoms related to the disease and its treatment, underscoring the complexity of oncological care and the need for complementary interventions to mitigate multifactorial suffering [8].

Recent research indicates that psychological distress can act as a catalyst and negatively influence cancer prognosis, being associated with higher mortality and lower survival rates. Thus, emotional distress has been recognized as the “sixth vital sign” in oncology, underscoring the importance of management and relief strategies throughout treatment [9].

Non-pharmacological interventions have gained prominence as complementary approaches to alleviate treatment-related discomfort and improve patient outcomes. Strategies such as cognitive-behavioral therapy, yoga, distraction techniques, virtual reality, music therapy, and progressive muscle relaxation have demonstrated benefits, with the latter two standing out for their feasibility, low cost, and positive acceptance in clinical practice [10].

The integration of psychosocial interventions, such as music therapy, into comprehensive oncological care effectively addresses not only physical symptoms but also promotes improvements in patients’ psychological and emotional states. Evidence highlights that adherence to alternative strategies contributes to overall well-being, fostering quality of life and coping abilities in the face of treatment and illness [11].

Musical interventions have been shown to reduce anxiety by modulating stress-related hormones and inducing physiological states of calm and relaxation. They influence the autonomic nervous system, helping stabilize respiratory rate, heart rate, blood pressure, and pulse [12,13].

In general, musical interventions involve listening to pre-selected music, guided or facilitated by healthcare professionals. Music therapy, in contrast, entails a structured therapeutic process conducted by a qualified music therapist, who uses individualized musical experiences to achieve specific clinical objectives [14].

Within this context, nursing care seeks to address the biopsychosocial and spiritual needs of individuals through preventive, promotive, and rehabilitative actions grounded in ethical, aesthetic, empirical, personal, and political ways of knowing. Thus, music emerges as a complementary strategy in nursing, offering therapeutic benefits while fostering sensitivity and humanization in care practice [15–17].

Nevertheless, despite existing studies on the use of music in oncological contexts, the scientific output remains fragmented regarding approaches focused on the psychological distress experienced by these patients. Therefore, this manuscript is justified by its contribution to the scientific community, showcasing studies that address the use of music for reducing psychological distress in cancer patients and expanding knowledge about this practice, identifying existing literature gaps, and contributing to scientific advancement in the field.

A search was conducted to identify reviews with similar themes, ensuring the exclusivity of the data. The Open Science Framework (OSF) platform was searched, and no publications with a scope similar to this review were found. Thus, this study aims to map how music has been used in nursing care to alleviate psychological distress among adult cancer patients in oncology rehabilitation settings.

Methods

This scoping review protocol is conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) [18] and the guidelines formulated by the Joanna Briggs Institute (JBI) [19]. This study was pre-registered on the Open Science Framework (OSF) public platform prior to commencing the formal search (https://osf.io/vxazq/). Complementary searches were also conducted in the international repositories PROSPERO and the Cochrane Library, where no registered protocols with identical themes were identified, reinforcing the originality of the present study.

The work was developed following the methodological framework proposed by Arksey & O’Malley (2005) [20], which was subsequently expanded, adhering to the following stages: 1) defining the research question; 2) aligning the review’s inclusion and exclusion criteria; 3) approaching study selection; 4) selecting, extracting, and presenting evidence; 5) analyzing extracted data; 6) presenting results; and 7) synthesizing data according to the objective.

Search strategy

Initially, a limited preliminary search was performed in the PubMed and CINAHL databases to identify descriptors, keywords, and indexing terms frequently used in studies related to the scope review to be developed.

Following the initial analysis of studies in the databases, a consultation was conducted with the Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH), with adaptations for language (Portuguese and English) to optimize results. The following indexed descriptors were used: “Music Therapy”, “Psychological Distress”, “Anxiety”, “Depression” “Subjective Stress”, “Nursing Care”, “Neoplasms”. The Boolean operators “AND” and “OR” were used to combine the descriptors in the search strategy.

The databases were selected based on their comprehensiveness and relevance to the field of healthcare and music therapy in oncology, including internationally indexed databases that concentrate clinical studies, systematic reviews, and literature on musical interventions.

