The study of the effect of music on children suffering from cancer before and after chemotherapy in Avencina Hospital A Randomized clinical trial
Abbasi Spanji AA1 , Nikkhah M2, Heidari Gorji MA3 ,Agai N2
1-Ph.D, fecalty member of Azad Islamic University Babol Branch, 2- MA, Azad Islamic University Amol Branch, 3- Ph.D, Nursing and Midwifery Faculty, Mazandaran University of Medical Science, , tel: 09113262964(corresponding Author)
Abstract
Background: Regarding to the negative effects of cancer on children's physical and mental relaxation, the side effects of chemotherapy and the positive effects of music therapy this research was made to study the effects of music on children's stress with cancer before and after chemotherapy.
Material and Method: This study is a random clinical trial research.32children with cancer under chemotherapy were chosen as the method of available sampling then randomly divided in two to people groups, experiment group and controlling group. Data were collected by questionnaires of demographic data and sharer- winger stress evaluation. For each child in experiment groups, a piece of music was played 20 minutes before and after chemotherapy regarding to this or her toleration.
In experiment group, stress questionnaires were filled in before and after music therapy before and after chemotherapy. In controlling groups, also the questionnaires were filled in before chemotherapy.
Finding: There was no meaning full statistical different between the stress scores of experiment and controlling groups after music therapy before chemotherapy [p=o, 240] but after music therapy was surprisingly decreased and there was a meaning full statistical difference [p=0.001].
Conclusion: Music therapy as an efficient medium can help the children deal with the life after cancer easily.
Key words; stress – chemotherapy- music therapy
Introduction
The most common malignant cancer in pediatrics is locum which includes two third of children cancers. The head of association of Iranian children blood and cancer in the sixth conference of children blood and cancer Ahvaz medical university said; there is no exact stastics of the number of children with cancer.
But it is predicted that 1500 to 2000 children under 15 suffer from cancer that 20 of them have leukemia which is increasing worldwide and of every 100.000 children under 15 years of age 4 children suffer from leukemia. Cancer is a disease that disrupts the children's and their families' mental comfort. Based on its symptoms and treatment, cancer causes anxiety and depression and their families and it's worse in children due to their age. Cancer treatment causes unwanted side effects during the treatment or after that. So quick treatment of the symptoms and side effects of cancer cause better feelings to cope with the life with cancer.
Cancer treatments include surgeries, chemotherapy and radiotherapy. These treatment and especially anti caner medicines often have many side effects that suitable behaviors with them. O`Callaghan quotes from Hilliard [2006] , Kazak and baxt [2007] that diagnosis of cancer , its treatments and side effects can be horrible , painful, threatening and embarrassing for young patients and their families and also experiencing the solitude . Since stress and also experiencing the patients mentally they may have negative effects on treatments. Using non medication methods to reduce and killing pains and anxiety are increasing which music therapy is an effective method.
In nursing action, music therapy as an effective medium can be part of patients' care program and also can be used a treatment method to reduce pains and anxiety, to increase relaxation , body immunity, to decrease blood pressure, pulse and breath. Listening to music causes to secrete endorphins and makes the patient calm and relaxed.
Music therapy can be economical and needs no special training and the patients can do it without any body's help. It can be recommended as a suitable method and the most important is that music therapy is so efficient in children due to their age circumstances and simplicity of this method. Based on the results of the studies made about the effects of music in adaptation to environment and stress management and lack of any studies about the effect of music on children with cancer, the present research decided to study the problems of children with cancer and side effects of by music therapy to answer the question that is there any difference between the stress of children with cancer who listened to music before and after chemotherapy and children without music therapy before and after music therapy
Material and Method
This is a random clinic trail research that was made on the children who came to Boali hospital in sari far chemotherapy from the month of esfand2012 to June2013 and had a file there. The criteria to enter the research: The criteria include accompanying one parent during chemotherapy, the parents' satisfaction, children must be only in research, having no other illness except for cancer, having no hearing problem, having no surgery for the children, lack of fever or pain while registering and filling out life vital signs symptoms forms, having mental illnesses and not taking relaxing drugs based on the doctors' prescription and having stress score of over 10 in sharer and wangler questionnaires.
If the patients and their families want to leave the study, if the children get hearing problems by the side effects of treatment, if the patients' treatment case changes from the aspect of kinds of chemotherapy medicine in two stages, the children will send to another hospital to go on treatment.
The tools of collecting data include two questionnaires of population information and children stress symptom scale of sharer and wangler (2002) and two ways of library and field ways were used to collect data.
The questionnaire of population includes patient's medical information, age, sex, education level, weight, height, surgery background, diabetes background, blood pressure and hypertension background, duration of previous illnesses, living place, and dose of present drugs taken daily. Also, patients' heart beat number, systolic and diastolic blood pressure (by german Hiny blood pressure scale) and respiration number were measured before and after chemotherapy by the researcher.
