Burns, D.S., Azzouz, F., Sledge, R., Rutledge, C., Hincher, K., Monahan, P.O., & Cripe, L.D. (2008). Music imagery for adults with acute leukemia in protective environments: A feasibility study. Supportive Care in Cancer, 16, 507–513.

To determine the feasibility and possible benefits of a music imagery intervention for hospitalized patients with acute leukemia or high-grade non-Hodgkin lymphoma

Study patients completed baseline self-report instruments to assess affect, anxiety, and fatigue. Participants were then randomized to receive standard care or standard care plus music imagery. Standard care was hospitalization in a HEPA-filtered room with restricted visitor access and supportive medical care. A board-certified music therapist provided music imagery sessions. Sessions included relaxation and music imagery and were designed to provide participants with an opportunity to practice music imagery techniques, provide a successful music imagery experience, and answer any questions. When the initial session was complete, the therapist provided a CD with four 20-minute music imagery exercises as well as a CD player. Participants were encouraged to use the exercises at least once a day, and more frequently if they could. Participants used a journal to record how many exercises were used and their perceived effectiveness of the music therapy exercises. During therapist visits, patients could ask questions, change music imagery selections, and experience a therapist-led music imagery session. Music for the study included light classical and new age music chosen by the therapist based on assessment of the patients’ musical preferences and current emotional state and energy level. Sessions by the therapist occurred within three days of admission and twice a week during the hospital stay, up to four weeks.

• The study reported on a sample of 30 patients; 19 patients withdrew early from the study.
• Mean patient age was 52.47 years +/- 15.36 in the music imagery group and 55.53 years +/- 15.88 in the control group.
• The sample was 61% female and 39% male.
• Patients were hospitalized in a protective environment; all had either acute leukemia or non-Hodgkin lymphoma.
• Sixty-five percent of patients were married.

• Single site
• Inpatient setting
• Hematology oncology unit of Indiana University Hospital

Patients were undergoing the active treatment phase of care.

A randomized controlled trial design was used.

• Functional Assessment of Chronic Illness Therapy–Fatigue scale (FACIT-F)
• Spielberger State Anxiety Inventory (STAI-S)
• Music Imagery Journal
• Feasibility was assessed by rate of consent to participate, percent of completed music imagery sessions, and completion of measurement instruments.

Overall, 72% of therapy sessions were completed when accounting for study dropouts. No one completed the music imagery journal, due to feeling too sick or not remembering. Forty-nine percent completed an average of 60% of the measurement instruments. Analysis of mean scores over time, using repeated measures ANOVA, showed that both study groups improved in terms of greater positive affect, less negative affect, less fatigue, and less anxiety (p < 0.001). There were no differences in these results between study groups. Within those patients with low negative affect at baseline, those who received the therapy had lower anxiety at week 4 or hospital discharge than those in the control group.

Music imagery therapy is feasible in this population. Only those patients who had low initial negative affect demonstrated a potential benefit of the intervention in terms of lower anxiety at the end of the study period. Anxiety and fatigue declined over time in all patients.

• The study reported on a small sample, with less than 30 participants.
• The study design lacked an attentional control.
• The authors interpreted findings regarding apparent benefit only in those with lower initial negative affect scores to reflect an inability on the part of more negative patients to engage in the intervention. This suggests that patients who may need help for anxiety reduction the most would be those who are least able to benefit from this type of intervention.
• There was no way to evaluate actual use of therapy exercises because patients did not maintain the journals provided. This suggests that patients who are this severely ill may not be able to attend to this type of data collection.
• It cannot be determined whether patients used these exercises in between therapist-led sessions or not, and how this affected findings.
• The study had a high drop-out rate, with 10 patients (20% of the initial sample) withdrawing due to being too sick to carry out the intervention or voluntary withdrawal.

Results suggest that this type of intervention may only be of benefit in a select group of patients who are not as severely ill and do not have a high negative affect. The drop-out rate also suggests that this is a type of intervention for which participation and effect are highly dependent upon the patients’ preferences and interest in involvement. Findings suggest that once patients acclimate to the hospital environment, anxiety, fatigue, and negative affect decline, suggesting that nursing attention to helping patients with this acclimation may be most important in addressing these patient problems.