The study investigated the effects of a 15-minute music intervention on reducing pre-radiotherapy anxiety in 200 oncology patients. Patients were randomly assigned to either a music group, which received 15 minutes of music therapy before radiation treatment, or a control group, which received 15 minutes of rest. Both groups showed significant decreases in state and trait anxiety scores from before to after the intervention. However, the decreases were significantly greater in the music group compared to the control group. The music group also saw a significantly greater decrease in systolic blood pressure compared to the control group. The study concluded that music therapy effectively decreased levels of state anxiety, trait anxiety, and systolic blood pressure in oncology patients before radiotherapy treatment.

1. European Journal of Oncology Nursing 17 (2013) 436e441
Contents lists available at SciVerse ScienceDirect
European Journal of Oncology Nursing
journal homepage: www.elsevier.com/locate/ejon
Fifteen-minute music intervention reduces pre-radiotherapy anxiety
in oncology patients
Lee-Chen Chen a, Tze-Fang Wang b, *, Yi-Nuo Shih c, Le- Jung Wu d
a
Department of Nursing, Far Eastern Memorial Hospital, Taipei, Taiwan
School of Nursing, National Yang Ming University, No. 155, Section 2, Li-Nong St, Beu-Tou District, Taipei 112, Taiwan
c
Department of Occupational Therapy, College of Medicine, Fu Jen Catholic University, Xinzhuang City, Taipei County, Taiwan
d
Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei, Taiwan
b
a b s t r a c t
Keywords:
Anxiety
Music therapy
Oncology
Radiotherapy
State-Trait Anxiety Inventory
Purpose: Oncology patients may respond to radiation treatment with anxiety expressed as stress, fear,
depression, and frustration. This study aimed to investigate effects of music intervention on reducing
pre-radiotherapy anxiety in oncology patients.
Methods: Quasi-experimental study with purposeful sampling was conducted in the Department of
Radiation Oncology, at Far Eastern Memorial Hospital, Taipei, Taiwan. Subjects were assigned into
a music group (n ¼ 100) receiving 15 min of music therapy prior to radiation and a control group
(n ¼ 100) receiving 15 min rest prior to radiation. Both groups were evaluated for pre- and post-test
anxiety using the State-Trait Anxiety Inventory. Physiological indicators of anxiety were measured
pre- and post-test.
Results: Baseline State/Trait scores and vital signs were comparable between groups (P > 0.05). Mean
change in pre- and post-test State/Trait scores showed significant decreases from baseline to post-test in
both groups (all P < 0.05). A statistically significant difference was observed between music therapy and
control groups in mean change of State anxiety scores (mean decreases 7.19 and 1.04, respectively;
P < 0.001) and Trait anxiety scores (mean decreases 2.77 and 1.13, respectively; P ¼ 0.036). In vital signs,
both groups had significant decreases in pre- and post-test heart rate and respiration rate (P < 0.05).
A statistically significant difference in mean change of systolic pressure was found between music and
control groups (À5.69 Æ 0.41 mmHg vs. À0.67 Æ 1.29 mmHg, respectively; P ¼ 0.009).
Conclusions: Music therapy decreased State anxiety levels, Trait anxiety levels and systolic blood pressure
in oncology patients who received the intervention prior to radiotherapy.
Ó 2012 Elsevier Ltd. All rights reserved.
Introduction
Oncology patients often respond to their cancer diagnosis and
treatment, including chemotherapy (Lin et al., 2011) and radiation
(Chaturvedi et al., 1996; Clark et al., 2006), with emotional symptoms such as anxiety, depression and stress, as well as fear, frustration, loneliness and feelings of loss of control (Magill, 2006).
Music therapy is an evidence-based complementary therapy
commonly used in integrative oncology treatment programs
(Magill, 2006; Hilliard, 2006). Music therapy has been applied
successfully in various clinical settings to help reduce anxiety.
Music has improved mood and decreased anxiety and pain associated with surgery, medical procedures, and chronic conditions, as
* Corresponding author. Tel.: þ886 2 28267907; fax: þ886 2 28262487.
E-mail address: fang@ym.edu.tw (T.-F. Wang).
