Exploratory study of the association between Healing Scale and symptoms among terminally ill cancer patients
Brief Report | Symptom Management in Palliative Medicine and Palliative Care

Exploratory study of the association between Healing Scale and symptoms among terminally ill cancer patients

Tomofumi Miura1,2 ORCID logo, Takashi Kawaguchi3, Takashi Igarashi4, Koshin Katsu1, Sakiho Noda1, Mariko Harada1, Yuya Ashitomi1, Yukako Hattori1, Mitsue Takeuchi1, Emi Kubo1, Seiya Enomoto5, Hidehiko Taniyama5, Tetsuo Iwata5, Takuhiro Yamaguchi6

1Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan; 2Division of Biomarker Discovery, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Kashiwa, Japan; 3Department of Clinical Assessment, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan; 4Department of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan; 5JVCKENWOOD Corporation, Yokohama, Japan; 6Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan

Correspondence to: Tomofumi Miura, MD, PhD. Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwanoha 6-5-1, Kashiwa, Chiba 277-8577, Japan; Division of Biomarker Discovery, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Kashiwa, Japan. Email: tomiura@east.ncc.go.jp.

Abstract: The Healing Scale was developed to measure subjects’ sense of healing. This study aimed to investigate the association between the Healing Scale scores and symptom improvement in terminally ill cancer patients. A sub-analysis of a previous sound-based intervention study was performed. Data from 18 terminally ill cancer patients were analyzed. The Healing Scale and symptoms were measured before and 30 minutes after the intervention. Correlations between the Healing Scale score and symptoms before intervention, and improvement of the Healing Scale and symptoms were analyzed using Pearson’s rho. The mean age of subjects was 69.4 years and 33.3% were female. At baseline, higher Healing Scale Scores were significantly correlated with greater symptom burden, particularly well-being (ρ=−0.57), shortness of breath (ρ=−0.55), and lack of appetite (ρ=−0.50). At post-intervention, improvements in the Healing Scale scores showed moderate to strong correlations with reductions in shortness of breath (ρ=−0.68), tiredness (ρ=−0.58), and well-being (ρ=−0.56). These findings suggest that the Healing Scale may be a valuable outcome measure in palliative care research and clinical practice and may help to evaluate subjective aspects of patient healing and well-being that are often overlooked by traditional symptom scales. Further studies with larger sample sizes are required to validate the present findings in palliative care settings.

Keywords: Healing; symptom; cancer; palliative care


Submitted Feb 07, 2025. Accepted for publication Apr 17, 2025. Published online May 27, 2025.

doi: 10.21037/apm-25-12


Introduction

Cancer is well known as the leading cause of death in the world. Therefore, the importance of palliative care has gradually gained recognition (1). Palliative care focuses on alleviating distressing symptoms and improving the quality of life of patients and their caregivers (2). Palliative care also focuses on cultivating a sense of healing (3). For terminally ill cancer patients, usual care including emotional support through verbal or non-verbal communication and personal care such as assisting with bathing, toileting, supporting activities of daily living, and a clean and comfortable environment, is crucial as it nurtures a sense of healing with minimal side effects (4). Even if this sense of healing is temporary due to severe physical conditions, it enables patients to live more comfortably and meaningfully. To improve usual care, appropriate measurements are essential. However, there are limited methods available to evaluate patients’ sense of healing.

The Healing Scale was developed to assess the psychological state and changes in a subject’s sense of being “healed”, which arises from impressions of external objects, including appreciation of art and the environment (5). The most important characteristic of this scale is that it does not include religious dimensions, because healing is not a religious activity and patients do not need to have “religious faith” or hold any particular beliefs (6). We hypothesized that the sense of healing, as measured by this scale, was correlated with improvements in anxiety, depression, and overall well-being. While the association between this scale and symptoms remains unknown, this scale could effectively evaluate the healing effect of usual care. Our previous study reported that high-resolution natural sound with inaudible high-frequency components improved the healing status and symptoms using this scale (7). This study aimed to explore the association between the Healing Scale and symptoms to better characterize the Healing Scale among terminally ill cancer patients. We present this article in accordance with the STROBE reporting checklist (available at https://apm.amegroups.com/article/view/10.21037/apm-25-12/rc).


