Music therapy in supportive cancer care

Abstract

The purpose of this paper is to show some aspects of music therapy application in cancer care and to present the integration of music therapy program into a continuous supportive cancer care for inpatients. A cancer diagnosis is one of the most feared and serious life events that causes stress in individuals and families. Cancer disrupts social, physical and emotional well-being and results in a range of emotions, including anger, fear, sadness, guilt, embarrassment and shame. Music therapy is a part of a complementary medicine program in supportive cancer care which accompanies medical treatment. There are many benefits of music therapy for cancer patients—interactive music therapy techniques (instrumental improvisation, singing) as well as receptive music therapy techniques (listening to recorded or live music, music and imaginary) can be used to improve mood, decrease stress, pain, anxiety level and enhance relaxation. Music therapy is an effective form of supporting cancer care for patients during the treatment process. It may be also basic for planning effective programs of rehabilitation to promote wellness, improve physical and emotional well-being and the quality of life.

A cancer diagnosis is one of the most feared and serious life events that causes stress in individuals and families. Cancer disrupts social, physical and emotional well-being and results in a range of negative emotions, including anger, fear, sadness, guilt, embarrassment and shame. Commonly experienced by cancer patients are also fear of death and disease recurrence, the problems related to long and short-term effects of treatment, changes in personal relationships and economic issues. A cancer experience has radical consequences and is an existential challenge to the patient and their family, as well as to the caring staff. The development of modern cancer care has brought openness to new trends of integration and holistic thinking.^1–3 The idea that patients with cancer my benefit from musical expression and musical experiences has been supported by music therapy research. Music therapy not only helps patients cope with their negative emotions. It can also be used to benefit patients in a complex way as music is the most fundamental and unique form of art that affects people spiritually, emotionally, socially and physically.^4,5

Music therapy may be defined in various ways, however, the purpose of it does not change. The main idea of practicing music therapy is to benefit from therapeutic aspects of music. According to the American Music Therapy Association “Music Therapy uses music to address physical, emotional, cognitive, and social needs of patients of all ages and abilities. Music therapy interventions can be designed to promote wellness, manage stress, alleviate pain, express feelings, enhance memory, improve communication, and promote physical rehabilitation.”⁶ Music has nonverbal, creative, structural, and emotional qualities, which are used in the therapeutic relationship to facilitate contact, interaction, self-awareness, learning, self-expression, communication, and personal development.⁷Music therapy in oncology uses music in preventive, curative and palliative cancer care and is very helpful to a wide variety of patients who suffer from a large range of neoplasms. While music therapy does not actually affect the disease itself, it has a great impact on the their mood, and sometimes can make a difference in the way the patient copes with and feels about their disease. The effectiveness of music therapy for oncology patients has been documented in numerous descriptive and experimental studies. A number of publications have described the specific benefits of music therapy interventions. Music therapy in cancer care focuses on both physiological and psychological needs arising from the disease as well as from side-effects of cancer treatment.^8,9 Many studies presented in the literature indicate that music therapy is introduced primarily to relieve symptoms such as anxiety and pain,^10–12 side effects of chemo^13–15 and radiation therapy.^16–19 Other aspects affected by music include relaxation,^20,21 mood disturbances and the quality of life.^21–23

Music therapy is a growing discipline and includes diverse practices and models used worldwide. In developed countries, music therapy in cancer care is an emerging field. According to the survey of United States music therapists by Kruse, the majority of music therapists work in oncology, which reflects the importance of music therapy. Cancer care is a relatively new field for music therapists in the United Kingdom, with a majority of them having traditionally worked within the field of psychiatry, learning disabilities, general medicine, and neurology.²⁴ In Poland, there are not many music therapists working in medical settings. Bringing music into a hospital environment was and still is a big challenge, because music therapy is not commonly used especially in oncology treatment programs in Poland. The Greater Poland Cancer Centre in Poznan offered the first music therapy program to its patients in 2007 and employed a qualified music therapist. Music therapy is a part of the complementary program in supportive cancer care that accompanies medical treatment. While some types of cancer are best addressed with a single type of treatment, others are treated through a combination of surgery, chemotherapy and/or radiation therapy. The music therapy program is applied to meet patients’ needs during diagnosis and treatment and is practiced with both individual patients and patient groups. Music therapy is mainly used to promote relaxation, reduce anxiety and stress; relieve discomfort; reduce patients’ experience of pain; and offset some of treatment related symptoms. Music therapy offers opportunities for self-expression and brings positive experiences.

