We performed a prospective study (IIBSP-MUS-2020-137) on adult patients (≥ 18 years old) that were admitted to the hospitalization area of hematology to evaluate the effect of music therapy. Patients had to be diagnosed with hematological cancer and be able to participate in and follow a music therapy session actively. Exclusion criteria were: previous psychiatric disorder and moderate or severe hearing impairment.
Ethical considerations
The ethics committee of our institution approved the study. All eligible patients gave their authorization to participate and to register clinical and demographical information. Some of them also gave permission to record audio and videos.
Music therapy sessions, questionnaires, and mood assessment.
Sessions:
Weekly music therapy sessions were planned. Patients received at least one and up to six sessions during hospitalization. The duration of each session ranged from 15 to 60 minutes and was based on the patient's musical preferences. The adherence was sometimes limited by physical discomfort and by gastrointestinal and mucosal toxicity associated with chemotherapy.
Questionnaires and design:
Six baseline questionnaires (pre-treatment) were completed as follows:
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Demographic Information Form (by the patient)
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Clinical Information Form (by the physician)
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Musical Preferences and Previous Musical Experience Questionnaire (by the patient)
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Hospital Anxiety and Depression Scale (HADS) (by the patient)
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Shortened Profile of Mood States questionnaire (POMS-A Spanish version) (by the patient)
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European Organization for Research and Treatment of Cancer-Quality of Life Core Questionnaire-30 (EORTC QLQ-C30) (by the patient)
Before and after each music therapy session:
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Numerical Rating Scale (NRS) for Anxiety, Sadness, and Physical Discomfort (by the patient)
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Music Therapy Behavior Observation Form (by music therapist)
Before discharge (post-treatment 1)
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Music Therapy Program Satisfaction Questionnaire (by the patient)
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HADS, POMS, EORTC QLQ-C30 (by the patient)
Outpatient visits - 2 weeks after discharge (post-treatment 2)
Questionnaires parameters
The Hospital Anxiety and Depression Scale(18) (HADS compilates seven questions to evaluate anxiety and seven questions to evaluate depressive mood. Normal scores are between 0 to 7; risk scores range from 8-10, and scores equal to or higher than 11 are considered pathologic.
The Shortened POMS-A (19)consists of a 15-item five-point adjective rating scale in which participants rate how they are feeling at this moment or during the past week (scores range from (0) “not at all” to (4) “extremely. This self-report inventory includes four negative affect scales (Tension, Depression, Anger, and Fatigue) and one positive affect scale (Vigor). The sum of the subscales scores presents a Total Mood Disturbance Score (TMS), for which higher scores indicate a greater mood disturbance.
The European Organization for Research and Treatment of Cancer-Quality of Life Core Questionnaire-30, EORTC QLQ-C30(20) is a questionnaire developed to assess the quality of life of cancer patients, and it is a usual test in the music therapy field. It addresses five multi-item Scales of Functioning (physical, role, social, emotional and cognitive functioning), a Global Health Scale, and Scale of Symptoms and Problems. 28 of the 30 items are measured by a four-point Likert-type scale (1=not at all, 2=a little bit, 3=quite a bit, 4=very much), and the two remaining items, which address global physical health and global quality of life, are measured by a seven-point scale. The time frame focuses on the previous week. The raw scores for all multi- and single-item scales are linearly transformed to 0-to-100-scales, with ‘100’ reflecting highest functioning or highest symptomatology, respectively.
Statistical analysis:
We used frequencies and dispersion statistics to describe the study population and scale values. To establish differences between pre and post-music therapy sessions using the NRS for Anxiety, Sadness, and Physical Discomfort, we performed a two-tailed non-parametric paired sample test (Wilcoxon's signed rank test). We also used an unpaired two-sample t-test to compare patients EORTC QLQ-C30 with the referral population. We used R-studio RStudio 2022.07.0. We used the statistical graphical user interface EZR (21), PROscorer, and QoLMiss package. (22,23)