Materials and methods

This study represents a secondary analysis of data from a previous single-arm, open-label study that aimed to assess changes in healing status and symptoms using high-resolution natural sound with inaudible high-frequency components (7). Briefly, terminally ill cancer patients in the palliative care unit at National Cancer Center Hospital East, aged 20 years or older, with a Karnofsky Performance Status (KPS) of 50 to 100, and without delirium or deafness, were enrolled and listened to the high-resolution natural sound (KooNe, JVCKENWOOD Corp., Yokohama, Japan) for 4 hours from December 27, 2021, to June 30, 2022. The primary endpoint was the change in the Healing Scale 30 minutes after the start of the sound. Healing and symptoms were evaluated before and 30 minutes after the sound intervention.

The Healing Scale is a novel instrument crafted to assess an individual’s psychological well-being and to capture shifts in what is termed the “healed” axis—changes that occur as a result of impressions formed by external stimuli, such as art and the natural environment (5). This scale comprises 30 items, which are rated on a three-point verbal rating scale (0: disagree, 1: slightly agree, 2: agree). The Total Healing Scale Score, which sums all 30 items and ranges from 0 to 60, indicates the level of healing and was rated as: “not healed”, score of 0 to 14; “healed”, score of 15 to 31; “quite healed”, score of 32 to 48; and “extremely healed”, score of 49 to 60 (7). This scale includes 6 subscales, which sum 5 items and ranges from 0 to 12, respectively: (I) Nagomi (relieved healing): This subscale reflects a state of calm and relaxation, where the individual feels a sense of relief, warmth, and reassurance. It embodies a peaceful and comforting emotional experience (5,7). (II) Kiwami (self-developed healing): This subscale captures the inspiration and motivation derived from engaging with a work. It encourages feelings of hope, courage, and the drive to refine oneself, fostering personal growth and development (5,7). (III) Kiyoraka (pure healing): This subscale represents a serene and purified mental state. It evokes clarity and a sense of cleansing, often bringing about a sublime emotional experience that enhances a tranquil and noble mood (5,7). (IV) Uruoi (refreshing healing): This subscale indicates a refreshing and revitalizing psychological state. It is associated with relaxation and renewal, offering a light-hearted, refreshed, and relaxed feeling (5,7). (V) Hazumi (merry healing): This subscale expresses joyfulness and lightness of heart. It involves a playful, childlike delight that lifts the spirit, evoking a feeling of emotional buoyancy and cheerfulness (5,7). (VI) Mushin (selfless healing): This subscale represents a state of emptiness and stillness, where the individual enjoys simply being present without active thought. This experience aligns with the concepts of void in Mahayana Buddhism or non-action in Taoism, bringing about a peaceful, content state of nothingness (5,7). Additionally, this scale also has 2 subscales related to therapeutic power: “therapeutic energy” (a force that comforts and heals the heart), and “self-help energy” (a force for self-actualization, self-disclosure, and supremacy). The Healing Scale is only available as the Japanese version now (5,7).

The Japanese version of the Edmonton Symptom Assessment System Revised (ESASr-J) was employed to assess nine symptoms—pain, tiredness, drowsiness, nausea, appetite loss, shortness of breath, depression, anxiety, and well-being—with an 11-point numerical rating scale (8).

The following data on all patients: age, sex, cancer type, healing state using the Healing Scale before and 30 minutes after the sound intervention, and symptoms based on ESASr-J before and 30 minutes after the intervention were used in this analysis.

This study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. This study was approved by the National Cancer Center Institutional Review Board (No. 2021-227) and was registered in the Japan Registry of Clinical Trials (jRCT1032210523; https://jrct.niph.go.jp/en-latest-detail/jRCT1032210523). Written informed consent was obtained from all participants.

Statistical analysis

Descriptive statistics were used to summarize the study results. Continuous variables are expressed as the mean with standard deviation (SD) or median with interquartile range (IQR). Changes from before to 30 minutes after intervention were calculated. The correlation between the Healing Scale and ESASr-J baseline scores and changes in scores were analyzed using Pearson’s rho. Statistical analysis was performed using JMP 14.0 (SAS Institute, Cary, NC, USA).


