The benefits of music therapy have received attention in the popular press and professional research journals (Cassileth, Vickers, & Magill, 2003; Marwick, 2000; "Music as medicine," 2003; Sammon, 1997; Ziporyn, 1984). Researchers and clinicians have demonstrated that music therapy can improve health outcomes in surgery, cardiology, obstetrics, and oncology. Increased relaxation, decreased anxiety and pain, and improved mood are some of the positive outcomes associated with music therapy interventions (Aldridge, 1993; Standley, 2000).

Although linked to many positive outcomes, music therapy has not been fully or routinely integrated into healthcare. One reason for this may be that not all patients feel comfortable being involved in music therapy interventions. Another reason may be that no systematic method currently exists to determine the most appropriate music therapy intervention for individuals within specific clinical contexts. For example, cancer patients who care receiving treatment may not have the energy needed for music making. Therefore, the goal of this study was to examine cancer patients' interest in using music therapy and their preferences in relation to two types of music therapy interventions, music making and music listening.

A number of publications have described the specific benefits of music therapy interventions for cancer patients. Interactive music interventions such as instrumental improvisation, drumming, and singing have shown promise in improving mood in cancer patients (Burns, Harbuz, Hucklebridge, & Bunt, 2001; Cassileth et al., 2003; Milliard, 2003; Krout, 2001; McDougal-Miller, 1992). Most music and oncology studies, however, have examined the effects of receptive interventions such as music listening, music and imagery, or a combination of music therapy interventions (receptive and interactive) on outcomes such as decreasing pain and nausea, improving mood, increasing family communication, and improving quality of life (Boldt, 1996; Burns, 2001; Curtis, 1986; Pfaff, Smith, & Gowan, 1989; Sabo & Michael, 1996; Sahler, Hunter, & liesveld, 2003; Tilch et al., 1999; Weber, Nuessler, & Wilmanns, 1997; Zimmerman, Pozehl, Duncan, & Schmitz, 1989). Although these studies have yielded promising results they have not systematically assessed whether such receptive interventions were preferred over other more active intervention (e.g., music making). Few studies are available that provide detailed descriptions of the patients' preferences for music therapy. What little is known about the determinants of patients' preferences for music therapy is reviewed in the following section.

Personal factors such as anxiety, affect, coping styles, fatigue, and other symptoms may also be associated with the decision to use music therapy. In one sample of oncology patients, those who were moderately physically uncomfortable were more likely to accept music therapy than individuals who were comfortable or those in severe pain (O'Callaghan & Colegrove, 1998). Furthermore, the pattern of music therapy use during hospitalization may change depending on the severity of symptoms. Weber and colleagues (1997) found that, as cancer patients experienced the most aggressive phase of treatment, with concomitant levels of symptoms such as high fever, they preferred silence. When feeling better, they requested resumption of music therapy sessions (Weber et al., 1997).

In addition, individuals' self-efficacy or confidence in their ability to carry out a music therapy intervention may influence their decision to participate in music therapy and affect their preference for different types of therapy. For instance, individuals with formal musical training or previous success in performing may feel relatively more confident singing or playing an instrument during an interactive music intervention. The individual who has not had successful musical experiences in the past may choose to participate in a receptive music intervention, such as music imagery, music relaxation, or music listening, or may choose to refuse music therapy services altogether. Individuals who are presented with music therapy interventions with which they do not feel confident may experience increased anxiety (Montello & Coons, 1998). Exploring personal self-efficacy may prove useful when attempting to identify factors that drive interest in and preference for a particular music therapy intervention.

Question 1: What proportion of individuals undergoing treatment for cancer is interested in participating in music making and music listening interventions?

Question 2: Are there differences in personal characteristics (such as age, gender, education, music background, anxiety, affect, fatigue, coping) or intervention-specific characteristics (perceived benefits, and barriers, and self-efficacy) among individuals who are (a) interested in interactive music therapy, (b) interested in receptive music therapy, or (c) not interested in music therapy?

Participants who preferred music listening were younger than those who preferred music making or were not interested in music therapy. One possible explanation for this result is that age may be associated with music listening in the general population. Though we did not test this, it is possible that younger individuals are more likely to listen to music during their daily routines, thus they may be more likely to prefer music listening as a form of therapy. Alternatively, because there is some evidence that younger individuals experience more distress from cancer than their older counterparts, younger participants may have preferred an intervention requiring fewer cognitive, physical, or social demands to refrain from adding increased anxiety to an already distressing experience. These results are consistent with prior work showing that patients experiencing a higher frequency and intensity of symptoms decrease their level of involvement in music sessions (Gotay & Lau, 2002; Weber et al, 1997; Zabora et al., 1997).

