Effect of Music Therapy Combined With Aerobic Exercise on Sleep Quality Among Patients With Chemotherapy After Radical Mastectomy: Results From a Randomized Controlled Trial
Authors: Chang Li , Wang Yan , Zhang Jie , Zhao Wenqian , Yang Lei , Li Xiaomei 
Published: March 2021

Abstract
Background: The morbidity and mortality of breast cancer have gradually increased in recent years, seriously threatening women's health. Sleep disorder is one of the most common symptoms in patients with breast cancer. In recent years, with the increasing awareness of the importance of the quality of life of cancer patients, reducing symptoms and improving the quality of sleep have become the focus of cancer research. Some studies shown that music therapy can effectively promote the sleep quality. Other studies have indicated that aerobic exercise has the positive effect on sleep quality. However, the effects of these interventions on sleep quality of breast cancer patients, especially those in the chemotherapy after radical mastectomy is still unclear.Objective: The aim of this study was to explore the effect of music therapy combined with aerobic exercise on the sleep quality of patients undergoing chemotherapy after radical mastectomy.Methods: A randomized controlled trial was conducted at Breast Disease Diagnosis and Treatment Center, Shaanxi Province Tumor Hospital from November 2017 to January 2019.A total of 100 female breast cancer patients who underwent modified radical mastectomy (MRM) or extensive radical mastectomy (ERM), were recruited through convenient sampling, and randomly allocated into an intervention group of 51 patients and a control group with 49 patients respectively. The intervention group accepted music therapy combined with aerobic exercise from the first to the sixth admission to hospital for chemotherapy in addition to the routine nursing care, while the control group received only routine nursing care. Sleep quality of these patients were measured 3 times, eg, at the end of 10 days, the first cycle of chemotherapy, the third cycle of chemotherapy and the end of the sixth cycle of chemotherapy using Pittsburgh sleep quality index (PSQI), and to compare the total score of sleep quality and the difference of each factor between the two groups. A linear mixed model was used to measure the effect on PSQI of patients after controlling for other confounding factors.Results: The mean score of sleep quality of breast cancer patients who received chemotherapy after radical mastectomy, were 8.86±2.34.The patients with PSQI score greater than 7 points accounted for approximately 89.0%. Moreover, there were more than half of the patients with scores of subjective sleep quality, sleep duration, sleep disturbance and daytime dysfunction higher than 2 points. 56.0% of patients had the problem of poor subjective sleep quality; 42.0% of patients had the trouble in falling asleep; 34.0% of patients had sleep disturbance (easy to get up, get up early, frequently to go toilet at night). About 34.0% of patients slept less than 6 hours, and had daytime dysfunction such as energy shortage and fatigue.Significant improvements from baseline in all indices for sleep quality measurement were observed throughout the intervention period from 1st post-test to 3rd post-test.With the increase of chemotherapy cycle, the total score of PSQI and the score of sleep quality in the intervention group showed a decreasing trend. However, change in PSQI-total had increased from 1st post-test to 3rd post-test gradually increased in the intervention group (difference between groups: -1.31(-2.05,-0.57)to -2.102(-2.84,-1.36)) .On the contrary, significant increases in changes of the PSQI-total in control groups from 1st post-test to 3rd post-test was clear (difference between groups: 0.55 (-0.18,1.2752) to 2.75 (2.02,3.47)).Limitations: The data were self-reported, which could be influenced by many potential factors, and no biomarkers or physiological measurements were done, which need to be further explored. What’s more, bigger sample size was needed in the future studies to enhance the representativeness of the subjects.Conclusions: Music therapy combined with aerobic exercise intervention can significantly improve the sleepy quality of female breast cancer patients with chemotherapy after radical mastectomy, and it has a good continuous improvement effect on many aspects of reactive sleep.