Music Therapy and Mindfulness in the Cancer Care Plan

If music soothes the soul and mindfulness quiets our thoughts, can combining the two disciplines help a cancer patient navigate challenging times?

That question is at the heart of a study designed by Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine. The study is a collaboration with the University of Miami Frost School of Music and funded by a $2.6 million grant from the National Cancer Institute and other federal agencies.

Researchers from both institutions hope to find out if using music therapy and mindfulness together can help alleviate depression, anxiety, stress and treatment-related physical symptoms. They’ve been shown to have benefits individually.

“What we want to determine is that, when we induce a state of mindfulness, will the patient be more accepting of the benefits of music?” says Frank J. Penedo, Ph.D., associate director of Cancer Survivorship Services and Translational Behavioral Sciences and director of Cancer Survivorship and Supportive Care at Sylvester. “Can using stress reduction techniques and music reduce the common side effects of treatment and enhance the immune response?”

Study Recruits Patients Slated for Stem Cell Transplantation

The Sylvester-Frost School study recently entered phase 2. This phase has two stages, with 60 patients in the first part and 160 patients in the second. All were recruited from Sylvester and are scheduled for allogeneic stem cell transplantation (allo-SCT).

This type of transplant uses donated, healthy blood stem cells to replace the host’s malfunctioning bone marrow cells. Within two to four weeks, the cells travel through the blood to the bone marrow and make new white blood cells, red blood cells and platelets (engraftment).

Considered a potential cure, these transplants come with significant side effects, such as fatigue, pain, nausea and a weakened immune system.

“The treatment can be a real challenge both physically and mentally,” said Teresa L. Lesiuk, Ph.D., director and associate professor of music therapy at the Frost School. “Patients have to spend a good deal of time in isolation, away from their families and their normal routine, and that in itself can take a toll.”

People who report psychological distress after allo-SCT have higher mortality rates in the first year, longer hospital stays and higher rates of readmission. Mindfulness-based music therapy “can break the cycle of rumination that happens with stress,” Dr. Lesiuk adds.

The Power of Music Therapy

The five-year Sylvester-Frost School study builds on a growing body of research showing music therapy reduces stress, buffers pain response and increases chemotherapy tolerance. It can improve memory and cognitive functioning in cancer patients. Mindfulness-based interventions have also been linked to stress reduction and better clinical outcomes.

In the study, one group will receive instructions only in mindful meditation, the second mindfulness plus music therapy. Though some types of music will be “prescribed,” individuals will also select their own.

“We encourage patients to listen to preferred music,” explains music therapist Mary Adelyn Kauffman, D.M.A. “It usually brings more engagement.”

The eight-session study has a fluid timetable.

“Sessions are tied to treatment, not definite dates,” Dr. Kauffman says. “Each person will be different and we’ve tailored [the program] to meet individual needs.”

The sessions will be conducted by board-certified music therapists and last about an hour. The first five will be in person, covering mindfulness topics such as letting go, patience, acceptance and non-judgment. The last three will be done virtually, emphasizing trust, non-striving and moving back into the world.

In between sessions, patients will receive support from the study team via phone calls or texts. Participants will also receive supplementary video, audio and research articles to reinforce their learning.

Therapeutic Interventions

Patients will have their blood collected two times, at the beginning of the study and after engraftment. Blood work will track systemic inflammation, immune recovery and adaptation.

Study participants will complete questionnaires at the very beginning of the study, prior to infusion and after engraftment. These self-assessments are important, says Sara E. Fleszar-Pavlovic, Ph.D., a post-doctoral fellow in Sylvester’s Cancer Control Training in Disparities and Equity Program.

“It’s not just about treating the body, but also treating the mind and the social aspects that come with disease,” she explains. “It’s about incorporating therapeutic interventions that have had promising benefits with the way we practice Western medicine.”

Integrative interventions for cancer patients are more common than they used to be. Last year, the American Society for Clinical Oncology and the Society for Integrative Oncology published the first guidelines recommending mindfulness-based interventions and other integrative approaches.

“We want to see if there is a direct linkage between specific techniques and biological outcomes,” Dr. Penedo says, adding that establishing a connection would make this type of therapy “go beyond supportive care to becoming the standard of care.”

Tags: Dr. Frank Penedo, Frost School of Music, mindfulness, music therapy, Sylvester Comprehensive Cancer Center