Music interventions


Music intervention includes music therapy and music medicine. 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 medicine is different, defined as listening to pre-recorded music offered by medical staff. It has been suggested that music interventions can promote wellbeing, stress management, pain alleviation, emotional expression, memory enhancement, improved communication and physical rehabilitation. 


Evidence from an overview of systematic reviews (SRs), including a Cochrane review, plus 12 other SRs not included in the overview or including outcomes not included in the overview, suggests that music intervention may be a helpful supportive care approach among various cancer populations. 

The results from the most recent and rigorous systematic reviews suggests the following outcomes. 

Paediatric oncology: Music interventions may reduce pain and anxiety and improve quality of life, but evidence for other outcomes in inconclusive (three SRs).

Mental health

  • Anxiety: there is some evidence that music intervention can improve anxiety (seven SRs). Effects appear similar for music therapy or music medicine, and for patient or researcher selected music.
  • Depression: some evidence suggests that music intervention can improve depression (seven SRs).
  • Distress: the evidence is conflicting; two SRs included found no significant effects of music, while another two concluded that music interventions may reduce distress.
  • Mood: inconclusive evidence as findings varied across studies (overview of SRs, n=2 SRs).

Pain: Music interventions appear to reduce pain in people with cancer compared to standard care based on evidence from nine SRs, including between three and 25 mixed-design studies.

Chemotherapy-induced nausea and vomiting: Music therapy may reduce CINV for patients with gastrointestinal cancer, but evidence in other cancers is limited and contradictory (two SRs, n=7, n=25 mixed-design).

Fatigue: Music interventions can reduce cancer-related fatigue based on one overview of five SRs, including between three and eight RCTs.

Quality of life: Music interventions may improve quality of life, but this may depend on duration and timing of intervention. These findings are based on seven SRs, including between two and ten RCTs on QoL.

Other physiological outcomes: both music interventions using patient- or researcher-selected music may have small effects on blood pressure, heart rate and respiratory rate (two SRs).

There is considerable variation between RCTs 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, although caution is advised for some patients.


Ava Lorenc, CAM Cancer Collaboration. Music interventions [online document], [April 4, 2024]

Document history

This summary was previously titled “Music Therapy”.
Updated by Ava Lorenc in December 2023 and June 2020; Joke Bradt in May 2017; Helen Cooke in December 2014. First published in January 2013, authored by Helen Cooke.
Next update due: December 2026

Description and definition

Music intervention includes music therapy and music medicine. Music therapy is an established healthcare profession that uses music to address physical, emotional, cognitive and social needs (AMTA 2023; Richardson 2008). 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 toward the client’s needs (Bradt 2021; Gold 2011).

This is differentiated from music medicine or music listening (listening to pre-recorded music offered by a healthcare professional) (Bradt 2021; Gold 2011; Yinger 2014). Without the presence of a therapist and a therapeutic relationship, music listening in itself is not music therapy (Gold 2011). It should be noted, however, that there is a lack of consistency in the use of this terminology generally, and in the studies reviewed for this summary (Pearson 2018).  The term “music interventions” is used to encompass both music therapy and music medicine.

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 music (Richardson 2008; Bradt 2021). 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.  Music therapy in cancer can include replaying music from the patient’s life, exploring ‘new’ music, music relaxation and music-based gift or legacy creation (O'Callaghan and Magill 2016). 

Background and prevalence

The use of music to improve health dates back to ancient times (Richardson 2008). 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. 

The exact prevalence of the use of music interventions for people with cancer is unknown. It is thought that music interventions are a desired service for cancer patients during hospitalisation.  Music listening interventions are recommended in guidelines from the Society for Integrative Oncology and the American Society of Clinical Oncology (Kiernan 2023).

Alleged indications

In cancer care, music interventions are generally used for symptom management (Bradt 2021). It has been suggested that music interventions in cancer care can promote wellbeing, stress management, pain alleviation, emotional expression, improved communication, spiritual and emotional support, physical well-being, offer distraction during procedures, improve coping skills and a sense of control (O'Callaghan and Magill 2016; Richardson 2008; Bradt 2021).

In addition to symptom management, music therapists utilize various individualized interventions with cancer patients and their families to address prevailing biopsychosocial and spiritual needs (Magill 2009; McClean 2011). In paediatric/adolescent cancer populations, music therapy is thought to particularly benefit psychological well-being and social relationships (Rodríguez-Rodríguez 2022).

