Music therapy is the application of music to influence physiologic, psychological, and emotional functioning. It often is used with other behavioral techniques, such as relaxation. Music interventions vary from listening to recorded music to listening to live music to more formal music therapy provided by music therapists. Professional music therapy involves individualization of the intervention, may involve the patient in the music making, and includes a systematic therapeutic process including assessment, treatment, and evaluation. Music and music therapy have been evaluated for effects in anxiety, chemotherapy-induced nausea and vomiting, depression, dyspnea, pain, fatigue, and caregiver strain and burden.
Archer, S., Buxton, S., & Sheffield, D. (2015). The effect of creative psychological interventions on psychological outcomes for adult cancer patients: A systematic review of randomised controlled trials. Psycho-Oncology, 24, 1–10. doi:10.1002/pon.3607
Depression and anxiety were shown to improve in three of the studies although the interventions were different (music therapy, art therapy, and mindfulness-based art therapy). Other psychological factors also improved: lower ratings of somatic symptoms in an art therapy study and a creative arts study, and psychiatric symptom improvement. Improvements in various measures of quality of life were reported in studies of mindfulness-based art therapy, art therapy, music therapy, creative arts therapy, and dance/movement therapies. Art therapy showed improvements in coping resources and mood states. Music therapy showed improvements in stress and anger. Creative arts therapy showed improvements in specific aspects of the Profile of Mood States (POMS) that were reported: tension-anxiety, depression-dejection, anger-hostility, and confusion-bewilderment.
Evidence reviewed in this study is inconclusive regarding effectiveness of various creative interventions.
The therapies were implemented by qualified therapists and were varied in nature, although not exhaustive of available therapies. The value of music, art, and movement therapies are shown to effectively reduce symptoms of anxiety and depression and improve quality of life, coping, and mood. Suggestions for further research are offered.
Archie, P., Bruera, E., & Cohen, L. (2013). Music-based interventions in palliative cancer care: A review of quantitative studies and neurobiological literature. Supportive Care in Cancer, 21, 2609–2624.
STUDY PURPOSE: To review the evidence for efficacy of music interventions for patients with cancer receiving palliative care and review the neurobiological evidence to explain pathways by which music may have an effect
TYPE OF STUDY: Systematic review
DATABASES USED: PubMed, CINAHL, Plus, Ovid, PsycINFO, PoQuest, and the Cochrane Library
KEYWORDS: music; music therapy; cancer; oncology; palliative care; pain; anxiety; depression; mood; quality of life; neuroscience; endogenous opioids; dopamine; GABA; 5HT; permutations
INCLUSION CRITERIA: RCT; meta-analysis or systematic review from 1970–2012
EXCLUSION CRITERIA: Not reported
TOTAL REFERENCES RETRIEVED: Not reported
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Not reported
In the acute pain setting, music had a moderate analgesic effect with SMD of -.059, 95% CI -0.90, -0.27 (p = .0003). Effect for chronic pain is not known and has not been well studied. The study cites results of a Cochrane review of effects of music on anxiety (SMD -11.2, p = .0088). It is noted that effect on anxiety only has been studied in the acute, situational setting. Longer-term effects and application in palliative care are unknown. Review of neurobiologic evidence suggests that music may affect specific pathways that are implicated in the pathophysiology of pain, anxiety, and depression.
Music interventions have a moderate positive effect on procedural pain and acute, situational anxiety.
Music may be helpful to reduce acute anxiety and procedure-related pain. This is a simple intervention nurses could use in a variety of settings. Longer-term effects and effects in different situations are not known.
Bradt, J., Dileo, C., Grocke, D., & Magill, L. (2011). Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database of Systematic Reviews, 8, CD006911.
To examine the effects of music therapy and \"medical music\" on patients with cancer.
Music interventions appear to have beneficial effects regarding pain reduction and short-term reduction of anxiety.
Music therapy and listening to music may be helpful means of reducing anxiety and perceived pain, and these interventions can have an effect of moderate size. The effects may be relatively short-lived, and the evidence is somewhat weak in terms of study design. However, listening to music has no risks for patients, can be easy to implement, and is an intervention that patients can do themselves. Nurses can suggest that patients use this approach to help manage pain and anxiety.
Bradt, J., Dileo, C., Magill, L., & Teague, A. (2016). Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database of Systematic Reviews, 8, CD006911.
STUDY PURPOSE: To assess and compare the effects of music therapy and music medicine interventions for psychological and physical outcomes in people with cancer
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Multiple phases of care
The standard mean difference for fatigue in the music intervention group was 0.38 (7 studies, 253 participants, p = 0.03). Anxiety was reduced with music (13 studies, 1,028 patients, mean difference = –8.54, p < 0.0001). Results also showed a positive effect for depression (7 studies, 723 participants, standard mean difference = –0.4, p = 0.02).
Music interventions also had a small to moderate beneficial effect on fatigue, anxiety, and depression.
Music therapy may have a small to moderate effect on fatigue, anxiety, and depression.
Nightingale, C.L., Rodriguez, C., & Carnaby, G. (2013). The impact of music interventions on anxiety for adult cancer patients: A meta-analysis and systematic review. Integrative Cancer Therapies.
To clarify the effect of music interventions on anxiety for adult patients with cancer from rigorously conducted studies
TYPE OF STUDY: Meta-analysis and systematic review
Patients were undergoing active antitumor treatment.
