Tuinmann, G., Preissler, P., Böhmer, H., Suling, A., & Bokemeyer, C. (2017). The effects of music therapy in patients with high-dose chemotherapy and stem cell support: A randomized pilot study. Psycho-Oncology, 26, 377–384.
Evaluate the effects of music therapy in addition to standard treatment in patients undergoing high-dose chemotherapy (HDC) plus autologous stem cell transplantation (ASCT) on quality of life, anxiety, and depression.
For the intervention group, a trained music therapist administered therapy two times per week for at least 20 minutes, based on the individual needs of each patient established prior to therapy, and each session included a debrief or aftertalk. Quality of life was assessed prior to therapy, weekly during treatment, at discharge, and again three months later.
Randomized controlled trial
EORTC QLQ-C30, HADS-D, Karnofsky performance score
Quality of life declined less in the intervention group (8.1 points) versus control (11.4 points), difference between groups was not significant (p = 0.394)
Because of multiple limitations of study, the authors declared their findings to be preliminary.
Opportunity for further research
Ergin, E., Midilli, T.S., & Baysal, E. (2018). The effect of music on dyspnea severity, anxiety, and hemodynamic parameters in patients with dyspnea. Journal of Hospice and Palliative Nursing, 20, 81–87.
To examine the effects of music therapy in patients with dyspnea on the severity of dyspnea, state anxiety, and hemodynamic parameters such as heart rate, diastolic, systolic blood pressure, respiratory rate, and oxygen saturation.
Random assignment occurred by having patients who were hospitalized for dyspnea draw groups (A or B) from a bag for intervention or control groups. Intervention group patients were to rest supine in their hospital rooms for five minutes; patients were given earphones for music listening to 30 minutes of prepared music with instructions to listen with eyes closed and to concentrate on the music. Volume was adjusted by the researcher according to facial expressions of the participant.
Control group patients were to rest in bed for 30 minutes with eyes closed and headphones connected to a CD player but with no music playing, creating a quiet environment.
Testing via face-to-face interviews took place before and after the 30 minute period took place in both groups to measure dyspnea severity, respiratory rate, state anxiety, and hemodynamic parameters such as heart rate and diastolic and systolic blood pressure.
PHASE OF CARE: Seems not applicable in the current study
Randomized controlled study with pre-/post-test intervention and control group
Effect size: 0.519; significant at p = 0.05. The demographic and clinical characteristics of the intervention and control group were similar. There were no differences between groups before or after on hemodynamic measures. However, a simple paired t test of post-test scores revealed a significant between-groups difference in the decrease in diastolic blood pressure (p = 0.05) and state anxiety (p = 0.01) scores on post test, but no significant diff in systolic blood pressure, heart rate, respiratory rate, or oxygen saturation.
Music therapy has no significant effect on severity of dyspnea or on hemodynamic measures named, but showed an effective or significant change in state anxiety (p = 0.01) and a significance for decrease in diastolic blood pressure (p = 0.05) only for post-test between-groups scores.
Increased awareness that music of a patient’s choice may decrease anxiety: data needs to be collected before and after to determine effectiveness of music categories or genres. Patient choice may vary (according to cultural and spiritual and regional circumstances).
Bilgiç, Ş., & Acaroğlu, R. (2017). Effects of listening to music on the comfort of chemotherapy patients. Western Journal of Nursing Research, 39, 745–762.
To examine the effect of listening to music on comfort from chemotherapy symptoms (pain, tiredness, nausea, depression, anxiety, drowsiness, lack of appetite, not feeling well, and shortness of breath) for patients undergoing chemotherapy.
Intervention group: Each member was given a portable mp3 player (with double earphones) containing music prepared by Turkish Psychological Association (TPA) containing 30 minutes of relaxation wave sounds with harp and violin. Participants were asked to listen to the music in the chemotherapy unit before treatment. Instructions were to listen to the music at least three times weekly in keeping with recommendations from TPA.
Summary: Participants were given a pre-loaded mp3 player with instructions to listen for 20 to 30 minutes once a day for a minimum of three days per week and to record specific observations: dates and times of symptom experiences and music listening.
PHASE OF CARE: Active anti-tumor treatment
Quasi-experimental with two groups (intervention and control) using pre-/post-test measures
There was no significant between-group difference at baseline. The statistically significant differences in the intervention group related to music listening were for pain, exhaustion, nausea, anxiety, lethargy, lack of appetite, and not feeling well. However, no significant differences were found for depression or shortness of breath.
There were statistically significant differences between groups for comfort measures: general comfort, physical comfort, psycho-spiritual comfort, and sociocultural comfort. All intra-group (within-group) differences were statistically significant for comfort measures.