Results and discussion

Patients’ characteristics

Eighteen patients were included in the analysis. Their demographic and clinical characteristics are detailed in Table 1. The mean age was 69.4 years, with females constituting 33.3%. In addition, 83.3% of the patients exhibited a KPS of 50–60.

Table 1

Patient characteristics

Variables Values
Age (years) 69.4±7.5
Gender
   Male 12 (66.7)
   Female 6 (33.3)
Cancer type
   Lung 3 (16.7)
   Colorectal 3 (16.7)
   Gallbladder and pancreas 3 (16.7)
   Urinary tract 3 (16.7)
   Other 7 (38.9)
Metastasis
   Liver 7 (38.9)
   Bone 7 (38.9)
   Lung 4 (22.2)
KPS
   50 10 (55.6)
   60 5 (27.8)
   70–90 3 (16.7)

Data are presented as n (%) or mean ± standard deviation. , one patient had both lung and urinary tract cancer. KPS, Karnofsky Performance Status; SD, standard deviation.

Baseline data on healing state and symptoms

Baseline data on the healing state and symptoms are shown in Table 2.

Table 2

Baseline data on healing state and symptoms

Variables Mean SD
Healing Scale
   Total healing score 20.9 13.5
   Nagomi (relieved healing) 3.7 2.5
   Kiwami (self-developed healing) 3.3 2.6
   Kiyoraka (pure healing) 4.0 2.6
   Uruoi (refreshing healing) 4.2 2.8
   Hazumi (merry healing) 2.5 2.3
   Mushin (selfless healing) 3.5 2.4
   Self-help energy 8.8 5.8
   Therapeutic energy 9.5 6.4
Symptoms
   Pain 1.8 1.7
   Tiredness 2.3 2.4
   Drowsiness 2.3 2.3
   Nausea 0.4 0.6
   Lack of appetite 2.8 3.3
   Shortness of breath 2.4 2.5
   Depression 1.9 1.8
   Anxiety 2.6 2.3
   Well-being 3.9 2.4

SD, standard deviation.

The mean total healing score was 20.9±13.5. The mean scores for the subscales Uruoi and Kiyoraka were 4.2±2.8 and 4.0±2.6, respectively. The mean scores for lack of appetite and anxiety were 2.8±3.3 and 2.6±2.3, respectively.

Changes in healing state and symptoms

Changes in the healing state and symptoms are shown in Table 3. The mean change in the total healing score was 5.3±13.2. The mean changes in Nagomi, Kiyoraka, and Uruoi were 1.9±3.0, 1.4±2.6, and 1.4±2.6, respectively. The mean changes in anxiety, lack of appetite, and shortness of breath were −1.2±1.7, −1.0±2.6, and −1.0±1.5, respectively.

Table 3

Changes in healing state and symptoms

Variables Mean SD
Healing Scale
   Total healing score 5.3 13.2
   Nagomi (relieved healing) 1.9 3.0
   Kiwami (self-developed healing) 0.2 1.9
   Kiyoraka (pure healing) 1.4 2.6
   Uruoi (refreshing healing) 1.4 2.6
   Hazumi (merry healing) 0 2.2
   Mushin (selfless healing) 0.7 2.5
   Self-help energy −0.6 5.9
   Therapeutic energy 2.0 7.8
Symptoms
   Pain −0.4 0.9
   Tiredness −0.7 1.2
   Drowsiness 0.3 1.9
   Nausea −0.2 0.4
   Lack of appetite −1.0 2.6
   Shortness of breath −1.0 1.5
   Depression −0.8 1.9
   Anxiety −1.2 1.7
   Well-being −1.0 2.1

SD, standard deviation.

Correlation between healing state and symptoms at baseline

The correlations between the healing state and symptoms at the baseline are shown in Table 4. The total healing score had negative correlations with well-being [ρ=−0.57, 95% confidence interval (CI): −0.82 to −0.14] and shortness of breath (−0.55, 95% CI: −0.81 to −0.11). For subscales, the following are examples of significant negative correlations:

  • Nagomi and lack of appetite (−0.57, 95% CI: −0.82 to −0.14).
  • Kiwami and well-being (−0.57, 95% CI: −0.82 to −0.13).
  • Hazumi and well-being (−0.59, 95% CI: −0.83 to −0.16).
  • Therapeutic energy and well-being (−0.66, 95% CI: −0.86 to −0.27), lack of appetite (−0.60, 95% CI: −0.83 to −0.17), and shortness of breath (−0.58, 95% CI: −0.82 to −0.15).

