Written by: Dr. Raymond Cruz
Exposing palliative and hospice care patients to music has been shown to result in a decrease in pain and breathlessness. There is also a noted improvement in anxiety and depression scores.
Do you like music? Most people do. From the moment we were born, we have been exposed to different types of musical instruments and voices. It therefore comes as no surprise that music has exerted a profound influence in most people’s lives. There are some people who cannot tolerate absolute silence, and music breaks the monotony of an otherwise muted habitat. This utter silence is also one of the conditions that plague hospice centers.
Previous studies in end-of-life care have reported improved outcomes with music therapy.
Music therapy is divided into two categories — active (interactive) and receptive (passive). In the active form, 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 (1). The active form results in more favorable outcomes, but is more difficult to accomplish.
Previous studies in end-of-life care have reported improved outcomes with music therapy. In 2005, an analysis of 11 studies showed significant improvement in a hospice patient’s pain scores, physical comfort, fatigue and energy, anxiety and relaxation, time and duration of treatment, mood, spirituality, and quality of life (2). A 2018 study on the impact of music therapy in pediatric palliative care revealed “positive and meaningful experiences in music therapy”, creating vivid memories that would tide them over during difficult times (3). Patients who received music therapy were more likely to report discussions about spirituality, had less trouble breathing, and were more likely to receive the right amount of spiritual support (4).
Music therapy is an evidence-based activity that can help a wide variety of patients, including those at the end of life. In controlled clinical trials of people having colonoscopies, cardiac angiography, or knee surgery, those who listened to music before their procedure had less anxiety and less need for sedatives. People who listened to music in the operating room reported less discomfort during their procedure (5). And those who heard music in the recovery room used less opioid medications for pain.
Singing ability originates from the right side of the brain, and patients can be rehabilitated from brain damage on the the left side of their by singing their thoughts and then gradually dropping the melody (6). Listening to music activates certain neuronal networks, stimulating brain cell activity in previously inactive neurons. Because the ability to engage with music remains intact late into the disease process, music therapy can help evoke positive memories, reduce restlessness, assist in emotional expression, and improve physical coordination.
At The Ruth Foundation, we try to incorporate music therapy in some of our patient encounters.
Chemotherapy and radiotherapy are known to induce anxiety. Music can quell nausea and vomiting for patients receiving chemotherapy. It reduces anxiety and physiologic arousal, enhancing the patient’s sense of control and well-being (7). Listening to music can thus be considered an effective complement to treatment. It is an inexpensive way to help patients deal with the psychosocial aspects of illness.
A few other questions that need to undergo further investigation include the cost-effectiveness and duration of music therapy. There must also be a validation of scales for mood, anxiety, and depression. A more in-depth look at specific interventions used to address symptoms must also be undertaken.
At The Ruth Foundation, we try to incorporate music therapy in some of our patient encounters. This lightens up the mood, and it has proven to uplift the spirits of patients and their families. We try to engage the senses, so that each visit can become a memorable experience. It does not matter if you are a Pavarotti or a Josh Groban, or if you play an instrument like Kenny G. The most important aspect of caring lies in one’s presence, the provision of evidence-based therapeutic measures, and giving it your best shot.
REFERENCES
Stanczyk MM. Music Therapy in Supportive Cancer Care. Rep Pract Oncol Radiother. 2011; 16(5): 170-172.
Russell E. Hilliard, “Music Therapy in Hospice and Palliative Care: a Review of the Empirical Data,” Evidence-Based Complementary and Alternative Medicine, vol. 2, no. 2, pp. 173-178, 2005.
The Impact of Music Therapy in Paediatric Palliative Care in Residential Hospice
You, Hannah et al. Journal of Pain and Symptom Management, Volume 56, Issue 6, e75Music Therapy Is Associated With Family Perception of More Spiritual Support and Decreased Breathing Problems in Cancer Patients Receiving Hospice Care
Burns, Debra S. et al. Journal of Pain and Symptom Management, Volume 50, Issue 2, 225 - 231Vahed N, Kabiri N, Oskouei MM.The Effect of Music in the Operating Room: A Systematic Review.BMJ Open 2017;7:bmjopen-2016-015415.130. doi: 10.1136/bmjopen-2016-015415.130
Strzemecka J. Music therapy in stroke rehabilitation. Journal of Pre-Clinical and Clinical Research. 2013;7(1):23-26. doi:10.26444/jpccr/71429.
Bulfone T, Quattrine R, Zanotti R, Regattin L, Brusaferro S. Effectiveness of Music Therapy for Anxiety Reduction in Women with Breast Cancer in Chemotherapy Treatment. Holistic Nursing Practice. 2009. 23(4):238-242.