1462-3889/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ejon.2012.11.002
well as helping to improve quality of life during end-of-life care
(Kemper and Danhauer, 2005). In integrative oncology, music
therapy has been introduced to treat multiple symptoms such as
pain, mood disturbances, and communication issues; besides
ameliorating pain and anxiety symptoms, it specifically reduced
effects of noxious stimuli and enhanced mood and overall feelings
of comfort and sense of control (Magill, 2006). Music therapy has
also effectively reduced chemotherapy-induced anxiety (Bulfone
et al., 2009; Ferrer, 2007; Lin et al., 2011). Acknowledging the
high level of fear and anxiety that may be present before and during
radiation treatments, Smith et al. (2001) suggested that modifying
the treatment environment is one way to address the psychological
well-being of patients with cancer, and further suggested that
music therapy was an effective therapeutic intervention to
moderate treatment-related anxiety (Smith et al., 2001). Music
therapy significantly reduced anxiety, current distress and weekly
distress in response to radiotherapy (Clark et al., 2006). Introducing

2. L.-C. Chen et al. / European Journal of Oncology Nursing 17 (2013) 436e441
music therapy into a pediatric radiotherapy waiting area reduced
patients’ anxiety and stress as well as that of family members and
staff involved in their healthcare program (O’Callaghan et al., 2007).
In a mixed-methods analysis, measured effects of a computerbased music CD created by pediatric oncology patients undergoing initial radiotherapy revealed that 67% of children receiving
standard care used social withdrawal as a coping mechanism for
treatment-related distress but no children in the music therapy
group withdrew socially (Barry et al., 2010).
Although both quantitative results (Smith et al., 2001; Clark
et al., 2006) and qualitative outcomes (O’Callaghan et al., 2007) of
music therapy were promising in terms of reducing anxiety and
stress for patients receiving radiation treatments, the music
therapy procedures described in these previous studies were
diverse. The timing of receiving music therapy in relationship to
radiation was also not consistent with the various methods in
previous studies. O’Callaghan offered music therapy when the
patients were waiting for medical consultations and radiotherapy
treatments, Smith’s group allowed the patients to listen to the
music during their radiation therapy simulation appointment and
also during their daily radiation treatments, and Clark’s group
directed the music therapist to instruct participants to listen to the
music at any time during the course of therapy.
We hypothesized that music therapy received in the Radiology
waiting room may be able to reduce anxiety and improve anxietyrelated physiological parameters in oncology patients prior to
undergoing radiotherapy. Therefore, we aimed to evaluate the
physiological (e.g., blood pressure) and psychological effects (e.g.,
anxiety) of a single music intervention delivered to patients prior to
a single radiation treatment.
Patients and methods
Design
A quasi-experimental study was conducted. Pre- and post-test
data were collected from a purposeful sample between April 1,
2011 and October 31, 2011 at the Department of Radiation,
Oncology, at Far Eastern Memorial Hospital, Taipei, Taiwan. The
internal review board of the hospital reviewed the study protocol
and approved the study.
437
Main outcome measures
Primary outcomes
Scores from the self-reported State-Trait Anxiety Inventory
(Speilberger et al., 1983) were the primary outcome measures
applied in the experimental and control groups.
Secondary outcomes
Blood pressure, heart rate, respiratory rate, and fingertip oxygen
saturation (determined from peripheral circulation) were
measured in experimental and control groups using a Philips
SureSignsÒ VM6 patient monitor (Philips Medical Systems, Inc.,
Cleveland, OH, USA).