Table 4

Correlation between healing state and symptoms at baseline

Symptoms Total healing score Nagomi (relieved healing) Kiwami (self-developed healing) Kiyoraka (pure healing) Uruoi (refreshing healing) Hazumi (merry healing) Mushin (selfless healing) Self-help energy Therapeutic energy
Pain −0.29 (−0.67 to 0.21) −0.28 (−0.66 to 0.22) −0.30 (−0.67 to 0.20) −0.18 (−0.59 to 0.32) −0.25 (−0.64 to 0.25) −0.48 (−0.77 to −0.02) −0.13 (−0.56 to 0.36) −0.23 (−0.62 to 0.27) −0.36 (−0.71 to 0.13)
Tiredness −0.27 (−0.65 to 0.23) −0.29 (−0.66 to 0.21) −0.25 (−0.64 to 0.25) −0.26 (−0.65 to 0.24) −0.28 (−0.66 to 0.22) −0.32 (−0.68 to 0.18) −0.05 (−0.50 to 0.43) −0.17 (−0.59 to 0.32) −0.36 (−0.71 to 0.13)
Drowsiness −0.10 (−0.53 to 0.39) −0.11 (−0.54 to 0.38) −0.22 (−0.62 to 0.28) 0.03 (−0.45 to 0.48) −0.05 (−0.50 to 0.43) −0.26 (−0.64 to 0.24) 0.08 (−0.41 to 0.52) −0.07 (−0.51 to 0.42) −0.21 (−0.61 to 0.29)
Nausea 0.11 (−0.38 to 0.54) 0 (−0.47 to 0.47) −0.02 (−0.48 to 0.46) 0.22 (−0.28 to 0.62) 0.16 (−0.33 to 0.58) −0.03 (−0.49 to 0.44) 0.21 (−0.28 to 0.62) 0.07 (−0.42 to 0.51) 0.04 (−0.44 to 0.49)
Lack of appetite −0.50 (−0.78 to −0.03) −0.57 (−0.82 to −0.14) −0.31 (−0.67 to 0.19) −0.50 (−0.78 to −0.03) −0.54 (−0.80 to −0.09) −0.38 (−0.72 to 0.11) −0.40 (−0.73 to 0.09) −0.37 (−0.71 to 0.12) −0.60 (−0.83 to −0.17)
Shortness of breath −0.55 (−0.81 to −0.11) −0.53 (−0.80 to −0.08) −0.52 (−0.79 to −0.06) −0.55 (−0.81 to −0.10) −0.56 (−0.81 to −0.12) −0.51 (−0.79 to −0.05) −0.33 (−0.69 to 0.17) −0.47 (−0.77 to 0) −0.58 (−0.82 to −0.15)
Depression −0.39 (−0.72 to 0.10) −0.39 (−0.72 to 0.10) −0.34 (−0.69 to 0.16) −0.39 (−0.72 to 0.10) −0.40 (−0.73 to 0.09) −0.43 (−0.74 to 0.06) −0.17 (−0.58 to 0.33) −0.27 (−0.65 to 0.23) −0.45 (−0.76 to 0.02)
Anxiety −0.45 (−0.75 to 0.03) −0.41 (−0.73 to 0.08) −0.36 (−0.71 to 0.13) −0.56 (−0.81 to −0.12) −0.37 (−0.71 to 0.13) −0.37 (−0.71 to 0.12) −0.39 (−0.72 to 0.10) −0.41 (−0.73 to 0.08) −0.51 (−0.78 to −0.05)
Well-being −0.57 (−0.82 to −0.14) −0.55 (−0.81 to −0.10) −0.57 (−0.82 to −0.13) −0.54 (−0.80 to −0.09) −0.52 (−0.79 to −0.06) −0.59 (−0.83 to −0.16) −0.38 (−0.71 to 0.12) −0.49 (−0.78 to −0.03) −0.66 (−0.86 to −0.27)

Data are shown as ρ (95% confidence interval).

