Research trends and evidence gaps in integrative palliative care for cancer patients: a bibliometric analysis

Abstract

Introduction Palliative care for cancer patients has gained increasing recognition for its significance by improving patient quality of end of life care. However, unmet needs persist due to the limitations of conventional medical interventions and therapeutic approaches. Complementary and alternative medicine (CAM) interventions have potential applications in palliative care. This study aimed to investigate research trends and identify evidence gaps in this field through a bibliometric analysis of published research on the Web of Science (WoS). Methods The WoS database was comprehensively searched up to October 2025 for publications related to CAM used in palliative care. The extracted bibliographic information included basic study details and a citation analysis to identify the most influential publications. Additionally, thematic evolution analysis was conducted to structurally understand the research evolution. Co-word networks were constructed using author keywords from the included publications and were clustered based on density (development degree) and centrality (relevance degree). Results A total of 588 publications from 217 sources between 1995 and 2026 were included in the analysis. The annual growth rate of publications was estimated to be 9.67%. The United States of America, China, and United Kingdom emerged as the most productive countries in terms of publication output. Studies of music therapy, aromatherapy & massage, and acupuncture played key roles in integrative palliative care research, while digital health and telemedicine emerged as new areas of focus. Nevertheless, significant limitations in the evidence for these interventions, such as small sample sizes and methodological weaknesses in clinical trials, remain substantial barriers to establishing robust evidence. Conclusion This study highlights the continuous growth in research on CAM interventions in palliative care. Future studies are essential to establish the clinical evidence for individual interventions and future emerging and under-evaluated approaches in this field.

Keywords

complementary and alternative medicine / palliative care / hospice / bibliometric analysis / cancer / integrative medicine

References

[1] Tripodoro VA, Bouësseau MC, Connor SR, Centeno C. 35 years of palliative care progress: what lies ahead for society engagement? J Pain Symptom Manage. 2025; 70(5):e291-e298.

[2] Adler SR, Marchand LR, Heap N. Integrative palliative care: enhancing the natural synergy between integrative health and palliative medicine. J Altern Complement Med. 2019; 25(3):257-259.

[3] Pan CX, Morrison RS, Ness J, Fugh-Berman A, Leipzig RM. Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life. A systematic review. J Pain Symptom Manage. 2000; 20(5):374-387.

[4] Zeng YS, Wang C, Ward KE, Hume AL. Complementary and alternative medicine in hospice and palliative care: a systematic review. J Pain Symptom Manage. 2018; 56(5):781-794. e4.

[5] Frenkel M, Sapire K, Lacey J, Sierpinaet SV. Integrative medicine: adjunctive element or essential ingredient in palliative and supportive cancer care? J Altern Complement Med 2020; 26(9):779-783.

[6] Gan YN, Li DD, Robinson N, Liu JP. Practical guidance on bibliometric analysis and mapping knowledge domains methodology-a summary. Eur J Integr Med. 2022; 56:102203.

[7] Hilliard RE. The effects of music therapy on the quality and length of life of people diagnosed with terminal cancer. J Music Ther. 2003; 40(2):113-137.

[8] Gutgsell KJ, Schluchter M, Margevicius S, et al. Music therapy reduces pain in palliative care patients: a randomized controlled trial. J Pain Symptom Manage. 2013; 45(5):822-831.

[9] Wilkinson S, Aldridge J, Salmon I, Cain E, Wilson B. An evaluation of aromatherapy massage in palliative care. Palliat Med. 1999; 13(5):409-417.

[10] Soden K, Vincent K, Craske S, et al. A randomized controlled trial of aromatherapy massage in a hospice setting. Palliat Med. 2004; 18(2):87-92.

[11] Lau CH, Wu X, Chung VC, et al. Acupuncture and related therapies for symptom management in palliative cancer care: systematic review and meta-analysis. Medicine. 2016; 95(9):e2901.

[12] Towler P, Molassiotis A, Brearley SG. What is the evidence for the use of acupuncture as an intervention for symptom management in cancer supportive and palliative care: an integrative overview of reviews. Support Care Cancer. 2013; 21(10):2913-2923.

