Abstract
Background:
A significant proportion of patients with leukemia experience anxiety disorders, which negatively affect their quality of life and sense of hope. Music therapy, a noninvasive and cost-effective treatment, may help regulate emotions, reduce anxiety, and alleviate pain.
Objective:
This study examined the effects of music therapy as an adjunct treatment on mood and hope levels in patients with leukemia and anxiety disorders.
Methods:
We analyzed 86 adult patients with leukemia and anxiety admitted between August 2023 and October 2024. Patients were divided into a standard treatment group (n = 43, the conventional treatment) and a music group (n = 43, the conventional treatment plus 12 music therapy sessions over 4 weeks, each lasting 60 min, based on mindfulness). General data, Medical Coping Modes Questionnaire (MCMQ, coping styles), Profile of Mood States (POMS, mood states), Herth Hope Index (HHI, hope levels), Hamilton Anxiety Rating Scale (HAMA, anxiety), World Health Organization Quality of Life Measurement Scale Brief Form (WHOQOL–BREF, quality of life), and Piper Fatigue Scale (PFS, fatigue) were compared at admission (T1) and 1 month later (T2).
Results:
At T1, no significant differences existed between the groups (P > 0.05). At T2, the music group showed reduced MCMQ avoidance/resignation scores (P < 0.05), increased POMS positive mood, diminished negative mood (P < 0.05), and elevated HHI scores (P < 0.05). Additionally, their HAMA, PFS, and WHOQOL-BREF scores improved significantly (P < 0.05).
Conclusion:
In this study, we found that self-reported levels of hope and mood improved in patients with leukemia and anxiety disorder following music therapy treatment. Further studies are needed to optimize treatment timing and methods to improve efficacy.
Keywords: music therapy, leukemia with anxiety disorder, hope level, mood state, adjunctive treatment
KEY MESSAGES
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(1)
Music therapy can alleviate the fatigue of patients with leukemia and anxiety disorders and enhance their treatment experience.
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(2)
Music therapy can enhance patients’ mood and their sense of hope.
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(3)
Music therapy can optimize patients’ coping strategies, thereby improving their quality of life.
INTRODUCTION
Leukemia represents a category of fatal malignant disorders affecting the blood and bone marrow. It is a collective term for several malignant diseases characterized by an increase in white blood cell counts in the blood and/or bone marrow. Among adolescents and young adults, acute leukemia is the most prevalent, whereas chronic myeloid leukemia is rarely encountered.[1,2] Leukemia, as a malignant hematological disease, has distinct characteristics in terms of its progression, treatment methods, and prognosis compared with solid tumors or other chronic diseases. This also leads to unique clinical manifestations of anxiety symptoms in patients with leukemia. Compared with patients with ordinary anxiety disorders or other forms of cancer, patients with leukemia and anxiety disorders show significant differences in disease experience, treatment-related side effects, psychological and social stress, and prognosis cognition. These factors jointly influence their unique psychological state and impose special requirements on treatment strategies.[3] The predominant treatment methods currently include radiotherapy, chemotherapy, and targeted immunotherapy. Patients often suffer from treatment-related side effects, including physical pain and fatigue, as well as psychological adverse effects such as anxiety, depression, and bipolar disorder. The side effects associated with these treatment methods are much more severe than those observed in most solid tumors. For instance, chemotherapy drugs (such as cytarabine and anthracycline drugs) not only induce severe bone marrow suppression and elevate the risk of infection but also have the potential to result in long-term complications such as neurotoxicity and cardiotoxicity.[4,5,6] By contrast, surgical procedures or localized radiotherapy for solid tumors (such as breast cancer and lung cancer) usually do not induce the same level of systemic effects.[7] This difference in treatment intensity makes patients with leukemia more prone to falling into a vicious cycle of “treatment pain–increased anxiety–weakened immune function.”[8] Furthermore, the treatment cycle for leukemia is usually extended and requires repeated hospitalizations. Patients remain in an uncertain state of “treatment–remission–recurrence” for an extended period.[9] By contrast, many solid tumors (such as early-stage breast cancer and thyroid cancer) may enter a relatively stable follow-up period after surgical removal, and the psychological burden experienced by these patients is relatively manageable. Given the high likelihood of leukemia recurrence, the anxiety experienced by patients is not a short-term stress response but rather a persistent chronic psychological burden.[10] Over the past few decades, research on psychological and behavioral processes related to health and disease has flourished, leading to significant progress in disease prevention, symptom management, and the promotion of healthy behaviors. Research has revealed a notable association between anxiety and physical health, with multiple studies demonstrating a strong link between anxiety disorders and overall physical well-being.[11,12,13] The percentage of patients with leukemia suffering from anxiety disorders ranges from 22% to 47%.[14] Anxiety disorders are a common and severe mental illness. Its global prevalence rate is estimated to be 7.3%.[15] The symptoms include worry (verbal–subjective), avoidance (obvious behavioral actions), and muscle tension (physical–visceral activities). Inappropriate treatment may lead to disability.[16,17] As a result of inadequate pain management and prohibitive treatment costs, patients’ quality of life and hope may significantly decrease. Therefore, some complementary treatments may need to be carried out in coordination to alleviate the patient’s pain. Cognitive behavioral therapy serves as the primary approach for managing anxiety disorders, but research indicates that 36% of patients with anxiety disorders do not respond to this form of therapy.[18] Throughout history, music has been used as a special medium to calm and relax the mind. Music therapy significantly modulates affective states by attenuating situational anxiety, subjective distress, and psychophysiological tension while augmenting positive affectivity, including hedonic tone and subjective well-being.[19,20] Music therapy has been systematically implemented as an evidence-based treatment across diverse healthcare contexts, including mental health services, forensic environments, long-term care facilities, rehabilitation centers, and oncology units.[21] It has been proven to effectively reduce anxiety during adult cancer treatment. This may occur through the promotion of distraction, mental imagery, a state of relaxation, and positive recollections.[22]
However, for patients with leukemia and anxiety, the related research on music therapy as an auxiliary treatment remains relatively limited, and its effect on improving the emotional state and level of hope of patients requires further exploration. To this end, this study aimed to systematically evaluate the clinical feasibility of music therapy in this group and analyze its potential impact on emotional state, hope levels, and treatment experience.
MATERIALS AND METHODS
Study Design
This study is a clinical retrospective analysis aimed at evaluating the effect of music therapy on the emotional status and hope levels of adult patients with leukemia and anxiety. A total of 100 patients with long-term leukemia and anxiety were included from the First Affiliated Hospital of Soochow University from August 2023 to October 2024. Among them, five patients did not agree to participate in this study; three patients had Hamilton Anxiety Rating Scale (HAMA) scores below 7, suggesting the absence of anxiety and leading to their exclusion; and one patient had a score over 29, indicating a severe anxiety tendency and was therefore excluded. The reasons for excluding patients with severe scores were as follows: Music therapy is highly effective for mild to moderate anxiety (HAMA score 14–28) but has limited effect on severe anxiety [based on the following reasons: (1) Patients with severe anxiety disorders require pharmacological treatment. (2) Music therapy is strongly suitable for patients with mild to moderate anxiety. (3) Patients with severe anxiety disorders are excluded to avoid poor compliance or delayed treatment.[23] (4) The anxiety experienced by patients with leukemia is primarily associated with treatment-related stress (such as fear of chemotherapy), rather than with primary anxiety disorders.] The proportion of severe anxiety (HAMA >29) is usually below 10%, and after exclusion, the representativeness of the target population can still be preserved. Two patients with a history of severe alcohol dependence were excluded; one patient had other mental disorders, and was excluded; colorectal adenocarcinoma was diagnosed in one patient, who was excluded; and invasive ductal carcinoma of the breast was diagnosed in one patient, who was excluded. A total of 86 patients were included in the analysis. They were assigned to the standard treatment group (N = 43) and the music therapy group (N = 43) according to the actual clinical protocols received. The study design process is shown in Figure 1. The research has received approval from the Ethics Committee of the First Affiliated Hospital of Soochow University (approval number: 2024-475).