Length of the intervention varied substantially from 5 minutes to 4 hours. There was high variability in the number of sessions delivered. Most studies examined a single intervention with immediate pre and post anxiety measurement. Three delivered live music, 1 involved a music therapist, and 11 involved listening to music via headphones. Meta-analysis showed no significant difference between the music intervention and controls (SMD = -0.003 (95% CI -0.51, 0.52).
Meta-analysis showed no significant effect of music interventions on anxiety in adults with cancer.
Results of this analysis do not support an effect of music interventions on anxiety in adults with cancer.
Thrane, S. (2013). Effectiveness of integrative modalities for pain and anxiety in children and adolescents with cancer: A systematic review. Journal of Pediatric Oncology Nursing, 30, 320–332.
PHASE OF CARE: Multiple phases of care
APPLICATIONS: Pediatrics
Integrative interventions may be very effective for pain and anxiety in children undergoing cancer treatment. Integrative modalities, however, warrant further study with larger sample sizes to better determine their effectiveness in this population.
This study provided some evidence that complementary modalities can help children undergoing cancer treatment or painful procedures. The usefulness of a particular method should be further examined.
Tsai, H.F., Chen, Y.R., Chung, M.H., Liao, Y.M., Chi, M.J., Chang, C.C., & Chou, K.R. (2014). Effectiveness of music intervention in ameliorating cancer patients' anxiety, depression, pain, and fatigue: A meta-analysis. Cancer Nursing, 37, E35–E50.
STUDY PURPOSE: To evaluate the effects of music on symptoms in patients with cancer
TYPE OF STUDY: Meta-analysis and systematic review
DATABASES USED: Ovid, PsycARTICLES, and PsycINFO (2002–2012)
KEYWORDS: neoplasms, cancer, and music or melody
INCLUSION CRITERIA: Used a music intervention in patients with cancer; quantitative methods; quasi-experimental or experimental design; reported statistical information to describe results; evaluated effects on anxiety, depression, pain, or fatigue
EXCLUSION CRITERIA: Qualitative design, case studies, or single-group studies
TOTAL REFERENCES RETRIEVED = 367
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Quality assessment with adapted Cochrane guidelines; the k value between reviewers was 0.9.
APPLICATIONS: Pediatrics, palliative care
For anxiety, music therapy had a moderate and significant effect with an effect size of -0.553 (Hedges; g) (95% CI -0.716, -0.398). There was significant heterogeneity in the sample. For depression, music therapy moderately and significantly reduced depression with an effect size for each study ranging from -0.151 to -0.787. Results were homogenous. Five of eight studies showed significant effects. For pain, music had an overall effect size of -0.656 (Hedges' g) (95% CI -1.016 to about -0.295), showing moderate-level effects on pain. There was significant heterogeneity among studies. For fatigue, music therapy had a small effect size of -0.422 (Hedges' g) (95% CI -0.669, -0.175). Results were homogenous. Studies were seen to be of good quality. Results of subgroup analysis suggest that music therapy is more effective in adults than children and more beneficial when the music is selected by the patient rather than the therapist.
This analysis shows that music interventions can reduce anxiety, depression, pain, and fatigue in patients with cancer with small-to-moderate effect sizes.
In several areas, there was high heterogeneity. Sample sizes, timing, and types of music interventions varied substantially, and, in most, the impact was evaluated immediately after the music intervention. Whether music has ongoing effectiveness with continued use or any lasting effect on the symptoms assessed is unclear.
Music interventions can be a good adjunctive and non-medication therapy that is of benefit in reducing anxiety, depression, pain, and fatigue in patients with cancer. The most beneficial ways and times to use music therapy are unclear. Nurses can suggest that patients use listening to music as part of self-care and can advocate for use of music as a low-risk intervention to ameliorate acute anxiety and pain symptoms.
Alam, M., Roongpisuthipong, W., Kim, N.A., Goyal, A., Swary, J.H., Brindise, R.T., . . . Yoo, S. (2016). Utility of recorded guided imagery and relaxing music in reducing patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures: A single-blinded randomized controlled trial. Journal of the American Academy of Dermatology. Advance online publication.
To determine if brief guided imagery or music can reduce patient pain and anxiety during cutaneous procedures
Consecutive adults undergoing surgery for basal or squamous cell carcinoma of the face were randomized to three groups: (a) guided imagery, (b) music, or (c) control. The guided imagery patients were sent a recording of the guided imagery by mail and instructed to listen to this at least once daily starting at least four days before surgery. Those in the music group listened to music via earphones during the surgery. Patients in the other two groups also wore earphones during the surgery, but without any sound. Pain and anxiety scores were obtained before and after the procedure on the day of surgery.
There were no significant differences in average change in pain or anxiety scores between groups.
The visual imagery and music interventions as used here had no apparent effect on perioperative pain or anxiety.
This study did not show an effect of music or visual imagery on perioperative pain or anxiety. The lack of effects may be associated with the ways in which the interventions were provided or in the study design—it would be expected that pain should increase postoperatively and anxiety would decline after the surgery was completed. In addition, analysis was done regarding pre- and post-symptom change rather than actual postoperative symptom levels.
Bradt, J., Potvin, N., Kesslick, A., Shim, M., Radl, D., Schriver, E., . . . Komarnicky-Kocher, L.T. (2015). The impact of music therapy versus music medicine on psychological outcomes and pain in cancer patients: A mixed methods study. Supportive Care in Cancer, 23, 1261–1271.
