Abstract
<title>Abstract</title> <p> Background and Objectives Patients with non-small cell lung cancer (NSCLC) receiving palliative care (PC)often present with anxiety、depression and psychological distress, which exert a negative impact on their quality of life (QOL). Tibetan singing bowls (TSB), known for their rapid relaxing effects, are widely used as an adjuvant therapy for relieving anxiety and depression as well as improving quality of life in patients with severe physical illnesses. This study aimed to investigate the effects of a four-week continuous TSB intervention on QOL, anxiety, depression and psychological distress among NSCLC patients under PC. Methods At two study centers, recruited adult participants with NSCLC receiving PC were randomly assigned to the experimental group (EG) and the control group (CG). Ultimately, data from 183 participants were included in the analysis, with 92 cases in the EG and 91 cases in the CG. The EG received TSB intervention, while the CG received standard care. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), Hospital Anxiety and Depression Scale (HADS) and Distress Thermometer (DT) were used as outcome measures. HADS and DT were assessed at baseline (Week 0) and at the end of the first to fourth weeks (Week 1–Week 4), while EORTC QLQ-C30 was evaluated at Week 0 and Week 4 only. Results At Week 0, the baseline characteristics were comparable between the two groups. At Week 4, the EG showed statistically significantly greater changes than the CG in the increased score of the global quality of life factors of the EORTC QLQ-C30 (16.60 vs. 8.30, <italic>p</italic> < 0.001), role function (16.70 vs. 16.70, <italic>p</italic> < 0.001), emotional function (8.40 vs. 0.00, <italic>p</italic> < 0.01), and the reduced score of fatigue (22.20 vs. 11.10, <italic>p</italic> < 0.01). The effect sizes were small, small, small and medium respectively. From Week 1 to Week 4, the HADS-A factor of the EG was significantly lower than that of the CG. There was a main effect of time (F = 131.120, p < 0.001), a main effect of intervention (F = 7.631, p < 0.01), and a time*intervention interaction effect (F = 13.040, p < 0.001), corresponding to large, small and medium effect sizes respectively. From Week 1 to Week 4, the HADS-D factor score of the EG was significantly lower than that of the CG. There was a main effect of time (F = 64.943, p < 0.001), a main effect of intervention (F = 9.541, p < 0.01), and an interaction effect of time*intervention (F = 14.076, p < 0.001), corresponding to large, small and medium effect sizes respectively. From week 0 to week 4, the DT scores of the EG decreased significantly. The time effect of the EG was statistically significant (χ²=121.575, P < 0.001) with a small effect size. At week 2 (P > 0.05), there was no significant difference in DT scores between the two groups. At week 1, week 3 and week 4 (P < 0.05), the DT scores of the EG were significantly lower than those of the CG. EG reported no severe or persistent adverse events. Conclusion TSB may serve as an effective adjuvant approach to improve partial QOL, anxiety, depression and psychological distress in adult NSCLC patients receiving PC. </p>