The Effect of Music Intervention in Cancer Patients Receiving Radiation Therapy: A Systematic Review and Meta-Analysis

Radiation therapy (RT) is one of main treatments for cancer. Patients with cancer receiving radiation therapy may experience psychological problems not only from the treatment, but also from the fearing of losing themselves. Music intervention was one of the effective methods to alleviate patient's anxiety, depression, fatigue, however, its efficacy in patients receiving radiation therapy remained unclear. Therefore, this study aimed to assess the effect of music intervention on possible emotional problems including anxiety, depression, and fatigue during radiation therapy. We performed a systematic review by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for relevant studies from database inception until November 1, 2019. The study comparing the outcome between music intervention and non-music intervention in patients under radiation therapy would be included. Two independent authors assess the eligibility and quality of included studies according to the protocol. We used Cochrane Risk of bias assessment tool for randomized controlled trials, and Newcastle-Ottawa Scale for non-RCT. The random-effect meta-analysis was used to combine the data. Mean difference (MD) with 95% confidence interval (CI) was used for to reported the continuous outcome. The outcome was the improvement of anxiety, depression, and fatigue after intervention. Eight randomized controlled trials and one cohort study, comprising 840 patients (music group: 356; non-music group: 484), were included. When comparing with non-music group, the music group had a greater improvement of State-Trait Anxiety Inventory, STAI-S score (mean difference (MD), -4.36, 95% CI, -7.25 to -1.47), and a greater improvement of State Anxiety Scale, SAS score (mean difference (MD), -2.06, 95% CI, -4.17 to 0.06). Four randomized controlled trials and one cohort study was investigated the association of music intervention with music medicine (MM) and music therapy (MT). The subgroup analysis showed that music therapy is the more effective option (mean difference (MD), -9.4, 95% CI, -13.58 to -5.22). The improvement of depression and fatigue were not significantly different between two groups. The use of music intervention could probably improve anxiety status of patients receiving radiation therapy. The music intervention should be considered to be incorporated into routine care for patients under radiation therapy.