Complementary Therapies in Cancer Care: Music Therapy

Dr. Barrie Cassileth PhD Chief of Integrative Medicine - Memorial Sloan-Kettering Cancer Center explains Music Therapy

Complementary Therapies in Cancer Care: Music Therapy

An ongoing series highlighting complementary therapies, adapted from The Complete Guide to Complementary Therapies in Cancer Care

Music Therapy

Listen to a few bars of a song on the radio, and our immediate surroundings melt away, the melody carrying us back to where we heard it first. We link music to the milestones of life, both joyous and sorrowful. Sports arenas blast pounding rock music to arouse crowds. Colleges have fight songs for the same end.

Business offices, factories, and retail stores long ago learned the value of piped-in music to provide more beneficial environments in which to work or sell more goods. In fact, the idea of background or “elevator” music as a benefit to business created an entire new industry, developed by the Muzak system and marketed throughout commerce and industry.

We all have experienced the pleasing sounds of music that can lull us to sleep, develop a romantic mood, or stir us to tap in time to the beat. Music is used in hospital birthing rooms, newborn nurseries, and operating suites to help patients and staff. Can the undeniable power of music to arouse our emotions and change our mood be used in medicine?

What It Is

Music therapy is the use of music to encourage healing and promote a general sense of well-being. Patients listen to or perform music under the guidance of a professionally trained and certified music therapist. Music therapists perform, listen to music with patients, analyze their lyrics, write songs, and join in music improvisation. Patients can play or listen to music, based on their previous experience and current condition. After assessing a patient’s condition, the music therapist selects the type of music therapy most appropriate for that particular patient.

Sometimes music therapy is conducted on a group basis, where patients listen to or play music with groups of friends and loved ones or with other patients with the same condition. The music therapist may select music with the patient’s active input, finding songs and melodies that have special meaning or the ability to relax that individual.

The formal discipline of music therapy in the United States can be traced back to the granting of degrees in music therapy in the late 1940s and the use of music therapy with disabled soldiers in Veterans Administration hospitals. Today music therapists work in clinical settings throughout the world.

Music as therapy, however, has deeper roots. Early Egyptian tomb paintings display musicians accompanying the deceased to enhance the afterlife. Ancient Greek thinkers, such as Aristotle and Pythagoras, believed that music could facilitate healing. Singing is a part of Native American healing rituals that are hundreds of years old. Incantations and chants are part of many shamanic traditions and are included in the oldest references to medical practices.

Music therapy is used as a complementary therapy for many diseases in a wide variety of clinical settings, including hospitals, rehabilitation centers, and nursing homes. Music therapists work with all patient groups, including premature infants, the terminally ill, and patients with cancer, substance abuse problems, mental illness, chronic pain, physical disabilities, brain injuries, Alzheimer’s disease and other forms of dementia, childhood developmental disabilities such as mental retardation and autism, and other serious illnesses.

What Practitioners Say It Does

Music therapy has several purposes. It can alleviate pain and ease the psychological discomfort associated with many medical conditions. It helps improve physical and mental functioning among people with neurologic or developmental disorders.

Therapists say that music therapy can help terminally ill patients decrease anxiety, depression, and pain; improve the ability to sleep; and enhance overall quality of life. It helps reduce the need for medication for women during childbirth, and it distracts dental patients from the pain of a root canal. It can improve the ability of mentally handicapped and autistic children to learn, to interact with other people, and to relate to their environments. It enhances the well-being of elderly patients in nursing homes, including those suffering from dementia.

Music therapy is practiced in many forms, including actively playing instruments and listening to recordings.

Beliefs on Which It Is Based

There is no single theory to explain how music therapy works in various clinical situations. Instead clinical therapists offer hypotheses for different settings. In addition, despite substantial research, the mechanisms by which it works and precisely how the brain receives music and produces positive effects are not well understood.

In reducing pain, music therapy may act as the relaxation response does in meditation. Soothing music has been shown to reduce blood pressure and breathing rates and affect other aspects of physiologic functions. Altering brain and other physiologic activity may provide distraction from pain and promote relaxation.

Music therapy for stroke victims and patients with other neurological deficits may work through what is called “entrainment.” As patients listen to music that has a consistent pulse, their muscle movements come to synchronize with the beat. Motions become increasingly efficient and regular, which in turn improves the ability to walk and develop other motor skills. In essence, it is believed that practicing motor skills to a rhythm improves those skills and makes them more efficient.

