THE EFFECTS OF MUSIC THERAPY | The Effects of Music Therapy on Palliative and Cancer Care

It is with careful consideration that the focus of this research was placed on the effects of music therapy with standard palliative, end-of-life and cancer treatment care in the clinical setting. There is a growing usage of alternative therapeutic interventions in the nursing profession, however; the clinical evidence to support the usage of this holistic based care is not conveyed in an organized manner to help encourage nurses to implement this type of alternative therapy into their everyday practise. The information collected from this research was to solely help other nurses in better understanding the practicality and benefits of implementing music therapy into cancer care and palliative care. In the article, The effectiveness of music in relieving pain in cancer patients: A randomized controlled trial, the authors, Good, Huang, and Zausniewski, conducted a random controlled trial that showed that the cancer patients in the experimental music group who only listened to thirty minutes of any music of their choice actually experienced a reduction of 37% sensation of pain and 44% less distress at the post test evaluation time as opposed to the control group who had no musical interventions implemented in their care and experienced higher rates of pain (2010). The main focus of this article is to evaluate the intervention effects of music therapy with standard palliative and cancer care on pain and psychological symptoms such as anxiety on clients.

The definition of palliative care according to Health Canada refers to providing optimal care for clients that are near death (Health Canada, 2009). The words palliative care is interchangeable with the words hospice care and end-of-life care; it is usually the service or provider that may slightly differ in situations.

The use of complementary therapies being used in adjunct with end-of-life, palliative, and hospice care has risen over the past decade as mentioned in the article, Complementary therapies for end-of-life care (Horowitz, 2009). Complementary therapies adjunct with conventional methods of client treatment were created to help clients attain and experience a higher quality of life and to transition into the last phases of life smoothly by incorporating holistic methods in their health care (Horowitz, 2009). Horowitz (2009) listed in the article that some of the more prevalent alternative treatments being used were massage therapy, music therapy, pet therapy, acupuncture. As well, it is important to note that in the article, Use of complementary and alternative medicine in head and neck cancer patients, the prevalence of complementary and alternative medicine can be quite common place in cancer care treatment especially cancers of the head and neck (Lim, C.M., Loh, K.S., & Ng, A., 2010).

Furthermore, music therapy is essentially a complementary alternative therapeutic intervention that is implemented by a credentialed music therapist with the collaboration of members of the health care team in order to promote better health outcomes for the individual client or group (Mahon, E. M. & Mahon, S. M., 2011). Music therapy covers a range of activities such as singing, playing an instrument, song-writing, and listening to music. This intervention has been used adjunct in different clinical nursing fields such as oncology, pediatric care, post-operative surgery, and in hospice, palliative, and at the end-of-life stage of care. Moreover, the integration of these alternative therapies coupled with traditional health care treatment has led to the reduction of pain and negative psychological symptoms in clients during their treatment of cancer or at the end of life.


Pain Prevention
Pain can be the one of the most debilitating symptoms in any disease. It can inhibit a person’s ability to cope with their illness and manifest into other damaging physiological and psychological symptoms. The researchers of the study, The effectiveness of music in relieving pain in cancer patients: A randomized controlled trial, found that by incorporating calming music with little to no lyrics such as hymns or folk music, the participants in the experimental group that underwent cancer treatment reported lower levels of distress and pain compared to the control group in their post-test results (Good, M., Huang, S., & Zauszniewski, J. A., 2010). Also, in the Cochrane review, Music therapy for end-of-life care, two studies were compiled together and the results were that the effects of live music were greater and more effective in reducing the pain of the participants than pre-recorded music (Whitehead, 2011). Adding on further, the researchers in this study noted that, the experimental group with the musical intervention reported declining pain after one music intervention (DeGolia, Gutgsell, Harris, Margevicius, McLaughlin, Schluchter, & Wiencek, 2013). As well, out of the seventeen health care providers that were interviewed in the qualitative study set in Tanzania, five of them said that just the mere distraction of music could help potentially alleviate their clients’ pain and only two out of seventeen would not use this as an intervention in their health practise (Hartwig, R., 2010). Music has proven to be a flexible, inexpensive tool in helping to alleviate the pain in clients undergoing stressful cancer treatments and those that were at the end of life stage.

Anxiety Prevention
There is a building amount of literature that supports the effects that music therapy has on decreasing the anxiety levels of clients that are receiving cancer treatments and palliative care. It is important to relieve the client of anxiety symptoms because it can conflict with the individual’s coping mechanisms related to their illness and could lead to destructive habits that may further disrupt their quality of life. In 2008, researchers, Horne-Thompsom and Grocke were able to measure the significant drop of anxiety in clients using the Edmonton Symptom Assessment System, after the experimental group in the study participated in just one musical group session. As well, a team of researchers made up of Fetzer, Hsieh, Hsu, Hsu, & Lin, (2011) conducted a sample size of ninety-eight clients and put these people into random groups, and one of the groups had standardized health care and music therapy being provided to them. That specific group had favourable decreased levels of anxiety amongst the individuals in that group. Other scholars such as Drury, Leow, and Poon conducted qualitative interviews in the study, A qualitative exploration of patients’ experiences of music therapy in an impatient hospice in Singapore, with a small sample size of five participants that all responded back with feedback that the music in their sessions helped to diminish their negative emotions and stress that were associated with their terminal illnesses at the end-of-life stage (2010). It is important that music serves as a tool to help participants in this type of program to feel more connected to themselves, to nature, in order to heal by mental or spiritual means (Ahmadi, 2013). Lastly, this type of therapy has helped to foster better communication, uplift the individual’s mood and reduce the anxiety levels in pediatric oncology patients as well. (Baron, Barry, Dun, O’Callaghan, &2011).