Figure 1.
Research flowchart.
Inclusion and Exclusion Criteria
The inclusion criteria were as follows[24,25]: (1) The patient maintained complete case records. (2) The patient was diagnosed with leukemia (acute myeloid leukemia, acute lymphoblastic leukemia, chronic myelogenous leukemia, and chronic lymphocytic leukemia). (3) The patients’ ages ranged from 18 to 65 years old. (4) Patients have received an initial diagnosis and are currently in the induction remission and consolidation treatment stages. (5) All participants (patients and designated family representatives) voluntarily signed informed consent documents after full protocol briefing. (6) Patients were capable of normal communication.
The exclusion criteria were as follows[25,26]: (1) patients with other concurrent mental disorders, (2) patients with hearing impairments, (3) patients who did not agree to undergo music therapy, (4) patients with a HAMA score below 7 or above 29, (5) patients with other malignant diseases, (6) patients whose treatment was interrupted, (7) patients with a history of alcohol dependence, and (8) patients with poor compliance.
Treatment Group
Grouping
In a retrospective analysis of the included cohort, all patients received routine perioperative treatment in line with current treatment guidelines. The patients were naturally divided into two groups according to the treatment actually received in the electronic medical record:
1. Standard treatment group: Patients in this group received standard treatment procedures, including access to the ward environment, healthcare staff, and relevant regulations, with the exclusion of music-based interventions. Treatment included health education, question-and-answer sessions, and communication aimed at reassuring patients. The medical practice strictly followed established clinical practice:
Standard of treatment: Clinicians customize individual drug regimens, dosages, and treatment cycles based on the patient’s specific circumstances and tolerability, adhering to international guidelines for chemotherapy. Treatment options included specific agents, adjuvant chemotherapy, and symptom-modifying agents, selected on the basis of patients’ pathological characteristics and genetic testing results, with ongoing monitoring and adjustments for adverse drug reactions.
Supportive treatment: This includes nutritional support to improve quality of life and function (developing scientific diets, supplementing nutrients), psychological support (reducing anxiety and fear), and pain management (using pharmacological and nonpharmacological methods for pain control).
2. Music group: In addition to receiving usual care, this group was also provided with music therapy. The medical environment in which patients lived was characterized by a rational layout of wards and treatment areas and by ventilation, temperature, and humidity conditions that met the standards of the medical environment. The lighting system adopts a combination of soft natural light and adjustable artificial lighting to meet the needs of daily medical operations and avoid excessive light stimulation. In terms of hardware configuration, the wards and treatment areas are equipped with complete diagnostic and treatment equipment, such as vital signs monitors, ventilators, and electrocardiogram machines, to ensure their continuous and stable operation and to provide a reliable guarantee for diagnosis, treatment, and monitoring.
3. The standard treatment plan for patients in the standard treatment group included regular recreational activities, as follows: In terms of book resources, a small reading corner was set up in the ward to provide different types of books, including literary classics, inspirational books, and popular science books, which greatly enhanced the patients’ interest in reading, relaxation, and emotional well-being. In terms of game activities, patients are encouraged to interact with their peers for entertainment to promote social communication and create a relaxed and pleasant atmosphere.
Daily Operation of Treatment
In daily nursing, the nursing work is carried on strictly according to the standard operating procedure. The nursing staff provides regular basic treatment to the patient, including cleaning the body, changing bed linens, helping patients turn over, closely observing the patient’s condition, accurately recording vital signs data, and reporting abnormal conditions to the doctor in a timely manner to ensure comprehensive treatment. Explicit exclusion criteria: all prohibited include listening to recorded music of any type (pop, classical, light), singing, watching music videos, and engaging in interactive games with rhythm or melody. Research assistants and ward nurses have undergone specialized training, so the activity environment (e.g., the common lounge area) is not affected by background music.
Implementation and monitoring: each activity is conducted by a professional assistant, so the level of engagement and social interaction with the research team can be assured. Activities are recorded in activity logs.
Personalized Music Therapy Regimen
1. In this retrospective study, patients in each music group were administered a personalized music therapy program. Before the treatment, the staff was composed of the attending physician, the consulting specialist, and the music therapist. They matched the music to the patient through a comprehensive, multidimensional assessment. On the one hand, the patients’ psychological state was quantitatively assessed using standardized psychological scales [Profile of Mood States (POMS)], and their music preference information was systematically collected. The results were compared with those of the control group, including the patient’s preferred music genre (e.g., classical, popular, and folk), their favored singer or band, the thematic content of their preferred music (e.g., nature, love, and inspiration), and the type of music they preferred; the possible influence of their educational level on music comprehension was also considered.[27] In practical applications, among patients with a higher level of education and a preference for classical music, the selected songs included Bach’s Goldberg Variations and Beethoven’s Piano Sonata No. 14. Moreover, four movements by Vivaldi were incorporated. For patients who prefer pop music, songs that feature soothing lyrics and are appropriately aligned with the patients’ age group are likely to evoke a resonant response. On the other hand, the choice of music is closely related to the specific disease characteristics of patients. For insomniacs, alpha-wave music with a frequency similar to the brain’s relaxed state is preferred to modulate neural excitability; for pain-sensitive patients, specific music with analgesic cues is preferred to relieve physical and psychological discomfort.[28]
2. 3-D music therapy education system: Data showed that patients in the music group began receiving music therapy–related education about 1 week before their first chemotherapy session. The education system adopted a model of “the combination of online and offline learning” and “the combination of theory and practice.” In the offline part, popular lectures were organized by medical staff with qualifications in music therapy. The lectures provided a comprehensive explanation of the scientific mechanisms underlying music therapy, utilizing PowerPoint presentations and clinical research literature. For example, they explained how sound waves from music can resonate with cells in the body, modulate the endocrine system, and enhance the understanding of the effects of music therapy. Additionally, they highlighted how music therapy stimulates the production of neurotransmitters such as dopamine and endorphins, thereby improving emotional and physical well-being. The lectures also illustrated the potential role of chemotherapy in alleviating side effects and improving quality of life through a comparison of clinical cases. The hospital has also established a dedicated music laboratory for patients to experience the physical and mental effects of different musical genres, and invited music therapists to perform live instruments to enhance patients’ intuitive understanding. Patients who experienced positive outcomes from music therapy were invited to share their experiences, describe their methods of managing chemotherapy-related discomfort, and describe how music helped them adjust their mindset. Their testimonials can alleviate the doubts of new patients, bolster their confidence in treatment, and encourage adherence to follow-up appointments.