State-Trait Anxiety Inventory (STAI)
The State-Trait Anxiety Inventory (STAI) (Speilberger et al., 1983)
is a self-reported questionnaire, Form Y, which is divided into two
sections of 20 statements each based on two categories of anxiety:
State anxiety (S-Anxiety) or Trait anxiety (T-Anxiety). State-Anxiety
refers to the subjective and transitory feeling of tension, nervousness, and worry experienced at a given time. Trait-Anxiety refers to
a relatively general experience of anxiety as the individual’s
tendency to perceive and respond to stressful situations with
increased intensity (Speilberger et al., 1983). Form Y, which replaces
the pre-1983 STAI Form X (Spielberger et al., 1970) clearly differentiates temporary State anxiety from the more general and longstanding Trait anxiety in measuring anxiety in adults. Each of the
40 statements has four possible responses: The STAI is languageappropriate for individuals with at least a sixth grade reading
level. The median Cronbach’s alpha reliability coefficients for the
State and Trait scales (Form Y) are 0.92 and 0.90, respectively. Item
remainder correlation coefficients for both scales (Form Y) have
consistently been above 0.90 (Tluczek et al., 2009). A Chinese
version of the STAI was developed and tested on junior high school
students (Chung and Long, 1984). It had a test-retest reliability of
0.74 (n ¼ 259) and 0.76 (n ¼ 256) for STAI-state (S-anxiety) and
STAI-trait (T-anxiety), respectively. In another validation study of
the Chinese version of STAI among 737 and 725 junior high school
students, Cronbach’s alpha for S-Anxiety and T-Anxiety were 0.86
(n ¼ 737) and 0.90 (n ¼ 725), respectively.
Procedure of musical intervention
Participants
Patients who were scheduled to receive a treatment protocol of
radiation therapy lasting about 5 weeks or more and who were at
least 18 years old, were purposefully sampled by physicians from the
Radiation Oncology Department of Far Eastern Memorial Hospital,
Taipei, Taiwan, and were then referred to our research team and
invited to participate in this study. Inclusion criteria were: patients
with sufficient literacy to respond to a written questionnaire.
Patients with prior diagnosis of anxiety or psychological disorder,
those receiving anti-anxiety or anti-depressant medications, or
those with hearing deficit were excluded. A total of 209 patients who
met the inclusion criteria were enrolled. Nine of these patients
withdrew at the early stage for reasons of severe clinical condition or
personal reasons, and 200 patients were retained for analysis. No
data were collected from the Radiation Oncology Department
regarding chemotherapy or surgical treatment that patients may
have received before radiotherapy. The 200 patients were randomly
assigned by simple random sampling (every other patient) into two
groups, a music therapy group (n ¼ 100) and a control group
(n ¼ 100). After the study was explained thoroughly for each group
(separately since instructions were different) by a research assistant,
all included participants provided signed informed consent.
The intervention was conducted by two investigators from our
research team, one a clinical practitioner and the other a psychological testing professional, who measured patients’ physiological
conditions (blood pressure, heart rate, respiratory rate, and blood
oxygen concentration) and conducted the State-Trait Anxiety
Inventory test, respectively. Patients decided individually on which
day of their radiation treatment schedules their music intervention
should be conducted. Patients were asked to fill out the personal
information form (demographics) and the State-Trait Anxiety
Inventory Form Y with two scales prior to receiving the first
measurement of physiological conditions. Then patients were
instructed to sit comfortably on a couch in the radiology waiting
room and to wear headphones and listen to slow-paced, soft,
melodic music at low volume with consistent tempo and dynamics
and an average 60e80 beats per minute. Subjects chose their own
favorite music tracks from a selection of old songs in Mandarin,
Mandarin pop, traditional Taiwanese songs, Western music
(country and western), and classical music (e.g., chamber music
with string instruments). Patients were able to adjust the volume
and then listen to 15 min of music. Researchers again measured
patients’ physiological conditions, and asked the patient to fill out
the STAI anxiety scales once again. For the control group,

3. 438
L.-C. Chen et al. / European Journal of Oncology Nursing 17 (2013) 436e441
researchers followed the same procedure as above but without
providing music therapy. Instead patients were instructed to sit
comfortably on the radiology waiting room couch (a separate room
from the music therapy group but similar facility) and to rest for
15 min. These participants were not aware if they were in the
intervention or control group until after the 15-min rest period in
which they may have anticipated receiving music but did not; i.e.,
they were blinded to the assignment, thereby avoiding Hawthorne
effect. Measurement of patients’ physiological conditions and the
STAI test were both done before and after a 15-min rest period.
Power consideration
Based on G*Power 2 software, an effect size of 0.40 was used for
power analysis (power 0.80, alpha 0.05), and sample size requirement was 199. We estimated a dropout rate of 5% and therefore
aimed to recruit 209 patients.
