Guest Editor’s Note: Despite its high prevalence, cancer pain remains undertreated. Racial disparities present further challenges to assessing and managing pain. Music therapy, a nonpharmacologic intervention, has been documented to be effective in controlling cancer pain. In this article, Kevin T. Liou, MD, summarizes findings from a retrospective study in which his group reported that music therapy yielded similar reductions in pain in both Black and White patients with cancer.
Pain is one of the most prevalent symptoms affecting patients with cancer and is associated with worse health-related outcomes.1,2 However, approximately one in three patients with cancer is inadequately treated for pain.3,4
Racial inequities present further challenges to managing pain among patients with cancer.5,6 For example, Black patients appear to be less likely to receive opioid prescriptions and often receive lower opioid doses, compared with their White counterparts.7,8 These racial disparities stem from complex factors, ranging from provider biases (eg, underestimating the severity of pain)9 and patient belief systems (eg, fear of addiction)10 to systemic racism and structural issues (eg, pharmacy deserts).11 In light of these barriers to pharmacologic pain management, there exists an urgent need to develop effective nonpharmacologic interventions to address racial pain disparities in oncology.
Potential Role of Music Therapy
Music therapy is a nonpharmacologic intervention available at 75% of National Cancer Institute–designated comprehensive cancer centers and 55% of community cancer hospitals.12 During music therapy sessions, board-certified therapists engage patients in personalized experiences with music to target specific health outcomes.13 These experiences range from receptive activities (eg, guided music listening, music-based relaxation) to active musical engagement (eg, singing, playing an instrument, composing lyrics, creating playlists).13
“Cultural adaptation of music therapy, rather than a one-size-fits-all approach, will be critical to achieving equitable pain outcomes in racially diverse cancer populations.”— KEVIN T. LIOU, MD
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Research suggests that participation in musical activities may modulate the mesolimbic system and other neurochemical pathways implicated in pain.14,15 A relatively recent Cochrane review found music therapy to be associated with significant pain reduction among patients with cancer.16 Because of music’s multicultural presence in societies around the world, music therapy is uniquely equipped to appeal to diverse populations and represents a promising option to address racial pain disparities.
MSK Study Findings on Music Therapy
To further explore the potential role of music therapy, integrative medicine researchers at Memorial Sloan Kettering Cancer Center (MSK) conducted a retrospective study, examining the treatment approaches and responses of 358 Black and White hospitalized patients with cancer who received music therapy as part of their routine inpatient care. A description of the study and its findings were published in the Journal of Pain and Symptom Management.17
Compared with White patients who have cancer, a greater proportion of Black patients with cancer received a music therapy referral for pain and engaged actively with music, rather than receptively, during their treatment sessions. Furthermore, they reported similar improvements in their pain as the White patients.
However, there were some notable differences between the Black and White patients in terms of treatment goals, session content, and documented responses to treatment. For example, self-expression was more commonly documented as a treatment goal among Black patients, whereas relaxation was more commonly documented among White patients. As for the content of music therapy sessions, spirituality was the more common topic among Black patients, whereas family bonds were more commonly discussed among White patients. In terms of patient responses, gratitude and brighter affect were more frequently observed among Black patients, whereas relaxed and reflective affect were more commonly seen among White patients.
Implications and Future Directions
In the retrospective study, both Black and White patients achieved a similar magnitude of pain reduction with music therapy. These findings provide a notable contrast to prior research of pain interventions, which demonstrated minimal or fewer responses among Black patients compared with their White counterparts.18,19 Furthermore, Black patients and their providers appear to view music therapy as an acceptable intervention, with patients engaging actively with music, and providers referring frequently to music therapy for pain. Although pain reduction with music therapy was similar among Black and White patients with cancer, this clinical outcome was achieved through varying approaches. These findings highlight that cultural adaptation of music therapy, rather than a one-size-fits-all approach, will be critical to achieving equitable pain outcomes in racially diverse cancer populations.20
Guest Editor
Jun J. Mao, MD, MSCE
Dr. Mao is the Laurance S. Rockefeller Chair in Integrative Medicine and Chief of Integrative Medicine Service at Memorial Sloan Kettering Cancer Center, New York.