3. Immersive music therapy and internal imagery guidance: During the initial month of chemotherapy, patients in the music group received 60-min dedicated music therapy three times a week. The actual environment and procedure of the treatment were as follows. The treatment was carried out in a separate soundproof room equipped with professional audio equipment. The environment was decorated with soothing scents such as greenery, lavender, and sandalwood. The lighting was relatively dim, and the ambiance was warm and quiet. During each session, the music therapist dynamically adjusted the order and volume of music played based on the patient’s physical and mental state for the day. During music playing, the therapist guided the patient through mental imagery exercises to facilitate deep relaxation. In addition to visualizing common natural landscapes, the patient’s personal experiences (such as childhood anecdotes or travel memories) were recorded. The content of the guides was derived from these experiences, and imagery scenes were customized, creating a visual representation of the landscape. This approach was employed to assist the patient in establishing a positive psychological connection between music and imagination. At the end of each session, patients were given 10 to 15 minutes to share their feelings and thoughts. Based on this feedback, the music therapist subsequently adjusted the follow-up treatment regimen.
Observation Indicators
Baseline Data
1. At the time of admission, personal characteristics of the patients, including age, sex, education level, type of leukemia, and other basic information, were collected from electronic records. To comprehensively assess the psychosocial factors that may influence efficacy, we collected the following information: family support variables: primary caregiver role (such as spouse, parent, child, or caregiver) and whether the patient is an only child; socioeconomic variables: household monthly income class (e.g., <5000 yuan, 5000–10,000 yuan, and >10,000 yuan). For treatment-related variables, patients’ music preference types (such as classical, popular, ethnic, and natural soundscape) were assessed before treatment as the main basis for developing personalized programs.
2. Data obtained during the patient’s treatment were collected for research purposes. This study gathered test data on coping style, psychological state, hope level, anxiety, quality of life, and fatigue in patients at the time of admission (T1) and 1 month after admission (T2).
3. Assessment of coping styles: The Medical Coping Modes Questionnaire (MCMQ) quantified patient coping strategies across three domains: confrontation, avoidance, and submission.[29] MCMQ consisted of 20 items, which were divided into three dimensions: confrontation (8 items), avoidance (7 items), and acceptance (5 items). Among the 20 items, the scores of 12 items ranged from 1 (never) to 4 (often), whereas the scores of the 8 other items were reversed from 1 (often) to 4 (never). The Cronbach’s coefficients for this scale were 0.69, 0.60, and 0.76 for confrontation, avoidance, and acceptance, respectively.[30] Elevated confrontation scores indicated proactive disease management through the pursuit of treatment information and participation in rehabilitation, whereas reduced avoidance/submission scores reflected a reduction in passive resignation tendencies.
4. Assessment of mood states: The patient’s state of mind was quantitatively assessed using the POMS questionnaire.[31] The questionnaire covered six core dimensions: energy, tension–anxiety, depression–frustration, anger–hostility, fatigue, and confusion–loss. A 5-point Likert scale (0 = “Not at all” to 4 = “Very strong”) was used. The score for each dimension was calculated by aggregating the adjective scores associated with that dimension. The highest original scores were 24, 28, 20, 24, 24, and 20, whereas the lowest score was 0. Through a comprehensive analysis of the scores of these six dimensions, we evaluated the influence of nursing optimization on patients’ psychological state in a comprehensive and precise manner. The Cronbach’s coefficients were as follows: depression = 0.90; tension–anxiety = 0.89; anger–hostility = 0.89; fatigue = 0.91; confusion–loss = 0.88; and energy = 0.90.[32]
5. Assessment of hope level: The Herth Hope Index (HHI) was used to systematically assess patients’ hope levels before and after the nursing intervention.[33,34] Its Cronbach’s coefficient was 0.82.[35] The scale had a total of 12 items, and it was scored with a 4-point Likert scale (1 = strongly disagree, 4 = strongly agree), with a total score range of 12 to 48 points. Higher scores reflected a higher level of hope and a more optimistic expectation regarding the patients’ future life.
6. Anxiety assessment: The HAMA is a widely utilized professional tool in clinical and research settings to assess patients’ anxiety levels.[36,37] The scale consisted of 14 items, covering multiple dimensions such as anxious state, nervousness, fear, and insomnia. The scale was scientifically validated for high measurement reliability, with a Cronbach’s alpha coefficient of 0.890.[38] In the scoring system, the scale adopted a five-level scoring standard of 0 to 4 points, with each item assigned a score based on the severity of the symptoms. The total possible score for the scale was 56 points. Higher scores indicate greater severity of patient anxiety.
7. Quality of life assessment: The World Health Organization Quality of Life Measurement Scale Brief Form (WHOQOL–BREF) was used to assess the effect of treatment optimization on patients’ quality of life.[39,40] This scale had an overall α = 0.833; for each dimension, it ranged from 0.762 to 0.812.[41] The scale consisted of 26 items, divided into four dimensions: physical, environmental, psychological, and social. It utilized a 5-point rating system ranging from 1 to 5. The higher the scores of each dimension and the total score, the better the subjective evaluation of patients’ quality of life and the more significant the effect of treatment optimization.[42]
8. Fatigue score: The Piper Fatigue Scale (PFS) was used to assess the multidimensional aspects of fatigue (including emotional, cognitive, behavioral, and somatosensory fatigue) in patients with cancer.[43,44] Its Cronbach’s coefficient was 0.89.[45] The PFS contained four core dimensions: emotional fatigue, cognitive fatigue, behavioral fatigue, and sensory fatigue. The severity of symptoms was assessed for each entry on a scale of 0 to 10 (0 = no effect, 10 = extreme effect), with a total score ranging from 0 to 40; higher scores signify greater fatigue severity.[43]
Sample Size Calculation
Sample sizes were determined based on the study by Meixia et al. (SMD=−0.73) and were further refined through a power analysis performed using G*Power 3.1.9.7 computer software to determine the sample sizes required to detect statistically significant differences.[46] A t-test was employed, with a type I error probability (α) set at 0.05 and an efficacy (1 − β) of 0.9 to calculate a required sample size of 41 patients per group. A total of 100 potential subjects were screened for eligibility, and 86 patients were finally included in the analysis. The sample size in this study was deemed sufficient to yield reliable conclusions.
Statistical Analysis
The collected experimental data were analyzed using SPSS 25.0 (IBM, Armonk, NY, USA). The Shapiro–Wilk test was initially applied to determine whether or not the scores followed a normal distribution for continuous baseline variables, such as age, MCMQ, POMS, HHI, HAMA, WHOQOL–BREF, and PFS. A t-test was used to analyze the data. For categorical variables in the patient baseline information, the χ2 test was selected based on the characteristics of the analyzed data, and the results are presented as “number of cases (percentage), that is, n (%).” The results of MCMQ, POMS, HHI, HAMA, WHOQOL–BREF, and PFS showed normal distribution and were expressed as mean ± standard deviation x̄±s). Although no statistically significant difference was observed in the baseline scores between the groups, a group analysis of all outcome indicators was conducted using covariance analysis with the baseline score as a covariate to enhance the statistical test’s power and achieve an accurate estimation of the treatment effect. The prerequisite conditions for the applicability of the analysis of covariance model (such as linearity and homogeneity of slope) have all been tested and satisfied. The independent samples t-test was used to compare the differences between groups. All statistical tests were conducted in a bidirectional manner. Statistical significance was set at P < 0.05, indicating a significant difference between the groups.
