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.

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  

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.

• 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.
   

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

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

Randomized controlled trial with repeated measures

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

• 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).

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.

• 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.

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.