In the Journals

Music therapy fostered resilience among AYA patients undergoing high-risk cancer treatment

“After silence, that which comes nearest to expressing the inexpressible is music.” – Aldous Huxley

A large part of palliative care is supporting the patient and family on the journey of a difficult and potentially life-limiting medical condition.

One of the goals of the palliative care team’s multidisciplinary approach is to find different ways to connect with the patient and family and give them tools to help them cope with a scenario that has most certainly disrupted their lives.

Christine A. Zawistowski, MD 

Christine A. Zawistowski

I find that some of the most powerful and valuable support comes from child life therapists, art therapists and music therapists. These modalities allow patients to express themselves without necessarily having to find the words to do so. They also are ways of creating something that can endure — either as a reminder of the journeys traveled by patients who survived or as a memory of those who do not.

Study suggests benefit

A study published earlier this year in Cancer explored the use of music therapy — specifically, therapeutic music video — as a coping aid for adolescents and young adults (AYAs) who undergo hematopoietic stem cell transplants.

Data show that the high distress experienced by AYAs during HSCT contributes to poor coping skills that put them at risk for adjustment problems during survivorship. There are no models to predict which patients are at risk and, subsequently, require additional support.

The therapeutic music video intervention evaluated in the study was designed to improve resilience in AYAs undergoing HSCT. The researchers based their approach on two models: the Resilience in Illness Model and Robb’s Contextual Support Model of Music Therapy. The former is a strengths-based positive health model that elucidates pathways by which risk and positive factors influence AYAs adjustment to difficult life circumstances. The latter describes how music interventions create predictability, autonomy and relationship support to promote positive health outcomes.

The study consisted of 113 patients aged 11 to 24 years who were undergoing stem cell transplants at one of eight Children’s Oncology Group sites.

Researchers randomly assigned them to be part of a therapeutic music video intervention group or a control group. All patients participated in six sessions with a board-certified music therapist for a 3-week period during the acute transplant phase.

Patients assigned to the control group received audio books they could listen to and/or discuss during their sessions with their music therapist.

The therapists offered structure and support to patients in the intervention group as they wrote song lyrics and produced music videos. The goal was to help patients reflect on their experiences and identify what was most important to them, such as spirituality, family and relationships.

Each phase of the intervention focused on different tasks, such as sound recordings, collecting video images and storyboarding. Patients had the opportunity to involve family, friends and health care providers in their projects. When the projects were completed, patients had the option to share their works through a video premiere that allowed others to gain a better understanding of the patient’s perspective and experiences.

Researchers evaluated several variables — including illness-related distress, spiritual perspective, social integration, coping, family environment and resilience — at baseline, after completion of the six sessions, and at 100 days post-transplant.

Results showed patients in the intervention group demonstrated significantly better courageous coping. At 100 days post-transplant, those in the intervention group also showed significantly better social integration and family environment.

Several protective factors were found to help foster resilience in this population. They included spiritual beliefs and practices, a strong family environment, and a feeling of being socially connected to and supported by friends and health care providers.

The study’s findings provide evidence supporting the use of a music-based intervention, delivered by someone with expertise in that field, to help AYAs cope with high-risk, high-intensity cancer treatment.

Science behind therapy

To many clinicians, music therapy often falls under the category of “complementary and alternative therapy” — in other words, something “fluffy” that may help but does not qualify as a true “therapy.” I would argue that it should be seen as another facet of care similar to physical therapy and occupational therapy.

Music therapy came to fruition after World War I when community musicians went to veterans’ hospitals to play for patients who were suffering from physical and emotional trauma. The patients’ positive responses to music led the doctors and nurses to request the musicians be hired by the hospitals.

Music therapists possess a bachelor’s level degree or equivalent and have hundreds of hours of field work. They also are board-certified professionals — board certification came about in 1985 — comparable to occupational and physical therapists.

There is science behind this therapy, as well. There are several peer-reviewed journals devoted to music therapy. There are data that show benefits of music therapy for both pediatric and adult oncology patients. Music therapy as an oncology patient intervention is supported by the Society for Integrative Oncology.

Anecdotally, I have witnessed the benefits patients can receive from music therapy. Children who are withdrawn light up when the music therapist enters their room. The music therapist enlightens the medical team about the patient’s fears, concerns and sometime even symptoms they won’t share with us. Patients with difficult-to-treat pain show improvement in their pain scores once music therapy is introduced, and parents see it as a “normal” activity that their child can participate in while in the “abnormal” environment of the hospital.