Correlation between healing state and symptoms to determine changes after intervention

The correlations between the healing state and symptoms to determine changes after intervention are shown in Table 5. The total healing score had negative correlations with shortness of breath (−0.68, 95% CI: −0.87 to −0.30), tiredness (−0.58, 95% CI: −0.82 to −0.14), and well-being (−0.56, 95% CI: −0.81 to −0.12). For subscales, the following are examples of significant negative correlations:

  • Kiyoraka and shortness of breath (−0.65, 95% CI: −0.85 to −0.26).
  • Uruoi and shortness of breath (−0.63, 95% CI: −0.85 to −0.22).
  • Hazumi and tiredness (−0.66, 95% CI: −0.86 to −0.27) and shortness of breath (−0.63, 95% CI: −0.85 to −0.22).
  • Mushin and well-being (−0.64, 95% CI: −0.85 to −0.23).

Table 5

Correlation between healing state and symptoms to determine changes after intervention

Symptoms Total healing score Nagomi (relieved healing) Kiwami (self-developed healing) Kiyoraka (pure healing) Uruoi (refreshing healing) Hazumi (merry healing) Mushin (selfless healing) Self-help energy Therapeutic energy
Pain −0.02 (−0.48 to 0.46) −0.12 (−0.55 to 0.37) −0.32 (−0.68 to 0.18) 0.17 (−0.33 to 0.59) 0.12 (−0.38 to 0.55) −0.23 (−0.62 to 0.27) 0.23 (−0.27 to 0.63) −0.04 (−0.50 to 0.44) 0.05 (−0.43 to 0.50)
Tiredness −0.58 (−0.82 to −0.14) −0.54 (−0.80 to −0.09) −0.57 (−0.82 to −0.14) −0.55 (−0.81 to −0.11) −0.50 (−0.78 to −0.04) −0.66 (−0.86 to −0.27) −0.31 (−0.68 to 0.19) −0.49 (−0.77 to −0.02) −0.49 (−0.78 to −0.02)
Drowsiness −0.40 (−0.73 to 0.09) −0.36 (−0.70 to 0.14) −0.54 (−0.8 to −0.10) −0.23 (−0.63 to 0.27) −0.43 (−0.74 to 0.05) −0.46 (−0.76 to 0.02) −0.18 (−0.60 to 0.31) −0.40 (−0.73 to 0.09) −0.37 (−0.71 to 0.12)
Nausea −0.11 (−0.55 to 0.38) −0.08 (−0.53 to 0.40) −0.30 (−0.67 to 0.19) −0.06 (−0.51 to 0.42) −0.07 (−0.51 to 0.42) −0.07 (−0.52 to 0.41) −0.07 (−0.51 to 0.42) 0.04 (−0.44 to 0.49) −0.16 (−0.58 to 0.33)
Lack of appetite −0.18 (−0.59 to 0.32) −0.34 (−0.69 to 0.15) 0.05 (−0.43 to 0.50) −0.19 (−0.60 to 0.31) −0.24 (−0.63 to 0.26) −0.17 (−0.59 to 0.32) 0.04 (−0.44 to 0.50) −0.05 (−0.50 to 0.43) −0.19 (−0.60 to 0.31)
Shortness of breath −0.68 (−0.87 to −0.30) −0.61 (−0.83 to −0.19) −0.50 (−0.78 to −0.04) −0.65 (−0.85 to −0.26) −0.63 (−0.85 to −0.22) −0.63 (−0.85 to −0.22) −0.62 (−0.84 to −0.20) −0.56 (−0.81 to −0.12) −0.61 (−0.83 to −0.19)
Depression −0.25 (−0.64 to 0.25) −0.23 (−0.63 to 0.27) −0.26 (−0.65 to 0.24) −0.21 (−0.62 to 0.29) −0.18 (−0.59 to 0.32) −0.34 (−0.70 to 0.15) −0.17 (−0.58 to 0.33) −0.17 (−0.59 to 0.33) −0.19 (−0.60 to 0.31)
Anxiety −0.43 (−0.74 to 0.06) −0.47 (−0.76 to 0) −0.21 (−0.61 to 0.29) −0.39 (−0.72 to 0.10) −0.48 (−0.77 to −0.02) −0.26 (−0.65 to 0.24) −0.41 (−0.73 to 0.07) −0.33 (−0.69 to 0.17) −0.34 (−0.69 to 0.16)
Well-being −0.56 (−0.81 to −0.12) −0.37 (−0.71 to 0.12) −0.51 (−0.79 to −0.05) −0.45 (−0.76 to 0.03) −0.53 (−0.79 to −0.07) −0.56 (−0.81 to −0.13) −0.64 (−0.85 to −0.23) −0.45 (−0.76 to 0.02) −0.62 (−0.84 to −0.21)

Data are shown as ρ (95% confidence interval).