Statistical analysis
Categorical variables were analyzed by Chi-square analysis/
Fisher’s exact test. Paired t tests in both groups were employed to
analyze pre- and post-test differences in primary and secondary
endpoints. Independent two-sample t tests were used to detect
between-group differences in baseline to post-intervention
changes in primary and secondary endpoints. Continuous data
were presented as mean Æ standard deviation, while categorical
data were represented by a number and percentage. All statistical
assessments were two-tailed and considered significant at the 0.05
level. Statistical analyses were performed using SPSS 15.0 statistics
software (SPSS Inc, Chicago, IL).
Results
Demographic data and baseline characteristics of music group
and control group subjects were comparable (Table 1). No significant differences were found between groups in the pre-test
(baseline) STAI-S/STAI-T scores and vital signs before intervention
(P > 0.05). However, a significant difference was found in oxygen
saturation between the two groups (P ¼ 0.005).
Mean changes in STAI-S and STAI-T scores from baseline to posttest are shown in Table 2. Significant decreases were observed in
STAI-S and STAI-T scores from baseline to post-test in both groups
(all P < 0.05) after intervention. Also, statistically significant
differences were observed in mean change of STAI-S and STAI-T
scores between the music and control groups (P < 0.05). A mean
decrease of 7.19 for STAI-S score was found in the music intervention group, compared to a mean decrease of 1.04 in the control
group. Also, a mean decrease of 2.77 for STAI-T score was found in
the music intervention group compared to a mean decrease of 1.13
in the control group.
Mean changes in pre- and post-test vital signs are also shown in
Table 2. Significant decreases in heart rate and respiration rate from
baseline to post-test were observed in both groups (P < 0.05). In
addition, a statistically significant difference in mean change of
systolic pressure was noted between the music therapy and control
groups (À5.69 Æ 0.41 mmHg vs. À0.67 Æ 1.29 mmHg, respectively;
P ¼ 0.009) after the intervention. No significant difference between
two groups was found in mean change of oxygen saturation before
and after the music intervention (Table 2).
Discussion
In this study, we investigated the effects of music intervention
on reducing pre-radiotherapy anxiety in oncology patients. A music
Table 1
Basic demographic parameters and baseline characteristics of study population
(n ¼ 200).
Music group
(n ¼ 100)
Age (Years)1
Gender, n (%)2
Male
Female
Education, n (%)2
Elementary school
High school
University
Type of cancer, n (%)3
Head and neck
Gynecological
Breast
Digestive tract
Lung
Prostate
Tumor stage, n (%)2
I
II
III
IV
Medication history, n (%)2
Hypertension
Heart disease
Radiotherapy4
STAI1
S-Anxiety
T-Anxiety
Heart rate (beat/min)1
Systolic pressure (mmHg)1
Diastolic pressure (mmHg)1
Respiration rate (breaths/min)1
Oxygen saturation (%)1
Control group
(n ¼ 100)
P-valuea
55.06 Æ 13.50
55.66 Æ 11.41
0.735
64 (64.0)
36 (36.0)
57 (57.0)
43 (43.0)
0.311
31 (31.0)
54 (54.0)
15 (15.0)
37 (37.0)
58 (58.0)
5 (5.0)
0.218
34
6
17
21
6
13
(34.0)
(6.0)
(17.0)
(21.0)
(6.0)
(13.0)
33
17
21
16
6
5
(33.0)
(17.0)
(21.0)
(16.0)
(6.0)
(5.0)
0.111
18
29
35
18
(18.0)
(29.0)
(35.0)
(18.0)
17
16
36
31
(17.0)
(16.0)
(36.0)
(31.0)
0.064
23 (23.0)
10 (10.0)
5 (3, 9)
24 (24.0)
12 (12.0)
5 (3, 9)
0.868
0.651
0.867
42.63 Æ 11.01
41.94 Æ 10.74
85 Æ 13
125.9 Æ 18.5
73.8 Æ 14.2
18 Æ 2
98.0 Æ 1.2
42.03 Æ 10.41
42.35 Æ 9.24
84 Æ 12
126.8 Æ 20.4
74.8 Æ 12.6
19 Æ 2
97.5 Æ 1.2
0.693
0.773
0.970
0.753
0.615
0.050
0.005*
Data presented as 1mean Æ S.D., 2,3number (percentage) and 4median (IQR).
STAI: State-Trait Anxiety Inventory.
