Written by Helen Cooke and the CAM-Cancer Consortium.
Updated December 9, 2014

Music therapy

Abstract and key points

  • Music therapy is a therapeutic intervention involving the use of music to address physical, emotional, cognitive and social needs.
  • Some evidence exists for improvements in cancer-related anxiety, mood, depression, pain and quality of life
  • Based on the considerable variation between trials, it is however not possible to generalise the results or to draw clear conclusions about the effectiveness of music therapy for people with cancer
  • 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 techniques used include playing instruments, rhythmic based activities, improvising, singing, composing/song writing, imagery and music listening.

It has been suggested that music therapy can promote wellbeing, stress management, pain alleviation, emotional expression, memory enhancement, improved communication and physical rehabilitation.

Although some evidence suggests that music therapy may be a helpful supportive care intervention among various cancer populations, to date there is no strong evidence about its specific effect in patients. There is considerable variation between trials with regards to the manner in which music therapy was carried out and it is therefore not possible to generalise the result.

No safety issues are on record.

What is it?

Description

Music therapy is an established healthcare profession that uses music to address physical, emotional, cognitive and social needs1,16. In cancer care, music therapy is generally used as a supportive therapy to help improve quality of life.

It should be noted that although a distinction is made in some of the literature2 between music interventions administered by a medical or health care professional (music medicine) and those implemented by a trained music therapist (music therapy), there is a lack of consistency in these definitions in the trials reviewed for this summary. The methodological variety of the music interventions applied depends on the different cultural contexts in which the studies were conducted. For example, listening to pre-recorded or live music is one of the main methods utilised by music therapists, particularly in the USA. Research has shown that music therapy interventions are significantly more effective than music medicine interventions with medical populations for a wide variety of outcomes2. It has been suggested the difference might relate to how music therapists individualise their intervention to meet patients’ specific needs2.

Components

Music therapists use a variety of different intervention techniques according to the needs and preference of the group or individual and the circumstance in which it is being administered. The techniques include playing instruments, rhythmic based activities, improvising, singing, composing/song writing, imagery and music listening.

Application and dosage

Music therapists work in a variety of different health settings including psychiatric hospitals and community mental health institutions, rehabilitation centres, hospices, nursing homes and private practice. Music therapy often takes place in a group setting, but can also be conducted on an individual basis. Music therapy sessions administered by a music therapist are generally designed according to the needs of the individual or group and involve a systematic therapeutic process which includes assessment, treatment and evaluation.

Recipients of music therapy do not need any prior musical knowledge or experience. Music therapy can be given as a single session, but is more typically carried out over a series of sessions.

History/provider(s)

The use of music to improve health dates back to ancient times1.Although music therapy as a health profession is a relatively recent initiative, it is now 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 consider music therapy to be a health profession in its own right, but often see their contribution, especially in clinical contexts, as a complementary therapy. Several institutions around the world offer music therapy qualifications, often at post-graduate level3. Music therapists who work with cancer patients are specially trained to carefully select music interventions with the aim of offering emotional and spiritual support, assisting communication, enhancing a sense of control, and improving physical well-being2.

Claims of efficacy/alleged indication(s)/mechanism of action

It has been suggested that music therapy can promote wellbeing, stress management, pain alleviation, emotional expression, memory enhancement, improved communication and physical rehabilitation1. It has been proposed that music therapy offers a creative, non-verbal means of expressing thoughts and feelings and that rhythmic based activities can not only aid relaxation, but also ‘prime’ motor areas of the brain3.

Possible mechanisms of action include activation of the limbic or other areas of the brain related to the reward and motivation circuitry (limbic-cortical circuits) which may initiate secondary physiological changes and bodily reactions including regulation of autonomic processes (such as breathing and heart rate). The analgesic and relaxation responses are considered to be associated with the lowering of stress levels and stress hormone production similar to the relaxation response4. Other researchers have suggested that music therapy can alleviate pain via the gate control theory and that it may act as a mental distraction5

It has been proposed that advances in neuroscience and functional neuro-imaging studies are providing new insights into the mechanism of action of music therapy on the brain:.music has been suggested to affect specific neural pathways implicated in the pathophysiology of pain, anxiety and depression11.

