Perspective

Music therapy significantly reduces preoperative anxiety among women undergoing breast surgery

A study led by researchers at University Hospitals of Cleveland showed music therapy significantly decreased preoperative anxiety levels among women undergoing surgery for diagnosis or treatment of breast cancer.

Investigators conducted the study to assess whether live or recorded music therapy affected anesthesia requirements, anxiety levels, recovery time and patient satisfaction.

The investigators randomly assigned 207 women to one of three study arms: patient-selected live music before surgery and therapist-selected recorded music intraoperatively (n = 69); patient-selected recorded music preoperatively and therapist-selected recorded music intraoperatively (n = 70); or usual care preoperatively and noise-blocking earmuffs intraoperatively (n = 68).

Deforia Lane

Deforia Lane

Researchers observed no significant difference between groups with regard to the amount of anesthesia required to reach moderate sedation.

However, women assigned to the music intervention groups reported less preoperative anxiety than those assigned usual care (P < .001). From pre-test to post-test, anxiety scores declined by a mean 30.9 points (standard deviation, 36.3) among those assigned live music and 26.8 points (standard deviation, 29.3) among those assigned recorded music. Results showed no change between pre-test and post-test among patients assigned usual care.

Researchers reported no significant difference in recovery time or satisfaction scores between those assigned a music intervention and those who received usual care.

“To the best of our knowledge, this is the first randomized controlled trial to test music therapy for anxiety management with women undergoing outpatient breast cancer surgery, and the largest study of its kind to use live music therapy in the surgical arena,” researcher Jaclyn Bradley Palmer, MM, MT-BC, music therapist at University Hospitals Case Medical Center, said in a press release. “In this trial, both live and recorded preoperative music therapy interventions reduced anxiety significantly more than usual preoperative management … representing percent reductions of 43% and 41%, respectively.”

Study researcher Deforia Lane, PhD, associate director of Seidman Cancer Center and director of music therapy at University Hospitals of Cleveland and Rainbow Babies and Children’s Hospital, spoke with HemOnc Today about the potential of music therapy as a complementary treatment in inpatient and outpatient settings.

Question: What prompted your study?

Answer: One of our surgeons saw the benefit of the music therapy with a patient who was much calmer and was not asking as many questions before surgery. The patient felt cared for, and the surgeon was able to focus on the procedure and what they do best rather than the anxiety of the patient. When we see patients at bedside and during procedural support, we see the changes that happen in both the patient and staff with music therapy. I have been through multiple breast cancer surgeries myself, so I understand what these patients are going through and understand the need for comfort that comes from music therapy.

Q: Can you describe the effect music has on a patient?

A: Music — especially patient-preferred music — is able to reduce pain perception and can provide a sense of relaxation and calmness. The body’s natural opiates are released when we hear an auditory cue. With music therapy, we are using the body’s natural response to the music and stimulating the brain to focus on the positive.

Q: Are these benefits sex- or disease-specific?

A: I have read several studies that suggest women are more responsive to music than men, and this can be for several reasons. However, in my experience, I have seen as much of a response — if not more of a response — from men. The calming effect we hope to achieve with music therapy can be helpful for multiple types of procedures, not just for patients undergoing breast biopsy. This will not change the outcome of the procedure, but our focus is on how to individually customize the experience to the immediate need of the patient to assure benefit. This can be holding a hand, talking, humming, singing or providing an iPod with the specific music the patient requested.

Q: In your opinion, will music therapy eventually become routine?

A: Yes. We published our study in Journal of Clinical Oncology, a high-impact journal. As a result, other institutions will learn about music therapy. We also have been asked to present our study at multiple medical conferences. The trend now is for neurologists to work with music therapists and to look at how music is affecting our brain and what it can do holistically, especially in the hospital setting. I am also looking into integrating music therapy as much as possible with those institutions that do not have a music therapist. Music therapy is something that other institutions can offer, and we can provide guidelines for how best to accomplish this. We hope music therapy will develop wings and fly.

Q: Does one style of music have a more profound effect than others?

A: No. Patients respond best to what they like the most. We have done everything from Michael Jackson’s “P.Y.T. (Pretty Young Thing)” to “Ave Maria.”

Q: Were you surprised by any of the study findings?

A: I had hoped the results of the live music arm would have been more significantly off the charts compared with the recorded music arm. We did achieve higher results with the live music, but they were not statistically significant. I also hoped patient satisfaction would differ. What I learned from this was that people are just glad when the procedure is over. I am also surprised and elated that this took on a life of its own and physicians and nurses were so pleased with the results.

Q: Beyond decreasing preoperative anxiety, could music therapy have a ripple effect in terms of recovery?

A: We did find that patients who received live music therapy were discharged an average of 12 minutes earlier. We think the personal attention of a music therapist was a factor, and we were very glad that the recovery time did not take longer with us being there for patients and using our music. We feared that if the process was slowed, we would not be as welcomed by everyone.

Q: What do you hope this study will mean for practice?

