- Music therapy is a therapeutic intervention involving the use of music to address physical, emotional, cognitive and social needs.
- Evidence exists for improvements in cancer-related anxiety, depression, pain, fatigue.
- Some evidence exists for improvements in quality of life.
- Most trials were at high risk of bias, so these results need to be interpreted with caution.
- No safety issues are on record.
Music therapy is an established healthcare profession that uses music to address physical, emotional, cognitive and social needs. The interventions used include playing instruments, vocal and instrumental improvisation, singing, composing/song writing, music-guided imagery and music listening. Music therapy is different from music medicine, which is defined as listening to pre-recorded music, offered by medical staff.
It has been suggested that music therapy can promote well-being, stress management, pain alleviation, emotional expression, memory enhancement, improved communication and physical rehabilitation.
Evidence suggests that music therapy may be a helpful supportive care intervention among various cancer populations. Results from the most recent and rigorous systematic review suggested that music interventions may have moderate to strong treatment effects on anxiety, depression, fatigue, pain, and quality of life in people with cancer. Music interventions lead to small improvements in physiological responses such as heart rate, blood pressure and respiratory rate. There is considerable variation between trials with regards to type of music intervention and dosage used and it is therefore not possible to generalise the result.
No safety issues are on record.
Fully updated and revised by Joke Bradt in May 2017.
Fully updated and revised by Helen Cooke in December 2014.
Summary first published in January 2013, authored by Helen Cooke.
Joke Bradt,Helen Cooke, CAM-Cancer Consortium. Music therapy [online document]. May 20, 2017.
Music therapy is an established healthcare profession that uses music to address physical, emotional, cognitive and social needs1,2. Music therapy is delivered by a trained music therapist and is characterized by the presence of a therapeutic relationship and the use of music interventions specifically tailored towards the client’s needs3,4. This is differentiated from music medicine, which has been defined as listening to pre-recorded music offered by a healthcare professional3,4,5. Without the presence of a therapist and a therapeutic relationship, music listening in itself is not music therapy4. It should be noted, however, that there is a lack of consistency in the use of this terminology in the trials reviewed for this summary.
In cancer care, music medicine is generally used for symptom management3. In addition to symptom management, music therapists utilize various individualized interventions with cancer patients and their families to address prevailing biopsychosocial and spiritual needs7,8.
Music therapists use a variety of music interventions including playing instruments, singing, instrumental and vocal improvisations, song writing, composing, music-guided imagery and listening to live, improvised or recorded music2,3. Music therapy sessions are designed according to the needs of the individual or group and involve a systematic process which includes assessment, treatment and evaluation.
In the music medicine trials included in this summary, the pre-recorded music was often selected by the healthcare professionals. However, it has been recommended that patients be encouraged to select their own preferred music3.
Application and dosage
In cancer care, music therapy is often offered as individual sessions with the patient and may include family members. Music therapy is also offered in group sessions to facilitate social support among patients. In the trials included in this summary, the dosage and frequency greatly varied. The number of sessions ranged from 1 to 40 (e.g. multiple music listening sessions per day for length of hospital stay). Most sessions lasted 30 to 45 minutes. At this time, the relationship between the frequency and duration of treatment and treatment effect remains unclear.
Recipients of music therapy do not need any prior musical knowledge or experience.
The use of music to improve health dates back to ancient times2. Although music therapy is a relatively young health profession, it is well established in both academic and clinical contexts. The first official training program started in Austria in 1959, the UK in 1968 and Norway in 1978. Music therapists often function as a member of an interdisciplinary team in clinical settings but also offer services through private practice. There are many training programs around the world that offer music therapy training at the undergraduate, graduate and doctoral level9.
Claims of efficacy/alleged indication(s)/mechanism of action
It has been suggested that music therapy in cancer care can promote wellbeing, stress management, pain alleviation, emotional expression, improved communication, spiritual support, physical well-being and a sense of control2,3. Research suggests that music therapy interventions may be more effective than music medicine interventions with medical populations for a wide variety of outcomes3. It has been suggested that the difference might relate to how music therapists individualise their intervention to meet patients’ specific needs3.
Possible mechanisms of actions are framed within a biopsychosocial perspective. Listening to music may reduce anxiety through suppressive action on the sympathetic nervous system, leading to decreased adrenergic activity10,11,12. In addition, research indicates that music offers an escape from stress and worries related to the cancer diagnosis, treatment, and prognosis6. Music also activates the rewards and motivation circuitry in the brain resulting in the release of dopamine which regulates perception of pleasure and mood13. Music making provides opportunities for emotional expressivity which has consistently been linked to mood enhancement14,15. Music experiences offer opportunities to explore and process emotions in a creative process unique from other therapeutic disciplines and facilitate meaning making through music-evoked reflections6.
Importantly, music provides patients with an aesthetic experience that can offer comfort and peace during times of distress6.