Prevalence of use

The exact prevalence of the use of music therapy for people with cancer is unknown.

Legal issues

The World Federation of Music Therapy3 acts as the international umbrella organization for the profession of music therapy. In the US, the Certification Board for Music Therapists has introduced a national standard certificate programme. 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 Council6. 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.

Does it work?

Four systematic reviews (including one Cochrane review) and eight additional randomised clinical trials were reviewed for this summary. The reviews are described in table 1 and the trials in table 2. The results of these reviews and trials offer some evidence of effectiveness of music interventions for cancer-related anxiety, mood, depression, pain 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. Only a relatively small number of trials included actual music therapy.  The methodological rigour of the trials included in the reviews varied considerably. It is therefore not possible to draw clear conclusions or generalise the results from these reviews or trials about the effectiveness of music therapy.

Systematic reviews

A 2013 systematic review included 13 randomised controlled trials (participants n=709) of music interventions to reduce anxiety for adult cancer patients undergoing medical treatment.12 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. The failure to demonstrate the positive effect in the meta-analysis may have been in part due to small sample size.

A 2012 systematic review and meta-analysis examined the effect of music interventions on psychological and physical outcome measures in cancer patients. With 32 RCTs including 3181 participants it is much larger than the other reviews. Reason for the difference in included studies is that both English and Chinese databases were searched and 22 out of the 32 trials included were Chinese articles. In addition, paediatric studies were reviewed alongside adult studies.13 Results suggested that music interventions are accepted by patients and associated with improved psychological outcomes (anxiety and depression), but the effects of music on vital signs such as blood pressure are small.

A 2011 Cochrane Review examining the effects of music therapy or music medicine interventions on psychological and physical outcomes in patients with cancer included 30 trials (total 1891 participants).2 The review also compared the effects of music therapy versus music medicine interventions. Results suggested that music interventions may have a beneficial effect on anxiety, mood, quality of life and a moderate pain-reducing effect in people with cancer. The authors concluded that the quality of the evidence was low. Due to the small number of studies per outcome it was not possible to compare the effectiveness of music therapy versus music medicine interventions.

A 2014 systematic review and meta-analysis examining arts therapies (art, music and dance) on anxiety, depression and quality of life in breast cancer patients included 13 clinical controlled trials (n=606).14 Results of all 13 studies suggest that arts therapies seem to positively affect patients’ anxiety (p<0.01), but not depression or quality of life. This review combined the results of a variety of different arts therapies and out of the 13 trials, only 6 of these were music therapy trials.

Clinical trials

An additional eight randomised clinical trials (RCTs) not included in the above reviews have been published.5,7,8,9,15,16,17,18 They are also described in Table 1.

Four of the RCTs7,8,15,16 comparing the effects of music interventions with standard care or rest16 on anxiety and depression reported improvements in both anxiety and depression, although some of the trials have methodological limitations. One of the trials reported a decrease in anxiety in both the music and the control group with no significant between-group difference.16 Again, there is considerable variation in the manner in which the music interventions were conducted. Only one trial involved a music therapist (in the creation of the music library).7 Several of the trials used self-report measures only which may have influenced the results and so limits the methodological quality of the trials.

Three of the RCTs comparing the effects of music interventions with standard care on pain reported significant improvements.5,8,18 Although these were relatively large studies (n=120, n=100, n=200), self-report data may have influenced the results. It should be noted that two of these trials5,8 did not appear to involve a music therapist (apart from in the creation of the music library in one of the trials5).

One of the RCTs assessing the benefits of music CD creation (a prominent music therapy approach in Australia and USA) in children attending an initial radiotherapy appointment reported that the intervention group experienced a variety of intrapersonal and interpersonal benefits and employed less social withdrawing coping than the control group who received standard care.9 It should be noted that the small numbers (n=11) of children who participated in the trial may not have had the power to capture between group differences.