RESULTS
Baseline Information Comparison
From August 2023 to October 2024, this study initially enrolled 86 adult patients with leukemia and anxiety disorder who were admitted to the hospital. Compared with the general data of the standard treatment group, no apparent differences were observed in gender, age, education level, disease type, treatment giver role, only child status, music preference type, or family monthly income in the music group (P > 0.05), as shown in Table 1. This result indicated that the basic information of the patients did not contain systematic errors that might affect the outcomes.
Table 1.
Baseline Information for the Observation and Standard Treatment Groups (x̄±s).
| Baseline Information | Standard Treatment Group (n = 43) | Music Group (n = 43) | t/χ2 | P | |
|---|---|---|---|---|---|
| Age (years) | 40.95 ± 10.69 | 41.58 ± 10.82 | −0.271 | 0.787 | |
| Gender (n, %) | Male | 25 (58.14) | 26 (60.47) | 0.480 | 0.826 |
| Female | 18 (41.86) | 17 (39.53) | |||
| Type of disease | AML | 33 (76.74) | 35 (79.07) | 0.372 | 0.946 |
| ALL | 2 (4.65) | 2 (4.65) | |||
| CML | 5 (11.63) | 4 (9.30) | |||
| CLL | 3 (6.98) | 2 (4.65) | |||
| Educational attainment | Primary and below | 6 (13.95) | 3 (9.30) | 0.470 | 0.791 |
| Junior high school | 28 (65.12) | 29 (67.44) | |||
| High school and above | 9 (20.93) | 10 (23.25) | |||
| One child | Yes | 10 (23.26) | 11 (25.58) | 0.063 | 0.802 |
| No | 33 (76.74) | 32 (74.72) | |||
| Treatment giver | Father and mother | 10 (23.26) | 11 (25.58) | 0.894 | 0.640 |
| Children | 15 (34.88) | 11 (25.58) | |||
| Other relatives | 18 (41.86) | 21 (48.84) | |||
| Monthly household income (¥) | ≤1000 | 2 (4.65) | 2 (4.65) | 0.350 | 0.950 |
| 1001–4000 | 8 (18.60) | 6 (13.95) | |||
| 4001–10,000 | 21 (48.84) | 22 (51.26) | |||
| ≥10001 | 12 (27.90) | 13 (30.23) | |||
| Musical preference | Classical music | 16 (37.20) | 15 (34.88) | 0.072 | 0.965 |
| Popular music | 12 (27.91) | 13 (30.23) | |||
| Folk song | 15 (34.88) | 15 (34.88) | |||
| BMI (kg/m2) | 23.81 ± 3.42 | 24.08 ± 3.62 | −0.355 | 0.723 |
ALL = acute lymphoblastic leukemia, AML = acute myeloid leukemia, BMI = body mass index, CLL = chronic lymphocytic leukemia, CML = chronic myeloid leukemia
Comparison of Anxiety Level Scores
Analysis of the Hamilton Anxiety Scale scores at T1 and T2 revealed that, at T1, the total anxiety scores for the two groups of patients exceeded 29 points, indicating severe anxiety. We found no significant difference between the two groups (P > 0.05). At T2, after 1 month of music therapy, the total anxiety score of the music group was significantly lower than that of the standard treatment group (P < 0.05), suggesting that the anxiety levels of the music group were significantly reduced after a 1-month course of music therapy [Table 2].
Table 2.
Comparison of Anxiety Levels in the Two Groups (x̄±s, Score).
| Groups | Mental Anxiety | Physiological Snxiety | Anxiety Total Score | |||
|---|---|---|---|---|---|---|
|
|
|
|
||||
| Prenursing | After Treatment | Prenursing | After Treatment | Prenursing | After Treatment | |
| Standard treatment group (n = 43) | 10.45 ± 2.71 | 10.83 ± 2.61 | 18.92 ± 1.51 | 17.26 ± 1.85* | 29.37 ± 1.98 | 28.09 ± 1.92* |
| Music group (n = 43) | 10.38 ± 2.51 | 5.43 ± 1.94* | 18.86 ± 1.65 | 15.19 ± 1.26* | 29.24 ± 1.62 | 20.63 ± 1.45* |
| F | 32.031 | 36.285 | 274.289 | |||
| ηP 2 | 0.547 | 0.304 | 0.768 | |||
| P | <0.001 | <0.001 | <0.001 | |||
Compared with before nursing in the same group, * P < 0.05.
Comparison of Coping Modes Scores
Compared with the standard treatment group, no significant differences were observed in the scores of coping, avoidance, and submission before the nursing intervention (P > 0.05). However, after the nursing treatment, the coping styles of the music group exhibited increased positivity. The coping score was significantly elevated (P < 0.05), whereas the scores of avoidance and submission decreased (P < 0.05). Thus, after a 1-month treatment with music therapy, the patients in the music group adopted a positive attitude toward the treatment, as shown in Table 3.
Table 3.
Scores of Coping Styles for the Two Groups (x̄±s, Score).
| Groups | Face Coping | Avoidance Coping | Yield Coping | |||
|---|---|---|---|---|---|---|
|
|
|
|
||||
| Prenursing | After Treatment | Prenursing | After Treatment | Prenursing | After Treatment | |
| Standard treatment group (n = 43) | 15.28 ± 2.57 | 15.68 ± 2.78 | 17.95 ± 1.87 | 14.28 ± 2.06* | 12.74 ± 2.27 | 11.28 ± 2.17* |
| Music group (n = 43) | 14.91 ± 2.46 | 18.64 ± 1.53* | 17.68 ± 1.65 | 11.38 ± 2.15* | 11.96 ± 2.35 | 9.62 ± 1.53* |
| F | 36.703 | 39.571 | 19.132 | |||
| ηP 2 | 0.307 | 0.323 | 0.187 | |||
| P | <0.001 | <0.001 | <0.001 | |||
Compared with before nursing in the same group, * P < 0.05.
Comparison of Mood State Scores
Compared with the standard treatment group, at T1 before the nursing intervention, we found no significant difference in the positive and negative mood scores of the music group (P > 0.05). However, at T2 after the nursing session ended, the positive mood score in the mood state of the music group was significantly elevated (P < 0.05), and the negative score significantly decreased (P < 0.05). After a 1-month course of music therapy, the patients in the music group experienced reduced effects from negative emotions. Moreover, it demonstrated that music therapy effectively contributed to mood regulation and the alleviation of negative emotions, as shown in Table 4.
Table 4.