Implications
The authors of Multidisciplinary perspectives of music therapy in adult palliative care, O’kelly and Koffman examined the perspectives of clinicians such as doctors and nurses concerning the use of music therapy in the palliative setting (2007). The general consensus was that the music was able to create an environment that helped to relax the patients, helped to create verbal communication, and create satisfaction and fulfillment in the patients after sessions.

The nurses in this qualitative study also talked about their fear of going into lengths discussing the emotional aspect of this therapy. Although, all the health care professionals in this study felt that they were able to open up and provide better communication to their patients. This fear of
discussing feelings concerning death could lead nurses in the future of the practice to conduct workshops or set standards or best practice guidelines to help them to reflect on their own feelings concerning death and have better communication towards their patients. As well, there needs to be more nurse leaders willing to educate and incorporate more alternative medicine in their care in order to be able to properly implement these newly supported evidence-based practices.

In the article, Music Therapy and Health Benefits, Smith & Waugh (2009) elaborate that music therapy could be incorporated easily into more nursing areas such as pain management outpatient areas, hospice centres, rehabs, oncology units because of how safe, legal and cost effective intervention it is. As well, the writers go on to state there is room for collaboration between different musical therapy educations on an international level. This cross-communication of information is important for the development of this complementary therapy and strengthens the bonds between nursing organizations on a global scale.

It is important to patient care because music therapy focuses more on the wellness of the individual, so there would be more emphasis on the emotional, spiritual, and holistic side of nursing. These interventions could help relax clients, help them with symptoms of anxiety and pain and help them even come to terms with the emotions involving their diagnosis.

In conclusion, it is important for the nurse to have the knowledge and stay educated on the different complementary alternative medicines such as music therapy that may be used more in the future of the practice. It is important that the nurse continues to develop safe ways to enhance the quality and healing in the lives of their clients.

References
Ahmadi, F. (2013). Music as a method of coping with cancer: A qualitative study among cancer patients in sweden. Arts & Health, 5(2), 152-165. doi:10.1080/17533015.2013.780087
Baron, A., Barry, P., Dun, B., & O’Callaghan (2011). Music’s relevance for pediatric cancer patients: A constructivist and mosaic research approach. Supportive Care in Cancer, 19(6), 779-788. doi:10.1007/s00520-010-0879-9
Bengston, A., Hellstrom, A., Nilsson, S., & Thanh Nhan Nguyen. (2010). Music therapy to reduce pain and anxiety in children with cancer undergoing lumbar puncture: A randomized clinical trial. Journal of Pediatric Oncology Nursing, 27(3), 146-155. doi:10.1177/1043454209355983
DeGolia, P.A., Gutgsell, K.J., Harris, M., Margevicius, S., McLaughlin, B., Schluchter, M., & Wiencek, C. (2013).Music therapy reduces pain in palliative care patients: A randomized controlled trial. Journal of Pain and Symptom Management, 45(5), 822-831.
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Drury, V., Leow, Q., & Poon, W. (2010). A qualitative exploration of patients’ experiences of music therapy in an inpatient hospice in Singapore. International Journal Of Palliative Nursing, 16(7),

Fetzer, S., Hsieh, Y., Hsu, M., Hsu, Y., & Lin, M. (2011). A randomised controlled trial of the effect of music therapy and verbal relaxation on chemotherapy‐induced anxiety. Journal of Clinical Nursing, 20(7‐8), 988-999. doi:10.1111/j.1365-2702.2010.03525.x
Good, M., Huang, S., & Zauszniewski, J. A. (2010). The effectiveness of music in relieving pain in cancer patients: A randomized controlled trial. International Journal of Nursing Studies, 47(11), 1354-1362. doi:10.1016/j.ijnurstu.2010.03.008
Grock, D. & Horne-Thompson, A. (2008).The effect of music therapy on anxiety in patients who are terminally ill. Journal of Palliative Medicine, 11(4), 582-590. Doi:10.1089/jpm.2007.0193
Hartwig, R. (2010). Music therapy in the context of palliative care in Tanzania. International Journal Of Palliative Nursing, 16(10), 499-504.
Health Canada. 2009. Palliative and End-of-Life Care. Retrieved February 28th, 2014 from http://www.hc-sc.gc.ca/hcs-sss/palliat/index-eng.php.
Horowitz, S. (2009). Complementary therapies for end-of-life care. Alternative & Complementary Therapies, 15(5), 226-230.
Koffman, J. & O’kelly, J.(2007). Multidisciplinary perspectives of music therapy in adult palliative care. Palliative Medicine, 21(3), 235-241. doi:10.1177/0269216307077207
Lim, C.M., Loh, K.S. & Ng, A. (2010). Use of complementary and alternative medicine in head and neck cancer patients. The Journal of Laryngology & Otology, 124(5), 529-532.
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doi:10.1017/S0022215109992817
Mahon, E. M., & Mahon, S. M. (2011). Music therapy: A valuable adjunct in the oncology setting. Clinical Journal Of Oncology Nursing, 15(4), 353-356. doi:10.1188/11.CJON.353-356
Smith, D. & Waugh, S. (2009). Music therapy and health benefits. Kansas Nurse, 84(4), 3-5
Whitehead, P. (2011). Music therapy for end-of-life care. Clinical Journal of Oncology Nursing, 15(6) 697-698. doi: 10.1188/11. CJON.697-698