Music therapy is divided into two categories—active (interactive) and receptive (passive). In the active form of patients are musically engaged and encouraged to create or describe their experiences with music. Receptive forms of music therapy involve the patient simply listening to either live or recorded music.²⁵ The patients have a chance to experience several music therapy interventions. Techniques are selected from a variety of options based on patients’ needs, expressed preferences and music therapist's assessment. They include listening to the live or recorded music, instrumental improvisation, relaxation techniques with music, movement with music.

Listening to music has many beneficial effects on cancer patients. Listening to music as a passive/receptive form of therapy can be easily introduced into clinical situation. Patients receiving chemotherapy often experience harsh side effects, such us nausea, difficulty in breathing, and many flu-like symptoms. Patients receiving radiotherapy often experience anxiety, fear, stress, or sense of loneliness. Listening to recorded music while receiving those forms of treatment can help take patients’ minds away from the discomfort caused by the treatment and help them cope with high levels of stress, fear and loneliness. Patients and their families also have an opportunity to participate in live music concerts. Live music can be used to create a mood of peace, relaxation, to improve the level of comfort, express feelings and emotions.

Music therapists and patients often participate in spontaneous playing the instruments. Improvisation can improve communication and self-expression. Playing the instruments can facilitate a sense of control, as patients play an active role in creating the sounds and in setting the rhythm and mood.

Music therapy cancer treatment program also consists of relaxation techniques with music (progressive muscle relaxation, imagery techniques). Relaxation techniques ease side effects for cancer patients in treatment. Learning how to relax as they undergo a variety of hard-to-tolerate cancer treatments helps them cope with symptoms such as tension, anxiety, depression, nausea and pain.

“Music and movement therapy”, a breast cancer music therapy supportive group is a therapeutic program for women after breast surgery, lymph nodes dissection, lymphoedema, based on music and movement. This program helps breast cancer survivors regain a range of motion, boost energy, heal and thrive, both physically and emotionally, increase feelings of grace and femininity. Participation in a group music therapy brings people out of isolation, creates powerful social and emotional bonds and generates an overall good feeling. Movement (spontaneous or rhythmical) with music is a therapeutic tool that creates positive thinking and feeling of wellness.

According to Preti and Welch, the musical experience within a hospital setting embraces a few main features.²⁶ One of the prime intentions behind the provision of music in hospital is to use its sonic features to elicit particular emotional responses, such us calm, excitement, alleviation, cheerfulness. Another important issue is the interconnection between psycho-acoustic phenomena and emotional responses related to the communication and evocation of emotions through music and the effects this process has on different people involved. Sonic features can also deflect attention from clinical experiences by the use of slow or fast tempo, changing pitches and familiar timbres. Many studies recognise the effect of music on a number of variables concerning people as they are admitted to hospital. In a hospital setting, especially in an oncology ward, communication of emotions involves quite a number of additional variables, including the presence of pain, fear of dying, stress coming from long hospitalisation, as well as changes in family dynamics. Other physical or physiological impacts of music are those concerning the physical, physiological and psychological condition of a human, and how these effects improve hospitalisation. The therapeutic role of music involves different ways or techniques of playing with music at hospital and their use for different hospital situations. Most of the definitions of music therapy stress the importance of the relationship between patient and therapist within a therapeutic context.²⁷ This implies a professional and systematic use of music and the acceptance of the institutional role of a music therapist in medical staff. A significant, social aspect of music therapy is that it facilitates interpersonal processes, such as interaction and verbalisation. One of the most important functions of music at hospital is to help patients to verbalise their hospital experience in order to cope with it better, minimising the effect of hospitalisation. Music in this context can be successfully employed to support social interaction between people involved in musical activity. Participating in music therapy facilitates an increased sense of community, of belonging to a group. Music also offers possibilities for collaboration and interaction between the patient's family and medical staff, while giving insight into different cultures or different social backgrounds.

Experience of cancer generates a number of physical, emotional, social and existential needs. Music can address many of them by offering a wide range of benefits. Music therapy in cancer care focuses on needs of patients arising from the experience of disease, as well as from side effects of treatment. A wide variety of music therapy activities can take place in cancer care setting. Music therapy as a receptive and active intervention can be used to relieve stress and fear of hospitalisation hospital and the unfamiliarity of the hospital environment. Music therapy is an effective method of supporting cancer care for patients at various stages of the disease and is practiced with individual patients as well as patient groups. It can be also included for planning programs of treatment and rehabilitation to promote wellness, improve physical and emotional well-being and the quality of life.

Conflict of interest statement

None declared.