What is cancer and how bad are the numbers?

Cancer is an uncontrolled growth of either normal or abnormal cells. According to the American Cancer Society, between 1 and 2 million Americans are diagnosed with cancer each year, and about 5 million Americans die from cancer each year (1). The spectrum of disease from cancer spans the gamut. Those who have the least aggressive, slowest growing cancer may be forever asymptomatic while those with a wildly aggressive cancer may experience significant pain and a much shortened lifespan.

Is cancer ever diagnosed in the E.R.?

Many cancer patients are first seen and diagnosed in the Emergency Department. Often, they present with vague symptoms which they may have had for a long time but have never mentioned to their primary care doctor. The Emergency Department also sees its share of cancer treatment-related problems, some of them life threatening.

What are some problems associated with cancer treatments?

Scientists and physicians have developed methods to help contain and even cure many cancers. Unfortunately, the cancer itself, as well as the side effects of the treatments, may cause debilitating pain and suffering. Medicines help with nausea from chemotherapy and the pain experienced from surgery or the cancer. However, the most effective treatments often have unwanted side effects. The fight against cancer can be a battle against the side effects of necessary medical and surgical treatment.

Can music help in the treatment of the cancer patient?

During the past 20 years or so, much research devoted to music and music therapy has attempted to learn what role they might play in helping cancer patients. As a result of this research, music therapy has become an established and respected adjunctive therapy and is widely used in major cancer centers to help patients and families deal with the physiological and psychological aspects of their disease.

It is difficult to conduct a study with a significant number of cancer patients to assess the effectiveness of music as a treatment. Music and music therapy does not come as a measurable device. One cannot standardize a dose and administer it in the same quantity and quality to each patient. Music may be likened to a religion in that it can offer comfort, strength, and hope to those who are receptive. Given the enormous role music has played in human civilization, it is likely that most people are receptive to music on some level.

What studies have been conducted using music to aid the cancer patient?

The medical literature is dotted with articles describing the use of music and music therapy in the treatment of cancer patients and the terminally ill. There are case reports illustrating how music has been used to address the needs of these patients (2-5). There have also been a couple of recent, well-done, studies describing how quality of life was improved with the use of music administered by a licensed music therapist. In the Journal of Music Therapy, Russell Hilliard, Ph.D, conducted a study of 80 adults in hospice care who were diagnosed with terminal cancer. Half of them received music therapy, and the other half, the control group, received routine hospice services only. Subjects receiving musical therapy recorded a statistically significant improvement in their perception of quality of life over the control group. Although the study reports that the patients in the music therapy group lived an average of 12 days longer than the control group, these results were not statistically significant (6).

A randomized controlled study, a study which reduces the potential for error by randomly assigning patients to intervention or control groups, was recently conducted by Cassileth, Vickers, and Magill at Memorial Sloan-Kettering in New York and at the Ireland Cancer Center at University Hospitals of Cleveland. They found that patients receiving autologous stem cell transplantation combined with music therapy scored 28% lower on a combined Anxiety/Depression scale and 37% lower on a total mood disturbance score compared with those who did not receive music therapy. It is notable that Memorial Sloan-Kettering, one of the most respected cancer care centers in the world, provides more than 2,000 "episodes" of musical therapy care to their patients each year (7).

Music in the animal laboratory

Cancer research often takes place in the animal laboratory. Rodents such as rats and mice have short life spans, and their organ systems have a similar genetic makeup to humans and certain syndicated talk show hosts. It might seem somewhat odd playing music for rats and mice (although in some suburbs they attend more concerts than humans), but a study conducted by Nunez et al in Spain in 2002 exposed noise and/or music daily to groups of presumably uncultured rodents. They found that music reduced the effects of stress on the mice and decreased the number of lung tumors found in cancer-injected rats (8).

What about the child with cancer?

Pediatric cancer patients present unique challenges. They often cannot understand the source of their discomfort. They also may not understand why they must be in a hospital and undergo painful procedures. According to Standley and Hanser: "The goals of music therapy in pediatric oncology include anxiety and pain reduction, tension release and relaxation, provision of opportunities to exercise control of an aversive environment, expression of feelings, facilitation of hope, nurturing, normalization and improvement of the quality of life, development of trust, improvement in parent/child relationships, promotion of self-esteem and celebration of the healthy/positive aspects of the child's life."

"Referral to music therapy for pediatric patients would be indicated for the following problems: when the patient is in pain, has a terminal illness, is distressed by the medical environment or treatment, is withdrawn or non-responsive to medical personnel, is deprived of stimulation due to isolation restrictions, is developmentally regressing, has a poor relationship with family members, has recently become aware of the death of a special friend in the medical setting, or has difficulty sleeping (9)."

E.R.'s bottom line about the use of music for the cancer patient:

We agree with Standley and Hanser's indications (see above) for the use of music in the pediatric cancer patient. We also believe music and music therapy should play a role in the treatment of adult cancer patients.

We at E.R. Music are grateful to readers who inform us about new research studies being published involving music and the treatment of cancer patients. We will review the studies and incorporate them into this chapter. Please join our mailing list if you would like to be informed of the latest developments.

Copyright 2008, E.R. Music, LLC

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

1) American Cancer Society, http://www.cancer.org/downloads/STT/CancerFacts&Figures2002TM.pdf

2) Beggs, C, "Life Reviews With a Palliative Care Patient," in Bruscia (Ed.), Case Studies in Music Therapy (pp.611-616). Phoenixville, PA; Barcelona Publishers

3) Hilliard, R.E., "The Use of Music Therapy in Meeting the Multidimensional Needs of Hospice Patients and Families," Journal of Palliative Care, 17(3), 161-166

4) Martin, J.A, "Music Therapy at the End of Life," in Case Studies in Music Therapy (pp.617-632), K. Brusia (Ed.), Phoenixville, PA: Barcelona Publishers

5) Skaggs, R., "The Bonny Method of Guided Imagery and Music in the Treatment of Terminal Illness: A Private Practice Setting," Music Therapy Perspectives, 15, 39-44

6) Hilliard, RE, "The Effect of Music Therapy on the Quality and Length of Life of People Diagnosed with Terminal Cancer," Journal of Music Therapy, XL(2), 2003, 113-137

7) Cassileth, et al, "Music Therapy for Mood Disturbance during Hospitalization for Autologous Stem Cell Transplantaton," Cancer, December 15, 2003/ Volume 98/ Number 12

8) Nunez MJ, et al, "Music, Immunity, and Cancer," Life Science, 2002 Jul 19;71(9):1047-57.

9) Standley, Hanser, "Music Therapy Research and Applications in Pediatric Oncology
Treatment," Journal of Pediatric Oncology Nursing, Vol 12 No 1 (January), 1995; pp3-8

Copyright, 2008, E.R. Music, LLC.