[13] Breitbart W, Poppito S, Rosenfeld B, et al. Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. J Clin Oncol. 2012; 30(12):1304-1309.

[14] Chung VCH, Wu X, Lu P, et al. Chinese herbal medicine for symptom management in cancer palliative care: systematic review and meta-analysis. Medicine (Baltimore). 2016; 95(7):e2793.

[15] Thrane SE, Maurer SH, Ren D, Danford CA, Cohen SM. Reiki therapy for symptom management in children receiving palliative care: a pilot study. Am J Hosp Palliat Care. 2017; 34(4):373-379.

[16] Kutner JS, Smith MC, Corbin L, et al. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial. Ann Intern Med. 2008; 149(6):369-379.

[17] Horne-Thompson A, Grocke D. The effect of music therapy on anxiety in patients who are terminally ill. J Palliat Med. 2008; 11(4):582-590.

[18] Warth M, Keßler J, Hillecke TK, Bardenheuer HJ.Music therapy in palliative care. Deutsches Ä rzteblatt Int. 2015; 112:788-794.

[19] Mansky PJ, Wallerstedt DB. Complementary medicine in palliative care and cancer symptom management. Cancer J. 2006; 12(5):425-431.

[20] He Y, Guo X, May BH, et al. Clinical evidence for association of acupuncture and acupressure with improved cancer pain: a systematic review and meta-analysis. JAMA Oncol. 2020; 6(2):271-278.

[21] Hilliard RE. Music therapy in hospice and palliative care: a review of the empirical data. Evid Based Complement Alternat Med. 2005; 2(2):173-178.

[22] Gallagher LM, Lagman R, Walsh D, Davis MP, Legrand SB. The clinical effects of music therapy in palliative medicine. Support Care Cancer. 2006; 14(8):859-866.

[23] Lian WL, Pan MQ, Zhou DH, Zhang ZJ. Effectiveness of acupuncture for palliative care in cancer patients: a systematic review. Chin J Integr Med. 2014; 20(2):136-147.

[24] Lee H, Schmidt K, Ernst E. Acupuncture for the relief of cancer-related pain: a systematic review. Eur J Pain. 2005; 9(4):437-444.

[25] Wilkinson SM, Love SB, Westcombe AM, et al. Effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer: a multicenter randomized controlled trial. J Clin Oncol. 2007; 25(5):532-539.

[26] Archie P, Bruera E, Cohen L. Music-based interventions in palliative cancer care: a review of quantitative studies and neurobiological literature. Support Care Cancer. 2013; 21(9):2609-2624.

[27] Wu X, Chung VCH, Hui EP, et al. Effectiveness of acupuncture and related therapies for palliative care of cancer: overview of systematic reviews. Sci Rep. 2015; 5:16776.

[28] Wilcock A, Manderson C, Weller R, et al. Does aromatherapy massage benefit patients with cancer attending a specialist palliative care day centre? Palliat Med. 2004; 18(4):287-290.

[29] McConnell T, Porter S. Music therapy for palliative care: a realist review. Palliat Support Care. 2017; 15(4):454-464.

[30] Mao JJ, Ismaila N, Bao T, et al. Integrative medicine for pain management in oncology: society for integrative oncology-ASCO guideline. J Clin Oncol. 2022; 40(34):3998-4024.

[31] Wlodarczyk N. The effect of music therapy on the spirituality of persons in an in-patient hospice unit as measured by self-report. J Music Ther. 2007; 44(2):113-122.

[32] Standish LJ, Kozak L, Congdon S. Acupuncture is underutilized in hospice and palliative medicine. Am J Hosp Palliat Care. 2008; 25(4):298-308.

[33] Choi TY, Lee MS, Kim TH, Zaslawski C, Ernst E. Acupuncture for the treatment of cancer pain: a systematic review of randomised clinical trials. Support Care Cancer. 2012; 20(6):1147-1158.

[34] Dean-Clower E, Doherty-Gilman AM, Keshaviah A, et al. Acupuncture as palliative therapy for physical symptoms and quality of life for advanced cancer patients. Integr Cancer Ther. 2010; 9(2):158-167.

