As researchers continue to integrate neuroscientific findings on how music impacts the human brain, we may see more studies examining biomechanisms in music therapy as well as new situations in which music therapy can play a role in the care of patients with cancer.— Karen Popkin, LCAT, MT-BC, HPMT
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Music therapy, an established adjuvant to standard cancer care, is offered in a growing number of cancer centers throughout the United States and internationally. Defined by the American Music Therapy Association (AMTA) as “the evidence-based use of music interventions to accomplish individual goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program,”1 music therapy has a well-established place in integrative oncology.
Music therapy aims to support the coping strategies of patients who experience a range of physical, psychological, emotional, and spiritual suffering. Music therapists create a milieu within which the cancer patient can engage with the therapist. Goals may include promotion of wellness, stress management, pain alleviation, expression of feelings, memory enhancement, improved communication, and enabling of physical rehabilitation.
Once a rarely offered therapy, both the profession and therapeutic intervention have grown substantially. In the United States, the majority of National Cancer Institute–designated Comprehensive Cancer Centers offer music therapy for patients, and many community cancer centers do as well.
Professional organizations and training programs exist throughout the world. In 2011, the AMTA reported that its members live in 30 countries and 6 continents around the globe. The World Federation of Music Therapy has regional liaisons representing professionals and training programs across North America, Europe, Australia/New Zealand, South East Asia, South Africa, the Western Pacific, Eastern Mediterranean, and Latin America.2
Integrative Oncology is guest edited by Barrie R. Cassileth, MS, PhD, of Memorial Sloan Kettering Cancer Center, New York.
In her book Survivorship: Living Well During and After Cancer, Barrie R. Cassileth, MS, PhD, of Memorial Sloan Kettering Cancer Center, New York, offers valuable insights for cancer patients and families on a wide spectrum of integrative cancer treatment approaches, including music therapy.3 Some excerpts on music therapy are included on these pages.
Music Therapy at Memorial Sloan Kettering
At Memorial Sloan Kettering Cancer Center, the Music Therapy program, supported by a grant from Gabrielle’s Angels Foundation for Cancer Research, serves pediatric and adult inpatients and their families. Therapists who are board-certified by the Certification Board for Music Therapists and licensed by New York State work with patients at the bedside and in small groups, customizing interventions designed to address the needs of each patient. An integral part of the Integrative Medicine Service, the program was established in the year 2000 and has maintained a continuously active presence since that time.
Barrie R. Cassileth, MS, PhD
This inpatient music therapy program provides physical, emotional, psychological, and spiritual benefit, applying the various elements of music, which include rhythm, melody, tone, harmony, and lyrics. The therapy helps ease patients’ fear and anxiety, enhances creative expression, helps manage symptoms, and promotes relaxation and comfort. Available to hospitalized patients of all ages, music therapists work throughout Memorial Sloan Kettering’s inpatient areas to help restore a critical sense of control over mind and body at a time of paramount uncertainty. Music therapists often serve in an interdisciplinary capacity, working in tandem with physical therapists, occupational therapists, social workers, and chaplains.
Bedside visits are a primary feature of the program. Sessions for patients who are in isolation for extended periods of time, such as those undergoing hematopoietic stem cell transplantation, report that music therapy helps to improve mood4,5 and reduce anxiety and pain.6-8 Techniques for individual sessions vary according to the needs, abilities, and preferences of the patient.
Environmental music therapy is provided in various areas within the hospital, such as the Post Anesthesia Care Unit and the Pre-Surgical Unit, offering a powerful way to influence the hospital environment, as patients cope with stressors surrounding surgery and recovery. Staff members also describe a sense of personal benefit from the environmental music therapy, citing stress reduction as helpful to job performance.
Music therapists connect with their patients through sound and song, rather than words. As musicians who are also trained counselors, they typically bring portable instruments to the bedside, allowing patients to participate in playing, singing, or writing songs. This type of therapy often benefits both the patient and his or her family. It can reduce anxiety, depression, and pain, as well as encourage communication.