Another one of the RCTs investigated resilience outcomes in adolescents/young adults undergoing stem cell transplant reported that the music video intervention group (carried out by a certified music therapist) experienced significantly better courageous coping and social integration than listening to audio-books with a certified music therapist.17

Is it safe?

Adverse events

No adverse events are on record4.

Contraindications

No contraindications are on record4.

Interactions

No interactions are on record4.

Warnings

No warnings are on record4.

Citation

Helen Cooke, CAM-Cancer Consortium. Music therapy [online document]. http://www.cam-cancer.org/CAM-Summaries/Mind-body-interventions/Music-therapy. December 9, 2014.

Document history

Summary first published in January 2013, authored by Helen Cooke.

Fully updated and revised by Helen Cooke in December 2014. 

References

  1. Richardson MM, Babiak-Vazquez AE, Frenkel MA. Music therapy in a comprehensive cancer center. Journal of the Society of Integrative Oncologists 2008; 6(2):76-81.
  2. Bradt J, Dileo C, Grocke D, Magill L. Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database Systematic Reviews 2011; (8):CD006911.pub2
  3. World Federation of Music Therapy website  http://www.wfmt.info/home-version-1/ [Accessed 14/11/14]
  4. Ernst E, Pittler MH, Wider B and Boddy K. Oxford Handbook of Complementary Medicine. Oxford University Press (2008) ISBN 978-0-19-920677-3.
  5. Li XM, Yan H, Zhou KN, Dang SN, Wang DL, Zhang YP. Effects of music therapy on pain among female breast cancer patients after radical mastectomy: results from a randomized controlled trial. Breast Cancer Research and Treatment 2011; 128(2):411-419.
  6. European Music Therapy Confederation website http://emtc-eu.com/ [Accessed 14/11/14}
  7. Li XM, Zhou KN, Yan H, Wang DL, Zhang YP. Effects of music therapy on anxiety of patients with breast cancer after radical mastectomy: a randomized clinical trial. Journal of Advanced Nursing 2012; 68(5):1145-1155.
  8. Shabanloei R, Golchin M, Esfahani A, Dolatkhah R, Rasoulian M. Effects of music therapy on pain and anxiety in patients undergoing bone marrow biopsy and aspiration. Association of Perioperative Registered Nurses Journal 2010; 91(6):746-751.
  9. Barry P, O'Callaghan C, Wheeler G, Grocke D. Music therapy CD creation for initial paediatric radiation therapy: a mixed methods analysis. Journal of Music Therapy 2010; 47(3):233-263.
  10. Wigram T, Pedersen IN, Bonde LO. A Comprehensive Guide to Music Therapy. Theory, Clinical Practice, Research and Training. London: Jessica Kingsley, 2002.
  11. 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.
  12. Nightingale CL, Rodriguez C, Carnaby G. The impact of music interventions on anxiety for adult cancer patients: a meta-analysis and systematic review. Integrative Cancer Therapies 2013; 12: 393-403.
  13. 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.
  14. Boehm K, Cramer H, Staroszynski  T, Ostermann T. Arts therapies for anxiety, depression, and quality of life in breast cancer patients: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2014;2014:103297.
  15. Chen LC, Wang TF, Shih YN, Wu LJ. Fifteen-minute music intervention reduces pre-radiotherapy anxiety in oncology patients. Eur J Oncol Nurs 2013; 17: 436-41.
  16. O'Callaghan C, Sproston M, Wilkinson K, Willis D et al. Effect of self-selected music on adults' anxiety and subjective experiences during initial radiotherapy treatment: A randomised controlled trial and qualitative research. Journal of Medical Imaging and Radiation Oncology 2012; 56: 473-77.
  17. Robb SL, Burns DS, Stegenga KA et al. Randomized clinical trial of therapeutic music video intervention for resilience outcomes in adolescents/young adults undergoing hematopoietic stem cell transplant: a report from the Children's Oncology Group. Cancer 2014; 120: 909-17.
  18. Gutgsell KJ, Schluchter M, Margevicius S,  Degolia PA et al.  Music therapy reduces pain in palliative care patients: A randomized controlled trial. Journal of Pain and Symptom Management 2013; 45: 822-31.