Prevalence of use
The exact prevalence of the use of music therapy for people with cancer is unknown.
The World Federation of Music Therapy acts as the international umbrella organization for the profession of music therapy9. In the US, the Certification Board for Music Therapists grants music therapists a national board certification after successfully passing a board certification exam. Music therapists are required to recertify every 5 years. Professional music therapy courses are at postgraduate level in the UK and most of Europe. ‘Music Therapist’ is a protected title in the UK and all practicing therapists must be registered with the Health and Care Professions Council17. All professionally trained music therapists commit themselves to an ethical code as a quality criteria.
Cost(s) and expenditures
Costs vary depending on the context in which the therapy is given. Some health institutions do not charge for music therapy group sessions.
Four systematic reviews (including one Cochrane review) and six additional randomised controlled trials (RCTs) were reviewed for this summary. The reviews are described in table 1 and the RCTs in table 2. The results of these reviews and trials suggest that music interventions may be beneficial for cancer-related anxiety, depression, pain, fatigue and quality of life. It should, however, be noted that there is considerable variation in the manner in which the music interventions were conducted including the duration and number of sessions. Some of the interventions which were classified as music therapy simply involved participants listening to pre-recorded music without any additional therapeutic process or involvement of a music therapist. A major issue with music intervention trials is that, in most cases, participants cannot be blinded to the intervention. This introduces a potential for biased reporting of treatment benefits by the study participants. As a result, the evidence of these trials is typically assessed as ‘low’ and the results need to be interpreted with caution.
The most recent systematic review, a 2016 Cochrane review examining the effects of music therapy or music medicine interventions on psychological and physical outcomes in patients with cancer included 23 music therapy and 29 music medicine trials (n=52, total 3731 participants)3. The review also compared the effects of music therapy versus music medicine interventions. Results suggest that music interventions may have a moderate to large effect on anxiety (standardized mean difference, SMD = - 0.71), moderate effect on depression (SMD = - 0.40), large effect on pain (SMD = - 0.91), and small to moderate effect on fatigue (SMD = - 0.38). Music interventions lead to small improvements in physiological responses such as heart rate, blood pressure and respiratory rate. A comparison between music therapy and music medicine interventions was possible for a select number of outcomes. The results suggest that music therapy but not music medicine interventions demonstrated a moderate effect on quality of life (SMD = 0.42). No difference was found between the two types if interventions for anxiety, depression and mood.
A 2013 systematic review included 13 RCTs of music interventions to reduce anxiety for adult cancer patients undergoing medical treatment20. Only 4 RCTs could be included in the meta-analysis with a total of 185 participants. Although the meta-analytic results failed to demonstrate a positive effect on anxiety, the review suggests that music interventions may still offer a degree of clinical utility to mitigate anxiety in adult cancer patients.
A 2012 systematic review and meta-analysis examined the effect of music interventions on psychological and physical outcomes in adult and paediatric cancer patients21. The review included 32 RCTs with a total of 3181 participants and included studies from both English and Chinese databases. Results suggested that music interventions are accepted by patients and associated with improvements in anxiety, depression, pain and quality of life. The effects of music on vital signs such as blood pressure are small.
An additional six RCTs not included in the above reviews have been published22-27. They are also described in Table 2.
Three trials used music medicine interventions22,23,24 and three music therapy interventions26,27,28. Five RCTs compared the effects of music interventions with standard care and one paediatric trial27 used an audio storybook attention control.
Two of the music medicine trials22,24 did not find statistically significant differences between the music listening and the standard care condition for cancer-related symptoms such as pain and anxiety whereas one trial23 reported greater pain reduction in the music listening condition. Reasons for lack of between group differences may be small sample size resulting in insufficient statistical power and unfamiliarity of patients with music delivery technology (e.g. tablet and Spotify), which may possibly increase anxiety or even lead to reduced use.
The music therapy RCTs included different cancer populations. One trial included female cancer patients undergoing breast surgery25, one focused on adult cancer patients during high dose chemotherapy27, and one included paediatric cancer patients26. Greater anxiety reductions were reported by the surgical breast cancer patients in the music treatment condition compared to standard care25 whereas chemotherapy patients reported treatment benefits of music therapy for pain but not for anxiety, quality of life, depression or physical functioning27. Unfortunately, the latter study was underpowered. The paediatric trial was a pilot study in preparation of a larger clinical trial26. In this study, parents were trained by a music therapist to engage their child in music activities. Preliminary findings suggest treatment benefits for emotional distress but not child engagement.
No adverse events are on record4.
No contraindications are on record4.
No interactions are on record4.
It is important to consider the potential negative impact of the use of headphones during procedures because of hampered communication between the patient and medical personnel. This may increase anxiety in patients3.
- American Music Therapy Association website. Last accessed 18th May 2017.
- Richardson MM, Babiak-Vazquez AE, Frenkel MA. Music therapy in a comprehensive cancer center. J Soc Integr Oncol 2008; 6: 76-81.
