Written by Helen Cooke, Joke Bradt and the CAM-Cancer Consortium.
Updated May 20, 2017

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.
  • 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.

What is it?

Description

Music therapy is an established healthcare profession that uses music to address physical, emotional, cognitive and social needs 1,2. 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 needs 3,4. This is differentiated from music medicine, which has been defined as listening to pre-recorded music offered by a healthcare professional 3,4,5. Without the presence of a therapist and a therapeutic relationship, music listening in itself is not music therapy 4. 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 management 3.  In addition to symptom management, music therapists utilize various individualized interventions with cancer patients and their families to address prevailing biopsychosocial and spiritual needs 7,8

Components

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 2,3. 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 music 3.

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. 

History/provider(s)

The use of music to improve health dates back to ancient times 2. 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 level 9.

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 control 2,3. Research suggests that music therapy interventions may be more effective than music medicine interventions with medical populations for a wide variety of outcomes 3. It has been suggested that the difference might relate to how music therapists individualise their intervention to meet patients’ specific needs 3.

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 10,11,12. In addition, research indicates that music offers an escape from stress and worries related to the cancer diagnosis, treatment, and prognosis 6. Music also activates the rewards and motivation circuitry in the brain resulting in the release of dopamine which regulates perception of pleasure and mood 13. Music making provides opportunities for emotional expressivity which has consistently been linked to mood enhancement 14,15. 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 reflections 6.

Importantly, music provides patients with an aesthetic experience that can offer comfort and peace during times of distress 6.

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 Therapy acts as the international umbrella organization for the profession of music therapy 9. 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 Council 17. 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 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.

Systematic reviews

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 treatment 20. 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 patients 21. 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.

Clinical trials

An additional six RCTs not included in the above reviews have been published 22-27. They are also described in Table 2.

Three trials used music medicine interventions 22,23,24 and three music therapy interventions 26,27,28. Five RCTs compared the effects of music interventions with standard care and one paediatric trial 27 used an audio storybook attention control.

Two of the music medicine trials 22,24 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 trial 23 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 surgery 25, one focused on adult cancer patients during high dose chemotherapy 27, and one included paediatric cancer patients 26. Greater anxiety reductions were reported by the surgical breast cancer patients in the music treatment condition compared to standard care 25 whereas chemotherapy patients reported treatment benefits of music therapy for pain but not for anxiety, quality of life, depression or physical functioning 27.  Unfortunately, the latter study was underpowered. The paediatric trial was a pilot study in preparation of a larger clinical trial 26. 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.

Is it safe?

Adverse events

No adverse events are on record 4.

Contraindications

No contraindications are on record 4.

Interactions

No interactions are on record 4.

Warnings

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 3.

Evidence tables

Please view the PDFs listed below for details of the systematic reviews and/or controlled clinical trials included in this summary.

Table 1: Systematic reviews of music therapy for cancer

Table 2: Controlled clinical trials of music therapy for cancer

Citation

Helen Cooke, Joke Bradt, CAM-Cancer Consortium. Music therapy [online document]. http://www.cam-cancer.org/The-Summaries/Mind-body-interventions/Music-therapy. May 20, 2017.

Document history

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.

References

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  2. Richardson MM, Babiak-Vazquez AE, Frenkel MA. Music therapy in a comprehensive cancer center. J Soc Integr Oncol 2008; 6: 76-81.
  3. 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.
  4. 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.
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  22. 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.
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