To compare the effects of music therapy and music medicine on pain and psychological outcomes, and to explore relevant patient experiences
Patients were randomly assigned to receive either two music therapy or two music medicine interventions during a two-week timeframe. After two weeks, subjects were crossed over to the other intervention. Music therapy was provided by a certified therapist and included a brief discussion of patients' concerns followed by the provision of live music based on assessed needs. Participants were invited to play an instrument, participate in breathing exercises, and express thoughts and emotions. Music medicine involved providing music based on preferences. Patients were asked not to engage in any other activity during listening. A blinded assessor interviewed patients after each music session and after the final session. Verbatim transcripts were analyzed by two coders to identify reported benefits or harms from descriptions of the experience.
Single-blinded, randomized crossover trial
Anxiety was reduced by 15 points with music therapy and 12 points with music medicine (p < 0.0001). There was no difference between the two conditions. Pain was reduced by 0.9–1.1 points (p < 0.0005) with no difference between the groups. Common themes from the qualitative analysis were experiencing the music as relaxing, peaceful, and soothing, and many patients appreciated the playful nature of interactive therapy sessions.
Both music therapy and listening to preferred music were associated with reductions in pain and anxiety.
Listening to music was shown to be as effective as music therapy provided by a therapist to assist in reducing pain and anxiety. Although the degree of change shown here was small and this study had several limitations, listening to music is a low-risk and simple intervention that may be beneficial to patients. Nurses should consider employing this technique with patients in anxiety-producing situations and as part of pain management.
Bulfone, T., Quattrin, R., Zanotti, R., Regattin, L., & Brusaferro, S. (2009). Effectiveness of music therapy for anxiety reduction in women with breast cancer in chemotherapy treatment. Holistic Nursing Practice, 23, 238–242.
To evaluate the effect of musical therapy on anxiety in patients with breast cancer receiving conventional treatment
Patients were randomly assigned to the music or control group. While in the waiting room for 30 minutes prior to chemotherapy treatment, those assigned to the music group had the opportunity to choose and listen to pretaped musical themes with a Walkman and earphones for 15 minutes. Control patients received standard care. Anxiety levels were measured at baseline and after 15 minutes.
Patients were undergoing the active treatment phase of care.
A randomized controlled trial design was used.
Speilberger State and Trait Anxiety Inventories
There were no differences between groups in pretreatment anxiety levels. Both groups demonstrated moderate pretreatment anxiety levels. Pretreatment state anxiety levels were higher than trait anxiety levels in both groups (p < 0.05). Post-test anxiety scores in the experimental group decreased by 9.9 (p < 0.001). In the control group, there was no significant change, although anxiety increased slightly after 15 minutes. There were no significant relationships between anxiety scores and demographic variables.
Listening to music may reduce anxiety related to chemotherapy administration. The levels of state anxiety compared to trait anxiety indicates that chemotherapy treatment is a stressful situation for patients.
Chemotherapy administration can be stressful for patients, and listening to music prior to treatment may be helpful to them. Providing the opportunity to listen to music is a simple intervention that has no inherent risks to patients and could easily be incorporated into practice in healthcare settings.
Burns, D.S., Azzouz, F., Sledge, R., Rutledge, C., Hincher, K., Monahan, P.O., & Cripe, L.D. (2008). Music imagery for adults with acute leukemia in protective environments: A feasibility study. Supportive Care in Cancer, 16, 507–513.
To determine the feasibility and possible benefits of a music imagery intervention for hospitalized patients with acute leukemia or high-grade non-Hodgkin lymphoma
Study patients completed baseline self-report instruments to assess affect, anxiety, and fatigue. Participants were then randomized to receive standard care or standard care plus music imagery. Standard care was hospitalization in a HEPA-filtered room with restricted visitor access and supportive medical care. A board-certified music therapist provided music imagery sessions. Sessions included relaxation and music imagery and were designed to provide participants with an opportunity to practice music imagery techniques, provide a successful music imagery experience, and answer any questions. When the initial session was complete, the therapist provided a CD with four 20-minute music imagery exercises as well as a CD player. Participants were encouraged to use the exercises at least once a day, and more frequently if they could. Participants used a journal to record how many exercises were used and their perceived effectiveness of the music therapy exercises. During therapist visits, patients could ask questions, change music imagery selections, and experience a therapist-led music imagery session. Music for the study included light classical and new age music chosen by the therapist based on assessment of the patients’ musical preferences and current emotional state and energy level. Sessions by the therapist occurred within three days of admission and twice a week during the hospital stay, up to four weeks.
Patients were undergoing the active treatment phase of care.
A randomized controlled trial design was used.
Overall, 72% of therapy sessions were completed when accounting for study dropouts. No one completed the music imagery journal, due to feeling too sick or not remembering. Forty-nine percent completed an average of 60% of the measurement instruments. Analysis of mean scores over time, using repeated measures ANOVA, showed that both study groups improved in terms of greater positive affect, less negative affect, less fatigue, and less anxiety (p < 0.001). There were no differences in these results between study groups. Within those patients with low negative affect at baseline, those who received the therapy had lower anxiety at week 4 or hospital discharge than those in the control group.
Music imagery therapy is feasible in this population. Only those patients who had low initial negative affect demonstrated a potential benefit of the intervention in terms of lower anxiety at the end of the study period. Anxiety and fatigue declined over time in all patients.
Results suggest that this type of intervention may only be of benefit in a select group of patients who are not as severely ill and do not have a high negative affect. The drop-out rate also suggests that this is a type of intervention for which participation and effect are highly dependent upon the patients’ preferences and interest in involvement. Findings suggest that once patients acclimate to the hospital environment, anxiety, fatigue, and negative affect decline, suggesting that nursing attention to helping patients with this acclimation may be most important in addressing these patient problems.