To complement the search and minimize publication bias, gray literature sources, including dissertations, theses, and institutional reports, will be considered, alongside reverse search procedures (checking the references of included studies) to identify additional relevant evidence. No restrictions will be applied regarding language or publication date. Studies published in languages other than Portuguese or English will be translated or analyzed with the assistance of specialized translators, and all publication dates will be included to capture the full extent of available evidence for gray literature. This approach broadens the scope of the review, ensuring that all pertinent evidence, regardless of language or date, is incorporated into the scoping summary.

Twenty data sources will be used to construct this review, namely: PubMed Central (PMC), Latin American and Caribbean Health Sciences Literature (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Scientific Electronic Library Online (SciELO), Cochrane Library, Elsevier’s Scopus, ScienceDirect, Wiley Online Library, and Virtual Health Library (BVS). For gray literature, the Catalog of Theses and Dissertations of the Coordination for the Improvement of Higher Education Personnel (CAPES), Networked Digital Library of Theses and Dissertations (NDLTD), Google Scholar, European Thesis Portal (DART); Electronic Thesis Online Service (EThOS); Open Access Scientific Repository of Portugal (RCAAP); National Theses and Dissertations (ETD Portal); Theses Canada; Treasury of the National Library of Australia (TROVE); Online Academic Archive (DIVA). The search will be conducted through the CAPES Periodicals Portal, via remote access on the Federated Academic Community (CAFe) platform. As an example of the search strategy the following string was created for the PubMed PMC database, represented in Table 1, resulting in 1964 free full-text documents in October 2025.

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Table 1. Search strategy in PubMed PMC. Natal, RN, Brasil, 2025.

https://doi.org/10.1371/journal.pone.0335895.t001

The literature search is scheduled to be conducted primarily in November 2025, including all articles published up to that date. The subsequent stages of the study are expected to be completed by the end of December or January 2025.

Discussion

The susceptibility to experiencing psychological distress can accompany cancer patients at various stages, from diagnosis to palliation, irrespective of age. Statistics indicate that the likelihood of a cancer patient developing psychoemotional symptoms is double that of a healthy individual, remaining an inherent reality for the patient even after treatment cessation and disease remission [22]. Mental suffering from treatment, combined with the emotional burden of a cancer diagnosis, compromises patients’ quality of life and increases suicide risk, highlighting the need for integrative approaches to address the psychological dimension of coping with cancer [10].

Complementary non-pharmacological strategies have been widely investigated for their potential to promote more humanized and holistic care, contributing significantly to the alleviation of stress, anxiety, and other emotional symptoms in patients. Thus, nursing, grounded in a holistic perspective, plays a leading role in the use of effective non-pharmacological integrative and complementary practices for reducing pain, anxiety, nausea, and other symptoms [23].

Music therapy, as a rising non-pharmacological strategy, has been applied in the context of oncological patient care. Pre-existing systematic reviews indicate that the use of this approach promotes positive effects in reducing anxiety and depression. Research conducted in a palliative care setting revealed that patients, when immersed in the experience of musical intervention, direct their attention to pleasant experiences. This participation contributes to the alleviation of suffering and assists the patient in overcoming the frequent difficulty of verbally expressing emotions and feelings [24,25].

In a study conducted by Lagattolla F. et al., it was demonstrated that music can induce relaxation in breast cancer patients, contributing to the reduction of anger, heart and respiratory rates, as well as attenuating pain, decreasing the need for anesthetics and analgesics, and shortening recovery time—factors that significantly contribute to the reduction of anxiety and depression [26].

In this sense, it is observed that interventions aimed at spiritual well-being are not yet comprehensively addressed in clinical practice, which can negatively impact treatment adherence, quality of life, and even functional recovery of patients. Therefore, the production of empirical evidence supporting practices capable of promoting physical health, psychosocial adaptation, and spiritual balance constitutes a fundamental priority in the context of healthcare provision [25].

In summary, this scoping review will map current evidence on musical interventions in the psychosocial care of cancer patients, providing nursing professionals with up-to-date knowledge to support effective and compassionate practice. It may also inform the development of structured intervention protocols and stimulate further research in this area.

Conclusions

This scoping review protocol aims to map the available scientific evidence on the use of music as an intervention for reducing psychological distress in cancer patients. The findings are expected to contribute to the strengthening of clinical practice, particularly in oncology nursing, by promoting more humanized and evidence-based care. Furthermore, the results may guide the development of care protocols and help identify knowledge gaps that can inform future research on the topic.

Supporting information