I believe this can be adopted in most institutions, it just may require advocating for it.

In terms of cost, a full-time music therapist is no different than any other skilled certified professional employed by a hospital or clinic. There are standard industry rates, benefits, etc. If the cost is prohibitive, there are companies that subcontract therapists on a part-time basis.

Music therapy is a reimbursable service for Medicare under benefits for Partial Hospitalization Programs falling under the heading of Activity Therapy. Under Medicaid, a few states allow payment for music therapy services through use of Medicaid Home and Community Based Care waivers for certain client groups.

Third-party reimbursement for provision of music therapy continues to grow as more clinicians seek this coverage. Grants and philanthropy can be used to fill in the financial gaps hospitals and clinics cannot cover.

Music therapy as an allied health profession is a young discipline and, as with any young discipline, it will take time for the data to guide its use: Which patients will benefit? What type of therapy is best in what patients? What is the magnitude of the treatment effect?

Most of the medications we prescribe for our pediatric patients for symptom relief have never been tested in our population, and many have potentially unpleasant side effects. We use them because of the benefit we hope they will provide and because of our experience with them.

Music therapy has no “bad” side effects and has the potential to mitigate side effects of the therapies our patients endure on their paths to recovery. I encourage those who still don’t see this as a true “therapy” to do a little research to see if you have a patient who might benefit from it.

References:

Cepeda MS. Cochrane Database Syst Rev. 2006;doi:10.1002/14651858.CD004843.pub2.

Magill L. Am J Hosp Pall Care. 2009;26:33-39.

O’Callaghan C. Australas Radiol. 2007;51:159-162.

O’Callaghan C. Palliat Support Care. 2009;7:219-228.

Richardson MM. J Soc Integr Oncol. 2008;6:76-81.

Robb SL. Cancer. 2014;doi:10.1002/cncr.28355.

For more information:

Christine A. Zawistowski, MD, is a pediatric palliative care and intensive care doctor at NYU Langone Medical Center in New York. She can be reached at NYU Langone Medical Center, Department of Pediatrics, 462 First Ave., New York, NY 10016.

Disclosure: Zawistowski reports no relevant financial disclosures.

“After silence, that which comes nearest to expressing the inexpressible is music.” – Aldous Huxley

A large part of palliative care is supporting the patient and family on the journey of a difficult and potentially life-limiting medical condition.

One of the goals of the palliative care team’s multidisciplinary approach is to find different ways to connect with the patient and family and give them tools to help them cope with a scenario that has most certainly disrupted their lives.

Christine A. Zawistowski, MD 

Christine A. Zawistowski

I find that some of the most powerful and valuable support comes from child life therapists, art therapists and music therapists. These modalities allow patients to express themselves without necessarily having to find the words to do so. They also are ways of creating something that can endure — either as a reminder of the journeys traveled by patients who survived or as a memory of those who do not.

Study suggests benefit

A study published earlier this year in Cancer explored the use of music therapy — specifically, therapeutic music video — as a coping aid for adolescents and young adults (AYAs) who undergo hematopoietic stem cell transplants.

Data show that the high distress experienced by AYAs during HSCT contributes to poor coping skills that put them at risk for adjustment problems during survivorship. There are no models to predict which patients are at risk and, subsequently, require additional support.

The therapeutic music video intervention evaluated in the study was designed to improve resilience in AYAs undergoing HSCT. The researchers based their approach on two models: the Resilience in Illness Model and Robb’s Contextual Support Model of Music Therapy. The former is a strengths-based positive health model that elucidates pathways by which risk and positive factors influence AYAs adjustment to difficult life circumstances. The latter describes how music interventions create predictability, autonomy and relationship support to promote positive health outcomes.

The study consisted of 113 patients aged 11 to 24 years who were undergoing stem cell transplants at one of eight Children’s Oncology Group sites.

Researchers randomly assigned them to be part of a therapeutic music video intervention group or a control group. All patients participated in six sessions with a board-certified music therapist for a 3-week period during the acute transplant phase.

Patients assigned to the control group received audio books they could listen to and/or discuss during their sessions with their music therapist.

The therapists offered structure and support to patients in the intervention group as they wrote song lyrics and produced music videos. The goal was to help patients reflect on their experiences and identify what was most important to them, such as spirituality, family and relationships.