Chen, L., Wang, T., Shih, Y., & Wu, L.J. (2013). Fifteen-minute music intervention reduces pre-radiotherapy anxiety in oncology patients. European Journal of Oncology Nursing, 17, 436–441.
To evaluate the effect of 15 minutes of music on anxiety prior to receiving radiation therapy
Participants were randomly assigned to control or music group. Both took pretests using the State-Trait Anxiety Inventory and filled out demographic questionnaires, and vital signs were obtained. The intervention group received 15 minutes of self-selected music with similar tempo from a provided list. Patients were able to select which day they received intervention, select music that was paced at 60-80 beats/min. Postintervention data were obtained from both groups.
STAI scores decreased significantly in both groups, but decreased more in intervention group and was statistically significantly lower in the intervention group (decline of 7.19 with intervention, 1.04 decline in control; p < .001). Both groups had significant decrease in heart rate and resting rate (pre- and postintervention). Music group had statistically significant difference in mean change of systolic blood pressure.
Anxiety levels and systolic blood pressure may decrease when music therapy intervention is provided before radiation therapy treatment.
A choice of music therapy provided at radiation treatment centers may help to reduce anxiety that is caused by treatment and provide a way for the patient to relax at the treatment center and at home.
Chu-Hui-Lin Chi, G., Young, A., McFarlane, J., Watson, M., Coleman, R.L., Eifel, P.J., . . . Richardson, M. (2015). Effects of music relaxation video on pain and anxiety for women with gynaecological cancer receiving intracavitary brachytherapy: A randomised controlled trial. Journal of Research in Nursing, 20, 129–144.
To determine the effect of watching a music relaxation video on pain and anxiety in women diagnosed with gynecological cancer who were undergoing intra-cavitary brachytherapy
A music relaxation video was played four times for a total of 120 minutes during the first 44 hours of brachytherapy treatment, with monitoring of pain scores, opioid consumption, and perceived anxiety scores compared to usual nursing care during the same time period.
Women in the intervention group reported less pain. There was no difference in levels of opioid consumption between the intervention and control groups. Participants in the music viewing group indicated significantly reduced anxiety levels in analysis (p = 0.001).
Nurses and other medical personnel should consider using music relaxation videos to help reduce pain and anxiety during intracavitary brachytherapy and other procedures that may be uncomfortable. The intervention is non-invasive, with beneficial effects.
This non-invasive intervention could be nurse-driven without a physician’s order. Women undergoing brachytherapy must lie still in a shielded isolation room for 2-3 days with limitations on visitors, resulting in physical and psychological discomforts, including pain. This study shows that pain experiences may be lessened with music relaxation videos.
Doro, C.A., Neto, J.Z., Cunha, R., & Doro, M.P. (2017). Music therapy improves the mood of patients undergoing hematopoietic stem cells transplantation (controlled randomized study). Supportive Care in Cancer, 25, 1013–1018.
To examine the effect of music on patients undergoing HCT with the purpose of reducing social confinement in this group of patients
Patients were assigned to music and control groups by a throw of dice. Live music sessions with a therapist were done in the patient’s room twice weekly for 30 minutes each. Study assessments were done at the end of music therapy sessions.
PHASE OF CARE: Active anti-tumor treatment
RCT
Visual analog scale (VAS) for pain and anxiety
Anxiety was lower in the music group after the first (p < 0.001) and last sessions (p = 0.002). Pain was lower after the first music session in the music group but, at study completion, there was no difference between groups in pain.
Music may help to alleviate anxiety associated with social isolation in patients undergoing HCT.
This study showed that music therapy may be helpful for patients undergoing HCT in terms of anxiety. This study has multiple design limitations. Music therapy is a low-risk intervention; however, it does require staff time of a music therapist. Further research regarding benefit of live music therapy versus listening to music would be helpful.
Eckhouse, D.R., Hurd, M., Cotter-Schaufele, S., Sulo, S., Sokolowski, M., & Barbour, L. (2014). A randomized controlled trial to determine the effects of music and relaxation interventions on perceived anxiety in hospitalized patients receiving orthopaedic or cancer treatment. Orthopaedic Nursing, 33, 342–351.
To explore effects of music and relaxation interventions on anxiety among patients with cancer and orthopedic interventions
Patients were randomly assigned to the music group, relaxation group or usual care control. Participants in the music group listened to a 20 minute CD of music composed by the hospital’s music therapist. The CD used harp and vocal music with spoken relaxation instructions. Patients in the relaxation group listened to and viewed a music video for 20 minutes that featured nature scenes and instrumental music. The control group were allowed 20 minutes of unstructured free time and were not allowed to listen to music during that time. The intervention was provided once during the first 48 hours of hospital admission. Study data were obtained immediately before and after the intervention.
Although there were some differences among groups in single items on the anxiety measurement tool, there were no differences across groups for total anxiety scores. Anxiety scores declined in all on average (p < 0.001)
Results did not show effectiveness of the music and relaxation interventions used here, although anxiety did decline somewhat more in both intervention groups.
This study did not provide strong evidence supporting effectiveness of music and relaxation interventions for anxiety among the hospitalized patients involved. At the same time, there have been some studies showing benefits of music for various symptoms, and although not significant, this study did show greater reduction in anxiety with the intervention. This type of intervention is low risk and low cost, and may be beneficial to some patients. Here, the intervention was provided via the hospital television system, which can provide a very practical approach to delivery of the intervention.