- Bradt J, Dileo C, Magill L, Teague A. Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database Syst Rev2016; 8: CD006911.
- Gold C, Erkkila J, Bonde LO, Trondalen G, Maratos A, Crawford MJ. Music therapy or music medicine? [Letter to the Editor]. Psychother Psychosom 2011; 80: 304.
- Yinger OS, Gooding L. Music therapy and music medicine for children and adolescents. Child Adolesc Psychiatr Clin N Am 2014; 23: 535-53.
- Bradt J,Potvin N, Kesslick A, Shim M, Radl D, Schriver E, Gracely E, Komarnicky-Kocher LT.The impact of music therapy versus music medicine on psychological outcomes and pain in cancer patients: A mixed methods study. Support Care Cancer 2015, 23: 1261-71.
- Magill L. Meaning of the music: The role of music in palliative care music therapy as perceived by bereaved caregivers of advanced cancer patients. Am J Hosp Palliat Care 2009; 26: 33-9.
- McClean S, Bunt L, Daykin N. The healing and spiritual properties of music therapy at a cancer care centre. J Alternat Complement Med 2011; 18: 402-7.
- World Federation of Music Therapy website. Last accessed 18th May 2017.
- Gillen E, Biley F, Allen D. Effects of music listening on adult patients’ pre-procedural state anxiety in hospital. Int J Evid Based Healthc2008; 6: 24-49.
- Nilsson U. Soothing music can increase oxytocin levels during bed rest after open-heart surgery: A randomised control trial. J Clin Nurs2009; 18: 2153-61.
- Nakayama H, Kikuta F, Takeda H. A pilot study on effectiveness of music therapy in hospice in Japan. J Music Ther2009; 46: 160-72.
- Salimpoor VN, Benovoy M, Larcher K, Dagher A, Zatorre RJ. Anatomically distinct dopamine release during anticipation and experience of peak emotion to music. Nat Neurosci 2011; 14: 257-62.
- Livesey L, Morrison I, Clift S, Camic P. Benefits of choral singing for social and mental well-being: Qualitative findings from a cross-national survey of choir members. J Public Mental Health 2012; 11: 10-26.
- Zakowski S, Valdimarsdottir H, Bobvjerg D. Emotional expressivity and intrusive cognitions in women with family histories of breast cancer: Application of a cognitive processing model. Br J Health Psychol2001; 6: 151-65.
- Ernst E, Pittler MH, Wider B and Boddy K. Oxford Handbook of Complementary Medicine. Oxford: Oxford University Press, 2008.
- European Music Therapy Confederation website. Last accessed 18rd May 2017.
- Wigram T, Pedersen IN, Bonde LO. A Comprehensive Guide to Music Therapy. Theory, Clinical Practice, Research and Training. London: Jessica Kingsley, 2002.
- Archie P, Bruera E, Cohen L. Music-based interventions in palliative cancer care: a review of quantitative studies and neurobiological literature. Support Care Cancer 2013; 21: 2609-24.
- Nightingale CL, Rodriguez C, Carnaby G. The impact of music interventions on anxiety for adult cancer patients: a meta-analysis and systematic review. Integr Cancer Ther 2013; 12: 393-403.
- Zhang JM, Wang P, Yao JX, Zhao MP et al. Music interventions for psychological and physical outcomes in cancer: a systematic review and meta-analysis. Support Care Cancer 2012; 20: 3043-53.
- Alam M, Roongpisuthipong W, Kim NA, Goyal A, Swary JH, Brindise RT, et al. Utility of recorded guided imagery and relaxing music in reducing patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures: A single-blinded randomized controlled trial. J Am Acad Dermatol 2016; 753: 585-9.
- Arruda M, Garcia M, Garcia J. Evaluation of the effects of music and poetry in oncologic pain relief: a randomized clinical trial. J Palliat Med 2016; 19: 943-8.
- Mische LL, Glennon C, Fiscus V, Harrell V, Krause K, Moore A, et al. Effects of making art and listening to music on symptoms related to blood and marrow transplantation. Oncol Nurs Forum 2017; 43: E56-63.
- Palmer JB, Lane D, Mayo D, Schluchter M, Leeming R. Effects of music therapy on anesthesia requirements and anxiety in women undergoing ambulatory breast surgery for cancer diagnosis and treatment: A randomized controlled trial. J Clin Oncol 2015; 33: 3162-8.
- Robb SL, Haase JE, Perkins SM, Haut PR, Henley AK, Knafl KA, et al. Pilot randomized trial of active music engagement intervention parent delivery for young children with cancer. J Ped Psychol 2017; 42: 208–19.
- Tuinmann G, Preissler P, Bohmer H, Suling A, Bokemeyer C. The effects of music therapy in patients with high-dose chemotherapy and stem cell support: a randomized pilot study. Psycho-Oncol 2016; 26: 377–84.