According to the American Cancer Society, cancer is “a group of diseases characterized by the uncontrolled growth and spread of abnormal cells. It is predicted that approximately 1.7 million new cancer cases are expected to be diagnosed by the end of 2018” (Siegel, Miller, & Jemal, 2018, p. 7). Many physical and emotional burdens are associated with the diagnosis of cancer. Pain that is difficult to manage is a common physical burden amongst patients with this disease. More than half of people with cancer report having pain in the previous week, with 44% of those patients reporting that the pain is moderate to severe (Paice, 2018, p. 386). Pain is a common side effect of the cancer treatments that patients may receive, such as chemotherapy, radiation, cancer medications, and surgery. Nurses who work in oncology units are around the patient more often than many other health care professionals, therefore, they must be advocates for these patients that are in pain. It is the job of the nurse to provide standard care for these patients, which includes administering the prescribed pain medications, however, there is a need for nurses to advocate for more nonpharmacological methods of pain management to support a more holistic healing (Krishnaswamy & Nair, 2016, p. 307).
Music therapy is a nonpharmacological approach used in many medical facilities to relieve pain, depression, anxiety, and stress. This therapy has been shown to alleviate symptoms of an illness and improve the overall well-being of patients (Franco, Deluca, Cahill, & Cabell, 2018, p. 63). Music therapy can include the patient listening to music or playing instruments to make their own music. There are studies that experiment using music therapy as a holistic treatment to lower the pain endured by patients with cancer. Music therapy is a relatively easy treatment to try and is harmless to the patient whether it works or not. Considering the possible benefits of music therapy on cancer pain, nurses should inform themselves about this holistic treatment and recommend their patients try it. Many patients may not know what music therapy is or know that it could possibly lower their pain, so it is up to the nurse to advocate for them by informing them and suggesting ways to start music therapy. In patients hospitalized with cancer, what is the effect of music therapy as an adjunct to pain medication administered during routine care delivery compared to pain medication alone administered as the routine standard of care on patients’ reports of pain control?
The search for scholarly journal articles was done online, through La Salle University’s Connelly Library. The two databases used in the search process were CINAHL and PubMed. To search for articles, the dates selected were from 2013-2018 and limited to only the English language. Different combinations of the following keywords were used to search for articles: cancer, oncology, pain, music, music therapy, chemotherapy, patients. The articles had to involve adults that had a diagnosis of cancer, therefore, all other diseases, as well as pediatric studies, were omitted. After narrowing down and reviewing the remaining the articles, six articles were selected for research.
Primary Article Review
Foster, Wiseman, and Pennert (2014) conducted a correlation study to assess the usefulness of music therapy for adult hemato-oncology patients. Convenience sampling was used on haemato-oncology inpatients to select 17 potential participants who were then approached by a music therapist and given printed information about the study. These inpatient participants did receive standard care, which includes pain medication. Participants were excluded from this study if they had employed music therapy in the past month or if they were unable to give consent. Among the 17 potential participants, two declined, resulting in 15 total participants for the study. Out of the 15 participants, 9 were female and 6 were male, with ages ranging from 27-56 and a mean of 56 years old. Regarding the diagnoses, five of the subjects had acute myeloid leukemia, three had chronic lymphoid leukemia, two had lymphoma, two had myelofibrosis, two had myeloma, and one had an unknown retro-sternal mass. To evaluate the patient’s pain before and after the music therapy, patients rated their pain on a FACES scale, which allows patients to pick a number from zero (no pain) to five (worst pain). Each participant had a single music therapy session lasting 20-45 minutes in either a single room or a music therapy room. The music therapist brought musical instruments along with song sheets to allow the patient to decide what to do. After the session, the subject filled out the FACES scale again. Bias was avoided by allowing the patient to fill out the score alone and put it in a sealed envelope so they did not feel pressure from the music therapist.
Foster et al. (2014) reported that music therapy does lower pain for the majority of patients. Ten participants out of 15 reported at least a one point improvement on the scale and five of those ten reported a two-point improvement. The remaining five participants reported no change on the FACES scale. There was a mean change of one point, which was found to be significant and gave a value of P=0.004. Considering this is a correlation study, it ranks a five for level of evidence, which is a weakness. A control group could have been added to this study in which patients only got standard care to compare to the group who received a music therapy session. Since there was no comparison group, this study did imply a use for music therapy for patients with cancer pain, however, there was no comparison with standard care alone. Another weakness was the use of convenience sampling because the results are bias towards haemato-oncology in one inpatient facility. A way to prevent this weakness could have been to include haemato-oncology patients from multiple inpatient facilities. A strength was that Foster et al. (2014) did recognize some bias and lower it by allowing the patients not to feel pressure marking the scale in front of the music therapist. Another strength was that there were multiple genders, ages, and cancer diagnoses. This helps the results of the study be considered useful for a larger population since many demographics were included. The study by Foster et al. (2014) suggests that music therapy may lower pain scores of patients with cancer and that more studies must be done on this theory as the research is limited.