Ferrer, A.J. (2007). The effect of live music on decreasing anxiety in patients undergoing chemotherapy treatment. Journal of Music Therapy, 44, 242–255.
To investigate the effects of live music on anxiety levels of patients undergoing treatment with chemotherapy
Possible participants were approached by the researcher at the beginning of a chemotherapy treatment session. Consenting patients completed questionnaires and were randomly assigned to the control group or to receive live music. The live music consisted of 20 minutes of singing with guitar accompaniment. During the intervention, patients were encouraged to sing along and to request other preferred songs. Control group patients completed questionnaires but had no other contact with the researcher. After 20 minutes, both groups completed a second questionnaire.
Not decribed
A randomized controlled trial design was used.
Mean anxiety declined in the experimental group, and increased in the control group. These changes were significantly different between groups (p = 0.009). Responses regarding fear (p = 0.047), relaxation (p = 0.004), and fatigue (p = 0.001) also showed a similar difference. There were no significant differences in heart rate or blood pressure changes between groups. Many patients in the experimental group were involved in the music with hand clapping, etc. Patients who received the music therapy stated that it made the time pass more quickly.
Use of live music may be helpful to patients who are receiving chemotherapy to manage anxiety related to the treatment.
Findings suggest that distractions such as live music as provided here can be helpful to patients during chemotherapy. This is a low-risk intervention that might be of benefit for some patients.
Jasemi, M., Aazami, S., & Zabihi, R.E. (2016). The effects of music therapy on anxiety and depression of cancer patients. Indian Journal of Palliative Care, 22, 455–458.
To study the effect of music on anxiety and depression
Patients listened to music for at least 20 minutes daily for three consecutive days. Music was provided through headphones and consisted of light music selected by experts. Study measurements were done daily after the intervention.
Two-group, non-random, quasi-experimental
Hospital Anxiety and Depression Scale (HADS)
There was no significant change in HADS scores in the control group. HADS scores declined significantly over the three days of the music group (p < 0.001)
Listening to music was associated with short-term reduction in symptoms of anxiety and depression.
Listening to music is a low-risk intervention that may be of benefit in managing symptoms of anxiety and depression.
Jeppesen, E., Pedersen, C.M., Larsen, K.R., Rehl, A., Bartholdy, K., Walsted, E.S., & Backer, V. (2016). Music does not alter anxiety in patients with suspected lung cancer undergoing bronchoscopy: A randomised controlled trial. European Clinical Respiratory Journal, 3, 33472.
To measure the effect of a music intervention on anxiety related to bronchoscopy
Patients undergoing bronchoscopy were randomly assigned to listen to music via earbuds during the procedures or use earplugs with no sound. On admission to the hospital, patients completed a study questionnaire, and blood cortisol samples were obtained. On admission to the operating area, baseline vital signs were taken, and actigraph sensors were applied to the patients' wrists, ankles, head, and hips. After 10 minutes, study measures were obtained again. About 60 minutes after bronchoscopy, the study measures were repeated.
PHASE OF CARE: Diagnostic
Single-blind, randomized, controlled trial
Prior to bronchoscopy, the music group had lower STAI scores. After the bronchoscopy, anxiety was lower in both groups, with no difference between groups. No differences in duration of the procedure, sedatives, or amount of patient movement during the procedure were reported.
Music was not shown to reduce anxiety associated with bronchoscopy.
Music during bronchoscopy was not shown to affect patients' level of anxiety. Measurement of anxiety immediately prior to or during a procedure to perform this type of research is difficult and questionable.
Karagozoglu, S., Tekyasar, F., & Yilmaz, F.A. (2013). Effects of music therapy and guided visual imagery on chemotherapy-induced anxiety and nausea-vomiting. Journal of Clinical Nursing, 22, 39–50.
To examine effects of music and visual imagery on anxiety and chemotherapy-induced nausea and vomiting (CINV) in patients receiving chemotherapy
Patients were assigned to the control group during their second cycle of chemotherapy and to the experimental condition during the third cycle of chemotherapy. Anxiety and CINV were measured before and after chemotherapy administration. Nature paintings were used for visual imagery, and instrumental Turkish music was selected for each image. Patients selected the image that was most appealing to them and were told to imagine being in the location of the painting. Patients were given the related music CD to listen to during chemotherapy with headphones.
The study was conducted at a single site, outpatient setting in Turkey.
Patients were undergoing active antitumor treatment.
A pre- and post-test repeated measures, single-group design was used.
Anxiety declined from prechemotherapy to postchemotherapy administration in both conditions. Both pre- and postchemotherapy state anxiety levels were lower during the intervention course of treatment. CINV declined over time for both pre- and postchemotherapy administration. Both pre- and postchemotherapy CINV levels were significantly lower during the intervention condition.
This study does not provide any clear conclusions about the effects of music and visual imagery.
Findings are inconclusive regarding the efficacy of music and visual imagery for anxiety and CINV during chemotherapy administration because of numerous study design and analysis limitations.
Kwekkeboom, K.L. (2003). Music versus distraction for procedural pain and anxiety in patients with cancer. Oncology Nursing Forum, 30, 433–440.
This intervention was music versus simple distraction and control (treatment as usual).
The study reported on a sample of 58 patients with cancer having painful, cancer-related medical procedures.
A randomized controlled trial design was used.
There were no significant differences in post-procedure anxiety (no p values reported), pain, or perceived control across conditions.
