Abstract and key points
- Music therapy is a therapeutic intervention involving the use of music to address physical, emotional, cognitive and social needs.
- Based on the limited number of trials, it is not possible 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 preliminary 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?
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.
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.
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.
Prevalence of use
The exact prevalence of the use of music therapy for people with cancer is unknown.
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?
Three Cochrane systematic reviews, two narrative reviews and seven additional randomised clinical trials were reviewed for this summary. The trials are described in Table 1. Although the results of these preliminary trials are encouraging for the effectiveness of music therapy for cancer-related anxiety, mood, depression, pain and quality of life, it should be noted that there is considerable variation in the manner in which the music therapy was 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. It is therefore not possible to generalise the results. Sessions varied in length and many of the trials did not involve music therapists as part of the therapeutic process.
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, pain, mood and quality of life in people with cancer. Small reductions in heart rate, respiratory rate and blood pressure were also found. 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 2010 Cochrane Review examined the effect of music therapy in end-of-life care7. Five trials (total 175 participants) were included which compared music therapy with standard care versus standard care alone or standard care combined with other therapies on psychological, physiological and social responses. Only one of the studies involved exclusively cancer patients (n=80). This study found no significant difference between the music therapy group and standard care group on the Palliative Performance Scale, but quality of life scores improved significantly in the intervention group. The authors concluded that there is insufficient evidence of high quality to support the effect of music therapy in end-of-life care. Although a number of studies suggest a benefit on quality of life for people in end-of-life care, these results stemmed from studies with small sample sizes and had a high risk of bias.
A further Cochrane review examined the efficacy of music (including music listening) for the treatment of pain8. Of the 51 trials included however, only 2 involved people with cancer (total 57 participants). One of the studies has been reported in the above 2011 review 2. The review concluded that listening to music reduces pain intensity and opioid requirements. The clinical importance is unclear, however, as the magnitude of the benefit is small.
Another non-systematic review published an overview of research studies in the area of paediatric oncology9. Twelve studies were included; 8 qualitative (number of participants was not documented) and 4 quantitative (total 87 participants). The review concluded that the qualitative studies demonstrated that music therapy can provide support and comfort to paediatric oncology patients and their families. The quantitative research studies showed promise for the effectiveness of music therapy in assisting the quality of life of paediatric patients. Benefits included reduction in anxiety, fear, pain and isolation. One large (n=65) pre-test/post-test pilot study evaluating the effects of interactive music therapy with hospitalised children indicated significant improvement in the children’s ratings of their feelings between pre- to post test and a positive view of music therapy was indicated on the satisfaction surveys. Most of the studies included in this review however have small sample sizes (n=10 maximum) and most do not include an adequate control. The studies were not critically evaluated in this review.
A further article published in 2008 reviewed the literature on the value of interactive music therapy in cancer care and described the experience of integrating music therapy in cancer care therapy at a large comprehensive cancer centre in the US1. Eight quantitative and qualitative studies (total 611 participants) and three review articles (which included 12 trials relating to music therapy for cancer) were included. They concluded that when used in conjunction with conventional cancer treatments, benefits include improvement in quality of life, emotional expression, ability to manage stress and alleviation of pain and discomfort. One study failed to show benefits of music therapy. The studies were not critically evaluated in this review.
Four randomised 10-13 clinical trials assessing the effects on anxiety and depression reported improvements in both anxiety and depression. Although some of the trials have methodological limitations, the results are encouraging. Again, there is considerable variation in the manner in which the music therapy was conducted. Only one trial10 involved a music therapist (in the creation of the music library). 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 randomised controlled trials 5,13,14 assessing the effects on pain reported significant improvements. Although these were relatively large studies (n=120, n=100, n=126), self-report data may have influenced the results. It should be noted that these trials did not appear to involve a music therapist (apart from in the creation of the music library in one of the trials5).
One randomised controlled trial15 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. 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.
Is it safe?
CitationHelen Cooke, CAM-Cancer Consortium. Music therapy [online document]. http://www.cam-cancer.org/CAM-Summaries/Mind-body-interventions/Music-therapy. January 25, 2013.
Summary first published in January 2013, authored by Helen Cooke.
- 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.
- 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.
- World Federation of Music Therapy website http://www.musictherapyworld.net/WFMT/FAQ_Music_Therapy.html [Accessed 05/09/12]
- Ernst E, Pittler MH, Wider B and Boddy K. Oxford Handbook of Complementary Medicine. Oxford University Press (2008) ISBN 978-0-19-920677-3.
- 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.
- European Music Therapy Confederation website http://emtc-eu.com/ [Accessed 18/12/12]
- Bradt J, Dileo C. Music therapy for end-of-life care. Cochrane Database Systematic Reviews 2010; (1):CD007169.
- Cepeda MS, Carr DB, Lau J, Alvarez H. Music for pain relief. Cochrane Database of Systematic Reviews 2006; (2). CD004843.
- Hilliard RE. Music therapy in paediatric oncology: a review of the literature. Journal of the Society of Integrative Oncologists 2006; 4(2):75-78.
- 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.
- Lin MF, Hsieh YJ, Hsu YY, Fetzer S, Hsu MC. A randomised controlled trial of the effect of music therapy and verbal relaxation on chemotherapy-induced anxiety. Journal of Clinical Nursing 2011; 20(7-8):988-999.
- Ferrer AJ. The effect of live music on decreasing anxiety in patients undergoing chemotherapy treatment. Journal of Music Therapy 2007; 44(3):242-255.
- 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.
- Huang ST, Good M, Zauszniewski JA. The effectiveness of music in relieving pain in cancer patients: a randomized controlled trial. International Journal of Nursing Students 2010; 47(11):1354-1362.
- 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.
- Wigram, T., Pedersen, I.N., & Bonde, L.O. (2002) A Comprehensive Guide to Music Therapy. Theory, Clinical Practice, Research and Training. London: Jessica Kingsley.
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