Clearly, younger and/or more distressed patients preferred receptive types of music interventions in this investigation. However, Standley (2002) reported greater benefits associated with interactive types of therapy (e.g., music making), it might be advantageous for music therapists to create interventions that move patients from passive involvement to a more active engagement through music making across multiple sessions. Passive music interventions could promote structure and self-regulation to decrease anxiety. Once stabilized, the intervention could then move toward a more interactive modality designed to develop new cognitive coping strategies by, for example, exploring the meaning of the cancer or behavioral coping strategies to manage symptom distress.

The lack of differences between groups related to past music experiences and music making self-efficacy is interesting. Common sense would suggest that self-efficacy and past musical experience would be major factors in determining interest in a specific intervention. Our data indicate that although majority of participants had been involved in one form of past music experience (e.g., singing in a choir or playing an instrument), however, they did not prefer music making over music listening. We did not ask participants if past musical experiences were positive ones. Negative musical experiences could have influenced interest in either intervention.

The lack of differences in music making self-efficacy indicates that participants across groups had similar levels of confidence with regard to the behaviors needed to carry out the music making intervention. Conversely, the individuals not interested in music indicated significantly less confidence in carrying out the music listening intervention than both of the other groups. The description of the music making session included the presence of a music therapist, perhaps implying a lower amount of patient control, thus influencing the responses to the self-efficacy items. The music listening description included several choices made by the client, perhaps implying more participant control and thereby decreasing self-efficacy. Therefore, an item-by-item analysis might illuminate specific behaviors involved in music listening that are problematic for participants. Older patients may find the idea of using compact disc or other playback devices threatening. It may be necessary to modify intervention descriptions to overcome those barriers to participation in music interventions.

The findings should be considered in light of study limitations. First, the cross-sectional nature of the study and lack of representativeness in terms of culture and education reduces generalizability. second, the lack of gender differences in interest is possibly related to sample size and limited power of the statistical tests. Anecdotally, research assistants reported that more men were interested in music making; however, there were no differences in interest based on gender. Third, the lack of differences in fatigue are likely due to floor effects, since the participants were generally too close to the beginning of chemotherapy treatment and may not yet have been experiencing treatment-related fatigue. Previous music therapy research has suggested that music therapy can decrease fatigue in cancer survivors (Burns, 2001).

In summary, the purpose of this study was to explore the interest of cancer patients in participating in music therapy during chemotherapy treatment. A high proportion of patients were interested in music therapy, especially music listening. Personal factors such as anxiety, negative affect, social supportive coping, and age were associated with interest in a particular music therapy treatment modality. Although this study is far from conclusive, it brings to light several new issues music therapists need to consider when developing interventions for cancer patients. It highlights the importance of assessing the problems, needs, and preferences of patients prior to intervening. Identifying factors that affect intervention effectiveness will further assist music therapists in developing meaningful and effective interventions.

Aldridge, D. (1993). Music therapy research 1: A review of the medical literature within a general context of music therapy research. The Arts in Psychotherapy, 20, 11-35.

Boldt, S. (1996). The effects of music therapy on motivation, psychological well-being, physical comfort, and exercise endurance of bone marrow transplant patients. Journal of Music Therapy, 33, 164-188.

Boon, H., Stewart, M., Kennard, M. A., Gray, R., Sawka, C., Brown, J. B., et al. (2000). Use of complementary/alternative medicine by breast cancer survivors in Ontario: Prevalence and perceptions. Journal of Clinical Oncology, 18, 2515-2521.

Bruscia, K. (1998). Defining Music Therapy (2nd éd.). Gilsum, NH: Barcelona Press.

Burns, D. (2001). The effect of the bonny method of guided imagery and music on the mood and life quality of cancer patients. Journal of Music Therapy, 38, 51-65.

Burns, S., Harbuz, M., Hucklebridge, F., & Bunt, L. (2001). A pilot study into the therapeutic effects of music therapy at a cancer help center. Alternative Therapies in Health & Medicine, 7(1),48-56.

Carver, C. S., Scheier, M. R, & Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality & Social Psychology, 56(Z), 267-283.

Cassileth, B. R., Vickers, A. J., & Magill, L. A. (2003). Music therapy for mood disturbance during hospitalization for autologous stem cell transplantation: A randomized controlled trial. Cancer, 98(IZ), 2723-2729.