Comparison of Mood State Scores Before and After Music Therapy between the Two Groups (x̄±s, Score).
| Groups | Positive Mood Score | Negative Mood Score | ||
|---|---|---|---|---|
|
|
|
|||
| Pretreatment | After Treatment | Pretreatment | After Treatment | |
| Standard treatment group (n = 43) | 11.93 ± 1.52 | 15.88 ± 1.29* | 20.16 ± 2.29 | 15.85 ± 1.69* |
| Music group (n = 43) | 11.68 ± 1.56 | 16.95 ± 1.67* | 20.53 ± 2.45 | 11.65 ± 2.89* |
| F | 11.408 | 74.124 | ||
| ηP 2 | 0.121 | 0.472 | ||
| P | 0.001 | <0.001 | ||
Compared with before nursing in the same group, * P < 0.05.
Comparison of Fatigue Severity Scores
Compared with the standard treatment group, no significant differences were observed in the scores of emotional, cognitive, behavioral, and somatic sensory fatigue before the nursing treatment at T1 (P > 0.05). However, at T2 after the nursing treatment, the scores of emotional, cognitive, behavioral, and somatic sensory fatigue in the music group significantly decreased (P < 0.05). This indicated that after a 1-month treatment course of music therapy, the fatigue levels of the patients in the music group decreased, as shown in Table 5.
Table 5.
Comparison of Fatigue Scores Before and After Music Therapy in Two Groups of Patients (x̄±s, Score).
| Groups | Standard Treatment Group (n = 43) | Music Group (n = 43) | F | ηP2 | P | |
|---|---|---|---|---|---|---|
| Behavioral fatigue | Pretreatment | 5.24 ± 1.46 | 5.19 ± 1.42 | |||
| After treatment | 4.68 ± 1.37 | 2.83 ± 1.65* | 31.726 | 0.277 | <0.001 | |
| Cognitive fatigue | Pretreatment | 4.16 ± 1.37 | 4.24 ± 1.13 | |||
| After treatment | 3.98 ± 1.01 | 2.41 ± 1.28* | 39.033 | 0.320 | <0.001 | |
| Emotional fatigue | Pretreatment | 5.58 ± 1.42 | 5.52 ± 1.39 | |||
| After treatment | 4.28 ± 1.35* | 2.23 ± 1.26* | 52.341 | 0.387 | <0.001 | |
| Sensory fatigue | Pretreatment | 4.69 ± 1.68 | 4.62 ± 1.25 | |||
| After treatment | 4.53 ± 1.35 | 2.68 ± 1.47* | 36.711 | 0.307 | <0.001 | |
| PFS total score | Pretreatment | 4.92 ± 0.70 | 4.89 ± 0.70 | |||
| After treatment | 4.37 ± 0.67* | 2.54 ± 0.82* | 126.655 | 0.604 | <0.001 | |
Compared with before nursing in the same group, * P < 0.05; PFS = Piper Fatigue Scale
Comparison of the Hope Level Score Level
After music therapy treatment, the hope level scores were evaluated. We found no significant difference in each item of the hope score between the standard treatment group and the music group before the music therapy (P > 0.05). After the nursing intervention, the music group showed significantly higher scores in positive attitude, positive behavior, intimate relationship, and total hope score (P < 0.05) than the standard treatment group. Thus, after 1 month of music therapy, patients’ hope levels were significantly improved, enabling them to approach the treatment with a positive and optimistic attitude [Table 6].
Table 6.
Comparison of Hope Level Scores Before and After Music Therapy Nursing in the Two Groups (x̄±s, Score).
| Groups | Standard Treatment Group (n = 43) | Music Group (n = 43) | F | ηP2 | P | |
|---|---|---|---|---|---|---|
| Positive attitude | Prenursing | 12.21 ± 2.56 | 11.97 ± 2.35 | |||
| After treatment | 12.64 ± 2.82 | 15.68 ± 2.49* | 27.486 | 0.249 | <0.001 | |
| Positive behavior | Pretreatment | 12.85 ± 2.46 | 12.82 ± 2.31 | |||
| After treatment | 12.95 ± 2.26 | 15.24 ± 2.35* | 21.138 | 0.203 | <0.001 | |
| Intimacy | Pretreatment | 11.67 ± 1.95 | 11.65 ± 1.95 | |||
| After treatment | 13.56 ± 3.56* | 16.98 ± 4.52* | 15.017 | 0.153 | <0.001 | |
| HHI total score | Pretreatment | 36.72 ± 4.15 | 36.44 ± 4.17 | |||
| After treatment | 39.15 ± 4.16 | 47.90 ± 6.46* | 56.783 | 0.406 | <0.001 |
Compared with before nursing in the same group, * indicates P < 0.05; HHI = Herth Hope Index
Comparison of the Quality of Life Scores
The quality of life scores of the control group and the music group before and after music therapy were analyzed and compared. At T1 (before the nursing), we found no significant differences in the physiological domain, environmental domain, psychological domain, and social domain of the quality of life and the total score of WHOQOL–BREF (P > 0.05). However, at T2 (after the nursing), the scores for each index in the quality of life assessment form showed significant increases (P < 0.05), as shown in Table 7.
Table 7.
Comparison of Quality of Life before and after Music Therapy in the Two Groups (x̄±s, Score).
| Indicators | Standard Treatment Group (n = 43) | Music Group (n = 43) | F | ηP2 | P | |
|---|---|---|---|---|---|---|
| Biological field | Pretreatment | 10.27± 1.82 | 10.18 ± 2.01 | |||
| After treatment | 11.25 ± 1.69 | 14.92 ± 1.63* | 93.176 | 0.529 | <0.001 | |
| Environmental field | Pretreatment | 10.12 ± 1.55 | 10.08 ± 1.74 | |||
| After treatment | 12.48 ± 2.32* | 16.85 ± 1.93* | 83.028 | 0.500 | <0.001 | |
| Psychological field | Pretreatment | 11.25 ± 1.65 | 11.16 ± 1.49 | |||
| After treatment | 13.58 ± 2.64* | 16.27 ± 2.28* | 25.897 | 0.238 | <0.001 | |
| Social domain | Pretreatment | 11.72 ± 2.68 | 11.61 ± 1.67 | |||
| After treatment | 13.46 ± 2.29 | 17.69 ± 1.85* | 11.840 | 0.574 | <0.001 | |
| WHOQOL–BREF total score | Pretreatment | 43.67 ± 3.68 | 43.04 ± 3.26 | |||
| After treatment | 50.77 ± 4.03* | 65.74 ± 4.07* | 291.230 | 0.778 | <0.001 | |
Compared with before nursing in the same group, * P < 0.05; WHOQOL–BREF = World Health Organization Quality of Life Measurement Scale Brief Form
DISCUSSION
In this study, a combination of active treatment and receptive treatment was adopted. The patient’s preferences and moods were comprehensively understood, and personalized music therapy plans were formulated. Music treatment was administered 1 month after admission. Results showed that music therapy significantly improved treatment-related side effects in patients with leukemia and anxiety disorders, notably reducing fatigue and anxiety levels. These findings were aligned with previous studies: Miladinia et al.[47] reported a decrease in fatigue from 7.29 to 5.45 after 4 weeks of music therapy, whereas Burns et al.[48] observed a reduction in anxiety scores (average 48 vs. 23, P = 0.02, n = 18) in adults with acute leukemia post-treatment. However, the effects on quality of life, coping strategies, mood states, and hope levels in anxious patients with leukemia remain underexplored. Evidence from similar conditions supports such benefits. For instance, Lima et al.[49] found elevated WHOQOL-BREF scores among patients with breast cancer receiving music treatment (15.9 ± 1.7 vs. 14.3 ± 2.2). Chen and Lin[50] noted that music therapy improves medical coping modes questionnaire (MCQC)scores in hemodialysis patients (16.00–23.00), reduces avoidance (19.00–14.00), and improves yield scores (16.00–7.00). Similarly, Ratcliff et al.[51] reported reduced POMS scores after music therapy in stem cell transplant patients (15.31–8.59 at 1 week and to 5.70 at 1 month). Accordingly, this study assessed the WHOQOL–BREF, MCQC, POMS, and HHI scores. After 1 month of music therapy, anxious patients with leukemia demonstrated significantly elevated WHOQOL–BREF scores (65.74 ± 4.07 vs. 50.77 ± 4.03), improved MCQC scores (facing: 18.64 ± 1.53 vs. 15.68± 2.78; avoidance: 11.38 ± 2.15 vs. 14.28 ± 2.06; yielding: 9.62 ± 1.53 vs. 11.28 ± 2.17), enhanced POMS scores (positive mood: 16.95 ± 1.67 vs. 15.88 ± 1.29; negative mood: 11.65 ± 2.89 vs. 15.85 ± 1.69) and increased HHI scores (47.90 ± 6.46 vs. 39.15 ± 4.16). These outcomes indicate that, similar to other disease contexts, music therapy enhances quality of life, promotes positive coping strategies and mood states, and increases hope levels in anxious patients with leukemia after 1 month of treatment. As a low-cost adjuvant treatment, music therapy holds significant positive implications for primary patient treatment. Addressing patients’ physical and mental health can facilitate effective treatment and improve prognosis, warranting further in-depth exploration of music therapy. Previous literature demonstrated that music can alleviate physical, psychological, and cognitive problems and reduce the suffering of patients who are undergoing agonizing and distressing treatments.