—From Cassileth B: Suvivorship: Living Well During and After Cancer, p 147.3
A recent important extension of the Memorial Sloan Kettering music therapy program is the Rising Voices Chorus. This is the first North American chapter of Something to Sing About, a global network of choirs for cancer survivors. The group meets regularly to provide survivors the opportunity to experience the aesthetic pleasure, social bonding, group support, and community service benefits of group singing.
Music therapy referrals often request support and comfort care for end-of-life patients. Family members frequently benefit from this intervention as well, at a time when it can be most difficult to attain a sense of peace and calm. The music therapist may include music that is spiritually relevant to the patient and can facilitate the participation of family when appropriate.
Music Therapy vs Environmental Music
Although there is growing recognition of how music affects cognition, mood, and physical energy or motivation to move, some studies do not clearly define the difference between music therapy and environmental music. A major distinction is that in the former, a music therapist assesses the needs of the individual patient, enters into an interpersonal therapeutic relationship, and adjusts music interventions in real time according to patient needs. These important components are absent with environmental music, which can benefit many patients at once.
From the family of a patient following her death:
The music that you brought to Mom during her hospital stays gave her some of the most joyful moments she was able to experience in her final weeks, even when she was in terrible pain and distress. We cannot thank you enough for that gift, and for the meaningful time we were able to share as a family while you played and sang to her. Please know that you have our everlasting gratitude for the pleasure you brought to Mom.
—From Cassileth B: Suvivorship: Living Well During and After Cancer, p 132.3
In the case of environmental music, sometimes called “music medicine,” the patient typically is offered a passive listening experience with recorded material, usually preselected by health-care providers. An opportunity for the patient to reflect and explore the meaning of the music does not occur. The music method applied is a matter of great importance when reviewing the literature. Some of the most important music therapy studies in oncology are briefly summarized here.
Music therapy researchers are increasingly turning their attention to best practices, such as the randomized trial reported in 2014 from a group at Indiana University.9 The study tested a specific music therapy intervention, Therapeutic Music Video (TMV), which is designed to improve resilience in adolescent and young adult patients undergoing stem cell transplantation. A total of 113 patients aged 11 to 24 undergoing stem cell transplantation for cancer were randomly assigned to a TMV intervention group or a control group that received audiobooks. Participants completed 6 sessions over 3 weeks. The TMV group demonstrated significantly better measures of courageous coping, social integration, and family environment. Study results support the use of a music-based intervention delivered by a music therapist to help adolescents and young adults positively cope with high-risk, high-intensity cancer treatments.
When used with typical antiemetic medications, music therapy may help to further reduce nausea and vomiting from chemotherapy. At the very least, it can relieve stress and reduce blood pressure, lower heart rate, and promote general well-being. Even something as simple as music can be very powerful.
—From Cassileth B: Suvivorship: Living Well During and After Cancer, pp 156-157.3
Investigators in Southern Taiwan studied the effects of music therapy and verbal relaxation on anxiety in outpatients receiving chemotherapy.10 They randomly assigned 98 patients to 3 groups: music therapy, verbally guided relaxation, and standard care. Efficacy was measured using the Spielberger State-Trait Anxiety Instrument, Emotional Visual Analog Scale, and three biobehavioral indicators (skin temperature, heart rate, and consciousness level) measured during and after chemotherapy. The researchers found that music therapy had a greater positive effect on postchemotherapy anxiety than did verbal relaxation or control groups. Patients with high baseline anxiety receiving music therapy had a greater drop in postchemotherapy anxiety than did those with a predefined “normal” state of anxiety in a subset analysis.