Discussion

This study showed that the Healing Scale was correlated with several symptoms in cancer patients who listened to high-resolution natural sound with inaudible high-frequency components. The most important finding was the moderate association between changes in the Healing Scale and symptom improvements, particularly for shortness of breath, tiredness, and well-being. These are well known as refractory symptoms (9,10). Developing pharmacological treatment with fewer side effects is challenging due to severe physical conditions. While this study did not establish a causal relationship, providing care that nurtures a sense of healing may contribute to symptom improvement and benefit both patients and their caregivers. Most clinical trials in palliative care focus on evaluating anxiety, depression, and quality of life from psychological or emotional aspects (9,10), often overlooking the sense of healing due to a lack of adequate instruments. The Healing Scale may be an appropriate method to evaluate such a sense, as it was associated with several symptoms. Additionally, well-being is well known as difficult concept for patients to understand (11). Therefore, further research using the Healing Scale may be valuable to conceptualize well-being.

The Healing Scale, originally developed to assess the psychological state and changes in a subject’s “healed” axis based on external stimuli such as art appreciation and the environment (5), can potentially be extended to evaluate the effectiveness of routine care provided by healthcare professionals. Palliative care is often described as an art form (12), where the skills and empathy of healthcare providers play a crucial role in alleviating distress and enhancing the quality of life. If the Healing Scale effectively captures the therapeutic effects of art, this scale may also capture the healing effects of well-administered palliative care.

Our findings have practical implications for the development of non-pharmacological interventions in palliative care. By incorporating elements that enhance the sense of healing, healthcare professionals can provide more holistic care that addresses both physical symptoms and psychological or emotional well-being. Future research should focus on the development of an English version of the Healing Scale, refining the Healing Scale and exploring its applicability in different settings and populations. Additionally, longitudinal studies are needed to assess the long-term effects of interventions aimed at improving the sense of healing.

This study had several limitations. First, the sample size may limit the generalizability of our findings. Second, although the Healing Scale was rigorously developed in Japan (5,7), it is only available in Japanese and is not widely used internationally. The subjective nature of the Healing Scale and reliance on self-reported measures may introduce bias. Future research should include larger, more diverse populations and consider incorporating objective measures of symptom improvement.


Conclusions

The present study highlights the characteristics of the Healing Scale, suggesting it is a valuable instrument for evaluating the sense of healing, a key element of palliative care.


Acknowledgments

We thank Mses. Rumiko Osawa, Masako Ikeda, and Sachiko Nagatsuma of the National Cancer Center Hospital East for their secretarial support.


Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://apm.amegroups.com/article/view/10.21037/apm-25-12/rc

Peer Review File: Available at https://apm.amegroups.com/article/view/10.21037/apm-25-12/prf