[52,53] The therapeutic effect is most significant when music therapy sessions last for 30 to 60 min each time.[54] When implementing personalized music therapy programs, the music therapist adjusts the music in direct response to the patient’s needs. As an auxiliary treatment method for patients with leukemia and anxiety, this approach facilitates the optimal efficacy of music therapy. The results of this study suggested that family caregivers may use a dual-pathway model of “empowerment-buffering” to improve the mental resilience of adult patients with cancer. From the perspective of psychology, music, as a non-verbal communication medium, constructs a safe“Emotional container” for patients with anxiety disorders. In this process, the patients were able to project the underlying suppressed fear into the music to complete the emotional catharsis and release, which also became the internal motivation for the significant decrease of the negative mood score In the mood state profile. With the reduction of emotional burden, patients gain the mental space to carry out cognitive reconstruction, gradually get rid of the cognitive bias that regards the disease as an uncontrollable threat, thereby reducing the coping tendency of avoidance and submission, and improving the quality of life, instead, they adopt more positive coping strategies. It is this progressive process of“Emotional release-cognitive reconstruction” that ultimately leads to the overall improvement of hope reconstruction of patients’ psychological resilience.
The results of this study revealed a remarkable phenomenon: as shown in Tables 2, 3, 5, and 6, patients in the standard treatment group also showed statistically significant in-group improvements across multiple measures during the follow-up period (T1 to T2/T3). These results suggested that some natural recovery or adaptive changes may occur in the psychosocial status of elderly patients with cancer in the conventional nursing setting. Therefore, we propose the following possible explanations. Natural course and rehabilitation effect: After the completion of acute antitumor therapy, some patients gradually recover their physical function, and the side effects of treatment diminish, leading to a natural improvement in their emotional and psychological well-being. This represents a common occurrence in the process of rehabilitation. Nonspecific support for routine treatment: The routine treatment provided to the control group included basic medical interventions, health education, and visits by social workers. Such nonspecific social support may exert a beneficial influence on patients. Study participation effect: As a study participant, receiving regular evaluations and attention (known as the Hawthorne effect) may yield positive psychological implications for patients, prompting them to be mindful of their own condition. However, the primary finding of this study was that the improvement was significantly greater in the music group than in the standard treatment group, reaching a statistically significant level of “group × time” interaction. This strongly indicated that the structured treatment giver empowerment intervention employed in this study not only accelerated the natural recovery process but also offered an active and systematic psychosocial support mechanism beyond routine nursing care. For example, core themes such as “emotional anchoring” and “goal scaffolding” revealed by qualitative research represent precisely the targeted and empowering therapeutic elements that are lacking in the standard treatment group. Thus, improvements within the standard treatment group do not detract from the core conclusions of this study but confirm the general importance of addressing the psychosocial needs of patients during cancer rehabilitation. Simultaneously, the difference in progress between the two groups highlights the unique effectiveness of systematic, family-centered treatment approaches in optimizing rehabilitation outcomes and providing additional benefits.
However, further experimental research is needed to compare the weekly frequency and specific time of music therapy and determine its optimal auxiliary treatment effect. In addition, this study did not include a qualitative follow-up, and the duration of the patients’ feelings after the treatment remains uncertain. Moreover, this study was conducted in a single center and a single hematology outpatient department; therefore, further research should be conducted at different centers. This study has several methodological limitations that need to be clarified. Firstly, given the unique nature of the treatment method, the study did not employ blinded assessment, and the assessors were aware of the patient subgroups, which might introduce measurement bias. Secondly, in the design of the music treatment program, although a standardized framework for musical genres was established, the selection of musical pieces was allowed within a certain range to accommodate individual patient preferences. This combination of music genres may influence the consistency of the treatment effect. Furthermore, the study did not establish an active standard treatment group (such as ordinary relaxation training), relying solely on conventional nursing as a control, thereby making it difficult to completely eliminate the nonspecific placebo effect. Additionally, the assessment tools primarily depended on patient self-assessment scales, lacking the supplementation of observer assessment, which could be affected by social approval bias. Fourthly, the retrospective nature of the analysis method presents certain limitations and potential unmeasured confounders. This study aimed to describe and explain the mechanisms by which home-based interventions influence overall mental resilience, using a mixed approach rather than accurately quantifying the individual effect of a single variable. Therefore, repeated measures analysis of variance was used as the primary quantitative analysis to examine the interaction effect of “group × time.” Multivariate regression models were not used to adjust for all potential covariates. Finally, the physical environment where the patients were located during the treatment (such as the noise level in the ward) was neither standardized nor controlled. All these factors might impose certain limitations in the interpretation of the research results. Future research is recommended to adopt highly rigorous experimental designs, such as adding a standard treatment group for sham treatment, standardizing the music treatment program, and implementing assessor blinding, to improve the reliability of the research conclusions.
CONCLUSION
Based on the test results of the standard treatment group and the music group after the nursing process in this study, significant differences were observed in the MCMQ, POMS, HHI, HAMA, WHOQOL–BREF, and PFS scores between the two groups. Thus, music not only alleviated the anxiety and fatigue levels of patients with leukemia and anxiety during treatment but also improved their coping mechanisms, mood states, hope levels, and overall quality of life.
Availability of data and materials
The data supporting the findings of this study can be obtained from the corresponding author upon request.
