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.

• N = 98
• AVERAGE AGE = 53 years
• MALES: 34%, FEMALES: 66%
• KEY DISEASE CHARACTERISTICS: Primarily patients' first chemotherapy session
• OTHER KEY SAMPLE CHARACTERISTICS: Participants who were married were more prevalent. Breast cancer was more prevalent than lung or other cancers. Cancers were in stages 2 and 3. Elementary-level education was the most prevalent educational status.  

• SITE: Single-site  
• SETTING TYPE: Outpatient  
• LOCATION: Outpatient clinic, University Medical Center, Taiwan

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Pediatrics, elder care, palliative care 

Randomized, controlled trial

• Spielberger State-Trait Anxiety Instrument (STAI)
• Emotional Visual Analog Scale (VAS)  
• Three biobehavioral indicators, skin temperature, heart rate, and consciousness level, were measured before and after chemotherapy.

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.

• Small sample (< 100)
• Baseline sample/group differences of import
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)  
• Risk of bias (sample characteristics)
• Selective outcomes reporting
• Key sample group differences that could influence results
• Other limitations: This study is difficult to reproduce as it requires one-on-one staff time. Relaxation and music during chemotherapy often is interrupted. Baseline anxiety was lower in the music intervention group.

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.