Research Evidence to Date

Music therapy has been subjected to a great deal of research during the past three decades, and several professional journals are devoted to music therapy. Although many published articles consist of descriptions and anecdotal evidence, larger, more organized studies have also been conducted. These studies indicate that music therapy can be an effective complementary technique to reduce stress and other symptoms for patients with various medical conditions.

Premature babies exposed to music in intensive-care units gain weight more quickly and are discharged sooner than babies who do not hear music. Music therapy has also been shown to reduce anxiety levels in children undergoing surgical and medical procedures. Research supports the ability of music therapy to increase motor skills in developmentally disabled children and assist their capacity to learn math and other subjects. It has been used successfully to strengthen coordination and walking skills among children with muscular or skeletal disorders, to improve the speech of hearing-impaired students, and to lessen the isolation of autism.

Studies of music therapy with Alzheimer’s patients and other victims of dementia reveal that musical cues increase patients’ attention and ability to focus on their surroundings. Music therapy also reduces the agitation that often accompanies Alzheimer’s disease. Working with Alzheimer’s patients in nursing homes, music therapists help them perform simple group exercises such as beating a drum in time with the rest of the group, or they may work one-on-one with patients, playing songs that have been significant in the patients’ lives. In both group and individual activities, patients who are not normally responsive to speech or who do not recognize friends and relatives can become responsive for a time and connect with their immediate surroundings.

Music reduces the amount of anesthesia required during childbirth, and it is the practice in some hospitals for pregnant women to select music to accompany their labor. They often choose different music for each stage, using a remote control to regulate the volume.

Music therapy also reduces self-reported levels of dental and postoperative pain. It assists the physical rehabilitation of patients with stroke and Parkinson’s disease, improving the rate at which patients learn to walk when compared with no-music-therapy control patients. Stroke victims receiving music therapy have reported lower levels of anxiety and higher scores on measures of psychological health when compared with control groups. Several small studies have shown that music therapy can improve speech among those with traumatic brain injuries. Researchers at the University of California, Irvine discovered evidence that listening to Mozart produced short-term enhancement of spatial-temporal reasoning abilities in college students.

Government-supported initiatives in music therapy include a focus on the elderly and on patients with brain injuries. In 1992 Congress passed an act that provided $1 million in annual funding for music therapy research and education with elderly patients.

What It Can Do for You

Music therapy is a documented, effective complementary therapy for many conditions and problems. It is not a curative treatment, nor is it promoted as a cure for serious diseases, as are some other complementary therapies. As do the best of complementary treatments, however, it can improve well-being and quality of life, reduce symptoms, and enhance the effectiveness of primary treatment and rehabilitation therapy.

Music therapy is especially desirable because, for most people, it is an intrinsically pleasant, soothing experience. Furthermore, it is noninvasive, free of danger and side effects, usable in almost any setting and with any other treatment, and inexpensive. Music therapy appears to be an underutilized, extremely helpful complementary technique.

If you think you or a member of your family has a problem that may benefit from music therapy, ask your primary caregiver for referrals to music therapists who work with that condition, or contact an organization listed in the following section.

Where to Get It

The World Federation of Music Therapy is an international organization bringing together music therapy associations and individuals (musictherapyworld.de). Other organizations include the European Music Therapy Confederation (emtc-eu.com); the Canadian Association for Music Therapy (musictherapy.ca/en); Voices, a world forum for music therapy (voices.no); the Australian Music Therapy Association (austmta.org.au); and the American Music Therapy Association (musictherapy.org).

Most of these organizations provide general information about music therapy, universities with music therapy programs in your area, and qualified music therapists near your home. Often music therapists specialize in specific patient groups, working, for example, with palliative care teams to help terminally ill patients or treating developmentally challenged children.

Music therapy supports cancer patients through treatment to improve both emotional and physical well-being.

For many people, listening to or making music is an absolute pleasure. Consider also that music, a beloved form of entertainment for some and a passion or career for others, has a significant role in the care of cancer patients. Music therapy may accompany medical treatment to promote wellness, manage stress, alleviate pain, enhance memory, help patients communicate and express feelings, and even promote physical rehabilitation. Studies have shown that making or listening to music can even lower blood pressure and heart and breathing rates. But, according to Dr. Deforia Lane, director of music therapy at University Hospitals of Cleveland Ireland Cancer Center, music’s most precious contribution to individuals undergoing cancer treatment is how it can stir a person at the core, bringing out and honoring the real person behind the diagnosis and allowing for more freedom of self-expression.

