The Effect of a Music-Assisted Mandala Intervention on Psychological Well-being and Quality of Life in Cancer Patients Undergoing Chemotherapy

Today, cancer is a leading cause of death worldwide. However, thanks to advances in medicine and modern technology, the availability of tests and diagnostic methods used to detect cancer at an early stage, and the use of increasingly effective treatments-including chemotherapeutic agents-the number of cancer survivors is also rising. Chemotherapy, one of these treatment methods, not only treats the disease but also causes numerous physiological and psychological side effects that adversely affect quality of life. It has been reported that treatment adherence problems are more common in patients with a high symptom burden associated with these side effects. For this reason, it is crucial that patients have achieved psychological adaptation to their condition and treatment in order for the treatment to be effective, to ensure that toxicity is managed, and to ensure a positive progression of the disease. In cases of non-adherence to treatment or non-compliance with the condition, this can lead to unnecessary visits to the doctor, visits to A&E, hospitalisation, and an increase in the use of healthcare services and associated costs; it may also result in the development of treatment resistance, an increased burden on patients and carers, disease progression, and even death. Various non-pharmacological approaches, such as exercise, expressing emotions and art therapy, can be used to ensure the patient's adherence to treatment.Mandala, one of the forms of art therapy, is a Sanskrit term meaning 'circle' or 'centre'. It describes designs created by the repetition of geometric patterns in various forms, centred around a point and arranged in a pattern. Its origins date back to India, and it is a form of art practised in Asian culture as a means of religious contemplation and meditation. The mandala, one of the tools used by art therapists, is employed to promote relaxation and generate positive energy. It is believed that the drawings people make inside the circle represent their thoughts at that moment, help them to forget the turmoil they are experiencing, and assist them in withdrawing into themselves by enabling them to concentrate on the act of drawing itself. A review of the literature indicates that mandala practice has been reported to reduce anxiety, fatigue, insomnia and stress. In light of this information, the aim of this study is to assess the effect of mandala practice on psychological adjustment to the disease and treatment, and on quality of life, in cancer patients undergoing chemotherapy.

Inclusion criteria

• patients who have been diagnosed with cancer,
• aged 18 or over,
• receiving chemotherapy for the first time,
• able to hold a pen,
• agreed to take part in the study

Exclusion criteria

• Decline to participate in the study or do not provide written informed consent.
• Have physical conditions that would prevent participation in the mandala intervention (e.g., severe pain, severe nausea, or severe vomiting).
• Have mental health conditions or cognitive impairment that limit their ability to communicate or participate in the intervention.
• Experience fatigue primarily due to causes other than chemotherapy (e.g., severe anemia with hemoglobin < 9 g/dL).
• Are unable to hold or use a pen to complete the mandala activity.