Introduction of a Music-based Intervention for Patients Receiving Infusions at the Lifespan Cancer Institute Infusion Center in the Miriam Hospital
Phase: NA
Conditions: Music Therapy
Sponsor: Brown University

 
 
 
 
 
 
 
 
Introduction of a music-based intervention for patients receiving infusions at the Lifespan 
Cancer Institute Infusion Center in the Miriam Hospital 
NCT # Unassigned 
5/20/2024 
 
 
 
 
 
 
 
 
 
 
 
 

Background 
An estimated 17 million Americans are living with cancer, and the majority of this 
population will receive chemotherapy as part of their treatment plan each year. In addition to 
common side effects like pain, fatigue, nausea/vomiting, and hair loss, chemotherapy infusions 
can also take a significant psychological and emotional toll on patients. Many studies have 
shown increased prevalence of depression and anxiety among cancer patients due to both disease 
and therapeutic burden, with prolonged chemotherapy treatment in particular serving as a 
significant risk factor. Thus, there begs the question of nonpharmacological and non-invasive 
treatment methods to reduce the negative emotional states, psychological burden, and stress that 
often accompany chemotherapy. 
Music has increasingly been utilized in many clinical settings as a complementary 
intervention. One population that has benefited greatly from music intervention is individuals 
with dementia-related disorders. Active music therapy with these individuals can help in treating 
cognitive and/or behavioral symptoms of the disease by engaging participants through social 
interaction amongst other acute benefits.  Even more, studies have shown that passive music 
therapy techniques (e.g., listening to recorded or live music) can ease psychosocial symptoms 
associated with dementia, even when a trained music therapist is not present. Overall, music 
therapy interventions have been proven to promote wellness, manage stress, alleviate pain, 
express feelings, enhance memory, improve communication, and promote physical rehabilitation. 
In addition to these cognitive benefits, music therapy has also been shown to improve physical 
systems. For example, just four weeks of passive music therapy exercises in a population of 
hypertensive young adults significantly lowered systolic blood pressure and heart rate. This 
suggests a soothing and possibly rehabilitative effect of music on patients as they are battling 
their illnesses. In addition, singing along to music was found to boost the body’s cytokine levels, 
a sign of strengthening immunity. One can think about music’s ability to boost immunity as a 
beneficial chain reaction: music improves people’s moods and lowers stress, which affects 
activity of the autonomic nervous system, which then ramps up immune function. Altogether, 
while music therapy does not actually affect diseases themselves, it has a great impact on mood, 
and sometimes can make a difference in the way the patient copes with and feels about their 
disease. 
The idea that patients with cancer may benefit from musical expression and musical 
experiences has been supported by music therapy research. For instance, a randomized trial by 
Harper et. al found that at an adult outpatient chemotherapy infusion center, listening to self-
selected music during infusion was associated with improved positive mood and reduced 
negative mood and distress in patients. Another study by Mondaro et al. found that music therapy 
served as an outlet for patients to express their emotions and led to increased feelings of 
resilience, both of which were associated with promoting patients’ endurance through their 
chemotherapy regimens.10 And another study by Massimiliani et al. found that music 
intervention resulted in decreased anxiety level and heart rate in oncological patients receiving 
chemotherapy. Overall, many studies have shown the usefulness of music therapy in oncology 

settings, and its low-touch, low-risk, and low-cost administration makes it an attractive method 
for managing patients’ psychological well-being during challenging chemotherapy sessions. 
However, despite the demonstrated benefit of music intervention in the clinical setting, 
there has not been widespread implementation. In particular, music therapy services from 
licensed musicians are severely under-resourced and underrepresented in Rhode Island as a 
whole, let alone in an oncological context. In the American Music Therapy Association 2021 
Workforce Analysis, only one music therapist in Rhode Island responded to the association’s 
survey; they reported seeing around 2000 clients for the entire year of 2020 and delivering 
services to eight facilities across the state. While this number likely underreports the amount of 
music therapy services provided—especially when factoring in unlicensed music therapists 
working with various patient populations—jobs in this workforce have only decreased since the 
onset of the COVID-19 pandemic. Importantly, Miriam Hospital is a major outpatient clinic in 
Rhode Island providing infusion services for patients undergoing cancer treatment and would be 
an impactful initial location to launch this music therapy intervention. Thus, given the lack of 
structured music therapy programs for oncology patients in Rhode Island, this project serves to 
examine the success of receptive music therapy to improve the health and well-being of patients 
undergoing chemotherapy and to create a formal music therapy offering at the Miriam Hospital. 
Successful implementation at the Miriam Hospital could set the grounds for expansion to other 
Lifespan Infusion Centers, including Rhode Island Hospital and Newport Hospital which are two 
of the largest hospitals in Rhode Island.  
 
