Music Therapy Noninferior to CBT for Anxiety in Cancer Survivors in Large Telehealth Trial
核心洞察
The MELODY trial, a 300-participant randomized study, found music therapy (搜索) noninferior to cognitive behavioral therapy (搜索) for reducing anxiety (搜索) in cancer survivors.
At week 8, music therapy (搜索) reduced HADS anxiety (搜索) scores by −3.12 versus −2.97 for CBT, within the noninferiority margin (P < .001), with benefits persisting at week 26.
Both interventions improved fatigue, depression, insomnia, pain, and quality of life, with minimal and comparable adverse events.
Music therapy (搜索) delivered via telehealth is noninferior to cognitive behavioral therapy (搜索) (CBT)—the current first-line nonpharmacologic intervention for anxiety (搜索) in oncology—for reducing anxiety among adult cancer survivors, according to results from the MELODY trial, a two-arm, parallel-group randomized clinical trial conducted at Memorial Sloan Kettering Cancer Center and Baptist Health Miami Cancer Institute (搜索).
Anxiety (搜索) is among the most prevalent and distressing long-term symptoms experienced by cancer survivors, with an estimated one in two survivors reporting persistent anxiety symptoms that negatively affect quality of life, worsen fatigue, and contribute to functional impairment. Although CBT is recommended in oncology practice guidelines, including those jointly endorsed by the American Society of Clinical Oncology (ASCO) and the Society for Integrative Oncology (SIO), barriers related to access, stigma, and patient preference often limit its use.
Trial Design and Patient Population
The MELODY study enrolled 300 English- or Spanish-speaking adult cancer survivors who had completed active treatment and reported elevated anxiety (搜索), defined as a Hospital Anxiety and Depression Scale (HADS) anxiety subscale score of 8 or higher. The cohort represented a broad cross-section of cancer diagnoses, ages, and genders. Participants were randomly assigned to receive seven weekly telehealth sessions of either music therapy (搜索) or CBT delivered by trained providers.
Music therapy (搜索) is an evidence-based intervention delivered by a board-certified music therapist using tailored music-based approaches to address individual patient needs. The coprimary endpoints were HADS anxiety (搜索) score measured at 8 weeks (end of treatment) and 26 weeks (long-term follow-up). Secondary outcomes included fatigue, depression, insomnia, pain, cognitive dysfunction, and health-related quality of life.
Efficacy Results
Music therapy (搜索) was noninferior to CBT in reducing anxiety (搜索). At week 8, participants in the music therapy arm experienced a mean reduction in HADS anxiety score of −3.12 (95% confidence interval [CI] = −3.59 to −2.65), compared with −2.97 (95% CI = −3.45 to −2.50) in the CBT arm. The between-group difference fell within the predefined noninferiority margin of 1.20 (P < .001).
These reductions persisted at week 26, with mean changes of −3.31 (95% CI = −3.78 to −2.85) in the music therapy (搜索) arm and −3.00 (95% CI = −3.47 to −2.53) in the CBT arm, remaining within the noninferiority margin of 1.28 (P < .001). Reductions in anxiety (搜索) scores in both groups also exceeded the minimal clinically important difference of 1.7 points without maintenance sessions.
Secondary outcomes similarly improved across both treatment arms. Participants reported reductions in fatigue, depressive symptoms, insomnia, pain, and subjective cognitive complaints, along with improvements in health-related quality of life. Adverse events were minimal and comparable between groups, supporting the safety and tolerability of both interventions.
Clinical Implications for Survivorship Care
The findings carry important clinical implications. Music therapy (搜索) is not merely a complementary intervention, but a viable and effective alternative to traditional first-line psychotherapy for reducing anxiety (搜索) in survivors of cancer. Active music-based experiences—including guided music listening, improvisation, songwriting, and lyric analysis—may help regulate the nervous system, support social connection, and engage cognitive processes associated with anxiety reduction. This distinguishes clinical music therapy from passive music listening and underscores its role as a psychotherapeutic modality with measurable impact.
Patient preference and treatment fit are important considerations in anxiety (搜索) management. Not all patients are receptive to traditional talk therapy, and some may experience stigma or discomfort associated with conventional psychotherapy. Music therapy (搜索) offers an engaging alternative that many survivors find empowering, potentially enhancing treatment adherence and patient satisfaction. The study's telehealth delivery model further improves accessibility by addressing geographic, mobility, and workforce barriers that often impede access to psychotherapy among patients with cancer—a consideration particularly relevant in community and rural settings where mental health resources may be limited.
Qualitative Insights: Songwriting and Survivorship
Building on the MELODY research, Sarah Biedka, a PhD candidate in Joke Bradt's Music, Creativity and Wellness Lab at Drexel University's College of Nursing and Health Professions, led a qualitative study analyzing 26 songs written during the music therapy (搜索) sessions to better understand the needs and challenges of the cancer survivors who created them. The study was published in the Journal of Cancer Survivorship.
"We identified needs and challenges that extended far beyond cancer-related anxiety (搜索), including prioritizing self-care, redefining identity, navigating relationships and finding deeper meaning," said Biedka.
The analysis revealed nuanced stressors beyond cancer-related anxiety (搜索). "Several songs described how coping with one challenge often created new challenges in other areas of life, especially relationships," said Biedka. "Essentially, participants described feeling like they had to choose between acting on their needs and preserving the status quo in their relationships. Until MELODY, these participants had been mostly choosing their relationships over their needs, leading to feelings of isolation and resentment."
Researchers explained that songwriting helped participants explore, process, and communicate complex and often uncomfortable needs and challenges that they might not have otherwise discussed. Many cancer survivors avoid talking about difficult thoughts and feelings because they do not want to burden others or worry about being misunderstood or rejected.
An additional related study, led by Bradt and published in the European Journal of Integrative Medicine, found that participating in music therapy (搜索) during the MELODY study may have helped participants reduce anxiety (搜索) not only by helping them manage anxious moments, but also by helping them engage with the deeper personal, relational, and societal experiences that shape anxiety during survivorship.
"In light of the MELODY trial results, the findings of this qualitative study, as well as findings from interviews we conducted with 30 of the music therapy (搜索) participants, suggest that music therapy may offer a creative way to explore and address some of the underlying issues that contribute to anxiety (搜索) while also supporting longer-term coping," said Bradt. "Ultimately, all of the MELODY findings highlight the potential value of music therapy as a part of comprehensive cancer survivorship care."
As the number of cancer survivors continues to grow, scalable, evidence-based interventions to reduce symptom burden are increasingly essential. Findings from the MELODY trial support the use of music therapy (搜索) to reduce anxiety (搜索) in this population. Oncology clinicians should consider incorporating this modality into comprehensive survivorship care plans, with referrals made to board-certified music therapists, ideally those with expertise in oncology and survivorship care. Further research will need to examine the economic benefits and any potential implementation challenges and solutions, because CBT currently remains the first-line treatment for anxiety management.