An interventional study of Interactive Music Therapy and Verbal support in Advanced Cancer, sponsored by Drexel University. Completed at 3 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2022-02-21.
Sponsored by Drexel University · Not applicable, Interventional, and Supportive care
Chronic pain is one of the most feared symptoms in people with cancer. Insufficient relief from pharmacological treatments and the fear of side effects are important reasons for the growing use of complementary pain management approaches in cancer care. On such approach is music therapy. Although several studies have demonstrated that music therapy interventions can reduce pain in people with cancer, few studies have examined the therapeutic mechanisms that explain how music therapy interventions lead to improved pain management. The purpose of this study is to examine whether an interactive music therapy intervention improves psychological and social factors that play an important role in chronic pain management in people with advanced cancer. The findings will contribute towards the optimization of music therapy for palliation of chronic pain in people with advanced cancer.
This study addresses the public health problem of chronic pain as one of the most feared symptoms in people with cancer, with 70% to 90% of patients with advanced disease reporting pain. Unrelieved pain remains a challenge in cancer care. Insufficient relief from pharmacological treatments and the fear of side effects are important reasons for the growing use of complementary pain management approaches in people with cancer. One such approach is music therapy. Although efficacy of music therapy for pain has been established, there are no mechanistic studies clarifying how it works in clinical populations. Thus, there is a lack of knowledge related to 1) therapeutic mechanisms that lead to improvement (mediator effects) and 2) the relationship between patient characteristics and treatment response (moderator effects). Yet, it is well accepted that knowledge of mediators and moderators as well as a validated theory of action (i.e., how the intervention activates the mediators) are needed to optimize psychosocial treatment interventions. Therefore, the overarching goals of this study are to 1) examine mediators and moderators hypothesized to account for the pain-reducing effects of Interactive Music Therapy (IMT) in people with advanced cancer and chronic pain and 2) validate IMT's theory of action. The mediation model to be tested in this study aligns with a biopsychosocial framework to palliation of chronic pain and is based on findings from a preliminary study. The investigators postulate that anxiety, mood, self-efficacy and perceived support mediate the effects of IMT on pain outcomes (i.e. pain intensity and pain interference). In addition, the impact of several moderators on the hypothesized mediation model, namely adult playfulness, perceived musical competence, and treatment expectancy, will be tested. This study uses a mixed methods intervention design in which qualitative data (i.e. semi-structured follow-up interviews) are embedded within a randomized controlled trial. A total of 100 outpatients with advanced cancer and chronic bone pain will be randomized to one of two 6-week treatments: 1) Interactive Music Therapy or 2) Verbal-based support. The mediators and pain outcomes will be measured at baseline and after the fourth and sixth session using self-report measures as well as biomarkers (salivary cortisol, lachrymal dopamine content, serum oxytocin, and plasma β-endorphins). Follow-up interviews with a subsample of 30 participants will enable the investigators to examine the congruence between the hypothesized mediators and moderators and participant explanations of how IMT influences chronic pain management (i.e. theory of action). This study will contribute towards the optimization of music therapy for palliation of chronic pain in people with advanced cancer through a better understanding of the impact of mediators and moderators of IMT on chronic pain management. The results of this study will provide estimated effects sizes of IMT on the mediators and preliminary effect size estimates for the pain outcomes. This information will be instrumental in the development of a subsequent large-scale efficacy trial.
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Exclusion Criteria:
Six 45-minute individual interactive music therapy sessions.
Behavioral: Interactive Music Therapy
Six 45-minute individual verbal support sessions
Behavioral: Verbal support
Six 45-minute individual interactive music therapy (IMT) sessions delivered by a board-certified music therapist. Sessions start with music-guided breathing, imagery, or humming. The music therapist then engages the participant in singing of familiar songs and co-created vocal or instrumental music improvisations based on patient needs. Discussion about the meaning assigned to songs and emotions expressed through the improvisations follow. The IMT experiences are aimed at facilitating emotional expression, offering support through interactive music making, and strengthening inner resources of creativity. In addition, each week the participant learns music-based techniques for self-management of anxiety, stress, mood, and pain.
Six 45-minute individual sessions delivered by a master's level clinician with training in counseling. The sessions are focused on patient-initiated conversations about their pain, life stressors and the impact on their daily life. The intervener provides nondirective, supportive care by offering supportive, validating statements and reflective listening. The intervener refrains from employing active suggestion, problem-solving or behavioral or cognitive therapy techniques. The verbal support sessions are aimed at providing an empathic, therapeutic environment to facilitate emotional expression and sharing of worries and fears.
Pain Intensity
measured by PROMIS® Pain Intensity-Short Form (SF)3a
Time frame: through study completion, a maximum of 12 weeks
Pain Interference
measured by PROMIS® Cancer-Pain Interference -SF 6b
Time frame: through study completion, a maximum of 12 weeks
Patient Perception of Change
measured by Patient Global Impression of Change Scale (PGIC)
Time frame: through study completion, a maximum of 12 weeks
Serum β-endorphin
biomarker for pain intensity
Time frame: through study completion, a maximum of 12 weeks
Anxiety
Mediator outcome measured by PROMIS® Cancer-Anxiety - SF
Time frame: through study completion, a maximum of 12 weeks
Mood
Mediator outcome measured by Positive and Negative Affect Scale (PANAS)
Time frame: through study completion, a maximum of 12 weeks
Perceived support
Mediator outcome measured by PROMIS® Emotional Support - SF 6a
Time frame: through study completion, a maximum of 12 weeks
Self-efficacy
Mediator outcome measured by PROMIS® Self-Efficacy of Symptoms
Time frame: through study completion, a maximum of 12 weeks
Salivary cortisol
Mediator outcome (biomarker for anxiety)
Time frame: through study completion, a maximum of 12 weeks
Serum oxytocin
Mediator outcome (biomarker for social support)
Time frame: through study completion, a maximum of 12 weeks
Lachrymal dopamine
Mediator outcome (biomarker for mood)
Time frame: through study completion, a maximum of 12 weeks
Treatment expectancy
Moderator outcome measured by Credibility/Expectancy Questionnaire (CEQ)
Time frame: Baseline
Perceived Musical Competence
Moderator outcome measured by two-item questionnaire
Time frame: Baseline
Adult playfulness
Moderator outcome measured by Short Measure for Adult Playfulness (SMAP)
Time frame: Baseline
Plan to share: Yes — We will make the de-identified datasets available to other researchers. Researchers will be asked to submit a formal request for data sharing to the PI that outlines the purpose of the secondary data analysis. Data and associated documentation will be made available to users only under a data-sharing agreement that provides for: (1) a commitment to using the data only for research purposes; (2) a commitment to securing the data using appropriate computer technology; and (3) a commitment to destroying or returning the data after analyses are completed.
Supporting information: Study protocol
Time frame: After completion of study report and publication of results
Access criteria: We will make the de-identified datasets available to other researchers. Researchers will be asked to submit a formal request for data sharing to the PI that outlines the purpose of the secondary data analysis. Data and associated documentation will be made available to users only under a data-sharing agreement that provides for: (1) a commitment to using the data only for research purposes; (2) a commitment to securing the data using appropriate computer technology; and (3) a commitment to destroying or returning the data after analyses are completed.
This study is completed, as verified in Feb 2022. You cannot join it, but the record below documents what was studied.
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