Application and providers

Music therapists often function as a member of an interdisciplinary team in clinical settings but also offer services through private practice. (WFMT 2023) 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 number of sessions and frequency greatly varied. The number of sessions ranged from 1 to 48 (e.g. multiple music listening sessions per day for length of hospital stay). Most sessions lasted 30 to 45 minutes.

At this time, the impact of frequency, duration, music choice, listening features remains unclear, and there is little information on cost-benefit analysis (Chow 2023; Kiernan 2023). It is recommended that patients be encouraged to select their own preferred music (Bradt 2021). Recipients of music therapy do not need any prior musical knowledge or experience. 

With music therapy being recommended in guidelines it is now being implemented into cancer services, although this has been slower than expected, perhaps due to lack of information on the factors listed above (Kiernan 2023).

Mechanisms of action

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 activity (Gillen 2008; Nilsson 2009; Nakayama 2009), with greater effects on patients with higher sympathetic tone activity (Chen 2020). It may reduce pain via modulating leptin expression (Lv 2022). There is some very preliminary evidence that music can induce changes in gene expression in gastric cancer cells (Ramirez-Rivera 2019) and that it may improve the efficacy of conventional medication (Semyachkina 2022).

In addition, research indicates that music offers an escape from stress and worries related to the cancer diagnosis, treatment, and prognosis (Bradt 2015; O'Callaghan and Magill 2016). Music also activates the rewards and motivation circuitry in the brain resulting in the release of dopamine which regulates perception of pleasure and mood (Salimpoor 2011).

Music making provides opportunities for emotional expressivity which has consistently been linked to mood enhancement (Livesey 2012; Zakowski 2001). 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 reflections. Importantly, music provides patients with an aesthetic experience that can offer comfort and peace during times of distress (Bradt 2015). 

Research suggests that music therapy may be more effective than music medicine with medical populations for a wide variety of outcomes. It has been suggested that the difference might relate to how music therapists individualise their intervention to meet patients’ specific needs (Bradt 2021).

Legal issues 

The World Federation of Music Therapy acts as the international umbrella organization for the profession of music therapy (WFMT 2023). Regulation of music therapists varies greatly across Europe; an overview of the regulation and recognition status per country is available on the website of the European Music Therapy Confederation website.

There are many training programs around the world that offer music therapy training at the undergraduate, graduate and doctoral level (WFMT 2023).  Professional music therapy courses are at postgraduate level in most of Europe. All professionally trained music therapists commit themselves to an ethical code as well as fulfilling certain quality criteria.

In the US, the Certification Board for Music Therapists grants music therapists a national board certification after successfully passing a board certification exam (AMTA 2023).

Supportive care

There is a large body of evidence for music interventions in supportive cancer care. This summary is therefore based the findings from systematic reviews (SRs). Details of the identified evidence are as follows.

Included in this summary and described in table 1:

  • One overview of SRs including 13 SRs reviews containing 119 individual studies, published in 2023 and covering music-based interventions in all cancer types, although only for pain, fatigue and distress (Trigueros-Murillo 2023). This includes one Cochrane review updated in 2021 (Bradt 2021).
  • Twelve additional SRs which either were not included in this overview or included outcomes not included in the above overview. 

Excluded from this summary but summarized in table 2, see also References-excluded: 

  • Ten randomized controlled trials (RCTs) not included in the overview or any of the 12 systematic reviews. The outcomes included mental health (n=7), pain (n=5), CINV (n=1); paediatric outcomes (n=1); and fatigue (n=1). 
  • Eight additional RCTs in populations undergoing very specific procedures with very limited generalisability: two for cervical brachytherapy, one for laparascopic hysterectomy, one for robotic prostatectomy, one for infusion, two catheter placement, and one platinum-based chemotherapy.

Considerable variation in the conduct of music interventions should be noted, including the duration and number of sessions. Some interventions were classified as music therapy simply involved participants listening to pre-recorded music with no additional therapeutic process or involvement of a music therapist.  

Description of studies

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.  Many studies also had small sample sizes. As a result, the evidence of these trials is typically assessed as ‘low’ and the results need to be interpreted with caution.

Paediatric oncology 

Three SRs were conducted on music therapy in paediatric oncology in the same year (da Silva Santa 2021; Facchini 2021; González 2021). González (2021) was very limited in its reporting and data synthesis, so has not been reported here. Altogether they included 26 studies, with only minimal overlap as only four studies were included in all three SRs. The 2021 Cochrane review also included paediatric studies (Bradt 2021). 