Listening to specified music for specified time periods was positive for chemotherapy symptoms: pain, exhaustion (fatigue), nausea, anxiety, lethargy, lack of appetite, and not feeling well; and on measures of general comfort, physical comfort, psycho-spiritual comfort, and sociocultural comfort.
There were no positive effects on depression or shortness of breath.
Music listening may diminish symptom severity in patients undergoing chemotherapy. Music therapy should be considered as an important element of holistic treatment for patients who have a cancer diagnosis and chemotherapy.
Ho, R.T., Fong, T.C., Lo, P.H., Ho, S.M., Lee, P.W., Leung, P.P., . . . Chan, C.L. (2016). Randomized controlled trial of supportive-expressive group therapy and body-mind-spirit intervention for Chinese non-metastatic breast cancer patients. Supportive Care in Cancer, 24, 4929–4937.
To examine the effect of two interventions on emotion suppression and psychological distress in patients with non-metastatic breast cancer
Each group met for eight weeks for two hours each week. There were three groups:
PHASE OF CARE: Transition phase after active treatment
Three-arm RCT with measurement at baseline (T0), 4 months (T1), 8 months (T2), and 12 months (T3)
No difference in groups except for cancer duration, which was longer in SEG group and shorter in the BMS group (p = 0.01). There were no significant improvements in anxiety or depression. Emotion suppression: significantly decreased in the first four months for SEG and BMS with no change in control group. Perceived stress: No change in control or SEG but significant decreases in first four months in BMS group.
SEG resulted in moderate decrease in emotional suppression at 4 and 8 months, with participant perceived benefits; method is applicable for increased expression of emotions. SEG minimal effect on anxiety, depression and perceived stress.
BMS showed no effect on anxiety and depression (d = 0.38–0.46) and little (small to medium d = 0.07–0.2) effect on emotional suppression and perceived stress.
No significant effectiveness of the named therapies: SEG or BMS
Conduct large-scale research with sufficient power to examine effectiveness of these therapies. Learn and apply these therapeutic approaches. Use full-scale 52-week protocol for expression support therapy.
Emerson, K., Murphy, M., Quinlin, L., O'Malley, P., & Hayes, K. (2017). Evaluation of a low-light intervention—starlight therapy—for agitation, anxiety, restlessness, sleep disturbances, dyspnea, and pain at end of life. Journal of Hospice and Palliative Nursing, 19, 214–220.
To evaluate the effectiveness of low light therapy (starlight therapy) on symptoms at end of life, including anxiety, agitation, dyspnea, restlessness, insomnia, and pain.
Patients observed or reporting symptoms were enrolled in the study and low light therapy (starlight therapy) was applied for two hours with observations at baseline, 30 minutes, and at two hours.
Prospective trial of use of low light therapy in patients observed or self-reporting symptoms
Lux meter (measuring light levels), vital signs, adapted Assessing Distressing Symptoms STAR Symptom Scale and Questionnaire, outcome measurement tools (physiological symptoms)
Respiratory rate significantly reduced from a rate of 23.91 at baseline to a mean rate of 18.63 (p < 0.01) at 30 minutes and a mean rate of 17.88 (p < 0.0001) at two hours. Heart rate also significantly reduced from a mean of 98.45 at baseline to a mean of 84.9 at 30 minutes (p < 0.01) and 84.55 at two hours (p < 0.0001). End-of-life symptoms as measured on the STAR symptom scale were noted and presence of moderate or severe symptoms were totaled with significantly fewer patients with presence of moderate or severe symptoms at both 30 minutes and two hours for agitation (p = 0.003 for 30 minutes, p < 0.0001 for two hours), anxiety (p < 0.0001 for 30 minutes, p < 0.0001 for two hours), restlessness (p < 0.001 for 30 minutes, p < 0.0001 for two hours), and sleep (p = 0.002 for 30 minutes, p < 0.0001 for two hours), with no significant reduction in numbers of patients with moderate or severe pain or dyspnea seen at any other time point.
Low light therapy shows some promise symptoms of agitation/anxiety/restless/sleep in patients with terminal illness in hospice, but further research needed given the small sample size, prospective design, limited patient population, and specific setting.
An oncology nurse should be aware that noninvasive interventions such as low light therapy show promise for reductions in certain symptoms at end of life, but more research is warranted for recommendation for wider populations/settings.
Peng, Y., Zhang, W., Zhou, X., Ji, Y., Kass, I.S., & Han, R. (2016). Lidocaine did not reduce neuropsychological-cognitive decline in patients 6 months after supratentorial tumor surgery: A randomized, controlled trial. Journal of Neurosurgical Anesthesiology, 28, 6–13.