Li, X.M., Zhou, K.N., Yan, H., Wang, D.L., & Zhang, Y.P. (2012). Effects of music therapy on anxiety of patients with breast cancer after radical mastectomy: A randomized clinical trial. Journal of Advanced Nursing, 68, 1145–1155.
To evaluate the effects of music therapy on anxiety in women undergoing breast cancer surgery
Patients admitted to the hospital for mastectomy were randomly assigned to receive either music therapy or usual care. Patients in the intervention group listened to music they selected through a headphone connected to an MP3 player during their hospital stay. Music was provided twice daily for 30 minutes per session. The total time in the hospital receiving therapy was an average of 13.6 days following radical mastectomy and 18.9 days for chemotherapy. Assessments were done at baseline on the day before surgery, the day before hospital discharge, on second hospital admission for chemotherapy, and on a third hospital admission for chemotherapy.
Patients were undergoing active antitumor treatment.
A randomized controlled trial design was used.
State Anxiety Inventory
Pretest results showed that patients had moderate to severe anxiety levels prior to surgery. Mean post-test anxiety scores were lower in the experimental group, on the first post-test 4.57 points, and increasing across time to 9.69 points lower at the final post-test (p < 0.0001). Mean anxiety scores declined over time in all patients.
Findings suggest that listening to music can be beneficial in reducing anxiety during treatment for breast cancer.
Listening to music is a simple and low-cost intervention that may be helpful for some patients in reducing anxiety associated with cancer treatment.
Lin, M.F., Hsieh, Y.J., Hsu, Y.Y., Fetzer, S., & Hsu, M.C. (2011). A randomised controlled trial of the effect of music therapy and verbal relaxation on chemotherapy-induced anxiety. Journal of Clinical Nursing, 20, 988–999.
To identify patients in high-anxiety states and to test the effects of a music intervention
Cancer and its treatment provoke a series of changes in the emotional sphere of patient anxiety. In addition, there is a subgroup of patients who are in a high-anxiety state. These patients, when identified, obtain the most benefits from music or verbal relaxation. This study consisted of 98 patients in three groups: the music therapy group, which received 60-minute, single-music sessions; the verbal relaxation group, which received 30 minutes of guided relaxation; and the control group, which received usual care. Because patients were asked to rate their anxiety preintervention, the study also was able to test the intervention's effects on those in high-anxiety states.
Randomized, controlled trial
All groups experienced a significant decline in anxiety. The music intervention group experienced a greater decrease in poststate anxiety (p = .005). Physiologic indicators also changed in patients with high-anxiety states in the music therapy group. This study highlighted the need to target patients in high-anxiety states and to offer additional support, relaxation, and interventions such as music therapy to this population.
Music intervention and relaxation therapy reduces chemotherapy-induced anxiety.
This study highlighted the need to identify patients in high-anxiety states pretreatment. This population can then be offered additional interventions. Music and relaxation can reduce anxiety during chemotherapy. Most infusion centers offer personal music devices or allow patients to bring their own. Music can be offered via headphones if a patient desires. This intervention can be recommended safely.
Nguyen, T.N., Nilsson, S., Hellstrom, A.L., & Bengtson, A. (2010). Music therapy to reduce pain and anxiety in children with cancer undergoing lumbar puncture: A randomized clinical trial. Journal of Pediatric Oncology Nursing, 27, 146–155.
To evaluate the effect of music in children with cancer who undergo lumbar puncture (LP)
Children were randomized to use either earphones with music (intervention group ) or earphones without music (control group) using iPods. The researcher and physician were blinded to participant group assignment. Immediately prior to the LP procedure, heart rate, blood pressure, oxygen saturation, and respiratory rate were obtained, and pain and anxiety scores were recorded. Directly after the procedure was finished, anxiety was remeasured. Self-reported pain was obtained before, during, and after LP. Physiologic parameters were recorded throughout the procedure. No local anesthetics or other analgesics were administered, which was usual care. Ten children in each group were chosen to be interviewed as well immediately after the LP procedure.
A double-blind, randomized controlled trial design was used.
Pain scores during LP were significantly lower for the music group (p < 0.001), 2.35 compared to 5.65 in controls. Pain scores after the procedure were also lower for the music group (p < 0.003). Anxiety scores after 10 minutes of music before LP were lower for children in the music group (p < 0.001). Anxiety after LP was also lower in the music group (p < 0.001) compared to controls; however, pre- and post-differences in anxiety in both intervention and control groups were minimal. Heart rate and respiratory rate were significantly different between the two groups, with lowered heart (p = 0.012) and respiratory rate (p = 0.009) during the procedure. In interviews, most of the children in the music group indicated that listening to their favorite music helped them feel calm and took their minds off the procedure.
Use of music as a distraction may be helpful to reduce pain and anxiety in children undergoing lumbar puncture.
This study does not provide convincing support for effectiveness of listening to music to reduce anxiety, but it appeared to reduce pain during the procedure. Music provision is a potentially low-risk and low-cost intervention that may be helpful to reduce pain and anxiety in children who are undergoing uncomfortable procedures. Further study of the use of music in combination with other forms of distractions and methods to combat pain are indicated. It is not clear if providing music via use of iPod and earphones is the best approach, as children in this study did indicate that the earphones were somewhat uncomfortable, and use of earphones for multiple patients could be a potential source for transmission of infection.