Da Silva Santa 2021 conducted a meta-analysis and was higher quality than Facchini 2021. Da Silva Santa 2021 found benefits for music interventions including those combined with other interventions for pain, anxiety and quality of life compared to control. The Cochrane review found that music interventions may significantly reduce anxiety in paediatric oncology (SMD=-0.94) compared to usual care but no support for distress compared to placebo (SMD=-0.07; Bradt 2021).  Facchini 2021 found music therapy reduced distress and increased wellbeing, but no meta-analysis was possible due to heterogeneity, with inconclusive results for pain and other biological parameters. This review included young people up to age 24.

Mental health


Although the overview of systematic reviews claimed evidence was inconclusive for anxiety (Trigueros-Murillo 2023), four out of the six SRs they reviewed found significant differences (Bradt 2021; Bro 2018; Nguyen 2022; Wang 2018) and only two did not (Nightingale 2013; Yang 2021); one of these was on a specific type of music, five elements music therapy (Yang 2021). 

Additional SRs suggest music interventions significantly reduces anxiety compared to usual care for cancer patients (SMD = -1.51, Li 2020; SMD = –0.54, Zang 2022; MD=-7.40 for self-rated and MD-12.40 for state anxiety in breast cancer, Wang 2018). The review by Huang 2023 found that three out of four studies measuring anxiety found improvements, but this review is limited by its poor methodological quality and lack of meta-analysis.

In line with the results reported by Trigueros-Murillo 2023, the 2021 Cochrane review found that music therapy resulted in similar anxiety outcomes to music medicine, and, for music listening, patient-preferred had similar effects to researcher-selected (Bradt 2021).


Although the overview of systematic reviews concluded that results were inconclusive for depression (Trigueros-Murillo 2023), five out of seven SRs reviewed showed significant effects (Bradt 2021; Tao 2016; Tsai 2014; Wang 2018; Yang 2021) and only two did not (Bro 2018; Nguyen 2022). Additional SRs suggest music interventions significantly reduce depression compared to usual care (SMD =-1.12, Li 2020).

In line with the results reported by Trigueros-Murillo 2023, the 2021 Cochrane review found that music therapy resulted in similar depression outcomes to music medicine, and, for music listening, patient-preferred had similar effects to researcher-selected (Bradt 2021).


The overview of systematic reviews (Trigueros-Murillo 2023) found no evidence of a significant effect of music interventions on distress, with non-significant results* in two SRs (Bradt 2021; Bro 2018). Another systematic review concluded that combining music-based interventions and standard care seems to be more effective than standard care to reduce cancer-related distress (Sheikh-Wu 2021).

A further SR examined the effects of music therapist interventions on psychosocial outcomes from 30 studies, 21 of which were meta-analysed (Kohler 2020). The authors only searched three databases and did not report participant numbers. They found small but significant effects of music therapy from a therapist on physical symptom distress (p=0.017).

*Please note the original paper by Trigueros-Murillo 2023 erroneously reported significant results but this has been pointed out to the authors for correction.  


The overview of systematic reviews (Trigueros-Murillo 2023) concluded that results were inconclusive for mood based on two SRs, one with significant results (Bro 2018), one without (Bradt 2021).

A systematic review of survivors of all types of cancer found statistically significant overall treatment effect on psychological outcomes (psychological distress symptoms, positive psychology, and quality of life), with a large effect size for all outcomes, and improved positive psychology (benefit-finding and resilience) (Sheikh-Wu 2021). This review included 29 studies (total n=3162) and was well conducted and reported.  They also found that the effectiveness was impacted by interventions’ cultural sensitivity, use of headphones, passivity, frequency and duration and type of music.


The overview of systematic reviews (n=6 SRs on pain) concluded that combining music-based interventions and standard care seems to be more effective than standard care alone to reduce cancer-related pain. All 6 SRs reported improvements compared to various controls such as standard care, wait-list, bed rest, or wearing headphones with no music (Trigueros-Murillo 2023). The overview was well-conducted with quality appraisal of the included reviews.

Three additional SRs evaluated pain. The first included any cancer type and explored the effect of music therapy compared to usual care only, including 25 RCTs with a total of 1875 participants (Rennie 2022). They found that 92% of RCTs reported reduced pain.

The second review was in colorectal cancer and identified ten RCTs (n of participants not reported), seven of which studied pain, four of which reported significant improvements (Huang 2023).  However, neither review included meta-analysis and offered no explanation why not, only searched three databases and the search terms do not appear comprehensive. 

