Guest Editor’s Note: Anxiety is a troubling symptom for many cancer survivors, yet treatment options remain limited. Although cognitive behavioral therapy (CBT) can be beneficial, barriers to access may limit its use. Music therapy, a nonpharmacologic intervention, has been shown to be effective in managing cancer-related symptoms. In this article, music therapists Karen Popkin, Camila Casaw, and Sean McNally summarize findings from a large telehealth trial in which music therapy was found to be comparable to CBT for managing anxiety in cancer survivors.
Overview
Anxiety is among the most prevalent and distressing long-term symptoms experienced by cancer survivors, yet effective and accessible treatments remain limited. An estimated one in two survivors report persistent anxiety symptoms that negatively affect quality of life, worsen fatigue, and contribute to functional impairment.1,2 Cognitive behavioral therapy (CBT) is the first-line nonpharmacologic intervention recommended in oncology practice guidelines, including those jointly endorsed by the American Society of Clinical Oncology (ASCO) and the Society for Integrative Oncology (SIO). However, barriers related to access, stigma, and patient preference often limit its use.3-8
Music therapy is an evidence-based intervention delivered by a board-certified music therapist using tailored music-based approaches to address individual patient needs. Smaller trials and a meta-analysis have demonstrated the benefits of music therapy in reducing anxiety; however, long-term comparative effectiveness trials have been lacking.9,10
Music Therapy vs Cognitive-Behavioral Therapy for Cancer-Related Anxiety: The MELODY Trial
The MELODY study was a two-arm, parallel-group randomized clinical trial conducted at Memorial Sloan Kettering Cancer Center and Baptist Health Miami Cancer Institute. Representing a broad cross-section of cancer diagnoses, ages, and genders, the study enrolled 300 English- or Spanish-speaking adult cancer survivors who had completed active treatment and reported elevated anxiety, defined as a Hospital Anxiety and Depression Scale (HADS) anxiety subscale score of 8 or higher. Participants were randomly assigned to receive seven weekly telehealth sessions of either music therapy or CBT delivered by trained providers.
The coprimary endpoints were HADS anxiety score measured at 8 weeks (end of treatment) and 26 weeks (long-term follow-up). Secondary outcomes included fatigue, depression, insomnia, pain, cognitive dysfunction, and health-related quality of life. The results showed that music therapy was noninferior to CBT in reducing anxiety. At week 8, participants in the music therapy arm experienced a mean reduction in HADS anxiety score of –3.12 (95% confidence interval [CI] = –3.59 to –2.65), compared with –2.97 (95% CI = –3.45 to –2.50) in the CBT arm. The between-group difference fell within the predefined noninferiority margin of 1.20 (P < .001). Notably, these reductions persisted at week 26, with mean changes of –3.31 (95% CI = –3.78 to –2.85) in the music therapy arm and –3.00 (95% CI = –3.47 to –2.53) in the CBT arm, remaining within the noninferiority margin of 1.28 (P < .001). Reductions in anxiety scores in both groups also exceeded the minimal clinically important difference of 1.7 points without maintenance sessions.
Secondary outcomes similarly improved across both treatment arms. Participants reported reductions in fatigue, depressive symptoms, insomnia, pain, and subjective cognitive complaints, along with improvements in health-related quality of life. Adverse events were minimal and comparable between groups, supporting the safety and tolerability of both interventions.11
These findings carry important clinical implications for survivorship care. Music therapy is not merely a complementary intervention, but a viable and effective alternative to traditional first-line psychotherapy for reducing anxiety in survivors of cancer. Active music-based experiences—including guided music listening, improvisation, songwriting, and lyric analysis—may help regulate the nervous system, support social connection, and engage cognitive processes associated with anxiety reduction. This distinguishes clinical music therapy from passive music listening and underscores its role as a psychotherapeutic modality with measurable impact.
An important consideration in anxiety management is patient preference and treatment fit. Not all patients are receptive to traditional talk therapy, and some may experience stigma or discomfort associated with conventional psychotherapy. Music therapy offers an engaging alternative that many survivors find empowering, potentially enhancing treatment adherence and patient satisfaction. The study’s telehealth delivery model further improves accessibility by addressing geographic, mobility, and workforce barriers that often impede access to psychotherapy among patients with cancer. This is particularly relevant in community and rural settings, where mental health resources may be limited.
Conclusions
As the number of cancer survivors continues to grow, scalable, evidence-based interventions to reduce symptom burden are increasingly essential. Findings from the MELODY trial support the use of music therapy to reduce anxiety in this population. Oncology clinicians should consider incorporating this modality into comprehensive survivorship care plans. Referrals should be made to board-certified music therapists, ideally those with expertise in oncology and survivorship care.
Ms. Popkin is Clinical Program Lead, and Ms. Casaw and Mr. McNally are Research Music Therapists at Integrative Medicine and Wellness Service, Memorial Sloan Kettering Cancer Center, New York.
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