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 reported on a sample of 40 patients.
• Mean patient age was 59.65 ± 9.67 years.
• The sample was 77.5% male and 22.5% female.
• Of the sample, 80% had lung cancer, and all were receiving highly emetogenic chemotherapy.

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.

• The Spielberger State-Trait Anxiety Inventory was used.
• Nausea was rated on a 100-mm visual analog scale (VAS).
• The Morrow Assessment of Nausea and Vomiting 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.

• The study had a small sample, with less than 100 participants.
• The study had risk of bias due to lack of a control group, blinding, random assignment, and an appropriate attentional control condition.
• The authors stated use of a 100-mm VAS but then stated that they grouped scores into 1 cm intervals. It is not clear if actual score differences were maintained, as this was not well described.
• The authors concluded that the intervention was effective based on analysis of differences before and after chemotherapy between the two study conditions; however, they did not show analysis of the change between pre- and postscores in each condition. This does not make sense as an approach to evaluate the effects.
• The study design had multiple risks of bias and threats to internal validity. Patients were assigned to the experimental condition in the third cycle—it is possible that anxiety and CINV simply declined over time, unrelated to the intervention.

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.