Music May Boost a Patient’s Positive Mood During Chemotherapy Infusions

Felicity W.K. Harper, PhD

Patients who listen to music while receiving chemotherapy may experience a better mood and lower levels of distress than those who undergo a traditional, music-free infusion, according to findings published in JCO Oncology Practice.

Positive and Negative Affect Scale (PANAS) positive and PANAS negative scores, which range from 10 to 50, were used to assess mood outcomes. The study demonstrated that patients who listened to music while receiving their treatment experienced a significant improvement (1.55; SD, 5.46) in positive mood compared to those who did not listen to music (0.14; SD, 5.46; P = .001). Specifically, patients reported a PANAS positive score of 29.82 (SD, 8.53) before music and 31.36 (SD, 9.80) after music in the experimental group compared with 29.60 (SD, 8.53) pre- and 29.73 (SD, 9.50) in the postsettings in the control group.

Patients who listened to music also reported significant reductions in negative mood (–1.72 [SD, 3.43] vs –0.88 [SD, 4.24]; P = .004) and distress (–0.67 [SD, 1.96] vs – 0.35 [SD, 1.58]; P = .016). However, patients did not experience a significant decrease in pain levels with this intervention (–0.24 [SD, 1.14] vs –0.34 [SD, 1.32]; P = .316).

“The results of this rigorously designed large-scale, randomized trial of music medicine stand as evidence for the benefit of a music intervention for patients during chemotherapy infusion,” Felicity W.K. Harper, PhD, associate director of population science at the Wayne State University Oncology School of Medicine, and co-investigators, wrote in the study. “Listening to music has clinical benefit for improving positive mood and reducing negative mood and distress.”

According to study authors, music has previously demonstrated potential in managing stress in patients and that adult patients with cancer have shown interest in music interventions. However, previous studies have been limited by small sample sizes and inconsistent methodology. To that end, investigators designed an open-label, multisite trial to test the intervention on patients who were receiving chemotherapy.

The primary end point was to determine whether listening to music had an impact on patient mood, pain, or distress levels during their treatment. The trial’s secondary objective was to explore other potential factors contributing to these changes in the pre- and postintervention settings.

A total of 750 patients receiving chemotherapy from either the Karmanos Cancer Institute or one of their 5 affiliated McLaren Health Clinics, were enrolled between February 2018 and March 2020. To be eligible, patients needed to be at least 18 years of age, be able to speak, read, write, and understand English, have sufficient hearing for listening to music, and be scheduled for an infusion of chemotherapy that would be at least 60 minutes. Patients could not participate if they had cognitive or perceptual disturbances.

Investigators randomly assigned patients 1:1 to the music condition or control condition. Days were block-randomized so that there were “intervention days” when music was provided to all patients and “control days” when no music was provided to participants. Those who were selected for the music group were able to select a preprogrammed playlist with songs from a single genre (eg, Motown, classical, etc) from an iPod Shuffle.

Following consent, patients completed a brief survey which queried about their sociodemographic characteristics, musical background, levels anxiety and depression, and baseline levels of pain, mood, and distress. Patients who were randomly assigned to the control group were on an active waitlist and completed the pre- and postsurvey questions across a 60-minute timeframe to mirror the intervention group procedure. Following their participation in the control condition, patients were given the option to listen to music so that they could potentially receive benefit.

The average patient age was 60.39 years, and most patients were female (65%). Most patients were White (68%), or Black (28%). Most patients were also married (56%) and 40% had an annual household income less than $40,000.

Investigators leveraged PANAS scores to assess mood and the Distress Thermometer to assess distress. Patients used a visual analogs scale to rate their pain from 0 to 10.

Of note, a LASSO penalized linear regression model demonstrated a pronounced benefit for patients who were married or widowed vs those who were separated or widowed (P = .032) and for those who were on disability leave vs other employment status (P = .029). According to study authors, these findings underscore a need to understand which factors may drive changes in mood and distress for different populations during treatment.

The study authors concluded by acknowledging that the trial demonstrated small effect sizes in terms of changes in mood and that the trial is limited by the largely self-directed design. Nevertheless, they maintain that the findings are significant, given the ease at which music can be offered to patients during their infusion.

“Given that patients receiving chemotherapy can experience high levels of distress, the ease, low cost, and safety of the intervention suggest it might have ideal application in the fast-paced but often stressful context of a cancer infusion clinic,” they wrote.

Reference

Harper FWK, Heath AS, Moore TF, Kim S, Heath EI. Using music as a tool for distress reduction during cancer chemotherapy treatment. J Clin Oncol. Published online July 11, 2023. doi:10.1200/OP.22.00814