Palliative care teams frequently include music therapists as part of a multidisciplinary approach to the treatment of pain. Researchers at University Hospitals–Case Medical Center found that a single music therapy intervention incorporating therapist-guided relaxation and live music effectively lowered pain in palliative care patients.11 In this study, 200 inpatients were randomly assigned to standard care with vs without music therapy. Pain was assessed using a numeric rating scale as the primary outcome and the Functional Pain Scale as a secondary outcome. The Face, Legs, Activity, Cry, Consolability (FLACC) scale also was applied as a secondary outcome. Significantly greater decreases in both pain measure scores were seen in the music therapy group; scores did not differ between study groups per the third scale.
Music therapy harnesses the power of music to uplift our moods and arouse our emotions. It involves performing, creating, or listening to music to encourage healing and promote a general sense of well-being. Patients listen to or perform music with the guidance of a professional music therapist. The therapist can help to develop lyrics, improvise with the patient, or simply provide technical and emotional support. The practice can enhance relaxation, creativity, pleasure, and self-expression while helping to reduce pain and feelings of isolation. Music therapy is provided by musicians who received training, typically graduate training, in the use of music (rather than only words) as therapy. It is especially helpful in a hospital setting.
—From Cassileth B: Suvivorship: Living Well During and After Cancer, pp 120-121.3
These examples demonstrate the ability of music therapy to be used in a variety of oncologic investigational settings. More research will enable better understanding of biomechanisms, dosage, and clinical indications that may be especially amenable to music therapy. Finally, as researchers continue to integrate neuroscientific findings on how music impacts the human brain, we may see more studies examining biomechanisms in music therapy as well as new situations in which music therapy can play a role in the care of patients with cancer. ■
Disclosure: Ms. Popkin reported no potential conflicts of interest.
1. American Music Therapy Association: Profile of the 2011 Membership. A Snapshot of the Music Therapy Profession, p 10. Available at www.musictherapy.org/assets/1/7/statprofile11.pdf. Accessed September 15, 2016.
2. World Federation of Music Therapy: Regional information. Available at www.musictherapyworld.net/WFMT/Regional_Information.html. Accessed September 15, 2016.
3. Cassileth B: Suvivorship: Living Well During and After Cancer. Ann Arbor, Michigan; Spry Publishing; 2014.
4. Ratcliff CG, Prinsloo S, Richardson M, et al: Music therapy for patients who have undergone hematopoietic stem cell transplant. Evid Based Complement Alternat Med 2014:742941, 2014.
5. Cassileth BR, Vickers AJ, Magill LA: Music therapy for mood disturbance during hospitalization for autologous stem cell transplantation: A randomized controlled trial. Cancer 98:2723-2729, 2003.
6. Nguyen TN, Nilsson S, Hellstrom AL, et al: Music therapy to reduce pain and anxiety in children with cancer undergoing lumbar puncture: A randomized clinical trial. J Ped Oncol Nursing 27:146-155, 2010.
7. Bradt J, Dileo C, Grocke D, et al: Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database Syst Rev (8)CD006911, 2011.
8. Shabanloei R, Golchin M, Esfahani A, et al: Effects of music therapy on pain and anxiety in patients undergoing bone marrow biopsy and aspiration. AORN J 91:746-751, 2010.
9. Robb SL, Burns DS, Stegenga KA, et al: Randomized clinical trial of therapeutic music video intervention for resilience outcomes in adolescents/young adults undergoing hematopoietic stem cell transplant: A report from the Children’s Oncology Group. Cancer 120:909-917, 2014.
10. Lin MF, Hsieh YJ, Hsu YY, et al: A randomised controlled trial of the effect of music therapy and verbal relaxation on chemotherapy-induced anxiety. J Clin Nursing 20:988-999, 2011.
11. Gutgsell KJ, Schluchter M, Margevicius S, et al: Music therapy reduces pain in palliative care patients: A randomized controlled trial. J Pain Symptom Manage 45:822-831, 2013.
This article originally appeared in The ASCO Post, Volume 5, Issue 15, September 15, 2014.