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
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.
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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.The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.