Objectives 
The aims of the project are to (1) provide patients receiving infusions at the Miriam 
Hospital a relaxing therapeutic music experience, (2) qualitatively and quantitatively evaluate the 
effectiveness of this intervention to reduce physical and psychological symptom burden, and (3) 
investigate if there are beneficial effects of receptive music based interventions upon 
physiological parameters such as heart rate, respiratory rate, and blood pressure.  
 
Design and Methods 
We will screen patients undergoing infusion services at the Miriam Hospital outpatient 
infusion clinic to meet eligibility criteria for this study, including: (1) age >18 years, (2) 
sufficient hearing capacity to hear music, (3) scheduled for a chemotherapy infusion lasting at 
least 30 minutes, (4) having had at least one prior infusion session without music therapy 
intervention, and (5) ability to complete pre- and post-assessments in English. On each day of the 
study where researchers are on site at Miriam Hospital, researchers will approach patients at the 
infusion clinic and screen them for eligibility based on Q3 before their infusion session. 
Eligibility screening will be completed upon approaching patients where researchers will ask 
patients verbally if they qualify. Student researchers will follow an IRB-approved recruitment 
script as the recruitment process will all be done verbally with each patient on the day of their 

infusion session. For prospective subjects who are eligible, we will ask if they would like to 
participate in the study and obtain informed consent via our consent form which requires a 
signature. 
This study will be a self-controlled case series with 150 participants (an amount that will 
probably decrease due to natural attrition); each participant will serve as a control for themselves 
to evaluate any changes due to the music therapy intervention. Prior to intervention 
administration, we will directly obtain demographic data from each participant—including age, 
gender, diagnosis, and current infusion type. 
Before the infusion, participants will be given a pre-assessment survey, the Edmonton 
Symptom Assessment Scale (ESAS) regarding their current mood and symptoms, a tool that has 
been previously reported and clinically validated in the literature for assessing patient symptom 
burden among patients with cancer. During the infusion, participants will be asked if they have 
their own device, i.e. a phone or tablet, with music on it. If not, participants will use an iPad 
provided by the infusion clinic. Researchers will guide participants through the music selection 
process, which will include choosing emotionally salient songs unique to each patient’s 
preferences. Headphones will then be connected to the device for participants to listen to a self-
selected playlist (e.g. on YouTube or Spotify) for at least 30 minutes. Vitals such as blood 
pressure, respiratory rate, and heart rate will also be monitored before and after the music 
intervention. After the session, participants will be given the ESAS again as a post-assessment 
survey to evaluate outcomes of the music-based intervention. Outcomes will be self-reported 
changes in positive and negative mood, anxiety, distress, and pain using the ESAS. Participants 
will also be asked a set of qualitative questions about their overall experience with the music 
therapy session, including how their infusion session with music compared to previous sessions 
without music, as well as if they would want music included with infusions in the future.  
There are no statistical analyses to run on this data, including adjustments made for 
testing multiple variables. Differences in symptom data from the ESAS between the pres-
assessment and post-assessment surveys will be compiled across participants and reported in a 
chart. Similarly, differences in vital signs between baseline and after the 30-minute music 
listening intervention will be plotted on a chart. Data from the participant satisfaction feedback 
questions are qualitative in nature and will be listed out in a table.  
We will be raffling four $25 gift cards to local Rhode Island businesses to participants in 
December 2024. Participants will have about a 4 out of 100, or 4% chance of winning. To 
distribute gift cards to the winners, email addresses will be collected separately from the data 
gathered in the study; however, the emails will only be used for this purpose and be deleted after 
the study is completed.