* Indicates a significant difference between music and control groups, P < 0.05.
a
P-values based 1independent two-sample t test, 2Chi-square test, 3Fisher’s exact
test and 4ManneWhitney U test.
group received 15 min of music therapy prior to undergoing one
radiation treatment and a control group only had 15 min of rest
before radiation. Significant differences were shown in pre- to posttest State and Trait scores in both the music group and the control
group. More importantly, a significant increase in mean change was
observed in the music group in STAI-S and STAI-T scores from
baseline to post-test, indicating that music therapy was effective in
reducing anxiety symptoms. In terms of vital signs, significant preto post-test decreases in heart rate and respiration rate were
Table 2
Comparative primary endpoint (mean change of anxiety score from baseline) and
secondary endpoints (mean change in vital signs from baseline) between the two
groups (n ¼ 200).a
Mean change from baseline
Primary endpoint
STAI-S
STAI-T
Secondary endpoints
Heart rate (beat/min)
Systolic pressure (mmHg)
Diastolic pressure (mmHg)
Respiration rate (breaths/min)
Oxygen saturation (%)
Music group
(n ¼ 100)
Control group
(n ¼ 100)
P-value
À7.19 Æ 0.94**
À2.77 Æ 0.66**
À1.04 Æ 0.41**
À1.13 Æ 0.42**
<0.001*
0.036*
À4.40
À5.69
À1.71
À0.65
À0.01
À3.28
À0.67
À1.41
À0.46
À0.06
Æ
Æ
Æ
Æ
Æ
0.77**
0.41**
0.89
0.13**
0.13
Æ
Æ
Æ
Æ
Æ
1.10**
1.29
0.86
0.14**
0.13
0.405
0.009*
0.809
0.319
0.779
* Significant difference between two groups using independent two-sample t test,
P < 0.05.
** Significant difference between pre and post intervention using paired t test,
P < 0.05.
STAI: State-Trait Anxiety Inventory.
a
Data are presented as mean Æ S.E.

4. L.-C. Chen et al. / European Journal of Oncology Nursing 17 (2013) 436e441
observed in the music and control groups. However, a statistically
significant difference between groups was only noted in mean
change of systolic blood pressure, which was markedly reduced in
subjects receiving music therapy compared to controls. These
findings were consistent with a previous report in Taiwan that
music therapy was more effective in reduction of postchemotherapy anxiety than verbal relaxation, and the reduction
in anxiety was associated with a significant increase in skin
temperature. Patients with higher State anxiety also responded
more to therapy (Lin et al., 2011).
The conditions of music intervention may result in different
outcomes. A self-selected music listening intervention among
patients undergoing radiation therapy showed a significant correlation between the dose of music therapy (i.e., number of times per
week music was used) and changes in treatment-related distress
(Clark et al., 2006). Based on our preliminary study, multiple
interventions usually resulted in considerable missing data.
Besides, in this study, it was not possible to follow all 200 study
subjects at every appointment of radiotherapy. Therefore, we
decided to perform the intervention once prior to radiotherapy.
This agreed with a comprehensive review study showing that the
majority of music therapy studies provided only one music session
to participants with pre- and post-intervention evaluation (Bradt
and Dileo, 2009).
In the present study, each participant listened to music for
15 min prior to one of their scheduled radiation treatments;
although participants could have their music therapy conducted at
different stages of their treatment, all measurements (physiological
and STAI tests) were done pre- and post- a single treatment,
avoiding any impact on overall results. The 15-min timing also
agrees with the intervention times applied in previous studies. In
one study, patients received music intervention during their daily
radiation treatments, which lasted an average of 15 min each
(Smith et al., 2001). A 15-min self-selected music intervention
significantly reduced patients’ anxiety prior to gastrointestinal
procedures (Hayes et al., 2003). In addition, in the present study, all
patients received the 15-min listening period without interruption
by other people or medical staff and without falling asleep during
the intervention session. Exploring and comparing the effects of
longer music exposure at different time points may be valuable in
future study. A recent review of music therapy studies suggested
that more research is needed that examines relationships between
frequency and duration of music interventions and differences in
effects obtained (Bradt et al., 2011).