Author contributions
QingWen Gu: Developed and planned the study, performed experiments, and interpreted results. Edited and refined the manuscript with a focus on critical intellectual contributions.
Yan Wang: Participated in collecting, assessing, and interpreting the date. Made significant contributions to date interpretation and manuscript preparation.
WenJiao Huang, Tao Chen: Provided substantial intellectual input during the drafting and revision of the manuscript.
Ethics approval and consent to participate
This study has been approved by the Ethics Committee of the First Affiliated Hospital of Soochow University (No. 2024-475). We secured a signed informed consent form from every participant.
Conflicts of interest
The authors declare that they have no financial conflicts of interest.
Acknowledgment
None.
Funding Statement
None.
REFERENCES
- 1.Wu Z, Lyu T, Wu L, Yang H, Li W. The role of SIRT1 in leukemia. Curr Treat Options Oncol. 2024;25:1283–8. doi: 10.1007/s11864-024-01265-6. [DOI] [PubMed] [Google Scholar]
- 2.Pelcovits A, Niroula R. Acute myeloid leukemia: a review. R I Med J (2013) 2020;103:38–40. [PubMed] [Google Scholar]
- 3.El-Jawahri A, LeBlanc TW, Kavanaugh A, et al. Effectiveness of integrated palliative and oncology care for patients with acute myeloid leukemia. JAMA Oncol. 2021;7:1–9. doi: 10.1001/jamaoncol.2020.6343. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Lopes LM, Nucci M, Portugal RD. Toxicity and outcome of adults with acute myeloid leukemia receiving consolidation with high-dose cytarabine. Hematol Transfus Cell Ther. 2024;46:397–401. doi: 10.1016/j.htct.2023.07.007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Liu JC, Wang D, Callen E, et al. Mechanism of cytarabine-induced neurotoxicity. Nature. 2025;643:1400–9. doi: 10.1038/s41586-025-09210-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Camilli M, Cipolla CM, Dent S, Minotti G, Cardinale DM. Anthracycline cardiotoxicity in adult cancer patients. JACC CardioOncol. 2024;6:655–77. doi: 10.1016/j.jaccao.2024.07.016. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Mahumud RA, Shahjalal Md, Dahal PK, Mosharaf MdP, Hoque ME, Wawryk O. Systemic therapy and radiotherapy related complications and subsequent hospitalisation rates: a systematic review. BMC Cancer. 2024;24:826. doi: 10.1186/s12885-024-12560-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Antikainen E, Grönroos M, Huurre A, et al. Treatment intensity affects immune reconstitution even after childhood cancer not treated with hematopoietic stem cell transplantation. Cancer Rep. 2024;7:e2069. doi: 10.1002/cnr2.2069. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Goyal NG, Maddocks KJ, Johnson AJ, Byrd JC, Westbrook TD, Andersen BL. Cancer-specific stress and trajectories of psychological and physical functioning in patients with relapsed/refractory chronic lymphocytic leukemia. Ann Behav Med. 2018;52:287–98. doi: 10.1093/abm/kax004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Yin B, Liu X, Mao Y, Han Y. Effect of psychological intervention on the quality of life and mental health of leukemia patients: a meta-analysis. Front Psychol. 2025;16:1528512. doi: 10.3389/fpsyg.2025.1528512. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Roy-Byrne P, Stein MB, Russo J, et al. Medical illness and response to treatment in primary care panic disorder. Gen Hosp Psychiatry. 2005;27:237–43. doi: 10.1016/j.genhosppsych.2005.03.007. [DOI] [PubMed] [Google Scholar]
- 12.Mendoza LSM, Trujillo-Güiza M, Forero DA, Baez S. Health, psychosocial and cognitive factors associated with anxiety symptoms. Curr Psychol. 2024;43:22376–88. [Google Scholar]
- 13.Cariello AN, Perrin PB, Williams CD, et al. Moderating influence of enculturation on the relations between minority stressors and physical health via anxiety in Latinx immigrants. Cultur Divers Ethnic Minor Psychol. 2020;26:356–66. doi: 10.1037/cdp0000308. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Andersen L, McHugh M, Ulrich CM, Meghani SH, Deng J. A systematic review of coping skill interventions to reduce anxiety and depressive symptoms among adults with hematologic malignancies. Eur J Oncol Nurs. 2022;61:102224. doi: 10.1016/j.ejon.2022.102224. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Baxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med. 2013;43:897–910. doi: 10.1017/S003329171200147X. [DOI] [PubMed] [Google Scholar]
- 16.Maron E, Nutt D. Biological markers of generalized anxiety disorder. Dialogues Clin Neurosci. 2017;19:147–58. doi: 10.31887/DCNS.2017.19.2/dnutt. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Craske MG, Rauch SL, Ursano R, Prenoveau J, Pine DS, Zinbarg RE. What is an anxiety disorder? Depress Anxiety. 2009;26:1066–85. doi: 10.1002/da.20633. [DOI] [PubMed] [Google Scholar]
- 18.Lu G, Jia R, Liang D, Yu J, Wu Z, Chen C. Effects of music therapy on anxiety: a meta-analysis of randomized controlled trials. Psychiatry Res. 2021;304:114137. doi: 10.1016/j.psychres.2021.114137. [DOI] [PubMed] [Google Scholar]
- 19.Jäncke L., Music memory and emotion. J Biol. 2008;7:21. doi: 10.1186/jbiol82. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Iskender M, Akin A. Self-compassion and internet addiction. Turk Online J Educ Technol. 2011;10:215–21. [Google Scholar]
- 21.Fancourt D, Geschke K, Fellgiebel A, Wuttke-Linnemann A. Lifetime musical training and cognitive performance in a memory clinic population: a cross-sectional study. Music Sci. 2022;26:71–83. doi: 10.1177/1029864920918636. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Bradt J, Dileo C, Myers-Coffman K, Biondo J. Music interventions for improving psychological and physical outcomes in people with cancer. Cochrane Database Syst Rev. 2021;10:CD006911. doi: 10.1002/14651858.CD006911.pub4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Jiang X, Gao J, Zheng Y. Effectiveness of traditional Chinese medicine music therapy on anxiety and depression emotions of lung cancer patients: a protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021;100:e25040. doi: 10.1097/MD.0000000000025040. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Yanada M, Naoe T. Acute myeloid leukemia in older adults. Int J Hematol. 2012;96:186–93. doi: 10.1007/s12185-012-1137-3. [DOI] [PubMed] [Google Scholar]
- 25.Knoerl R, Mazzola E, Woods H, et al. Exploring the feasibility of a mindfulness-music therapy intervention to improve anxiety and stress in adolescents and young adults with cancer. J Pain Symptom Manage. 2022;63:e357–63. doi: 10.1016/j.jpainsymman.2021.11.013. [DOI] [PubMed] [Google Scholar]
- 26.Meza V, Arnold J, Díaz LA, et al. Alcohol consumption: medical implications, the liver and beyond. Alcohol. 2022;57:283–91. doi: 10.1093/alcalc/agac013. [DOI] [PubMed] [Google Scholar]
