Music/Music Therapy

Music/Music Therapy

PEP Topic 
Depression
Description 

Music therapy involves using music to influence physiologic, psychological, and emotional functioning. In many cases it is used with other behavioral techniques, such as relaxation. Music interventions range from listening to recorded or live music to formal interventions provided by music therapists. Professional music therapy involves individualization of the intervention and a systematic process including assessment, treatment, and evaluation. Music therapy may involve the patient in music making. Researchers have evaluated the effect of music and music therapy in the treatment of anxiety, chemotherapy-induced nausea and vomiting, dyspnea, depression, pain, fatigue, and caregiver strain and burden.

Effectiveness Not Established

Systematic Review/Meta-Analysis

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.

doi: 10.1002/14651858.CD006911.pub2
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Purpose:

To examine the effects of music therapy and "medical music" on patients with cancer.

Search Strategy:

  • Databases searched were MEDLINE, EMBASE, LILACS, CINAHL, Computer-Assisted Information Retrieval Service System (CAIRSS), and Cochrane Collaboration. The investigators also evaluated for inclusion studies listed on web sites about clinical trials or on the web sites of relevant professional organizations, those cited in journals dealing with music and music therapy, and those included in the reference lists of relevant articles.
  • The investigators provided an extensive list of search terms in the report.
  • Studies were included if patients, of any age, had cancer and if the studies compared music interventions to standard care, alternative interventions plus standard care, or placebo. Studies were included if they were randomized, controlled trials or incorporated quasiexperimental designs.
  • Studies were excluded if they involved patients who were undergoing diagnostic procedures.

Literature Evaluated:

  • The investigators retrieved a total of 773 studies.
  • The investigators evaluated the quality of the studies according to the criteria in the Cochrane Handbook for Systematic Reviews of Interventions.

Sample Characteristics:

  • The final number of studies analyzed was 30.
  • The studies analyzed included a total of 1,891 patients.
  • The range of mean patients per study was 8 to 86.
  • The analyzed studies comprised multiple cancer types and age groups.

Phase of Care and Clinical Applications:

  • Patients were undergoing multiple phases of care.
  • The study has clinical applicability for pediatrics and palliative care.

Results:

  • Findings from seven trials, regarding effect on anxiety, showed positive effects for reducing anxiety (standardized mean difference [SMD] = –0.61; 95% confidence interval [CI] [–0.97, –0.26]; p = 0.0007).
  • Findings from six trials, regarding effect on pain, showed positive effects on perceived pain (SMD = –0.59; 95% CI [–0.92, –0.27]; p = 0.0003).
  • The investigators noted no significant effects on depression or fatigue.
  • Several studies showed that music listening and music interventions affected physical findings—for example, the studies reduced pulse rate.
  • Many studies had high risks of bias, and the type, duration, and timing of the interventions varied greatly.

Conclusions:

Music interventions appear to have beneficial effects regarding pain reduction and short-term reduction of anxiety.

Limitations:

  • The investigators found a relatively small number of studies that examined a specific symptom or outcome.
  • The interventions were very different in terms of sample types, timing, and duration; therefore, synthesizing the findings was difficult. 
  • Most studies had small sample sizes and high risks of bias.

Nursing Implications:

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.

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.

doi: 10.1097/NCC.0000000000000116
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Purpose:

STUDY PURPOSE: To evaluate the effects of music on symptoms in patients with cancer

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy:

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

Literature Evaluated:

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.

Sample Characteristics:

  • FINAL NUMBER STUDIES INCLUDED =  21–17 for anxiety, 8 for depression, 6 for pain, and 5 for fatigue
  • SAMPLE RANGE ACROSS STUDIES = 32–126

Phase of Care and Clinical Applications:

  • APPLICATIONS: Pediatrics, palliative care

Results:

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.

Conclusions:

This analysis shows that music interventions can reduce anxiety, depression, pain, and fatigue in patients with cancer with small-to-moderate effect sizes.