Children stress symptom scale of sharer and wenger is a 24 item self report questionnaire that has 11 items about excitement symptoms and 13 items about physical symptoms of stress, each question has two choices of there is (1 score) and there is not (0 score).
Two other items of vomit and sadness were added to the questionnaire later after studying other items.
The range of scores of stress symptoms were from zero to 26 and stress symptoms were reported in 3 levels of low, medium and high (sharer and wenger 2002).
The validity of this questionnaire was studied by 10 professors of Tabriz nursing and midwifery university neurology department and the validity of translation was studied by an English translator.
The reliability of the questionnaire of stress symptoms in skibu and book study (2007) were studied by Krunbach Alpha that was equal to 0.88.
To collect the data, the researcher went to Encology ward of Avecina hospital in Sari with permission from Ayatolla Amoli university to study the samples.
32 children qualified to enter the study participated the research after sampling and regardless to their gender. After explaining the project to the parents and getting their written permission, the patients were put in two groups of music therapy and controlling groups.
The relaxing music was selected by a music instructor from the culture house of Sari with beat of 60 to 80 rounds per minute and was played by a ??? evaluator made of China.
Before chemotherapy, the demographic information of patients was given by their families or from their files and then stress questionnaire was filled. The way how the music must be played was explained to children and their mothers then the music was played for children in experiment group for 1 to 2 minutes then the children were asked to choose their favorite music and listen it for 20 minutes, 30 minutes before and after chemotherapy regarding to their tolerance and patience. The stress questionnaire was filled for children in experiment group after music therapy and before chemotherapy. The questionnaire was also filled and registered for children in controlling group before chemotherapy, and in a treatment period the process mentioned above for three times for three chemotherapy stages and again and again music therapy was done and questionnaires were filled and registered. For controlling group, the stress questionnaire were filled but without music was registered and evaluated.
These actions were performed between 9 AM and 4 PM because it was after doctors' visit and it was after office hours and it was so quite and peaceful, and without any disturbance.
The data was analyzed by descriptive statistical tests and analytical tests of pair T or dependent and independent T and (18 version) SPSS software.
The findings
The results show that the samples in both groups were the same from the aspects of the type of disease, gender and other demographic information of 32 patients in our study, 56.25% were girls (75% in experiment and 37.5% in controlling group) and 43% were boys (25% in experiment group and 62.5% in controlling group). 34% of the patients were over 9 years of age and most of them had severed lymphoid leukemia.
The results show that the medium or average score of stress in pretest and post test before chemotherapy were in order in experiment group as 12.81±2.68 and 13.93±2.51 and in controlling group as 13.81±1.97 and 12.87±2.6 and the average score of stress in pretest and post test after 3 items chemotherapy in experiment group was as 7.37±2.44 and 18.62±2.44 and in controlling group was as 14.37±1.8 and 13.43±2.30.
The statistical test of independent T showed no meaningful relation between two groups of experiment and control after once music therapy (P=0.240).
In the intra group comparison in experiment group before chemotherapy, the statistical test of pair T shows No meaningful decrease in the stress score after one music therapy (P=0.373) (table No.1).
The results show that in experiment group, the average stress score before chemo therapy and after music therapy was higher than controlling group and it was a meaningful difference (P=0.0001). The stress score of experiment group after chemotherapy and music therapy had a big decrease and independent T test showed a meaningful statistical difference (P=0.0001). In an intra group comparison in experiment group, the statistical pair statistical test of T showed a meaningful decrease in the stress score after the whole period of chemotherapy (P=0.0001) but there was no meaningful difference in stress score of controlling group (P=0.127) (table No.2).
The patients who had the stress score over 10 were 87.5% after one session music therapy and after the music therapy and chemotherapy they were 18.75% (they had stress score of 10).
Table1. The comparison of stress score average before chemotherapy separately in both the study and control group
GroupIndependent T-TEST / Total / control / Music therapy / Stress score
Befre of chemotherapy
Mean±SD / Frequency / Mean±SD / Frequency / Mean±SD / Frequency
T=1.307
df=30
p=0.201 / 13.40±2.32 / 32 / 12.87±2.06 / 16 / 13.93±2.51 / 16 / Pretest
t=1.19
df=30
p=0.240 / 13.31±2.37 / 32 / 13.81±1.97 / 16 / 12.81±2.68 / 16 / post test
df=15
1.074 =t
p= 0.003 / df=15pair t-test
T=0/919
P=0/373
Table2. The comparison of stress score average after chemotherapy separately in both the study and control group
GroupIndependent T-TEST / Total / control / Music therapy / Stress score
After chemotherapy
Mean±SD / Frequency / Mean±SD / Frequency / Mean±SD / Frequency
T=10.45
df=30
p=0.0001 / 16.03±3.52 / 32 / 13.43±2.3 / 16 / 18.62±2.44 / 16 / Pretest
t=10.45
df=30
p=0.0001 / 10.87±4.01 / 32 / 14.37±1.08 / 16 / 7.37±2.44 / 16 / post test
df=15
t=1.61
p=0.127 / df=15pair t-test
9.18=t
P=0.0001
Discussion
The fear of the side effects after chemotherapy in cancer patients leads to stress and anxiety that increases the pains of the disease (cancer), so listening to light music for inpatients can make them calm and relaxed and kills the pains.