A: We know educationally, academically, intuitively and clinically that music is powerful in medical settings with patients when used by a music therapist. I would never tell a patient, “Take this CD and call me in the morning.” Our hope is to serve people in an intimate and meaningful way. However, at 3 a.m. when a patient is in pain or has to be rushed to surgery, I will not be there, so what else can I do? Using recorded music that has certain meaning and can go with the patient can be a wonderful option. Our hope is to ultimately spread the word. Some things defy measurement. I feel I have the best of both worlds. My job is to take the intrinsic part of music therapy and join it with the finite and empirical basis of medicine and benefit the patient in the process.

Q: Do you have any final thoughts on music therapy?

A: There is joy in seeing such positive results in something that is coming into its own. Music therapy has been around for more than 60 years as a profession, and receiving the acknowledgement and being able to demonstrate the effectiveness in this way and to be supported has been beyond imagination. It is one thing knowing in your heart that what you are doing is making a difference. It is something else altogether to be able to show it in black and white or in graphic form. We had the statistical expertise with our statisticians, the excellence of surgeons and nurse aestheticians, and the buy-in of the patients and their families. Music therapy truly does make a difference. – by Jennifer Southall

Reference:

Palmer JB, et al. J Clin Oncol. 2015;doi:10.1200/JCO.2014.59.6049.

For more information:

Deforia Lane, PhD, can be reached at University Hospitals Case Medical Center, 1110 Euclid Ave., Cleveland, OH 44115; email: deforia.lane2@uhhospitals.org.

Disclosure: Lane reports no relevant financial disclosures.

A study led by researchers at University Hospitals of Cleveland showed music therapy significantly decreased preoperative anxiety levels among women undergoing surgery for diagnosis or treatment of breast cancer.

Investigators conducted the study to assess whether live or recorded music therapy affected anesthesia requirements, anxiety levels, recovery time and patient satisfaction.

The investigators randomly assigned 207 women to one of three study arms: patient-selected live music before surgery and therapist-selected recorded music intraoperatively (n = 69); patient-selected recorded music preoperatively and therapist-selected recorded music intraoperatively (n = 70); or usual care preoperatively and noise-blocking earmuffs intraoperatively (n = 68).

Deforia Lane

Deforia Lane

Researchers observed no significant difference between groups with regard to the amount of anesthesia required to reach moderate sedation.

However, women assigned to the music intervention groups reported less preoperative anxiety than those assigned usual care (P < .001). From pre-test to post-test, anxiety scores declined by a mean 30.9 points (standard deviation, 36.3) among those assigned live music and 26.8 points (standard deviation, 29.3) among those assigned recorded music. Results showed no change between pre-test and post-test among patients assigned usual care.

Researchers reported no significant difference in recovery time or satisfaction scores between those assigned a music intervention and those who received usual care.

“To the best of our knowledge, this is the first randomized controlled trial to test music therapy for anxiety management with women undergoing outpatient breast cancer surgery, and the largest study of its kind to use live music therapy in the surgical arena,” researcher Jaclyn Bradley Palmer, MM, MT-BC, music therapist at University Hospitals Case Medical Center, said in a press release. “In this trial, both live and recorded preoperative music therapy interventions reduced anxiety significantly more than usual preoperative management … representing percent reductions of 43% and 41%, respectively.”

Study researcher Deforia Lane, PhD, associate director of Seidman Cancer Center and director of music therapy at University Hospitals of Cleveland and Rainbow Babies and Children’s Hospital, spoke with HemOnc Today about the potential of music therapy as a complementary treatment in inpatient and outpatient settings.

Question: What prompted your study?

Answer: One of our surgeons saw the benefit of the music therapy with a patient who was much calmer and was not asking as many questions before surgery. The patient felt cared for, and the surgeon was able to focus on the procedure and what they do best rather than the anxiety of the patient. When we see patients at bedside and during procedural support, we see the changes that happen in both the patient and staff with music therapy. I have been through multiple breast cancer surgeries myself, so I understand what these patients are going through and understand the need for comfort that comes from music therapy.

Q: Can you describe the effect music has on a patient?

A: Music — especially patient-preferred music — is able to reduce pain perception and can provide a sense of relaxation and calmness. The body’s natural opiates are released when we hear an auditory cue. With music therapy, we are using the body’s natural response to the music and stimulating the brain to focus on the positive.

Q: Are these benefits sex- or disease-specific?

A: I have read several studies that suggest women are more responsive to music than men, and this can be for several reasons. However, in my experience, I have seen as much of a response — if not more of a response — from men. The calming effect we hope to achieve with music therapy can be helpful for multiple types of procedures, not just for patients undergoing breast biopsy. This will not change the outcome of the procedure, but our focus is on how to individually customize the experience to the immediate need of the patient to assure benefit. This can be holding a hand, talking, humming, singing or providing an iPod with the specific music the patient requested.

Q: In your opinion, will music therapy eventually become routine?

A: Yes. We published our study in Journal of Clinical Oncology, a high-impact journal. As a result, other institutions will learn about music therapy. We also have been asked to present our study at multiple medical conferences. The trend now is for neurologists to work with music therapists and to look at how music is affecting our brain and what it can do holistically, especially in the hospital setting. I am also looking into integrating music therapy as much as possible with those institutions that do not have a music therapist. Music therapy is something that other institutions can offer, and we can provide guidelines for how best to accomplish this. We hope music therapy will develop wings and fly.

