By Karen Popkin, LCAT, MT-BC, Regan Marooney, AGPCNP-BC, and Jyothirmai Gubili, MS
Despite pain’s prevalence as a debilitating symptom correlated with poor outcomes among patients with cancer, it is often inadequately treated. Racial disparities further contribute to the challenges of assessing and managing cancer pain, with health systems reporting markedly lower doses of opioid prescriptions for Black patients compared to White patients. The inequities stem from provider biases, patient belief systems, and systemic racism.
Music therapy is a nonpharmacologic intervention that may help patients manage cancer and its treatment-related effects. Data suggest that music has a positive effect on neurochemical pathways and the mesolimbic system implicated in pain.
Because music is an integral part of cultures around the world, it may promote equitable cancer pain management regardless of racial background.
What the Evidence Says About Music Therapy
Memorial Sloan Kettering Cancer Center’s Integrative Medicine Service evaluated the treatment approaches and responses for 358 Black (18%) and White (82%) patients with cancer who received music therapy as inpatients. The sessions were delivered by board-certified therapists, approximately 20–30 minutes long, and involved receptive (e.g., music-guided relaxation, listening) and active (e.g., singing, playing an instrument, writing a song, improvising) methods. Prior to the intervention, 42% of the study participants reported having moderate to severe pain and 47% received opioids. Black patients reported higher baseline pain than White patients, and more Black patients received a music therapy referral for pain than their White counterparts (73% versus 56%, respectively).
During their music therapy intervention sessions, Black patients were more likely to engage actively rather receptively (92% versus 82%, respectively). Black patients more frequently involved spirituality in their music therapy sessions than White patients, who more often focused on familial ties. Black patients expressed greater gratitude and brightened affect during music therapy than White patients, whereas White patients felt more relaxed and reflective.
On the postintervention survey, patients in both groups identified similar clinically meaningful pain reductions (p < 0.001). The findings suggest that music therapy may provide a personalized and culturally appropriate experience for effective pain control. The study may contribute to future investigations surrounding the cultural aspects of music therapy in addressing inequalities in cancer pain treatment across disparate populations.
What Oncology Nurses Need to Know
Racial inequities present further challenges to effective cancer pain management. Music therapy is an evidence-based, nonpharmacologic, and pleasant modality that can be offered to patients of all ages in a variety of cancer settings, including hospitals, clinics, cancer centers, or homes. Approximately 75% of National Cancer Institute–designated Comprehensive Cancer Centers and 55% of community cancer centers in the United States have integrated music therapy services into care. ONS, the American Cancer Society, American Society of Clinical Oncology/Society for Integrative Oncology, and National Comprehensive Cancer Network currently recommend it for reducing anxiety, stress, depression, and mood disorders and improving quality of life.
“As an oncology nurse practitioner who specializes in supportive care, music therapy is a critical part of my practice to treat my patients holistically,” Regan Marooney, AGPCNP-BC, said. “I’ve watched as music takes my patients to a safe and peaceful place and allows them the space and time they need to begin to heal. Regardless of race or culture, I’ve never seen a patient leave a music therapy session without a smile. In my experience, music may contribute to reducing racial disparities in pain management.”