The independent T test showed no meaningful relation in stress scores between the two groups of experiment and control after one session music therapy before chemotherapy (P=0.240) and in the intergroup comparison in the experiment group before chemotherapy, the pair T test showed no meaningful decrease in the stress score after one session music therapy (P=0.373) which can state that one session music therapy cannot be effective in lowering the stress in children with cancer.
The results show that the average score of stress in the experiment group after chemotherapy and before music therapy was higher than controlling group and it was a meaningful statistical difference (P=0.0001).
This can be different due to their high stress score before chemotherapy and playing music but because of lack of stress evaluation before chemotherapy in the final session it can't be proved and also because of the difference of impatients and out patients.
The average stress score of the experiment group after chemotherapy and after music therapy had a big decrease (P=0.0001) and 87.5% of patients had stress (score over 10) before chemotherapy and after one session music therapy that after the whole period of chemotherapy and music therapy only 18.75% had stress score higher than 10 so it can show that music therapy has positive effects on the stress after chemotherapy.
The findings of this study are as the same as those of Roshan Nejad, Yousefi Nejad, O'callaghan, Stanzuk, Canetken, Nan Bakhsh, Zenging, Rafian, Vahabi, Ghaderi, Shaban, Mottahedian and Sheybani Tzraji.
Roshan Nejad and Coworkers (2002) made a research on the study of music therapy effects on decreasing the pain in patients with chronic cancer.
Their study findings suggested that music therapy is efficient in decreasing pains of chronic cancer patients.
Yousefi Nejad (2005) observed the effects of music on the amount of pain in chronic cancer a suggested that there is a meaningful relation between the amount of pain and number of pain killers before and after music therapy.
O'callaghan and Coworkers (2013) made a qualitative study on the relation between music therapy and children suffering from cancer in the cancer center of peter McCallum in Melbourne Australia.
They found out that music can help cancer and it can make children calm, without stress, promotes care relationships, self care and makes them hopeful.
Stanczyk (2011) made a research on music therapy in supportive care of cancer in Poland. Some aspects of music functions in supportive care of cancer are shown in this study and music therapy can be a part of a supplementary medicine in cancer to lower the stress, pain and promotive the life quality.
Cantekin and Coworkers (2013) made a study in the effects of music on the stressful factors and the level of anxiety in Hemodialize patients in Meliksa university in Turkey. The findings suggested that music causes a meaningful decrease in anxiety level and stressful factors in hemodialize patients and can be part of nursing actions to help meet the physical and mental needs of these patients.
The results of Nan Bakhs and Coworkers' study (2008) in the effects of music on decreasing pain and stress of birth deliveries and suggested that listening to light music decreases the pain and anxiety of women while birth delivery.
Zengin and Coworkers (2013) made a study in the effects of music on the pain and anxiety of patients under counter port surgery in Turkey. The findings suggested that music meaningfully and significantly decreases the stress hormone level, physiologic parameters, pains and anxiety.
The results of study of Rafiian and Coworkers suggested that music therapy has a significant effect on the level of anxiety, pain, vomit and vital signs of the patients under caesarian surgeries in Dr. shariati hospital in Isfahan. Also, there was a significant meaningful difference between the sample cases and non samples after music therapy in decreasing pain, anxiety, vital signs in caesarian women.
Vahabi (2002) made a research named the effects of the music therapy and physical relaxation on impatients' anxiety in ICU. The results showed that music therapy caused a meaningful decrease of the anxiety.
Qaderi and Coworkers made a study in the effects of music on pain and anxiety and mental effects of music. Of 238 received articles 20 were chosen randomly that their main titles were the relation of music to the decrease of pain and anxiety and the results proved that music therapy has significant effects on pains and anxiety.
The results of Shaban and Coworkers' study (2005) in the effect of non medicine methods of muscular relaxation and music on the pain level of patients with cancer suggested that the level of pain in patients before and after relaxation and music therapy had a meaningful difference (P=0.001). Also there was a meaningful difference in relaxation groups and music therapy groups which means pain decreased much more in relaxation group than music therapy (P=0.016).
Mottahedian and Coworkers (2012) made a study in the effects of music on the level of pain after the surgery with spinal anaesthesia. The results showed that music therapy group patients had a meaningful decrease of pain level rather non music group (P=0.05) and taking the amount of petidine in both groups was meaningful statistically (P=0.041).