Palmer, J.B., Lane, D., Mayo, D., Schluchter, M., & Leeming, R. (2015). Effects of music therapy on anesthesia requirements and anxiety in women undergoing ambulatory breast surgery for cancer diagnosis and treatment: A randomized controlled trial. Journal of Clinical Oncology, 33, 3162–3168.
To determine if a decrease in the amount of anesthesia and a decrease in recovery time would occur in either of the treatment groups receiving music therapy compared to the usual care or control group.
Patients who met inclusion criteria were randomly assigned to a five-minute intervention or usual care in one of three groups: patient-selected live music (LM) with therapist-selected recorded music during the operative procedure; patient-selected recorded music (RM) preoperatively with therapist-selected recorded music during the operative procedure; or usual care (UC) preoperatively with noise-blocking earmuffs during the surgical procedure.
No significant baseline differences in the three groups nor in amount of propofol used to achieve sedation level of BIS 70. Intervention groups showed significantly decreased levels of anxiety compared to control group; no significant difference in changes between the two groups were noted. Greater changes in anxiety level were seen when baseline anxiety scores were high: (i.e., the higher the pretreatment anxiety, the greater the change [reduced anxiety] in anxiety level after treatment). The amount of change (slope) in the LM group and RM groups were not different from each other, but were different from the amount of change (slope) in the control group. Recovery time, or time to discharge readiness determined by the recovery nurse, was not different for the intervention groups compared to the control group, but was shorter in the LM group compared to the RM group. Patient satisfaction scores revealed no differences among the three groups.
Noise-blocking earmuffs and music therapy were not found to reduce the amount of anesthesia required as measured by the BIS monitor. Satisfaction scores were high with and without music therapy. Music therapy was found to reduce anxiety more when initial anxiety scores were high.
Patients felt cared for and cared about with or without music therapy; anxiety levels were lowered with either type of music therapy when baseline anxiety levels scored high. Nurses may conduct anxiety screening and offer music therapy to reduce anxiety scores as part of the usual care environment.
Soo, M.S., Jarosz, J.A., Wren, A.A., Soo, A.E., Mowery, Y.M., Johnson, K.S., . . . Shelby, R.A. (2016). Imaging-guided core-needle breast biopsy: Impact of meditation and music interventions on patient anxiety, pain, and fatigue. Journal of the American College of Radiology, 13, 526–534.
To evaluate the effects of guided meditation and music on patients’ anxiety, pain, and fatigue during breast biopsy
Patients were randomly assigned to meditation, music, or standard care with supportive dialogue. Patients in the meditation and music groups were given headphones. During the procedure, patients in the meditation group listened to an audio recorded medication designed to help patients relax and focus on feelings of kindness and compassion. The music group listened to their choice of music. The standard care control group received supportive dialogue during the procedure. Biopsies were done with local anesthesia. Study assessments were done pre and post biopsy.
Anxiety declined in all groups, while those in the meditation group (p = 0.04) and the music group (p = 0.03) had greater decline in anxiety compared to controls. Fatigue declined in all, with no significant differences between groups. Decline in pain differed among the study groups. The music group had greater increases in pain than the meditation group (p = 0.03), and pain increased in the control group. No difference in pain scores existed between the music and control groups. Overall post-procedure pain scores averaged 1.8.
The study findings suggest that a meditation intervention during biopsy may help to reduce patient anxiety and pain.
This study showed that listening to a meditation intervention during breast biopsy was associated with lower anxiety postprocedure. This is a low-risk intervention that may be helpful for patients; however, whether this effect would have lasted for any length of time after the procedure is unknown.
Tsivian, M., Qi, P., Kimura, M., Chen, V.H., Chen, S.H., Gan, T.J., & Polascik, T.J. (2012). The effect of noise-cancelling headphones or music on pain perception and anxiety in men undergoing transrectal prostate biopsy. Urology, 79, 32–36.
To assess the effect of noise-canceling headphones, with or without music, on patient pain and anxiety associated with routine, office-based transrectal ultrasound-guided prostate biopsy
Patients were randomly assigned to one of three groups: control group (no noise-canceling headphones), headphones group (patients wore noise-canceling headphones), or music group (which listened to Bach's Brandenburg Concertos through noise-canceling headphones). Patients donned headphones immediately before the procedure, after hearing a thorough description of the procedure and getting into position for the procedure.
Randomized controlled trial
Mean VRS scores showed that pain significantly increased from baseline to postprocedure for all groups (control group, 0.79–2.49, p = 0.001; headphones group, 0.89–2.29, p = 0.009; music group, 0.52–2.13, p < 0.001). In no group did anxiety level change from baseline to postprocedure. The music group had the lowest overall mean State-Trait Anxiety score. Blood pressure levels remained fairly stable from baseline to postprocedure. The control group’s mean diastolic blood pressure increased from 82.3 to 88.4, the headphones group’s mean diastolic blood pressure increased from 79.38 to 81.9, and the music group’s mean diastolic blood pressure increased from 82.5 to 84.9. Authors reported that these changes were not statistically significant.
According to this study, music or noise-canceling headphones do not appear to relieve pain perception and anxiety during transrectal prostate biopsy; however, further research is warranted due to the small sample size.
Although this study did not find music or noise-canceling headphones to be effective in decreasing pain perception and anxiety, nurses may want to ask patients if they would like to listen to music in the circumstances outlined. Listening to music may be a distraction and potentially mitigate pain.
Walworth, D., Rumana, C.S., Nguyen, J., & Jarred, J. (2008). Effects of live music therapy sessions on quality of life indicators, medications administered and hospital length of stay for patients undergoing elective surgical procedures for brain. Journal of Music Therapy, 45, 349–359.
