Baseline characteristics.
Complete baseline characteristics are shown in Table 1.
Table 1
| All patients (N = 50) | Active – Receptive (n = 25) | Receptive – Active (n = 25) |
Sex, female (%) | 32 (64) | 18 (72) | 14 (56) |
Age, years | 60 (29–79) | 59 (29–76) | 62 (40–79) |
BMI (kg/m2) | 24 (18–47) | 24 (20–36) | 24 (18–47) |
Tumour localization (%) | | | |
| Breast cancer | 12 (24) | 7 (28) | 5 (20) |
| Gynecological cancer | 8 (16) | 3 (12) | 5 (20) |
| Lymphoma/ Multiple Myeloma | 7 (14) | 1 (4) | 6 (24) |
| Colorectal cancer | 6 (12) | 3 (12) | 2 (12) |
| Hepatobiliary pancreatic cancer | 6 (12) | 3 (12) | 3 (12) |
| Hematologic neoplasms | 4 (8) | 4 (8) | - |
| Upper gastrointestinal cancer | 3 (6) | 1 (4) | 2 (8) |
| Prostate cancer | 2 (4) | 1 (4) | 1 (4) |
| Others | 2 (4) | 2 (8) | - |
Advanced disease stage (%) | 22 (44) | 14 (56) | 8 (32) |
Anti-tumour therapy (%) | | | |
| Chemotherapy | 22 (44) | 12 (48) | 10 (40) |
| Antibody/ Immunotherapy | 9 (18) | 6 (24) | 3 (12) |
| Radiation | 1 (2) | 1 (4) | - |
| Radiochemotherapy | 1 (2) | - | 1 (4) |
| Hormone therapy | 1 (2) | - | 1 (4) |
| None | 5 (10) | 1 (4) | 4 (16) |
Antihypertensive medication (%) | 16 (32) | 8 (32) | 8 (32) |
Married, yes (%) | 34 (68) | 14 (56) | 20 (80) |
Children, yes (%) | 34 (68) | 14 (56) | 20 (80) |
Sleeping problems (%) | 19 (38) | 12 (48) | 7 (28) |
Regular physical activity (%) | 20 (40) | 11 (44) | 9 (36) |
Playing an instrument (%) | 11 (22) | 8 (32) | 3 (12) |
How often do you play? (%) | | | |
| several times/ week | 3 (27) | - | 3 (100) |
| several times/ month | 3 (27) | 3 (38) | - |
| less than once a month | 2 (18) | 2 (25) | - |
| Not for at least a year | 3 (27) | 3 (38) | - |
How do you play? (%) | | | |
| sheet music | 6 (55) | 5 (63) | 1 (33) |
| Improvise | 2 (18) | 1 (13) | 1 (33) |
| Both | 3 (27) | 2 (25) | 1 (33) |
Within a group or alone? (%) | | | |
| Group | 3 (27) | 2 (25) | 1 (33) |
| Alone | 6 (55) | 5 (63) | 1 (33) |
| Both | 2 (18) | 1 (13) | 1 (33) |
Preferred music genre (%) (multiple responses possible) | | | |
| Pop | 18 (36) | 9 (36) | 9 (36) |
| Rock | 6 (12) | - | 6 (24) |
| Jazz | 2 (4) | 2 (8) | - |
| Classical music | 9 (18) | 6 (24) | 3 (12) |
| Hits | 5 (10) | 3 (12) | 2 (8) |
| Others | 4 (8) | 2 (8) | 2 (8) |
Data are presented as median (range) or numbers (frequencies). |
BMI, body mass index |
A total of 18 patients were male (36%) and 32 patients (64%) were female. The median age was 60 years (minimum 29 years, maximum 79 years). 34 patients (68%) were married and reported having children.
The most common tumor entity was breast cancer (12 pts, 24%), followed by other gynecological tumors (8 pts, 16%) and lymphoma/multiple myeloma (7 pts, 14%). 22 patients (44%) were receiving chemotherapy at study inclusion, 9 patients (18%) were treated with antibodies/ immunotherapy and one patient each received radiotherapy (2%), radiochemotherapy (2%) or hormone therapy (2%). An advanced disease stage was documented in 22 patients (44%). 16 patients (32%) received concomitant antihypertensive treatment. 19 patients (38%) indicated having sleeping problems. Regular physical activity was practiced by 20 study participants (40%).
Median values for global health status, assessed using the QLQ-C30, were 58 points (8–92), with median values of 67 to 73 observed for the functional scales and symptom scales ranging from a median of 0 to 50 (Supplemental Table ST1).
Musical activity.
A total of 11 study participants (22%) played an instrument, of which 8 are practicing regularly. The majority of these patients plays from sheet music (6 pts, 55%), while two patients improvise (18%) and three patients (27%) play both. Three patients (27%) are practicing music in a group and six patients (65%) are playing alone. Most common preferred music genres were pop (18 pts, 36%) followed by classical music (9 pts, 18%) and rock (6 pts, 12%).
