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

Music therapy

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.

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


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