Each phase of the intervention focused on different tasks, such as sound recordings, collecting video images and storyboarding. Patients had the opportunity to involve family, friends and health care providers in their projects. When the projects were completed, patients had the option to share their works through a video premiere that allowed others to gain a better understanding of the patient’s perspective and experiences.

Researchers evaluated several variables — including illness-related distress, spiritual perspective, social integration, coping, family environment and resilience — at baseline, after completion of the six sessions, and at 100 days post-transplant.

Results showed patients in the intervention group demonstrated significantly better courageous coping. At 100 days post-transplant, those in the intervention group also showed significantly better social integration and family environment.

Several protective factors were found to help foster resilience in this population. They included spiritual beliefs and practices, a strong family environment, and a feeling of being socially connected to and supported by friends and health care providers.

The study’s findings provide evidence supporting the use of a music-based intervention, delivered by someone with expertise in that field, to help AYAs cope with high-risk, high-intensity cancer treatment.

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Science behind therapy

To many clinicians, music therapy often falls under the category of “complementary and alternative therapy” — in other words, something “fluffy” that may help but does not qualify as a true “therapy.” I would argue that it should be seen as another facet of care similar to physical therapy and occupational therapy.

Music therapy came to fruition after World War I when community musicians went to veterans’ hospitals to play for patients who were suffering from physical and emotional trauma. The patients’ positive responses to music led the doctors and nurses to request the musicians be hired by the hospitals.

Music therapists possess a bachelor’s level degree or equivalent and have hundreds of hours of field work. They also are board-certified professionals — board certification came about in 1985 — comparable to occupational and physical therapists.

There is science behind this therapy, as well. There are several peer-reviewed journals devoted to music therapy. There are data that show benefits of music therapy for both pediatric and adult oncology patients. Music therapy as an oncology patient intervention is supported by the Society for Integrative Oncology.

Anecdotally, I have witnessed the benefits patients can receive from music therapy. Children who are withdrawn light up when the music therapist enters their room. The music therapist enlightens the medical team about the patient’s fears, concerns and sometime even symptoms they won’t share with us. Patients with difficult-to-treat pain show improvement in their pain scores once music therapy is introduced, and parents see it as a “normal” activity that their child can participate in while in the “abnormal” environment of the hospital.

I believe this can be adopted in most institutions, it just may require advocating for it.

In terms of cost, a full-time music therapist is no different than any other skilled certified professional employed by a hospital or clinic. There are standard industry rates, benefits, etc. If the cost is prohibitive, there are companies that subcontract therapists on a part-time basis.

Music therapy is a reimbursable service for Medicare under benefits for Partial Hospitalization Programs falling under the heading of Activity Therapy. Under Medicaid, a few states allow payment for music therapy services through use of Medicaid Home and Community Based Care waivers for certain client groups.

Third-party reimbursement for provision of music therapy continues to grow as more clinicians seek this coverage. Grants and philanthropy can be used to fill in the financial gaps hospitals and clinics cannot cover.

Music therapy as an allied health profession is a young discipline and, as with any young discipline, it will take time for the data to guide its use: Which patients will benefit? What type of therapy is best in what patients? What is the magnitude of the treatment effect?

Most of the medications we prescribe for our pediatric patients for symptom relief have never been tested in our population, and many have potentially unpleasant side effects. We use them because of the benefit we hope they will provide and because of our experience with them.

Music therapy has no “bad” side effects and has the potential to mitigate side effects of the therapies our patients endure on their paths to recovery. I encourage those who still don’t see this as a true “therapy” to do a little research to see if you have a patient who might benefit from it.

References:

Cepeda MS. Cochrane Database Syst Rev. 2006;doi:10.1002/14651858.CD004843.pub2.

Magill L. Am J Hosp Pall Care. 2009;26:33-39.

O’Callaghan C. Australas Radiol. 2007;51:159-162.

O’Callaghan C. Palliat Support Care. 2009;7:219-228.

Richardson MM. J Soc Integr Oncol. 2008;6:76-81.

Robb SL. Cancer. 2014;doi:10.1002/cncr.28355.

For more information:

Christine A. Zawistowski, MD, is a pediatric palliative care and intensive care doctor at NYU Langone Medical Center in New York. She can be reached at NYU Langone Medical Center, Department of Pediatrics, 462 First Ave., New York, NY 10016.

Disclosure: Zawistowski reports no relevant financial disclosures.