Cardiovascular parameters.
Cardiovascular parameters were assessed using the VascAssist before (pre) and after (post) the sound intervention (Table 2).
Table 2
Cardiovascular parameters
| Active sound intervention (n = 50) | Receptive sound intervention (n = 50) | p-value (Wilcoxon signed-rank test) |
Heart rate (bpm) |
pre | 76 (54–106) | 76 (48–115) | 0.35 |
post | 74 (51–93) | 72 (49–102) | 0.60 |
Difference post - pre | -2 (-13–5) | -4 (-13–6) | 0.01 |
p-value | < 0.001 | < 0.001 | |
Brachial systolic BP (mmHg) |
pre | 125 (93–166) | 127 (98–172) | 0.12 |
post | 127 (107–164) | 125 (99–166) | 0.62 |
Difference post - pre | 2 (-17–15) | -1 (-16–25) | 0.04 |
p-value | 0.08 | 0.26 | |
Brachial diastolic BP (mmHg) |
pre | 73 (40–100) | 72 (34–100) | 0.24 |
post | 72 (42–97) | 35 (97–102) | 0.72 |
Difference post - pre | 2 (-13–14) | 0 (-9–11) | 0.29 |
p-value | 0.34 | 0.49 | |
RMSSD (ms) |
pre | 19 (5–131) | 23 (4–100) | 0.68 |
post | 24 (4–130) | 23 (5–81) | 0.23 |
Difference post - pre | 3 (-41–44) | 1 (-27–38) | 0.24 |
p-value | < 0.001 | 0.67 | |
Compliance index | | | |
pre | 0.5 (0.2–0.6) | 0.5 (0.2–0.7) | 0.45 |
post | 0.5 (0.2–0.7) | 0.5 (0.3–0.6) | 0.98 |
Difference post - pre | 0 (-0.2–0.2) | 0 (-0.2–0.2) | 0.56 |
p-value | 0.90 | 0.49 | |
Resistance index | | | |
pre | 32 (12–68) | 29 (12–63) | 0.50 |
post | 29 (14–47) | 26 (13–51) | 0.32 |
Difference post - pre | -1 (-32–13) | -2 (-31–11) | 0.77 |
p-value | 0.053 | < 0.001 | |
Aortic systolic BP (mmHg) |
pre | 110 (77–147) | 109 (79–150) | 0.22 |
post | 113 (84–150) | 109 (84–158) | 0.67 |
Difference post - pre | 3 (-24–22) | 1 (-20–32) | 09 |
p-value | 0.005 | 0.66 | |
Aortic diastolic BP (mmHg) |
pre | 74 (40–103) | 74 (34–102) | 0.19 |
post | 74 (42–99) | 76 (34–104) | 0.68 |
Difference post - pre | 1 (-14–14) | -1 (-9–12) | 0.22 |
p-value | 0.52 | 0.19 | |
Aix@75 (%) | | | |
pre | 18 (-15–37) | 14 (-17–35) | 0.85 |
post | 19 (-14–48) | 19 (-19–37) | 0.11 |
Difference post - pre | 3 (-12–28) | 1 (-1–14) | 0.02 |
p-value | < 0.001 | 0.06 | |
Aortic PWV (m/s) | | | |
pre | 8.3 (6.0–13.5) | 8.3 (5.1–11.7) | 0.62 |
post | 8.1 (5.3–12.0) | 7.8 (4.5–9.9) | 0.61 |
Difference post - pre | -0.4 (-8.2–5.7) | -0.5 (-2.7–4.0) | 0.21 |
p-value | 0.002 | < 0.001 | |
LVET (ms) | | | |
pre | 261 (197–305) | 262 (192–313) | 0.70 |
post | 268 (192–338) | 266 (195–334) | 0.52 |
Difference post - pre | 11 (-36–62) | 11 (-43–74) | 0.23 |
p-value | < 0.001 | < 0.001 | |
Vascular age | | | |
pre | 58 (25–81) | 57 (27–86) | 0.58 |
post | 56 (23–89) | 56 (32–81) | 0.83 |
Difference post - pre | -2 (-20–16) | -2 (-32–24) | 0.77 |
p-value | 0.13 | 0.21 | |
Data are presented as median (range). |
Aix@75, augmentation index standardized to a heart rate of 75 bpm (beats per minute); BP, blood pressure; LVET, left ventricular ejection time; PWV, pulse wave velocity; RMSSD, root mean square of successive difference. |
Vitals
Both interventions led to a significant reduction in heart rate (p < 0.001), with a more pronounced effect in the receptive group (median reduction − 2 bpm (active) vs median reduction − 4 bpm (receptive), p = 0.01) (Fig. 2a). Blood pressure did not change. Interestingly, HRV, measured as RMSSD (ms), was only increased by the active intervention (median increase + 3 ms, p < 0.001), but not significantly different compared to receptive sound intervention (p = 0.24).
