Music Therapy Versus Cognitive Behavioral Therapy via Telehealth for Anxiety in Survivors of Cancer: A Randomized Clinical Trial

Author(s): Kevin T. Liou, MD¹; Joke Bradt, PhD²; M. Beatriz Currier, MD³; Raymond Baser, MS⁴; Katherine Panageas, PhD⁴; Jodi MacLeod, BA⁵; Desiree Walker, BA⁶; Susan Q. Li, MS¹; Ana Maria Lopez, MD⁷; Kelly McConnell, PhD⁸; Jun J. Mao, MD, MSCE¹;

Source: DOI: 10.1200/JCO-25-00726

Dr. Maen Hussein's Thoughts

Music therapy is noninferior to CBT for anxiety in survivors of cancer. Music therapy was found to be noninferior to cognitive behavioral therapy for anxiety among cancer survivors. Both telehealth interventions produced clinically meaningful and durable improvements in anxiety. Should we hire musicians?

PURPOSE

Anxiety is prevalent, disruptive, and undertreated among survivors of cancer. Cognitive behavioral therapy (CBT) is the first-line treatment, but not all individuals have access, respond to treatment, or prefer this option because of stigma. Music therapy is effective for short-term anxiety reduction, but it is unknown whether it is noninferior to first-line CBT for long-term anxiety reduction.

METHODS

This comparative effectiveness trial randomly assigned English- or Spanish-speaking survivors of cancer to seven weekly telehealth sessions of music therapy or CBT. The coprimary end points were changes in the Hospital Anxiety and Depression Scale (HADS) anxiety score weeks 8 and 26. The noninferiority margin was 0.35 standard deviations, informed by a minimal clinically important difference (MCID) of 1.7 points. Secondary outcomes included fatigue, depression, insomnia, pain, cognitive dysfunction, and health-related quality of life.

RESULTS

Among N = 300 patients, 74.7% was female, 76.5% was White, and 19.0% was Hispanic. week 8, the mean change in HADS anxiety score was –3.12 (95% CI, –3.59 to –2.65) in music therapy and –2.97 (95% CI, –3.45 to –2.50) in CBT; the between-group difference was –0.15 (95% CI, –0.78 to 0.49), within the noninferiority margin of 1.20 (P < .001). week 26, the mean change was –3.31 (95% CI, –3.78 to –2.85) in music therapy and –3.00 (95% CI, –3.47 to –2.53) in CBT; the between-group difference was –0.31 (95% CI, –0.95 to 0.32), within the noninferiority margin of 1.28 (P < .001). Both groups produced anxiety reductions exceeding the MCID and showed similar improvements in secondary outcomes.

CONCLUSION

Music therapy is noninferior to CBT for anxiety in survivors of cancer. Both telehealth interventions produced clinically meaningful, durable improvements in anxiety.

Author Affiliations

¹Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; ²Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, PA; ³Psychosocial Oncology, Miami Cancer Institute, Miami, FL; ⁴Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY; ⁵Society for Integrative Oncology, Pepper Pike, OH; ⁶Young Survival Coalition, New York, NY; ⁷Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA; ⁸Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY

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