Q: Does one style of music have a more profound effect than others?

A: No. Patients respond best to what they like the most. We have done everything from Michael Jackson’s “P.Y.T. (Pretty Young Thing)” to “Ave Maria.”

Q: Were you surprised by any of the study findings?

A: I had hoped the results of the live music arm would have been more significantly off the charts compared with the recorded music arm. We did achieve higher results with the live music, but they were not statistically significant. I also hoped patient satisfaction would differ. What I learned from this was that people are just glad when the procedure is over. I am also surprised and elated that this took on a life of its own and physicians and nurses were so pleased with the results.

Q: Beyond decreasing preoperative anxiety, could music therapy have a ripple effect in terms of recovery?

A: We did find that patients who received live music therapy were discharged an average of 12 minutes earlier. We think the personal attention of a music therapist was a factor, and we were very glad that the recovery time did not take longer with us being there for patients and using our music. We feared that if the process was slowed, we would not be as welcomed by everyone.

Q: What do you hope this study will mean for practice?

A: We know educationally, academically, intuitively and clinically that music is powerful in medical settings with patients when used by a music therapist. I would never tell a patient, “Take this CD and call me in the morning.” Our hope is to serve people in an intimate and meaningful way. However, at 3 a.m. when a patient is in pain or has to be rushed to surgery, I will not be there, so what else can I do? Using recorded music that has certain meaning and can go with the patient can be a wonderful option. Our hope is to ultimately spread the word. Some things defy measurement. I feel I have the best of both worlds. My job is to take the intrinsic part of music therapy and join it with the finite and empirical basis of medicine and benefit the patient in the process.

Q: Do you have any final thoughts on music therapy?

A: There is joy in seeing such positive results in something that is coming into its own. Music therapy has been around for more than 60 years as a profession, and receiving the acknowledgement and being able to demonstrate the effectiveness in this way and to be supported has been beyond imagination. It is one thing knowing in your heart that what you are doing is making a difference. It is something else altogether to be able to show it in black and white or in graphic form. We had the statistical expertise with our statisticians, the excellence of surgeons and nurse aestheticians, and the buy-in of the patients and their families. Music therapy truly does make a difference. – by Jennifer Southall

Reference:

Palmer JB, et al. J Clin Oncol. 2015;doi:10.1200/JCO.2014.59.6049.

For more information:

Deforia Lane, PhD, can be reached at University Hospitals Case Medical Center, 1110 Euclid Ave., Cleveland, OH 44115; email: deforia.lane2@uhhospitals.org.

Disclosure: Lane reports no relevant financial disclosures.

    Perspective
    Christine A. Zawistowski

    Christine A. Zawistowski

    Have you ever spent any time on the pediatric ward or a pediatric subspecialty clinic? I have, and pretty much every child above a certain age and developmental level is “plugged into” their music. If you ask them why they are listening to music, they will often tell you it helps them “zone out” from all the chaos, helps them calm down, provides something familiar that is comforting or is one of the few forms of control they still have. But that is not evidence based; that is just my own personal experience.

    Now we have additional evidence of the benefits of music therapy, as Bradley Palmer and colleagues have provided the first randomized controlled trial showing that music therapy with either live or recorded music can reduce preoperative anxiety for women undergoing ambulatory breast surgery for diagnosis and treatment.

    Their primary hypothesis — that patients who received music therapy would have lower anesthesia requirements and greater anxiety reduction preoperatively — was only partially proven. However, they nonetheless showed that integrative therapies can be studied in a rigorous fashion and produce meaningful results.

    The premise behind the study is sound, as there is a growing body of research about music therapy and the physiology behind it. Their intervention also demonstrated that, in an environment that often grapples with space and time constraints, the addition of yet another person — with a guitar or keyboard, no less — was feasible. Acupuncture and hypnosis have been investigated in this setting but require substantially more time — 15 to 30 minutes — than the 5-minute intervention conducted in this study.

    The study did not demonstrate a decreased requirement for anesthesia, recovery time or increase in patient satisfaction, but it did incidentally find that those patients who received live music met discharge readiness criteria 12 minutes sooner than patients who received recorded music. This finding is interesting and may warrant further investigation.

    The researchers correctly note the limitations of this study, such as the lack of blinding, the uncertainty of the proper timing of the intervention and the possibility that the findings represent the therapeutic value of a caring professional. The comments made by the participants, available in the study’s appendix, speak to that last possibility.

    This work is valuable on many levels. It demonstrated that integrative therapies can be rigorously studied, that they can be done in busy areas with time constraints and not increase patient time commitment, and even if all the results do not have a P value less than 0.5, the patients derive subjective benefit from them. More studies of this caliber are needed to discern which integrative therapies can truly benefit patients.

    • Christine A. Zawistowski, MD
    • HemOnc Today Editorial Board member NYU Langone Medical Center

    Disclosures: Zawistowski reports no relevant financial disclosures.