Effectiveness of five elements music therapy on negative emotions of tumor patients:a systematic review and grading recommendations(GRADE)system

Background:Many original studies have shown that traditional Chinese five-element therapy(FEM-therapy)can effectively relieve anxiety,depression and quality of life.However,one published systematic review refuted this conclusion.To further clarify the efficacy of FEM therapy in relieving negative emotion among cancer patients and to assess the reliability of the evidence,this systematic review and meta-analysis was performed.Methods:We searched for randomized controlled trials(RCTs)comparing FEM-therapy versus standard care for cancer patients,six databases(CBM,PubMed,Cochrane Library,Web of Science,CNKI,and WanFang),two clinical trial registries and one gray literature database were searched from inception to October 31,2022.Two investigators independently screened literature,extracted data,and assessed risk of bias according to the Cochrane Handbook Version 6.1.0.The RevMan 5.3 software was used to perform the meta-analysis.Overall quality of evidence was rated using GRADE(Grading of Recommendations,Assessment,Development and Evaluation).Results:25 RCTs involving 1990 patients were finally included.Two of which had high risk bias,the remaining 23 were rated as unclear risk bias.Compared with other treatments,FEM-therapy combined with conventional nursing can significantly relieve anxiety(MD=-10.33,95%CI:[-13.77,-6.88],P<0.05;very low certainty)and depression(SMD=-1.10,95%CI:[-1.41,-0.79],P<0.05;very low certainty),and can significantly increase the quality of sleep(MD=-2.92,95%CI:[-4.89,-0.95],P<0.05;low certainty).Compared with acupuncture intervention,FEM-therapy combined with acupuncture can decreased the anxiety(SMD=-0.64,95%CI:[-0.98,-0.30],P<0.05;Moderate certainty)and depression(SMD=-0.68,95%CI:[-1.00,-0.32],P<0.05;Moderate certainty).Conclusion:Traditional Chinese FEM therapy combined with other treatments are effective in alleviating negative emotions among cancer patients.In order to better improve the quality of life of cancer patients and give more reliable advice,more trials of direct comparisons are needed to inform clinical decision-making with greater confidence.