Krishnaswamy and Nair (2016) conducted a quantitative pilot study to assess the effect of music therapy on pain scores of patients with cancer. This study was performed on patients admitted for pain relief under the Department of Pain and Palliative medicine in a tertiary care hospital. The inclusion criteria required that patients had moderate to severe pain (numeric pain scale [NRS] rating from four to ten) and were administered morphine three hours prior to the intervention. Patients were excluded if they had hearing deficits or metastases to the brain. There were 14 total patients picked using convenience sampling. There was a study group with seven patients (five males and two females) and a control group with seven patients (three females and four males). To assess pain, a numerical pain rating scale was used before and after the therapy on both groups. The study group was subjected to 20 minutes of music via headphones, while the control group was kept occupied for 20 minutes by conversation. All the subjects in the study group listened to the same pieces of music on an MP3 player. A two sample t-test was used to compare the data collected from each group.
Krishnaswamy and Nair (2016) found that there was a statistically significant decrease in the post-intervention pain scores in the study group, with a P=0.003. Also, the difference between the study group and the control group regarding a decrease in pain scores was also statistically significant, with a P= 0.034. The team concluded that a single session of music therapy was effective in reducing the pain in the cancer patients, therefore can be considered a nonpharmacological treatment for oncological pain. A weakness in this study was the use of convenience sampling. As mentioned above, the results cannot represent the entire population of patients with cancer, but only those in that specific tertiary hospital. A strength of this study is it being a three on the level of evidence rating. Although not having many participants, the evidence level makes it a strong study. Another strength of this study was that the team’s results were in concurrence with the previously done studies mentioned in their review. The study done by Krishnaswamy and Nair (2016) implies that although more studies must be added to the current literature, music therapy can be considered as a nonpharmacological method to reduce pain in patients with an oncological disease.
Bilgiç and Acaro?lu (2016) conducted a quasi-experimental experiment to evaluate if listening to music lowers the severity of chemotherapy symptoms. Pain was one of the nine symptoms associated with chemotherapy that was studied. The study was performed at a public hospital in Turkey on patients receiving chemotherapy between February and October 2014. The inclusion criteria included patients who were 18 years or older, communicative and cooperative, literate, had chemotherapy sessions at least three time a week, and willing to take part in the research. The exclusion criteria included patients who were receiving psychiatric treatment or were in a terminal phase of their disease. The final sample consisted of 70 patients, 35 in a control group and 35 in an intervention group. The 70 participants had varied genders, marital status, education levels, professions, and cancer diagnoses. Amongst the cancer diagnoses included 22 with lung cancer, 23 with breast cancer, nine with colon cancer, and 16 under the category “other”. To measure the nine common symptoms of chemotherapy, an Edmonton Symptom Assessment System (ESAS) is used. The patient is asked to indicate a number that corresponds with the severity of each symptom. All patients filled out an ESAS survey before and after they attended their chemotherapy session. The intervention group listened to 20-30 minutes of music during their session, while the control group received routine care. The music selected for all patients was a Turkish relaxation CD, made by the Turkish Psychological Association, to listen to through an MP3 player.
Bilgiç and Acaro?lu (2016) found statistically significant results between the control and intervention group regarding pain. The intervention group had lower pain scores than the control group, with P=0.002. These findings support music therapy being a holistic therapy to help treat the pain of patients with cancer. A strength in this experiment is it being a quasi-experimental design, which ranks it a level three on the evidence scale, which is relatively high. Another strength is the large number of participants, along with their diversity. This allows the results to be useful to people of different backgrounds. A weakness of this study, similar to the previous studies, was the use of convenience sampling. A recommendation would be to conduct a similar study on patients in different hospitals to allow it to relate more to the general population. The limitations of this study included the difference in the severity of the cancer diagnoses, the difference in the type and dosage of the pain medications, and the limited literature to review before the study was conducted. The team’s results suggest that listening to music can ease pain of patients receiving chemotherapy.
Zengin et al. (2013) coordinated a study with a quasi-experimental design, with randomization, to assess the effect of music therapy on pain before and during port catheter placement procedures (PCPPs). This study was performed in a Turkish hospital’s emergency department on patients who were scheduled for a PCPP between the months of March and September of 2012. A PCPP is “among the most frequently performed medical procedures in oncology patients”, therefore, the participants consisted of 100 patients newly diagnosed with an oncological disease. The inclusion criteria consisted of patients who were undergoing a PCPP for the first time, 16 years or older, Turkish-speaking, able to read at a fifth-grade level, and mentally competent to sign the consent form. Patients who were excluded were those who had auditory problems, hormonal dysfunction, anxiolytic and sedative use, cocaine abuse problems, or a diagnosis of anxiety, dementia, or uncontrolled hypertension. Out of the 100 participants, there were 50 females and 50 males ranging from ages 18 to 75 years old. Each participant was randomly placed in either a music therapy group or a control group, which both received local anesthesia as part of standard care for a PCPP. The music therapy group listened to Turkish classical music from the time they entered the surgical room until the PCPP was completed. To measure pain, a visual analog scales (VAS), which measures pain from a 0 (no pain) to a 10 (maximal possible pain), was completed by each participant before and after the procedure.
Zengin et al. (2013) concluded that there was a statistically significant benefit of music therapy in reducing pain for the patients receiving a PCPP. The mean VAS score for the patients in the music therapy group was lower than that of the control group, with a P=0.004. One of the strengths of this study is the quasi-experimental design with randomization, which ranks a two on a level of evidence scale. This ranking is higher than any of the previously mentioned studies and is very reliable. Another strength of this study was the large number of participants and varied ages, which makes it applicable to more people. A weakness is that the study was conducted in a single hospital with only one type of music, therefore, it cannot be generalized to other hospitals or types of music.