Vascular indices
No change in vascular compliance was observed, while vascular resistance was reduced by both interventions, though failing to reach statistical significance in the active group (receptive: median reduction − 2.2, p < 0.001; active: median reduction − 0.5, p = 0.053). Vascular age as combined variable was not affected by neither intervention.
Central hemodynamics
A slight increase in systolic blood pressure was observed in the active group, which can be explained by measurement inaccuracy (median increase + 3 mmHg, p = 0.005; active vs receptive: p = 0.09), while there were no changes in aortic blood pressure in the receptive group. In both groups there was an increase in Aix (significant increase active group p < 0.001; statistical trend receptive group p = 0.06), which is physiological due to the reduction in heart rate. Aortic PWV (m/s) was reduced by both interventions, with a more pronounced effect for receptive intervention (active: median reduction − 0.4 m/s, p = 0.002; receptive: median reduction − 0.5 m/s, p < 0.001; active vs receptive: p = 0.21) (Fig. 2b). LVET as indicator of systolic length was extended by both interventions (p < 0.001).
Subjective feelings and emotions.
Both interventions were able to influence subjective feelings and emotions. A clear increase in emotional well-being was observed in both groups (p < 0.001), while anger, anxiety, sadness, emotional stress and fatigue were significantly reduced by both interventions (p < 0.001). The greatest effect was observed in a reduction in emotional stress (active intervention median reduction − 9, receptive intervention median reduction − 6). Pain, on the other hand, was only reduced by the receptive intervention (median reduction − 1, p = 0.04), but not significantly different compared to active intervention (p = 0.99) (Table 3).
Table 3
Subjective feelings and emotions
| Active sound intervention (n = 50) | Receptive sound intervention (n = 50) | p-value (Wilcoxon signed-rank test) |
VAS Emotional well-being |
pre | 68 (34–99) | 70 (4–93) | 0.79 |
post | 76 (41–100) | 77 (6–97) | 0.97 |
Difference post - pre | 6 (-7–47) | 4 (-17–39) | 0.75 |
p-value | < 0.001 | < 0.001 | |
VAS Pain |
pre | 7 (0–74) | 13 (0–63) | 0.11 |
post | 5 (0–69) | 9 (0–60) | 0.47 |
Difference post - pre | 0 (-48–15) | -1 (-54–14) | 0.99 |
p-value | 0.19 | 0.04 | |
VAS Anger | | | |
pre | 5 (0–73) | 6 (0–83) | 0.60 |
post | 4 (0–46) | 4 (0–86) | 0.78 |
Difference post - pre | -1 (-35–3) | -1 (-31–3) | 0.24 |
p-value | < 0.001 | < 0.001 | |
VAS Anxiety | | | |
pre | 12 (0–74) | 10 (0–80) | 0.39 |
post | 5 (0–63) | 4 (0–62) | 0.33 |
Difference post - pre | -3 (-63–3) | -3 (-66–3) | 0.97 |
p-value | < 0.001 | < 0.001 | |
VAS Sadness | | | |
pre | 11 (0–75) | 12 (0–87) | 0.48 |
post | 10 (0–48) | 5 (0–89) | 0.33 |
Difference post - pre | -2 (-48–2) | -2 (-66–2) | 0.90 |
p-value | < 0.001 | < 0.001 | |
VAS Emotional stress | | | |
pre | 23 (0–79) | 20 (0–81) | 0.93 |
post | 11 (0–63) | 9 (0–56) | 0.77 |
Difference post - pre | -9 (-74–7) | -6 (56–5) | 0.69 |
p-value | < 0.001 | < 0.001 | |
VAS Fatigue | | | |
pre | 33 (1–82) | 21 (0–79) | 0.36 |
post | 17 (0–83) | 17 (0–76) | 0.11 |
Difference post - pre | -6 (-63–11) | -5 (-58–14) | 0.75 |
p-value | < 0.001 | < 0.001 | |
Data are presented as median (range). |
VAS: visual analogue scale |
Almost half of the patients (24, 48%) stated that they liked both interventions equally. A total of 17 patients (34%) preferred the receptive intervention and 9 patients (18%) preferred active music making. The clear majority of patients (30 pts, 60%) felt more relaxed after the receptive intervention. Ten study participants (20%) stated that they felt more relaxed after active intervention and nine patients (18%) did not prefer either of the two therapies (Fig. 3). Twenty-two patients (44%) would like a receptive intervention to accompany their oncological treatment. For 16 study participants (32%), the type of intervention did not matter and 10 patients (20%) preferred the active intervention. Only 2 patients (4%) did not want any accompanying intervention (Supplemental Table ST2).