The STAI Form Y (Speilberger et al., 1983) clearly differentiates
between the temporary, current condition of “State-anxiety” (Sanxiety) and the more general and long-standing “Trait-anxiety” (Tanxiety). Argstatter et al. (2006) demonstrated that patients with
high levels of state and trait anxiety have much greater benefits from
music interventions than those with low levels of anxiety
(Argstatter et al., 2006). In the present study and others (Lin et al.,
2011; Smith et al., 2001), S-anxiety responded more to the effects
of music therapy and anxiety levels were reduced significantly.
However, differences between intervention and control groups
were less in the T-anxiety scores as a result of music intervention. Sanxiety refers to the subjective and transitory feeling of tension,
nervousness, and worry (Fountoulakis et al., 2006), factors that may
be more sensitive to the music intervention. T-anxiety refers to
relatively stable individual differences in anxiety proneness as
a personality trait (Fountoulakis et al., 2006) and may be less
affected by the music intervention. These preliminary impressions
suggest a need for additional study of the effects of music therapy in
terms of differential effect between S-anxiety and T-anxiety.
Our State anxiety results are also similar to those of a study on
early music therapy intervention for patients with high levels of
439
anxiety before and during radiotherapy (Smith et al., 2001). In that
study, experimental group patients listened to their preferred
music before and during simulation and daily treatments over the
planned course of therapy. Trends in State anxiety scores suggested
the benefit of music therapy delivered pre-treatment, although lack
of significance in between-group differences indicated that music
did not moderate anxiety levels during treatment. Still, the authors
suggested that music therapy is a simple, low-cost intervention
that may help to moderate high levels of State anxiety during
simulation and the early part of radiation therapy (Smith et al.,
2001).
The timing of music therapy and anxiety measurement may also
be an important factor. In the present study, we only provided
15 min of music therapy once to subjects prior to radiotherapy.
Measures of anxiety and vital signs, as physiological indicators of
anxiety, were evaluated pre- and post-test, but not during or after
radiotherapy. However, music intervention applying 30 min of
music prior to radiation only slightly reduced patients’ anxiety
scores and physiological indices after radiation without statistical
significance (Zhao et al., 2008). Smith et al. (2001) found no benefit
of music therapy when measuring anxiety during radiation (Smith
et al., 2001), but another study conducted by Clark et al. (2006)
found significant between-group differences in anxiety, current
distress (i.e., State anxiety), and weekly distress measured at
baseline, mid-treatment, and post-treatment in subjects who
listened to self-selected music weekly for the course of radiotherapy (Clark et al., 2006). In that study, anxiety and treatmentrelated distress were reduced but physical symptoms such as
fatigue and pain were not affected during the course of radiotherapy. Music therapy provided during the therapy also had
a positive effect on post-chemotherapy anxiety; patients with
initial high State anxiety scores who received music therapy had
a greater drop in post-chemotherapy anxiety than did normal State
anxiety subjects (Lin et al., 2011). These results suggest a need for
further evaluation of the effectiveness of music therapy received
pre-, during and post-treatmentdnot just evaluation of postmusic-intervention.
Dileo and Bradt (2007) clearly distinguished between music
interventions conducted by medical professionals, or so-called
“music medicine,” and those conducted by trained music therapists. Music medicine is typically passive listening to pre-recorded
music, while music therapy requires a therapeutic process and the
use of live music experiences (Dileo and Bradt, 2007). According to
professional music therapists, many types of music therapy may be
applied, including active (e.g., participation in chime or drum
circles, music meditation, sing-along or song writing) and passive
(e.g., recorded music or live performance); these techniques are
guided by music therapists and include feedback and measurements such as vital signs and self-reported changes in distress
levels (Mahon and Mahon, 2011). The particular type of music
therapy may produce different responses in different situations.
Differences in study results may be attributable to study design,
type and frequency of music intervention, and outcome measurements (Bradt and Dileo, 2009). Other influences on the response to
music, and subsequently to music therapy effects on anxiety and
physical parameters, may include age, gender, music preference,
personal associations with music, prior musical training and
culture, and patients’ emotional state (Bradt and Dileo, 2009).