- 27.Clements-Cortés A. Music therapy assessment for older adults: descriptive mixed-methods study. Behav Sci (Basel. 2024;14:354. doi: 10.3390/bs14050354. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Lassner A, Siafis S, Wiese E, et al. Evidence for music therapy and music medicine in psychiatry: transdiagnostic meta-review of meta-analyses. BJPsych Open. 2025;11:e4. doi: 10.1192/bjo.2024.826. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Shen XH, Jiang QJ. Test reports of medical coping styles in Chinese [in Chinese] Chinese J Behav Med. 2000;9:18–20. [Google Scholar]
- 30.Li X, He L, Wang J, Wang M. Illness uncertainty, social support, and coping mode in hospitalized patients with systemic lupus erythematosus in a hospital in Shaanxi. China. PLoS One. 2019;14:e0211313. doi: 10.1371/journal.pone.0211313. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Pollock V, Cho DW, Reker D, Volavka J. Profile of Mood States: the factors and their physiological correlates. J Nerv Ment Dis. 1979;167:612. doi: 10.1097/00005053-197910000-00004. [DOI] [PubMed] [Google Scholar]
- 32.Cáceres-Diego B, Alcaraz PE, Marín-Pagán C, Cáceres-Diego B, Alcaraz PE. Neuromuscular and psychological performance monitoring during one season in Spanish marine corps. J Funct Morphol Kinesiol. 2025;10:324. doi: 10.3390/jfmk10030324. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Herth K. Abbreviated instrument to measure hope: development and psychometric evaluation. J Adv Nurs. 1992;17:1251–9. doi: 10.1111/j.1365-2648.1992.tb01843.x. [DOI] [PubMed] [Google Scholar]
- 34.Chu Y, Zhang Y, Wang S, Dai H. Resilience mediates the influence of hope, optimism, social support, and stress on anxiety severity among Chinese patients with cervical spondylosis. Front Psychiatry. 2022;13:997541. doi: 10.3389/fpsyt.2022.997541. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Liu M, Liu Y, Li T, Yang J, Wang J, Wang H. Association between social participation and hope levels in stroke patients: a cross-sectional study. Front Psychol. 2025;16:1674893. doi: 10.3389/fpsyg.2025.1674893. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32:50–5. doi: 10.1111/j.2044-8341.1959.tb00467.x. [DOI] [PubMed] [Google Scholar]
- 37.Zhou Y, Li Z, Wang Y, et al. Prevalence and clinical correlates of psychotic depression in first-episode and drug-naïve outpatients with major depressive disorder in a Chinese Han population. J Affect Disord. 2020;263:500–6. doi: 10.1016/j.jad.2019.10.051. [DOI] [PubMed] [Google Scholar]
- 38.Ruan Y, Lin H, Lu X, et al. Application and value of anxiety and depression scale in patients with functional dyspepsia. BMC Psychol. 2024;12:244. doi: 10.1186/s40359-024-01744-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 39.Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL group. Psychol Med. 1998;28:551–8. doi: 10.1017/s0033291798006667. [DOI] [PubMed] [Google Scholar]
- 40.Chang FS, Zhang Q, Xie HX, et al. Preliminary validation study of the WHO quality of life (WHOQOL) scales for people with spinal cord injury in mainland China. J Spinal Cord Med. 2022;45:710–19. doi: 10.1080/10790268.2020.1847563. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 41.Liu Y, Luo X, Ru X, Wen C, Ding N, Zhang J. Impact of a multimodal health education combined with teach-back method on self-management in hemodialysis patients: a randomized controlled trial. Medicine (Baltimore) 2024;103:e39971. doi: 10.1097/MD.0000000000039971. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42.Kalfoss MH, Reidunsdatter RJ, Klöckner CA, Nilsen M. Validation of the WHOQOL-bref: psychometric properties and normative data for the Norwegian general population. Health Qual Life Outcomes. 2021;19:13. doi: 10.1186/s12955-020-01656-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 43.Piper BF, Dibble SL, Dodd MJ, Weiss MC, Slaughter RE, Paul SM. The revised Piper Fatigue Scale: psychometric evaluation in women with breast cancer. Oncol Nurs Forum. 1998;25:677–84. [PubMed] [Google Scholar]
- 44.Liang Y, Wang S, Tao J, Yao Z, Yao Y, Zhai J. Effects of lifestyle intervention by a nurse-led app on the prevention of symptoms in postpartum women: a randomized controlled trial. BMC Nurs. 2025;24:829. doi: 10.1186/s12912-025-03379-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 45.Demir OB, Yilmaz FT. The effect of posture regulation training on musculoskeletal disorders, fatigue level and job performance in intensive care nurses. BMC Nurs. 2024;23:778. doi: 10.1186/s12912-024-02387-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 46.Xiao M, Gong C, Mai M, et al. Efficacy and safety of music therapy for the treatment of anxiety and delirium in ICU patients: a meta-analysis and systematic review of randomized controlled trials. Minerva Anestesiol. 2024;90:439–51. doi: 10.23736/S0375-9393.24.17900-X. [DOI] [PubMed] [Google Scholar]
- 47.Miladinia M, Voss Joachim G, Molavynejad S, et al. Slow-stroke back massage compared with music therapy for leukemia-related pain and fatigue: a randomized controlled trial. JCO Oncol Pract. 2021;17:e1614–21. doi: 10.1200/OP.21.00156. [DOI] [PubMed] [Google Scholar]
- 48.Burns DS, Azzouz F, Sledge R, et al. Music imagery for adults with acute leukemia in protective environments: a feasibility study. Support Care Cancer. 2008;16:507–13. doi: 10.1007/s00520-007-0330-z. [DOI] [PubMed] [Google Scholar]
- 49.Lima TU, Moura ECR, de Olivera CMB, et al. Impact of a music intervention on quality of life in breast cancer patients undergoing chemotherapy: a randomized clinical trial. Integr Cancer Ther. 2020;19:1534735420938430. doi: 10.1177/1534735420938430. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 50.Chen P, Lin D. Solution-focused group counseling on mental states in hemodialysis patients with anxiety. Actas Esp Psiquiatr. 2024;52:122–9. doi: 10.62641/aep.v52i2.1562. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 51.Ratcliff CG, Prinsloo S, Richardson M, et al. Music therapy for patients who have undergone hematopoietic stem cell transplant. Evid-based Complement Altern Med. 2014;2014:742941. doi: 10.1155/2014/742941. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 52.Särkämö T. Music for the ageing brain: cognitive, emotional, social, and neural benefits of musical leisure activities in stroke and dementia. Dement (Lond Engl) 2018;17:670–85. doi: 10.1177/1471301217729237. [DOI] [PubMed] [Google Scholar]
- 53.Gassner L, Geretsegger M, Mayer-Ferbas J. Effectiveness of music therapy for autism spectrum disorder, dementia, depression, insomnia and schizophrenia: update of systematic reviews. Eur J Public Health. 2022;32:27–34. doi: 10.1093/eurpub/ckab042. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 54.Lee HY, Nam ES, Chai GJ, Kim DM. Benefits of music intervention on anxiety, pain, and physiologic response in adults undergoing surgery: a systematic review and meta-analysis. Asian Nurs Res. 2023;17:138–49. doi: 10.1016/j.anr.2023.05.002. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data supporting the findings of this study can be obtained from the corresponding author upon request.