Finally, a 2020 review and meta-analysis of the effects of music therapy on quality of life, anxiety, depression and pain of people with cancer, including studies in English or Chinese, identified 19 RCTs, nine thereof from China, with a total of 1548 participants, (Li 2020). This SR only included studies with a usual care control group. There was evidence of moderate to large effects on pain compared to standard care for music therapy (standardized mean difference, SMD =-0.73).

Outcomes from Bradt 2021 (included in Trigueros-Murillo’s overview) found that patient-preferred music led to a larger pooled effect on pain than researcher-selected. The review by Rennie (2022).

Chemotherapy-induced nausea and vomiting

A systematic review (n=7 RCTs) of patients with gastrointestinal cancer found that music therapy could reduce chemotherapy-related nausea, vomiting and incidence of grade I and above nausea and vomiting compared to standard care (Zhong 2023), although the majority of RCTs had a high risk of bias. The review was well-conducted with a meta-analysis. However, another SR (n=1 RCT) found no significant effects of music intervention for nausea applied during active cancer treatment (Bro 2018).


The overview of systematic reviews concluded that combining music-based interventions and standard care seems to be more effective than standard care to reduce cancer-related fatigue (Trigueros-Murillo 2023). T

he review by Rennie (2022) found that 22 RCTs (92% of RCTs) found improvements in fatigue but this review is limited by its poor methodological quality and lack of meta-analysis.

The 2021 Cochrane review found that music therapy affected fatigue but music medicine did not (Bradt 2021).

Quality of life/wellbeing/functioning 

The overview of systematic reviews found mixed results for quality of life, with two out of three SRs showing significant improvements (Trigueros-Murillo 2023).  Three additional reviews found evidence for significant effects of music therapy on quality of life.  Compared to usual care small/moderate effects were found (SMD=0.54, Li 2020; p=0.023, Kohler 2020), although subgroup analysis suggests this may be only for interventions of between 1 and 2 months, and for all controls a statistically significant effect on quality of life (Sheikh-Wu 2021).

The review by Rennie found that 22 RCTs (92% of RCTs) found improvements in quality of life but this review is limited by its poor methodological quality and lack of meta-analysis. (Rennie 2022)

The 2021 Cochrane review results suggest that music therapy, but not music medicine interventions, had a moderate effect on quality of life (SMD = 0.88) (Bradt 2021).  

Bradt (2021) found no evidence of an effect of music on physical status (SMD = 0.78).

Other physiological outcomes

The 2021 Cochrane review (Bradt 2021) and another SR (Wang 2018) examined other physiological effects of music intervention in cancer. Wang et al (2018) examined the effect of music intervention (mostly receptive music listening on headphones, with music chosen by researcher and patient) for physical and mental status of patients with breast cancer compared to usual care, including 30 RCTs (total n=2559), 24 of which were Chinese.  They found substantial heterogeneity and were unable to assess publication bias.

Both SRs found that music interventions may have a small effect on systolic blood pressure (MD= −4.18mmHg, Bradt 2021; SMD –0.63 breast cancer,  Wang 2018), diastolic blood pressure (MD= −2.34mmHg, Bradt 2021; SMD =–0.64 breast cancer,  Wang 2018),  and heart rate (MD= -3.4 mmHg, Bradt 2016; SMD =–0.454 breast cancer, Wang 2018), and one found effects on respiratory rate (MD=−0.71, Bradt 2021). Bradt additionally found no difference between patients- or researcher-selected music for heart rate, systolic or diastolic blood pressure (Bradt 2021). The review by Rennie (2022) found that 22 RTCs (92% of RTCs) found improvements in heart rate but this review is limited by its poor methodological quality and lack of meta-analysis.


Adverse events

Trigueros-Murillo conclude that music therapy is safe in cancer populations due to absence of adverse events, although only four systematic reviews evaluated adverse event data (Trigueros Murillo 2023). Two RCTs found no worsening of emotional or physical symptoms (Hohneck 2023) or adverse effects (Henneghan 2021).

Kiernan 2018 suggest practitioners ensure patient’s music listening does not exceed the recommended daily dose for noise.


O'Callaghan and Magill (2016) advise that as music therapy provokes emotions, music therapy may not be indicated for acutely distressed and/or emotionally fragile patients, particularly in patients with serious and life-threatening cancers. Music may be inappropriate during times of crisis or acute emotional/painful episodes, due to sensory overload (O'Callaghan and Magill 2016), and there may be specific limitations and difficulties in palliative care, including reminding patients of their altered state, and physical exhaustion (Pommeret 2019).


No interactions are on record (Ernst 2006).


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 patients (Bradt 2021).

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