To investigate the effect of intraoperative lidocaine infusion on postoperative cognitive function after craniotomy for supratentorial tumor resection
Patients in the experimental group received lidocaine (2%) as an IV bolus (1.5 mg/kg) after anesthesia induction followed by infusion at 2 mg/kg per hour throughout surgery (lidocaine group). Patients in the control group received normal saline at the same rate (normal saline group).
PHASE OF CARE: Active anti-tumor treatment
Double-blind randomized controlled trial of lidocaine versus placebo with repeated measures
There were no significant demographic or clinical differences between the lidocaine group and normal saline group at baseline. Postoperative neuropsychological-cognitive decline was defined as a decline greater than or equal to the preoperative standard deviation on two or more of the four tests (MMSE, IMCT, HRSD, and HAMA). Using this criteria, there were a greater proportion of patients with postoperative decline in the saline group as compared to the lidocaine group at 1 week after surgery (40% versus 16%, p < 0.05), but this was not statistically significant after correcting for multiple comparisons. There were no significant differences between the groups in the incidence of postoperative cognitive decline at 1 day, 1 month, 3 months, or 6 months. Additional analyses using less stringent criteria for cognitive decline on MMSE and IMCT alone also did not reveal any differences.
Intraoperative lidocaine had no effect on cognitive functioning after supratentorial tumor resection.
There is insufficient evidence to support the use of intraoperative lidocaine to reduce the incidence of cognitive decline after supratentorial tumor surgery.
Pimenta, F.C., Alves, M.F., Pimenta, M.B., Melo, S.A., de Almeida, A.A., Leite, J.R., . . . de Almeida, R.N. (2016). Anxiolytic effect of Citrus aurantium L. on patients with chronic myeloid leukemia. Phytotherapy Research, 30, 613–617.
To evaluate anxiety levels in patients with CML undergoing bone marrow biopsy who were exposed to the odor of C.aurantium essential oil versus those who were not
C. aurantium is an essential oil of the Citrus genus. In this study, participants were exposed to the essential oil odor via electronic diffuser. The study was divided into three groups. The first group received oral diazepam (10 mg), the second group was exposed to C. aurantium, and the third group was exposed to a placebo vaporized solution. In the second and third groups, exposure was 30 minutes long.
PHASE OF CARE: Multiple phases of care
Randomized controlled trial
State-Trait Anxiety Inventory (STAI) was used for subjective measurements. This is a self-reported anxiety scale. Physiological measurements including systolic and diastolic blood pressures, heart rate, and respiratory rate were also assessed.
The groups that received diazepam and exposure to C. aurantium both showed significant decrease in systolic blood pressure (p < 0.05). The group exposed to C. aurantium experienced significant decrease in heart rate (p < 0.001) as well as significant differences in anxiety levels as reported on the STAI-S before and after the treatment when analyzed by Wilcoxon test (p < 0.001).
Findings suggest that C. aurantium may potentiate anxiolytic effects in patients with CML undergoing bone marrow biopsy.
C. aurantium and other anxiolytic essential oils may be considered as nonpharmacologic tools for the reduction of anxiety in patients with cancer, although much more research is needed in more diverse patient populations.
Geerse, O.P., Hoekstra-Weebers, J., Stokroos, M.H., Burgerhof, J.G.M., Groen, H.J.M., Kerstjens, H.A.M., & Hiltermann, T.J.N. (2017). Structural distress screening and supportive care for patients with lung cancer on systemic therapy: A randomised controlled trial. European Journal of Cancer, 72, 37–45.
To examine effects of routine distress screening and referral on patient’s mood, satisfaction, and quality of life
Patients were randomized to receive the routine screening or usual care. Study assessment were done at outpatient visits weeks 1, 7, 13, and 25 after study entry. Usual care involved medical care and psychosocial care by the physician; psychosocial care was not integrated and referrals for psychosocial care were based on physician judgment. There was no structural distress screening. In the screening group, patients completed the Distress Thermometer and Problem List at each clinic visit. For scores of 4 or greater, patients were offered referral to an appropriate provider.
PHASE OF CARE: Active anti-tumor treatment
There were no differences between groups in study outcome results for quality of life, depression, or anxiety. There were no differences in hospitalizations or ED visits between groups.
Findings did not show that routine distress screening and provision of care based on screening had any effect.
This study did not show any significant differences in patient outcomes due to implementation of routine distress screening and associated supportive care referral.
Galliford, M., Robinson, S., Bridge, P., & Carmichael, M. (2017). Salute to the sun: A new dawn in yoga therapy for breast cancer. Journal of Medical Radiation Sciences, 64, 232–238.