To examine effects of live music therapy on quality-of-life indicators, medications administered, and length of stay in patients undergoing brain surgery
Patients were met 30–45 minutes prior to surgery in the outpatient surgery check-in area, inpatient room, or preoperative holding area and completed baseline study measures. Patients in the experimental group received 20–30 minutes of patient-preferred live music and completed postintervention measures prior to surgery. Those in the experimental group received the music intervention each subsequent day of hospital stay, and completed both pre- and postintervention measures. Patients, family members, and visitors could participate by singing, playing rhythm instruments, or listening. Techniques included lyric analysis, songwriting, progressive muscle relaxation, and guided imagery. Control group patients also completed study measures postoperatively and daily during their hospital stay.
Patients were undergoing the active treatment phase of care.
A randomized controlled trial design was used.
There were no significant differences between groups for anxiety, mood, pain, perception of hospitalization, relaxation, or stress. There were no differences between groups for medications used. There was no significant difference between groups for length of stay.
Results do not support an effect of live music therapy on anxiety, pain, medication use, or length of hospital stay in patients undergoing brain surgery.
This study does not demonstrate effectiveness of music therapy in hospitalized patients undergoing brain surgery. Practical application of this type of intervention in most acute inpatient settings and perioperative settings is questionable.
Zavotsky, K.E., Banavage, A., James, P., Easter, K., Pontieri-Lewis, V., & Lutwin, L. (2014). The effects of music on pain and anxiety during screening mammography. Clinical Journal of Oncology Nursing, 18, E45–E49.
To test whether women who listened to music during screening mammography report lower levels of pain and anxiety than women who did not listen to music
On three days of the week, patients listened to music during screening mammorgraphy, and on two days of the week, music was not provided. An MP3 player was preloaded with various types of music. Patients who were part of the music group were asked to select the music of their choice. Patients rated pain and anxiety immediately after completing the mammography.
No significant differences in pain or anxiety were seen between groups.
This study did not show an effect of listening to music during mammography on pain or anxiety.
This study did not show an effect of listening to music during screening mammography, but evidence has shown effectiveness of music in reducing anxiety during invasive procedures. Listening to music during mammography is a low-cost and low-risk intervention that may be helpful to some patients. This study had multiple limitations.
Zhou, K., Li, X., Li, J., Liu, M., Dang, S., Wang, D., & Xin, X. (2015). A clinical randomized controlled trial of music therapy and progressive muscle relaxation training in female breast cancer patients after radical mastectomy: Results on depression, anxiety and length of hospital stay. European Journal of Oncology Nursing, 19, 54–59.
To examine effects of music therapy and progressive muscle relaxation (PMR) training on depression and anxiety in Chinese patients with breast cancer
Patients randomly were assigned to the intervention group (which received the music and PMR intervention) or a usual care group after a radical mastectomy. To avoid contamination, intervention and control patients were placed in different inpatient areas. Music therapy involved listening to music via headphones connected to an MP3 player for 30 minutes twice per day. This began within 48 hours after surgery. Patients selected their preferred music. PMR training was conducted on the second postoperative day. Training was conducted twice per day for 30 minutes until discharge. Patients were encouraged to do PMR and music listening exercises together. Patients in the control group received the usual postoperative nursing care only. Study measures were obtained the day before surgery and the day before hospital discharge. Data collectors were blinded to group assignment.
Randomized, controlled, single-blinded trial
Analysis showed that there was a significant reduction in anxiety and depression over time alone (p < .001) as well as by group (p < .001), and there was a significant interaction between group and time (p = .0009). Depression scores declined an average of 7.2 points in the intervention group and 4.6 points in the control group. Anxiety scores declined an average of 16 points in the intervention group and 11 points in the control group. Hospital stay time was significantly lower in the intervention group (p < .001). Hospital stay length was shorter in the intervention group.
The findings of this study suggest that the combination of PMR and listening to music was helpful in reducing anxiety and depression in women after mastectomies.
Listening to music and using progressive muscle relaxation may have a positive impact on anxiety and depression in patients postoperatively. These are low-risk, low-cost interventions that may be beneficial. The findings of this study showed that those who had the intervention also had shorter hospital stays. There is insufficient evidence to determine the real impact of this intervention on duration of hospitalization; however, these findings suggest that this area deserves further exploration.
Greenlee, H., Balneaves, L.G., Carlson, L.E., Cohen, M., Deng, G., Hershman, D., . . . Society for Integrative Oncology. (2014). Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. Journal of the National Cancer Institute.Monographs, 2014, 346–358.
4,900 references were identified that were published between January 1, 1990 and December 31, 2013. 203 articles were included in the final review although only 174 were referenced. Grades used and reported here were A: recommended, high certainty of benefit, B: recommended, high certainty of moderate to substantial benefit, D: recommends against use, moderate to high certainty of no net benefit, and H: recommends against use, moderate to high certainty that harms outweigh benefits.
Interventions for specific symptoms that had strong recommendations for or against use were:
It appears that only specific types of interventions were included, and there are numerous types of integrative or complementary interventions that were not considered in this review. The findings considered were limited to women with breast cancer. Quality rating of evidence was not discussed individually.
These guidelines provided an evidence-based evaluation of various integrative therapies in women with breast cancer. This set of interventions is not all-inclusive; however, it does provide some guidance to clinicians and others regarding evidence strength in these areas as assessed by this specific study group.