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Randomized Controlled Trial
. 2022 Jan;30(1):625-634.
doi: 10.1007/s00520-021-06435-y. Epub 2021 Aug 6.

Psychoneuroendocrinological effects of music therapy versus mindfulness in palliative care: results from the 'Song of Life' randomized controlled trial

Friederike Koehler  1   2 , Jens Kessler  3 , Martin Stoffel  1   2 , Martin Weber  4 , Hubert J Bardenheuer  3 , Beate Ditzen  1   2 , Marco Warth  5   6
Affiliations
Randomized Controlled Trial

Psychoneuroendocrinological effects of music therapy versus mindfulness in palliative care: results from the 'Song of Life' randomized controlled trial

Friederike Koehler et al. Support Care Cancer. 2022 Jan.

Abstract

Purpose: Although research on psychosocial interventions in palliative care provided evidence for their effectiveness regarding patient-reported outcomes, few studies have examined their psychobiological effects yet. Therefore, the purpose of the present work as part of an overarching study was to investigate differential effects of music therapy versus mindfulness on subjective distress and both neuroendocrine and autonomic stress biomarkers.

Methods: A total of 104 patients from two palliative care units were randomly assigned to three sessions of either music therapy or mindfulness. Before and after the second session (completed by 89 patients), participants rated their momentary distress and provided three saliva samples for cortisol and α-amylase analysis. Furthermore, photoplethysmography recordings were continuously assessed to calculate mean heart rate and heart rate variability. Data were analyzed using multilevel modeling of all available data and sensitivity analysis with multiply imputed data.

Results: Between 67 and 75% of the maximally available data points were included in the primary analyses of psychobiological outcomes. Results showed a significant time*treatment effect on distress (b = - 0.83, p = .02) indicating a greater reduction in the music therapy group. No interaction effects were found in psychobiological outcomes (all p > .05), but multilevel models revealed a significant reduction in cortisol (b = - 0.06, p = .01) and mean heart rate (b = - 7.89, p = .05) over time following either intervention.

Conclusion: Findings suggest a beneficial effect music therapy on distress while no differential psychobiological treatment effects were found. Future studies should continue to investigate optimal stress biomarkers for psychosocial palliative care research.

Trial registration: German Clinical Trials Register (DRKS)-DRKS00015308 (date of registration: September 7, 2018).

Keywords: Cancer; Mindfulness; Music therapy; Oncology; Palliative care; Stress.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Timing of outcome assessments in intervention session 2. SOL “Song of Life” music therapy, RELAX relaxation intervention, T time point, sCort salivary cortisol, sAA salivary α-amylase, mHR mean heart rate, RMSSD root mean square of successive differences
Fig. 2
Fig. 2
Patient and sample flow chart. SOL “Song of Life" music therapy, RELAX relaxation, S session, sCort salivary cortisol, sAA salivary α-amylase, mHR mean heart rate, RMSSD root mean square of successive differences
Fig. 3
Fig. 3
Means and standard errors of momentary distress (NCCN Distress Thermometer). SOL “Song of Life” music therapy, RELAX relaxation, T time point
Fig. 4
Fig. 4
Means and standard errors of sCort, sAA, mHR, and RMSSD. sCort salivary cortisol, sAA salivary α-amylase, mHR mean heart rate, RMSSD root mean square of successive differences, SOL “Song of Life” music therapy, RELAX relaxation, T time point
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