Music therapy effects on breast cancer patients after mastectomy

¶ … clinical trial report regarding the effects of music therapy on female breast cancer patients following radical mastectomy. In this review, the article would be examined on the basis of its sampling unit, measurement methods, process of data collection and data analysis, researcher's interpretation of findings, the limitation of the study and its implication in clinical practice, its significance as well as the scope for further investigation.

The present study uses stratified random sampling, also known as proportional random sampling, of probability sampling technique wherein subjects are initially divided in groups on the basis of age, gender, condition etc. A final list or sub-group can then be chosen from the main group (as one hundred and twenty female patients suffering from breast cancer, aged between 25 to 65 years of age, have been chosen randomly here). The sample specifically took account of patients who required radical mastectomy, including modified radical mastectomy and extensive radical mastectomy (Li, Zhou, Yan, Wang & Zhang, 2012, p. 1147). This technique is very effective to study a particular group of people from the main population. It is also considered better than simple random sampling because it warrants more accurate statistical outcomes. The advantage of choosing a sub- group randomly, as chosen 120 random numbers through a computer program in the present case, is the absence of sampling bias (Explorable.com, 2009).

Sample size plays an active role in yielding accurate results as sample size is directly related to power. As stated by Suresh, Thomas and Suresh, "ceteris paribus, the bigger a sample, the higher the statistical power" (Suresh, Thomas & Suresh, 2011). The randomly selected 120 patients were further distributed randomly into two groups of 60 each; an experimental and a control group. As calculated earlier, a minimum number of 50 patients in each group are required to detect the difference of five state anxiety score with a power of 80% at the 5% level of statistical significance. Therefore, a size of 120 patients was a careful attempt, keeping in mind a 20% drop-out rate, as the detection might have been affected simply because not enough patients were selected (Li et al., 2012, p. 1148).

Being an interventional trial, as it uses a new technique of introducing music therapy, (Bos, 2007) this study considers the age group between 25-65 years of female patients suffering from breast cancer and required radical mastectomy as its inclusion criteria. While the exclusion criteria included patients who had voice sensitivity of epilepsy, or sound allergy, or simply did not prefer listening to music, (Li et al., 2012, p. 1148) none of the patients were lost in first post-test from either group. The second and third post-test observed a loss of 6 patients from the experimental group and 9 patients from the control group, respectively. Thus, a total of 15 patients were lost, thereby giving an attrition rate of 12.5% (Li et al., 2012, p. 1150).

Regarding ethical consideration, the study has been reviewed and acquired the approval of the appropriate Human Research Ethics Committee. All the participants were thoroughly explained to the process before participating and they gave written informed consent before participating voluntarily (Li et al., 2012, p. 1149). The setting of this clinical trial is the oncology center of a general hospital in Xian, China, which is very appropriate for the introduction of this new therapy under controlled circumstances. However, the effects of music therapy in an outpatient setting or external setting are still unknown (Li et al., 2012, p. 1147).

3. Measurement Methods

The instruments used in this study are a standardized demographical data questionnaire, which comprised of a total of 15 categories, namely: age, residence, educational level, occupation, income, marital status and age of first patients suffering from breast cancer, etc.; and the State Anxiety Inventory (SAI), which was used in its Chinese version for the evaluation of anxiety in patients in the present study. SAI's inclusion of a 20-item scale was planned to measure anxiety as an emotional state through a four-point Likert format, where one stands for not at all, and four for very much so. This is because SAI is one of the most widely used instruments to measure anxiety, in research and clinical settings and with Chinese populations. Anxiety score range varies from 20-80; the greater the anxiety, the higher the score. For example, low anxiety ranges between 20 to 39, moderate anxiety 40 to 59 and high anxiety ranges from 60 to 80. The validity coefficient of SAI is 0.88 and the test-retest reliability coefficient is 0.72. However, the effect of the application of Chinese version of SAI to many studies resulted in a test-retest coefficient of 0.88 while the Cronbach's Alpha reliability coefficient was 0.90 in this study (Li et al., 2012, p. 1148).

4. Data Collection

The researchers collected the data from March to November 2009, from female breast cancer patients, through demographical data questionnaire and SAI on the basis of their age, educational qualification, occupation, income etc. The validity and reliability is tested through accuracy and consistency of the data collected. Both the experimental and control group were made to complete this questionnaire and pre-test of SAI before radical mastectomy. The three post-test SAI were conducted later; the 1st post-test was conducted the day before the patient's discharge from hospital while the 2nd and 3rd post-test were done on their second and third time admission in the hospital for chemotherapy. The interval between the three tests was 14, 21 and 28 days respectively, i.e. an average of 18.9 (7.1) days. The data collectors were trained in documenting the information collected from the patients through questionnaire, anonymously and being unbiased, as they had no clue regarding the group allocation (Li et al., 2012, p. 1148).

6. Researcher's Interpretation of Findings

The key findings of the researcher include firstly, the positive effect of music therapy in reducing the anxiety of female breast cancer patients, following radical mastectomy, as a significant statistical group-difference could be observed in the scores of the two groups, with experimental group demonstrating a noteworthy reduced level of state anxiety, in all of the three post-tests. Other related studies also confirmed this positive result of applying music therapy. Secondly, music therapy can be used as an alternative nursing technique in clinical practice to cure patients. And thirdly, Lynda E. Hall's core, care and cure model proved to be very expedient in the implementation of the therapy appropriately (Li et al., 2012, p. 1153).

Similar results have been gathered by Boehm et al. by applying art therapy, which includes dance and movement therapy, music therapy, etc., as they concluded it to be significantly effective in reducing the anxiety level of breast cancer patients (Boehm, Cramer, Staroszynski & Ostermann, 2014, 8). Also concluded by Daykin et al. was the usage of music therapy as an instrument of treatment. De Niet et al. considers it beneficent in improving, maintaining and remediating clinical issues (as cited in Li et al., 2012, p. 1146).

This study, being self-reported, has many limitations. Firstly, the research only includes quantitative data; hence a further study is required to measure subjective experiences. Secondly, the absence of physiological variables, thus further examination needs to be done to study the effect of music therapy on physical aspects. Thirdly, routine nursing care has been provided to the control group while different experimental time and methods should be applied for further investigation. Lastly, a very small portion of ERM patients were taken into account, therefore a further study is required to study the anxiety of those patients (Li et al., 2012, p. 1153).

The researcher further suggests that music therapy should therefore be used in clinical practice as an alternative method for the improvement of anxiety in breast cancer patients as it was advantageous for a huge number of patients in China and will improve their welfare and satisfaction. The core, care and cure model can be referred to for its implication (Li et al., 2012, p. 1153).