Cella, D. (1998). Factors influencing quality of life in cancer patients: Anemia and fatigue. Seminars in Oncology, 25(3, Suppl 7 (June)), 43-46.

Curds, S. (1986). The effect of music on pain relief and relaxation of the terminally ill. Journal of Music Therapy, 23, 10-24.

Gotay, C. C., & Lau, A. K. (2002). Preferences for psychosocial interventions among newly diagnosed cancer patients from a multiethnic population. Journal oJPsychosocial Oncology, 20(4), 23-37.

Hilliard, R. E. (2003). The effects of music therapy on the quality and length of life of people diagnosed with terminal cancer. Journal of Music Therapy, 40(2), 113-137.

Krout, R. E. (2001). The effects of single-session music therapy interventions on the observed and self-reported levels of pain control, physical comfort, and relaxation of hospice patients. American Journal of Hospice Palliative Care, 18(6), 383-390.

Marwick, C. (2000). Music therapists chime in with data on medical results. Journal of the American Medical Association, 283(6), 731-733.

McDougal-Miller, D. (1992). The effect of music therapy on the immune and adrenocortical systems of cancer patients. Unpublished master's thesis, The University of Kansas, Lawrence, KS.

Montello, L., & Coons, E. (1998). Effects of active versus passive group music therapy on preadolescents with emotional, learning, and behavioral disorders. Journal of Music Therapy, 35, 49-67.

Music as medicine. (2003). Harvard Mens Health Watch, 7(8), 5-6.

O'Callaghan, C., & Colegrove, V. (1998). Effect of the music therapy introduction when engaging hospitalized cancer patients. Music Therapy Perspectives, 16, 67-74.

Pfaff, B., Smith, K., & Gowan, D. (1989). The effects of music-assisted relaxation on the distress of pediatrie cancer patients undergoing bone marrow aspirations. Children's Health Care, 18(4), 232-236.

Sabo, C. E., & Michael, S. R. (1996). The influence of personal message with music on anxiety and side effects associated with chemotherapy. Cancer Nursing, 19(4), 283-289.

Sahler, O. J., Hunter, B. C., & liesveld, J. L. (2003). The effect of using music therapy with relaxation imagery in the management of patients undergoing bone marrow transplantation: A pilot feasibility study. Alternative Therapies in Health &" Medicine, 9(6), 70-74.

Sammon, T.J. (1997). A piece of my mind. March music. Journal of the American Medical Association, 275(10), 816.

Spielberger, C. D. (1983). Manual for the state-trait anxiety inventory. PaIo Alto, CA: Consulting Psychologists Press.

Standley, J. (2000). Music research in medical/dental treatment: An update of a prior meta-analysis. In C. Furman (Ed.), Effectiveness of music therapy procedures. Documentation of research and clinical practice (3rd ed., pp. 1-64). Silver Springs, MD: American Music Therapy Association.

Tilch, S., Haffa-Schmidt, U, Wandt, H., Kappauf, H., Schafer, K., Birkmann, J., et al. (1999). Supportive music therapy improves mood state in patients undergoing myeloablative chemotherapy. Bone Marrow Transplant, 23 Supple 1, 566.

Warrick, P. D., IrishJ., Morningstar, M., Gilbert, R., Brown, D., & Gullane, P. (1999). Use of alternative medicine among patients with head and neck cancer. Archives of Otolaryngology-Head & Neck Surgery, 125, 573-579.

Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality & Social Psychology, 54(6), 1063-1070.

Weber, S., Nuessler, V., & Wilmanns, W. (1997). A pilot study on the influence of receptive music listening on cancer patients during chemotherapy. International Journal of Arts Medicine, 5(2), 27-35.

Zabora, J., Blanchard, C., Smith, E., Roberts, C., Glajchen, M., Sharp, J., et al. (1997). Prevalence of psychological distress among cancer patients across the disease continuum. Journal of Psychosocial Oncology, 15(2), 73-87.

Zimmerman, L., Pozehl, B., Duncan, K., & Schmitz, R. (1989). Effects of music in patients who had chronic cancer pain. Western Journal of Nursing Research, 11(3), 298-309.

Ziporyn, T. (1984). Music therapy accompanies medical care. Journal of the American Medical Association, 252(8), 986-987.

This research was conducted in affiliation with the Walther Cancer Institute. The authors wish to thank the Scientists in the Behavioral Cooperative Oncology Group (BCOG) and Dr. Sheri Robb for their assistance in study design and manuscript preparation.

This is only a portion of the actual study. A full text version is available through the Journal of Music Therapy from The American Music Therapy Association at www.musictherapy.org