[35] Burns DS, Perkins SM, Tong Y, Hilliard RE, Cripe LD. Music therapy is associated with family perception of more spiritual support and decreased breathing problems in cancer patients receiving hospice care. J Pain Symptom Manag. 2015; 50(2):225-231.

[36] Paley CA, Johnson MI, Tashani OA, Bagnall AM. Acupuncture for cancer pain in adults. Cochrane Database Syst Rev. 2015; 2015(10):CD007753.

[37] Muecke R, Paul M, Conrad C, et al. Complementary and alternative medicine in palliative care: a comparison of data from surveys among patients and professionals. Integr Cancer Ther. 2016; 15(1):10-16.

[38] Schmid W, Rosland JH, von Hofacker S, Hunskår I, Bruvik F. Patient’s and health care provider’s perspectives on music therapy in palliative care - an integrative review. BMC Palliat Care. 2018; 17(1):32.

[39] Hyodo I, Amano N, Eguchi K, et al. Nationwide survey on complementary and alternative medicine in cancer patients in Japan. J Clin Oncol. 2005; 23(12):2645-2654.

[40] Tao WW, Jiang H, Tao XM, Jiang P, Sha LY, Sun XC. Effects of acupuncture, tuina, tai chi, qigong, and traditional Chinese medicine five-element music therapy on symptom management and quality of life for cancer patients: a meta-analysis. J Pain Symptom Manage. 2016; 51(4):728-747.

[41] Jodie F, Anna K, Ursula W. Effectiveness of music therapy, aromatherapy, and massage therapy on patients in palliative care with end-of-life needs: a systematic review. J Pain Symptom Manage. 2025; 69(1):102-113.

[42] Candy B, Armstrong M, Flemming K, et al. The effectiveness of aromatherapy, massage and reflexology in people with palliative care needs: a systematic review. Palliat Med. 2020; 34(2):179-194.

[43] Choi TY, Ang L, Jun JH, Alraek T, Lee MS. Acupuncture and moxibustion for cancer-related fatigue: an overview of systematic reviews and meta-analysis. Cancers. 2022; 14(10):2347.

[44] Yang J, Wahner-Roedler DL, Zhou X, et al. Acupuncture for palliative cancer pain management: systematic review. BMJ Support Palliat Care. 2021; 11(3):264-270.

[45] Yu X, Gong SY, Luo Q, et al. Effectiveness of acupuncture in improving quality of life for patients with advanced cancer: a systematic review and meta-analysis. Chin J Integr Med. 2025; 31(4):360-371.

[46] Wu Y, Pan J, Lu Y, Chao J, Yu H. Psychotherapy for advanced cancer patients: a meta-analysis of the quality of life and survival assessments. Palliat Support Care. 2023; 21(2):301-307.

[47] Utli H, Dinç M, Utli MDA. The effect of acupressure or reiki interventions on the levels of pain and fatigue of cancer patients receiving palliative care: a randomized controlled study. Explore. 2023; 19(1):91-99.

[48] Seaman JB, Bear TM, Documet PI, Sereika SM, Albert SM. Hospice and family involvement with end-of-life care: results from a population-based survey. Am J Hosp Palliat Care. 2016; 33(2):130-135.

[49] Wang T, Molassiotis A, Chung BPM, Tan JY. Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliat Care. 2018; 17(1):96.

[50] Wu VS, Ben Smith AB, Girgis A. The unmet supportive care needs of Chinese patients and caregivers affected by cancer: a systematic review. Eur J Cancer Care. 2022; 31(6):e13269.

[51] Sewitch MJ, Cepoiu M, Rigillo N, Sproule D. A literature review of health care professional attitudes toward complementary and alternative medicine. Complementary Health Pract Rev. 2008; 13(3):139-154.

[52] Shah AQ, Noronha N, Chin-See R, et al. The use and effects of telemedicine on complementary, alternative, and integrative medicine practices: a scoping review. BMC Complement Med Ther. 2023; 23(1):275.