Music therapy, cognitive behavioral therapy comparable for anxiety in cancer survivorship

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Key takeaways:

• Music therapy and cognitive behavioral therapy yielded durable reductions in anxiety among cancer survivors.
• Both approaches offered comparable improvements in fatigue, depression and pain.

CHICAGO — Music therapy appeared as effective as first-line cognitive behavioral therapy for reduction of anxiety among cancer survivors, according to findings presented at ASCO Annual Meeting.

Each approach delivered meaningful and durable benefit, results of the MELODY trial showed.

“We live in a very high-stress world and, for cancer survivors who also have to deal with the emotional toll of their diagnosis, the need for effective mental health treatments has never been greater,” researcher Kevin T. Liou, MD, an integrative medicine specialist at Memorial Sloan Kettering Cancer Center, said during a presentation. “Both interventions were able to be successfully delivered by telehealth, which has the potential to expand mental health services for cancer survivors.”

Addressing an evidence gap

Anxiety affects up to half of cancer survivors. It has been associated with poorer health outcomes and higher health care expenditures.

Medications are available but, because two-thirds of cancer survivors take five or more medications, there is a high unmet need for nonpharmacologic anxiety treatments, Liou said.

Cognitive behavioral therapy is widely considered as the standard first-line therapy. However, not all survivors have access to it, respond to it or even agree to this option due to concerns about stigma.

Guidelines from Society for Integrative Oncology and ASCO recommend music therapy for anxiety among individuals undergoing active cancer treatment. However, its long-term effectiveness for cancer survivors in ambulatory care settings had not been established.

“Our study really tried to address this evidence gap,” Liou said. “There has never been a head-to-head trial to compare music therapy with other existing therapies for cancer survivors.”

Liou and colleagues conducted the MELODY study — a two-arm, parallel-group, randomized comparative effectiveness trial — to determine if music therapy is noninferior to first-line cognitive behavioral therapy when both approaches are delivered remotely.

The cohort included 300 English- or Spanish-speaking cancer survivors (mean age, 56.9 years; 74.7% women; 76.5% white; 19.1% Hispanic) who had anxiety for at least 1 month. One-third (33%) had been diagnosed with generalized anxiety disorder and 43% were taking anxiety medications at baseline.

Survivors of all cancer types and stages were eligible. Survivors of breast cancer (45.3%) and hematologic malignancies (15.7%) comprised the majority of the cohort.

Researchers randomly assigned 153 survivors to cognitive behavioral therapy, delivered by nine licensed social workers and one clinical psychologist. Investigators assigned the other 147 survivors to music therapy, delivered by four board-certified music therapists.

The music therapy intervention included collaborative songwriting, where the patient would work with a therapist to create a full original song.

“The collaborative nature of the process — bouncing ideas off each other, sharing ideas — helped foster a social connection, and then brainstorming the song themes, drafting the lyrics, shaping the melodies, these were all opportunities and outlets to process and make sense of the experience.”

Both interventions included seven weekly telehealth sessions delivered via Zoom using standardized protocols. Sessions lasted about an hour. Follow-up continued through week 26.

Change in Hospital Anxiety and Depression Scale (HADS) anxiety subscale score at week 8 — the end of treatment — and after long-term follow-up at week 26 served as co-primary endpoints. Changes in fatigue, depression, pain, insomnia, cognitive function and quality of life served as secondary outcomes.

Broaden impact

The final analysis included 150 survivors assigned cognitive behavioral therapy and 145 assigned music therapy.

At week 8, results showed mean changes in HADS anxiety scores of –3.12 (95% CI, –3.59 to –2.65) in the music therapy group and –2.97 (95% CI, –3.45 to –2.5) in the cognitive behavioral therapy group. The between-group difference of –0.15 (95% CI, –0.78 to 0.49) fell within the noninferiority margin.

At week 26, results showed mean changes of –3.31 (95% CI, –3.78 to –2.85) in the music therapy group and –3 (95% CI, –3.47 to –2.53) in the cognitive behavioral therapy group. The between-group difference of –0.31 (95% CI, –0.95 to 0.32) again fell within the noninferiority margin.

Both groups demonstrated anxiety reductions that exceeded the minimum clinically importance difference of 1.7 points.

Researchers also observed comparable improvements in secondary outcomes in both groups.

Three people in the music therapy group experienced mild adverse events (depression or headache). One person in the cognitive behavioral therapy group experienced increased anxiety.

Liou and colleagues acknowledged limitations, including lack of a control group. Also, the study took place at two academic cancer centers, and the study cohort consisted primarily of women and had a large proportion of breast cancer survivors, potentially limiting the generalizability of the findings.

To broaden impact, more work is needed to determine how these interventions can be implemented in different health care settings or to make them more scalable.

“We’re also interested in trying to understand if there are personal characteristics that can predict better response to one therapy vs. another,” Liou said. “That will be critical to developing personalized approaches to mental health and really help individuals choose which option is best for them.”

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