The mechanism behind the effects of music intervention on
anxiety levels is still unclear. Clinical research findings suggest that
music may facilitate reduced anxiety levels, decreased blood
pressure and heart rate, and changes in plasma stress hormone
levels (Watkins, 1997). Music induces an arousal effect, predominantly related to the tempo. Slow or meditative music can induce
a relaxing effect (Bernardi et al., 2006). Passive listening to music

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L.-C. Chen et al. / European Journal of Oncology Nursing 17 (2013) 436e441
accelerates breathing rate and increases blood pressure, heart rate,
and the LF:HF ratio in proportion to the tempo and perhaps also
related to the complexity of the rhythm (Bernardi et al., 2006).
Bernardi et al. (2009) also found significant correlations between
cardiovascular or respiratory signals and music profiles, especially
skin vasoconstriction and blood pressure responses produced by
vocal and orchestral crescendos compared to uniform emphasis
(Bernardi et al., 2009). Outcomes of a systematic review conducted
by Bradt and Dileo (2009) found that listening to music reduced
heart rate, respiratory rate and blood pressure. Those physiological
changes associated with music intervention may facilitate a reduction in the stress response, including decreased anxiety levels
(Bradt and Dileo, 2009).
A recent review found that selection of the primary music for
music intervention is first based on research and then a variety of
selections can be presented to subjects for choice on the basis of
personal preferences (Chi and Young, 2011). However, they suggested that using patient-selected music may have more heterogeneous results than trials using researcher-selected music (Bradt
and Dileo, 2009). Clark et al. (2006) also suggested using patients’
preferred music in pre-radiation music interventions; however,
although anxiety levels and treatment-related distress were
reduced in those who self-selected music, differences were not
significant when compared to controls not receiving music therapy
(Clark et al., 2006). Also, individual preferences in music style have
been found to be less important to physiological response than
music characteristics such as tempo (Bernardi et al., 2006). In the
present study, researchers selected and organized types of music
randomly without any rationale except for constant tempo (beats
per minute) and volume. To maintain a fairly consistent style of
music, including consistent tempo and dynamics, we (and most
previous researchers) selected music that had a relatively constant
speeddslow-paced, soft, melodic music at low volume with an
average of 60e80 beats per minute. Thus, we can expect that the
slow tempo and consistent style of music in our intervention would
produce mild and uniform responses, inducing a relaxing effect and
reduction of pre-treatment anxiety.
Limitations
This study is limited by the collection of data in only one
medical center in northern Taiwan, which precludes generalizing
results to all Taiwanese radiation oncology patients. In addition,
subjects’ cancer types and stages were heterogeneous, which
affects the type and intensity of radiotherapy and limits generalizability to the cancer population. Also, the present study only
performed music intervention once in participating subjects prior
to radiotherapy, and collected only one set of pre- and postintervention measurements of the STAI scales and vital signs
rather than repeating either music therapy or measurements, that
is, no testeretest was conducted immediately after the intervention. Anxiety levels were not measured during or after radiotherapy as in some other trials (Clark et al., 2006) to evaluate
duration of effects. We also did not conduct a double-blind
experiment, and therefore cannot rule out experimenter bias.
Future study should adopt a randomized controlled study design
and recruit a larger sample in multiple institutions and locations.
Longer-term music intervention may also be important in future
study; although our results showed a beneficial effect on outcomes
related to short-term physiologic changes and anxiety levels, this
study provided no evidence of long-term outcomes. Many studies
of music therapy suffer from small sample size, which may make it
difficult to achieve statistically significant results (Bradt and Dileo,
2009). Multiple and possibly longer music therapy sessions should
be included for comparison and verification of data. It may also be
valuable to measure music therapy effects after radiation treatment and to determine anxiety-related factors that may respond
to music therapy.
Conclusions and implications for nursing practice
Music therapy provided prior to radiation treatment decreases
State-Trait anxiety levels and systolic blood pressure in oncology
patients receiving radiotherapy. Nursing staff at radiation treatment centers can provide a choice of music for patients to listen to
in the waiting room before treatment to help reduce anxiety.
Patient education may instruct patients about practicing music
therapy at home, helping to ease symptoms of anxiety and enhance
comfort levels prior to radiation therapy. Music intervention and
nurse-guided education also may enhance the quality of nursing
care and patients’ satisfaction with nursing.
Conflict of interest statement
None declared.
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