The impact of music therapy on pain and anxiety levels in patients with gynaecological cancer undergoing complex intracavitary brachytherapy

Brachytherapy has a pivotal role in the curative treatment of cervical cancer as it enables delivery of high doses of radiation to the cervix, while relatively sparing other organs-at-risk reducing side effects. However, cervical cancer brachytherapy is associated with significant mental distress and physical discomfort including severe lower abdominal cramping pain,back pain, and pain during applicator insertion. Pain control especially during applicator insertion is critical but challenging to achieve for this group of patients. Music therapy(MT) offers a low-risk supportive interventional modality that most patients find appealing, increasing relaxation and decreasing pain. Methodology A one-year single arm pilot study studying effects of MT on pain and anxiety levels in 10 patients with gynaecological cancer receiving complex intracavitary brachytherapy was carried out. Each patient received four sessions of concurrent MT interventions with complex intracavitary brachytherapy treatment, delivered pre-, during, and post-applicator insertion. The MT interventions consisted of live music provided by the music therapist using an acoustic guitar, entrainment and iso-principle with live music improvisation to match patients’ anxiety and pain-levels, therapeutic singing, and instrumental play. Outcome measures included patient reported pain score using the the Visual Analogue Scale at 6 time-points (during pre-insertion, urinary catherization,tandem insertion, ovoids insertion, packing and post-insertion); and anxiety score using the State Trait Anxiety Inventory(STAI) pre-and post-insertion procedure. Amount of anaesthetic agents and opioids consumption, duration of procedure, and patients’ feedback were also collected. Value stream mapping was constructed to evaluate waste and wait times in order to improve work efficiency. Results The mean patient-reported post-procedure pain scores for the most uncomfortable parts of the procedure – tandem insertion and packing were 3 and 4 respectively. These results indicated a relatively low pain score across patients post-procedure. Patient-reported anxiety using the STAI indicated a significant decrease in anxiety pre-and post-insertion procedure. The mean anaesthetic agents and opioids used across the ten patients in this study were 2mg IV Midazolam and 25 mcg of IV Fentanyl. The mean overall procedural time for this study across all 40 sessions decreased from the initial 45 minutes to 20 minutes. Positive qualitative feedbacks were also given by patients. These positive results were encouraging, with potential clinical implications in improving patient care and experience for patients undergoing similar procedures. Conclusion Music therapy has the potential to become an adjunct standard of care for reducing pain, anxiety as well as usage of opioids for gynaecological cancer patients undergoing complex intracavitary brachytherapy.

Jia Yi Joy Lim

National Cancer Centre Singapore
Radiation Therapist

Ms Joy is working inNational Cancer Centre Singapore as a radiation therapy, currently specialising in gynaecological and prostate high-dose-rate brachytherapy treatments since 2017. She graduated from Trinity College with a Bachelor of Science in Radiation Therapy and currently, and currently in her last year of her Master in advanced practise radiotherapy. Her research interests centre around the intersection of improving patient's standard of care and treatment technique advancement.