STUDY PURPOSE: To synthesize published research to assess if yoga improves physical and psychosocial quality of life in patients receiving treatment for breast cancer.
TYPE OF STUDY: Systematic review
DATABASES USED: Scopus, Medline, PubMed, Science Direct, Cochrane, ProQuest
YEARS INCLUDED: (Overall for all databases) January 2009 to July 2014
INCLUSION CRITERIA: Articles with a yoga or mindfulness-based stress reduction (MBSR) intervention that reported outcomes related to physical or psychosocial quality of life in patients with breast cancer; studies with 15 or more participants were included.
EXCLUSION CRITERIA: Articles that were duplicate, inaccessible, or with irrelevant records.
TOTAL REFERENCES RETRIEVED: 395
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Blinded/duplicated two-stage screening approach to select appropriate articles; critical review and article scoring was independently done by two researchers
FINAL NUMBER STUDIES INCLUDED: 38
TOTAL PATIENTS INCLUDED IN REVIEW: Not reported
SAMPLE RANGE ACROSS STUDIES: RCTs: 18 to 410; NRTs: 15 to 286; otherwise not noted
KEY SAMPLE CHARACTERISTICS: RCTs: average age was 58.3 years; NRTs: average age was 50.3 years; all participants in all studies were women except for nine men included in one study; all studies look at patients with breast cancer though further details were not specified (exact phase/type of treatment, etc.)
PHASE OF CARE: Not specified or not applicable; details about each study’s participants not specified
As relevant to this PEP topic: 60% (3 of 5) studies that examined anxiety supported decreased general anxiety among patients who participated in yoga therapy. The other two large studies also showed less anxiety in this population, although it was divided into state and trait anxiety. A decrease in depression and depressive symptoms was reported in all of the studies reviewed that looked at psychosocial benefits related to yoga, which supports other meta-analyses stating that adding yoga therapy to traditional breast cancer treatment can decrease depression in these patients.
Evidence supports that yoga can have benefits on both physical and psychosocial quality of life in patients with breast cancer, including a decrease in both anxiety and depression. Additional research should aim to assess long-term effects of yoga in this population.
Yoga is an evidence-based intervention that may reduce anxiety and depression in patients with cancer. Recommending yoga to patients with breast cancer undergoing active treatment may be beneficial, particularly for those with high levels of anxiety and/or depression.
Danhauer, S.C., Addington, E.L., Sohl, S.J., Chaoul, A., & Cohen, L. (2017). Review of yoga therapy during cancer treatment. Supportive Care in Cancer, 25, 1357–1372.
STUDY PURPOSE: To review results of yoga trials conducted among patients during cancer treatment
TYPE OF STUDY: Systematic review
DATABASES USED: MEDLINE, CINAHL, and PsycINFO through October 2015
INCLUSION CRITERIA: Children or adults undergoing cancer treatment, intervention was yoga or a component of yoga, randomized or non-randomized study
EXCLUSION CRITERIA: Patients receiving only hormone therapy, interventions involving only meditation or yoga, delivered as part of an MBSR intervention
TOTAL REFERENCES RETRIEVED: Not reported
FINAL NUMBER OF STUDIES INCLUDED: 4 studies of children, 22 total studies–13 were RCTs
TOTAL PATIENTS INCLUDED IN REVIEW: 1,046
SAMPLE RANGE ACROSS STUDIES: 4 to 164
KEY SAMPLE CHARACTERISTICS: Varied tumor types–majority were done in women with breast cancer. Treatments include chemotherapy, radiation, surgery and combination of these
PHASE OF CARE: Active anti-tumor treatment
Doses of yoga ranged from 1 to 18 sessions and frequency ranged from every three weeks to three times per week. Some were delivered as group classes and two included caregivers. Some interventions included psychoeducation and supportive interventions. Some provided instructions and recommendations for practice at home. Attrition rates ranged from 8%-56%. Adherence to planned sessions ranged from 59%-88% and where measured, adherence to home practice ranged from 50%-80%. In non-random studies, improvements in anxiety, depression, mood, cognition, sleep, and fatigue were reported. Several RCTs reported improvement in distress, depression, anxiety, and multiple treatment-related side effects and symptoms.
Evidence suggests that yoga can be helpful to adults undergoing cancer treatment. There is insufficient evidence to draw any conclusions regarding benefit for children.
There is not a lot of strong evidence to show benefits of yoga for various symptoms for patients during cancer treatments due to individual study design limitations. Existing evidence suggests that yoga may be helpful for anxiety, depression, sleep, and cognitive impairment. Further well-designed research to explore these areas is needed. Yoga is a relatively low-risk intervention that may be helpful and could be suggested to patients who are interested and able to participate.