Since this study was a retrospective program evaluation, it was intended to be hypothesis-generating. The findings should, therefore, be interpreted as associations, rather than causal relationships, and the results may have been affected by confounding factors. Nevertheless, the study represents an important step toward understanding the diverse range of music therapy experiences among Black and White cancer patients with pain. Future research must focus on the personalization and cultural adaptation of music therapy to promote equitable cancer pain management for all communities.
DISCLOSURE: Dr. Liou reported no conflicts of interest.
REFERENCES
1. Onyeakusi NE, Mukhtar F, Gbadamosi SO, et al: Cancer-related pain is an independent predictor of in-hospital opioid overdose: A propensity-matched analysis. Pain Med 20:2552-2561, 2019.
2. Nipp RD, El-Jawahri A, Moran SM, et al: The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer. Cancer 123:4720-4727, 2017.
3. Greco MT, Roberto A, Corli O, et al: Quality of cancer pain management: An update of a systematic review of undertreatment of patients with cancer. J Clin Oncol 32:4149-4154, 2014.
4. Roberto A, Greco MT, Uggeri S, et al: Living systematic review to assess the analgesic undertreatment in cancer patients. Pain Pract 22:487-496, 2022.
5. Cleeland CS, Gonin R, Baez L, et al: Pain and treatment of pain in minority patients with cancer. The Eastern Cooperative Oncology Group Minority Outpatient Pain Study. Ann Intern Med 127:813-816, 1997.
6. Fisch MJ, Lee JW, Weiss M, et al: Prospective, observational study of pain and analgesic prescribing in medical oncology outpatients with breast, colorectal, lung, or prostate cancer. J Clin Oncol 30:1980-1988, 2012.
7. Morden NE, Chyn D, Wood A, et al: Racial inequality in prescription opioid receipt: Role of individual health systems. N Engl J Med 385:342-351, 2021.
8. Vitzthum LK, Nalawade V, Riviere P, et al: Racial, ethnic, and socioeconomic discrepancies in opioid prescriptions among older patients with cancer. JCO Oncol Pract 17:e703-e713, 2021.
9. Anderson KO, Mendoza TR, Valero V, et al: Minority cancer patients and their providers: Pain management attitudes and practice. Cancer 88:1929-1938, 2000.
10. Anderson KO, Richman SP, Hurley J, et al: Cancer pain management among underserved minority outpatients: Perceived needs and barriers to optimal control. Cancer 94:2295-2304, 2002.
11. Qato DM, Daviglus ML, Wilder J, et al: ‘Pharmacy deserts’ are prevalent in Chicago’s predominantly minority communities, raising medication access concerns. Health Aff (Millwood) 33:1958-1965, 2014.
12. Desai K, Liou K, Liang K, et al: Availability of integrative medicine therapies at National Cancer Institute-designated comprehensive cancer centers and community hospitals. J Altern Complement Med 27:1011-1013, 2021.
13. O’Callaghan C, Michael N: Music therapy with adult cancer patients and their families, in The Oxford Handbook of Music Therapy, pp 112-134. Oxford, UK; Oxford University Press; 2016.
14. Chanda ML, Levitin DJ: The neurochemistry of music. Trends Cogn Sci 17:179-193, 2013.
15. Serafini RA, Pryce KD, Zachariou V: The mesolimbic dopamine system in chronic pain and associated affective comorbidities. Biol Psychiatry 87:64-73, 2020.
16. Bradt J, Dileo C, Myers-Coffman K, et al: Music interventions for improving psychological and physical outcomes in people with cancer. Cochrane Database Syst Rev 10:CD006911, 2021.
17. Lichtl A, Casaw C, Edwards J, et al: Music therapy for pain in Black and White cancer patients: A retrospective study. J Pain Symptom Manage 64:478-485, 2022.
18. Hooten WM, Knight-Brown M, Townsend CO, et al: Clinical outcomes of multidisciplinary pain rehabilitation among African American compared with Caucasian patients with chronic pain. Pain Med 13:1499-1508, 2012.
19. Anderson KO, Mendoza TR, Payne R, et al: Pain education for underserved minority cancer patients: A randomized controlled trial. J Clin Oncol 22:4918-4925, 2004.
20. Crombez P, Bron D, Michiels S: Multicultural approaches of cancer pain. Curr Opin Oncol 31:268-274, 2019.
Dr. Liou is an Integrative Medicine Specialist at Memorial Sloan Kettering Cancer Center, New York.