The roots of music therapy, now an established healthcare profession, can be traced throughout history, from noted examples in ancient times to its more formal application in the 1940s. In ancient Greek culture, music was believed to heal both body and soul. Native American healing rituals incorporated singing and chanting. These historical instances suggest a timeless relationship between human well-being and the harmonies and rhythms of various cultures and traditions. This long history of a natural relationship between music and well-being ultimately inspired the U.S. Veterans Administration hospitals during World War II to apply music in the treatment of soldiers suffering from shell shock (combat stress reaction). Soon thereafter, in 1944, Michigan State University introduced the world’s first music therapy degree program.

Since then growth in the field of music therapy has included the establishment of degree programs at more than 70 colleges and universities and the founding of the American Music Therapy Association (AMTA), which oversees the development of therapeutic applications of music and monitors educational and training standards for music therapists. The AMTA requires that therapists complete an approved curriculum, including an internship, and successfully complete the Certification Board for Music Therapists exam.

Dr. Lane, a board-certified music therapist who also holds a PhD in music education, says that the application of music therapy must be as individualized as the patients with whom she works. “A diverse patient response requires a similarly diverse offering,” she explains. Depending on the situation, therapy might involve songwriting, employing a favored instrument, playing live or recorded music according to the patient’s request, and sometimes adding visualization or soothing scents.

A positive emotional reaction to music is of course infinitely valuable to cancer patients, but studies have shown that music therapy can also trigger important physical responses. Alleviation of pain is one such area, says Dr. Lane, explaining that the brain uses the same neurotransmitter to send the sensations of both pain and music. If both elements are received at the same time, neither can reach the brain with full intensity. Hence pain is felt less intensely, so patients may experience a decreased dependence on pain medications.

A physical response to music can also relax muscles and dilate veins, both of which can make procedures—such as bone marrow aspirations—less uncomfortable. Music can also support physical rehabilitation as rhythms seem to drive the repetition of movement, compel the listener to cover greater distances, and help naturalize movement as formerly immobile patients relearn how to use their bodies.

As a two-time cancer survivor herself, however, Dr. Lane always returns to the benefits of music that can’t be physically measured or empirically proven. Such experiences she can only describe as—with a nod to Nat King Cole—“unforgettable” are, for her, the soul of her profession. Having witnessed such events as a previously unresponsive patient crying when, at his family’s request, Dr. Lane played “Amazing Grace,” or being told by patients who had been comatose that they remembered hearing her music while unconscious and were stirred to, as one individual reported, “get to the music,” affirms her commitment to music therapy. Of its role in cancer care, she says, “I have an appreciation for anything that helps, that gives hope.”

Fortunately, for individuals undergoing treatment for cancer, dedicated music therapists like Dr. Lane and her ever-growing number of colleagues continue to bring comfort—both physical and emotional—and often happiness. Hope within music therapy rests on the continued growth of this branch of healthcare and within the extended collaboration between therapists and medical experts that will increase the scope and the use of the practice.

To learn more about music therapy, please visit the American Music Therapy Association at www.musictherapy.org.

Barrie R. Cassileth, MS, PhD*, is Laurance S. Rockefeller Chair and chief of the Integrative Medicine department at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City. She has an extensive medical leadership career and is a recognized authority on complementary therapies and integrative medicine in oncology. Her work includes more than 170 publications in medical literature, more than 40 medical textbook chapters, and 22 books for physicians, patients, and families. She was a founding member of the Advisory Council to the US National Institutes of Health Office of Alternative Medicine, now the National Center for Complementary and Alternative Medicine; she previously served on the National and the NY-NJ Regional Boards of the American Cancer Society and on multiple national and international committees. She is a staunch opponent of cancer quackery. She is founding president of the Society for Integrative Oncology. Since joining MSKCC in 1999, Dr. Cassileth has established prototypic research, education, and clinical programs in integrative medicine. Her most recent book, The Complete Guide to Complementary Therapies in Cancer Care: Essential Information for Patients, Survivors and Health Professionals, was published in 2011 by World Scientific Publishing Company.*

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