Guest Editor’s Note: Despite the high prevalence of cancer-related fatigue, there are few effective management strategies for this debilitating condition. Music therapy is a nonpharmacologic modality that has been shown to reduce anxiety in oncology settings. In this installment of The ASCO Post’s Integrative Oncology series, Kevin Liou, MD, and Karen Popkin, LCAT, MT-BC, HPMT, describe the study conducted by their group to determine the potential of music therapy in alleviating cancer-related fatigue.
Kevin Liou, MD
Karen Popkin, LCAT, MT-BC, HPMT
Overview
Cancer-related fatigue in hospitalized patients is a debilitating and disruptive symptom that contributes to increased use of health-care resources. Music therapy is an evidence-based intervention that uses various approaches, ranging from receptive or passive techniques (music listening) to more active techniques (singing, selecting songs). Preliminary findings suggest a potential benefit of music therapy in managing cancer-related fatigue in inpatient settings. However, data are lacking on which music therapy techniques are most effective.
Understanding Cancer-Related Fatigue
Cancer-related fatigue occurs in up to 90% of patients treated for cancer and is of particular concern for hospitalized patients, with the majority reporting moderate-to-severe fatigue.1-4 It is defined by the National Comprehensive Cancer Network (NCCN) as a “distressing, persistent, subjective sense of tiredness or exhaustion related to cancer or cancer treatment which is not proportional to recent activity and interferes with usual functioning.”2
Cancer-related fatigue is associated with longer hospitalizations and higher risk of readmission.3 In addition, it interferes with patients’ ability to complete their cancer treatments and to engage in routine daily activities, which can diminish health-related quality of life and ultimately affect overall survival.5,6 Despite the high prevalence of cancer-related fatigue and its deleterious impact, 60% of patients in a large survey reported cancer-related fatigue as inadequately addressed.1
Role of Music Therapy
Music therapy is a complementary modality offered at nearly 50% of National Cancer Institute–designated comprehensive cancer centers.7 Board-certified music therapists engage patients in music-based activities within a therapeutic relationship.8 They seek to empower and engage patients through active or passive music therapy. With active music therapy, patients sing, play instruments, write lyrics, or select music and then listen, move, and/or discuss their musical experience. With the more receptive, passive music therapy, therapists provide music to guide patients into a calm, restful, or meditative state.
The Society for Integrative Oncology recommends music therapy for alleviating anxiety and depression, but its benefits for cancer-related fatigue are inconclusive.9 A Cochrane review (6 trials, n = 253) reported a small-to-moderate effect of music therapy on cancer-related fatigue, but the quality of evidence was deemed as low.10 Our group sought to address the knowledge gap by conducting a cross-sectional mixed-methods study.
GUEST EDITOR
Jun J. Mao, MD, MSCE
Integrative Oncology is guest edited by Jun J. Mao, MD, MSCE, Laurance S. Rockefeller Chair in Integrative Medicine and Chief of Integrative Medicine Service at Memorial Sloan Kettering Cancer Center, New York.
The study took place at Memorial Sloan Kettering Cancer Center in New York; we enrolled 436 hospitalized adults with cancer, including hematologic, breast, gastrointestinal, and gynecologic. We offered active music therapy to 360 patients and passive music therapy to 76 based on the music therapist’s assessment, patient preference, and baseline patient-reported symptoms. We tailored the length of sessions (20–30 minutes) to suit patient stamina and engagement. To assess cancer-related fatigue, we used the Edmonton Symptom Assessment Scale fatigue item11 before and after music therapy sessions. Patients were also asked to provide free-text comments following their sessions.
Among patients with moderate or severe fatigue, active music therapy was associated with a 0.88-point greater reduction in cancer-related fatigue (95% confidence interval = 0.26–1.51; P = .006; Cohen’s D = 0.52) compared with passive music therapy. Analysis of free-text responses revealed higher frequencies of words describing positive emotions among participants in active music therapy.12
Recommendations
In a large sample of inpatient adults with diverse cancer types, active music therapy was associated with a clinically and statistically significant improvement in cancer-related fatigue. It was also correlated with increased reporting of positive emotions compared with receptive or passive music therapy techniques. Rigorous randomized trials are necessary to confirm these findings. More studies are also needed to determine the mechanisms underlying the effects of different music therapy techniques. This research will help inform more targeted approaches to address this challenging symptom and ultimately improve clinical outcomes for patients with cancer-related fatigue.
Dr. Liou is an Integrative Medicine Specialist and Ms. Popkin is Program Coordinator of Creative Arts and Movement Therapies, both of whom are employed by the Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York.
DISCLOSURE: Dr. Liou and Ms. Popkin reported no conflicts of interest.
REFERENCES
1. Smith TG, et al: Perceptions of patients with breast and colon cancer of the management of cancer-related pain, fatigue, and emotional distress in community oncology. J Clin Oncol 37:1666-1676, 2019.
2. Berger AM, et al: Cancer-related fatigue, version 2.2015. J Natl Compr Canc Netw 13:1012-1039, 2015.
3. Nipp RD, et al: The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer. Cancer 123:4720-4727, 2017.
4. Modonesi C, et al: Impact of palliative care unit admission on symptom control evaluated by the Edmonton Symptom Assessment System. J Pain Symptom Manage 30:367-373, 2005.
5. Curt GA, et al: Impact of cancer-related fatigue on the lives of patients. Oncologist 5:353-360, 2000.
6. Hofman M, et al: Cancer-related fatigue: The scale of the problem. Oncologist 12(suppl 1):4-10, 2007.
7. Yun H, et al: Growth of integrative medicine at leading cancer centers between 2009 and 2016. J Natl Cancer Inst Monogr 2017:lgx004, 2017.
8. O’Callaghan C, Magill L: Music therapy with adults diagnosed with cancer and their families, in Edwards J (ed): Oxford Handbook of Music Therapy, pp 112-134. Oxford, UK; Oxford University Press; 2016.
9. Lyman GH, et al: Integrative therapies during and after breast cancer treatment. J Clin Oncol 36:2647-2655, 2018.
10. Bradt J, et al: Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database Syst Rev Aug 15(8):CD006911, 2016.
11. Hui D, Bruera E: The Edmonton Symptom Assessment System 25 years later. J Pain Symptom Manage 53:630-643, 2017.
12. Atkinson TM, et al: Association between music therapy techniques and patient-reported moderate to severe fatigue in hospitalized adults with cancer. JCO Oncol Pract 16:e1553-e1557, 2020.