Limitations:

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.

Nursing Implications:

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.

Research Evidence Summaries

Zhou, K.N., Li, X.M., Yan, H., Dang, S.N., & Wang, D.L. (2011). Effects of music therapy on depression and duration of hospital stay of breast cancer patients after radical mastectomy. Chinese Medical Journal, 124(15), 2321–2327.

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Study Purpose:

To study the effects of music therapy on depression in female patients with breast cancer after radical mastectomy; to study how music therapy affects duration of hospital stay  

Intervention Characteristics/Basic Study Process:

Subjects were randomly assigned to a music or usual-care group (control). Investigators collected data on the day before radical mastectomy (pretest), the day before hospital discharge (first post-test), and at the second and third hospital admissions for chemotherapy (second and third post-tests). Different chemo intervals meant that the second and third post-tests were between 14 and 28 days; the mean time was 18.6 days (SD = 7.4 days). Total intervention time involved the hospital stay after radical mastectomy (mean 13.6 days [SD = 2 days]) and the two chemotherapy periods (the mean time of each period was 8.9 days (SD = 7.1 days). The experimental group received an introduction to music, and participants selected preferred music. Each participant listened to his or her choice of music through headphones connected to an MP3 player. Participants listened to music twice a day, 30 minutes each time. Investigators did not offer music to the control group.

Sample Characteristics:

  • The sample was composed of 120 participants, 60 in each group.
  • The age range of participants was 25–65 years.
  • All the participants were female.
  • All the participants had breast cancer that required radical mastectomy.
     

Setting:

  • Single site
  • Medical college
  • Xi’an, Shaanxi, China
     

Phase of Care and Clinical Applications:

  • Phase of care: active treatment
  • Clinical applications: late effects and survivorship
     

Study Design:

Randomized controlled trial with repeated measures

Measurement Instruments/Methods:

  • Chinese version of the Zung Self-Rating Depression Scale (ZSDS)   
  • General questionnaire, for the collection of demographic data

Results:

  • Investigators retrieved 450 validated questionnaires. The rate lost to follow-up was 12.5%.
  • Clinical data and demographic data about age, education, income, marital status, and quality of spousal relationship revealed no significant baseline differences between the two groups (P > 0.05).
  • Before radical mastectomy, the mean depression score of all participants was 37.19 (SD = 6.30); 36 participants (30%) suffered from depression symptoms. At baseline, data revealed no statistical difference in depression between groups. Post-test depression scores did demonstrate significant differences between the two groups (F = 39.13, P < 0.001; F = 82.09, P < 0.001).
  • The depression scores of both groups trended downward during follow-up periods, but the score curve of the experimental group was lower than that of the control group (p < 0.001).
  • Postradical mastectomy, the mean duration of hospitalization, experimental group, was 13.62 days (SD = 2.04 days); mean duration of hospitalization, control group, was 15.53 days (SD = 2.75 days). This difference was significant (P < 0.001).

Conclusions:

Postmastectomy, depression scores of the experimental group were lower than those of the control group, and duration of hospital stay was shorter for patients receiving music therapy. However, lack of data regarding actual use of music therapy by patients and lack of information regarding patients’ health status and other types of treatment preclude recommendation of music therapy without further study.

Limitations:

  • Data were self-reported.
  • Double-blind methodology was not used because of the specificity of the intervention.
  • Investigation was from a quantitative aspect only; subjective experiences were not studied.
  • Subjects with extensive radical mastectomy played a small part in this trial.
  • The percentage lost to follow-up was high. 
  • The study had a potential testing effect as a result of repeated measurement.

Nursing Implications:

When caring for patients with breast cancer who are suffering from mood disturbance, nurses should select interventions whose evidence of mood-disturbance reduction is greater than the evidence of effect that listening to music presents. However, listening to music is a low-risk, low-cost intervention that might be helpful to some patients.


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