Funding: This study was funded by JVCKENWOOD.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-25-12/coif). T.M. received fund by JVCKENWOOD for this research, and received honoraria from Shionogi Co., Ltd., Daiichi-Sankyo Co., Ltd., Igakushoin, MSD Co., Ltd., EA Pharma Co., Ltd., S.E. is a director of a general incorporated association KANSEI Projects Committee. T.Y. received honoraria from AC MEDICAL INC., A2 Healthcare Corporation, ClinChoice, Japan Tobacco Inc., Japan Media Corporation, Medidata Solutions, Inc., ONO PHARMACEUTICAL Co., Ltd., Medrio, Inc., NIPRO CORPORATION, Intellim Corporation, Welby Inc., 3H Medi Solution Inc., Baseconnect Inc., Nobori Ltd., Puravida Technologies LLC., Hemp Kitchen Inc., Kyowa Kirin Co., Ltd., TSUMURA & Co., DAIICHI SANKYO COMPANY, LIMITED., Otsuka Pharmaceutical Co., Ltd., Solasia Pharma K.K., Cordis, NTT DOCOMO, INC.; received consulting fee from Public Health Research Foundation, EPS Corporation, Japan Tobacco Inc., Medidata Solutions, Inc., ONO PHARMACEUTICAL Co., Ltd., Kowa Company, Ltd., CHUGAI PHARMACEUTICAL Co., Ltd., DAIICHI SANKYO COMPANY, LIMITED., Eisai Co., Ltd., 3H Medi Solution Inc., Intellim Corporation, AstraZeneca, SONIRE Therapeutics Inc., SEIKAGAKU CORPORATION, Merck & Co., Inc., Mebix, Inc., Nippon Boehringer Ingelheim Co., Ltd.; participated on a Data Safety Monitoring Board for Incyte Biosciences Japan. S.E., H.T., and T.I. are employees of JVCKENWOOD. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the National Cancer Center Institutional Review Board (No. 2021-227) and was registered in the Japan Registry of Clinical Trials (jRCT1032210523; https://jrct.niph.go.jp/en-latest-detail/jRCT1032210523). Written informed consent was obtained from all participants.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.


References

  1. Chua GP, Pang GSY, Yee ACP, et al. Supporting the patients with advanced cancer and their family caregivers: what are their palliative care needs? BMC Cancer 2020;20:768. [Crossref] [PubMed]
  2. Hui D, De La Cruz M, Mori M, et al. Concepts and definitions for "supportive care," "best supportive care," "palliative care," and "hospice care" in the published literature, dictionaries, and textbooks. Support Care Cancer 2013;21:659-85. [Crossref] [PubMed]
  3. Hanks G. Palliative care: careless use of language undermines our identity. Palliat Med 2008;22:109-10. [Crossref] [PubMed]
  4. Post-White J, Kinney ME, Savik K, et al. Therapeutic massage and healing touch improve symptoms in cancer. Integr Cancer Ther 2003;2:332-44. [Crossref] [PubMed]
  5. Matsumoto K AK, Takaku S, et al. Completion of the Healing Scale, Report of “Research on Art and Healing”. Nihon University College of Art 2005:105-15.
  6. Vaghela C, Robinson N, Gore J, et al. Evaluating healing for cancer in a community setting from the perspective of clients and healers: a pilot study. Complement Ther Clin Pract 2007;13:240-9. [Crossref] [PubMed]
  7. Shimotsuura Y, Ishizuka K, Kawaguchi T, et al. Effects of High-Resolution Natural Sound with Inaudible High-Frequency Components on Healing, Symptoms, and Sleep Satisfaction in Terminally Ill Cancer Patients. Palliat Med Rep 2025;6:53-60. [Crossref] [PubMed]
  8. Yokomichi N, Morita T, Nitto A, et al. Validation of the Japanese Version of the Edmonton Symptom Assessment System-Revised. J Pain Symptom Manage 2015;50:718-23. [Crossref] [PubMed]
  9. Henson LA, Maddocks M, Evans C, et al. Palliative Care and the Management of Common Distressing Symptoms in Advanced Cancer: Pain, Breathlessness, Nausea and Vomiting, and Fatigue. J Clin Oncol 2020;38:905-14. [Crossref] [PubMed]
  10. Cherny NIESMO Guidelines Working Group. ESMO Clinical Practice Guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation. Ann Oncol 2014;25:iii143-52. [Crossref] [PubMed]
  11. Watanabe S, Nekolaichuk C, Beaumont C, Mawani A. The Edmonton symptom assessment system--what do patients think?. Support Care Cancer 2009;17:675-683. [Crossref] [PubMed]
  12. Abyad A. Palliative care: The future. Am J Hosp Palliat Care 1993;10:23-8. [Crossref]
Cite this article as: Miura T, Kawaguchi T, Igarashi T, Katsu K, Noda S, Harada M, Ashitomi Y, Hattori Y, Takeuchi M, Kubo E, Enomoto S, Taniyama H, Iwata T, Yamaguchi T. Exploratory study of the association between Healing Scale and symptoms among terminally ill cancer patients. Ann Palliat Med 2025;14(3):239-246. doi: 10.21037/apm-25-12

Download Citation