Music therapy may be a way to help children cope with cancer treatment, and find emotional and physical comfort, said a study in Psycho-Oncology (Vol. 11: 379-388).

While music has been thought therapeutic since the time of the ancient Greeks, the discovery of the phonograph in the late 1800s set the stage for modern day music therapy.

Since then, music has been used periodically in hospitals to help patients sleep and to help in surgery and anesthesia, wrote the authors.

A renewed interest in the use of music in a medical setting included studies of its effect on children. These studies were done in the 1980s, wrote the authors. But how well music therapy worked was still not established. With that in mind, a group of researchers at the Hospital for Sick Children in Toronto looked at the effects of music therapy on 65 children with cancer.

But these researchers did more than provide recorded music to the children. Instead, the children had live, interactive music therapy, brought to them by a trained music therapist.

"It seemed to take their mind off their disease [and] treatments," said the parent of a child in the study. One's child "seemed to rest easier both during and after," said another parent. And a third said the music "helps children to be less anxious."

The study was conducted by Maru E. Barrera, PhD, and colleagues at the Hospital for Sick Children. Barrera is a psychologist at the hospital.

James Murdoch, a musician in the Art for Recovery program at the University of California San Francisco (UCSF) Comprehensive Cancer Center at Mt Zion, agreed.

"[Patients'] comments are universally that it helps them to relax by taking the stress — the apprehension — out of the treatment that they're going to get," he said.

Murdoch said there's always worry on some level, whether it's about needle sticks or test results. "On the most basic level, [the music] relaxes people and that’s what they appreciate."

He said patients and the family members who come to treatment with them come up to the musicians and talk to them "all the time — usually they're thanking them or showing appreciation, or they want to ask about the kind of music or ask for a specific type of music," he said.

"And, I think what they're saying is, thank you for bringing this light into this place that can be a place of fear or apprehension or uncertainty," Murdoch noted.

Murdoch's observations bear witness to what Barrera is trying to show. The study is important, she said, because "it opens the doors for complementary therapies that may contribute to improving the well-being of children being treated for cancer, and their parents."

Overall, 94% of the parents who provided comment to the authors felt their children benefited from the music therapy sessions. And 49% of the parents said it brought comfort to them and reduced their own anxiety.

The children in the study ranged in age from birth to 17, and all were at different stages of their illness. Some were newly diagnosed, and some were getting chemotherapy. Others were receiving palliative care, a treatment to make them more comfortable, which is not intended to cure their disease.

Different cancers affected the children. Some had Ewing's sarcoma, while some had brain tumors, lymphoma, or leukemia.

A trained music therapist visited with each child and sometimes his or her family. Children and their families chose songs and instruments that were used in the sessions.

The music making was aimed at reducing the child's distress and increasing his or her well-being. This was geared to each child's development. For instance, infants and children who did not feel well enough to participate were often helped to sleep or comforted by lullabies, the authors wrote.

Older children and teens were drawn in by camp songs, singing, songwriting, listening to pre-recorded music of their choice and improvising with the instruments, wrote the authors.

Some of the instruments used were a classical guitar, an electric autoharp, shakers, bells, and drums.

The researchers based their findings on three measures:

• The children's ratings of their feelings based on a "faces pain scale." In this measure, children as young as three were shown a set of drawn faces, representing a scale from very happy to very sad. (Infants were not included in this part.) Each child pointed to the face that best described their feelings.

• The researchers also judged the results by having children's parents answer a set of questions about their child's play before and after music therapy. Answers were based on a number scale. In this scale, 0 was "unresponsive," 10 was "does not play, does not get out of bed," 90 was "minor restrictions on strenuous activity," and 100 was "fully active — normal."

• The children and parents were also given a set of questions to answer together about the therapy. Hospital staff also answered questions about how the therapy seemed to affect the parents and children.

The results of the faces pain scale showed "there was a significant improvement in the children's feelings from pre- to post-music therapy," wrote the researchers.

The parents' ratings showed that "children actively involved in music sessions were [seen] by parents to [be more active] after music therapy than children who were [passive]."

The final set of questions, answered by children, parents and staff yielded many favorable comments. "Children and parents look forward to [the music therapist's] visit," one staff member said, according to the authors. "There is a change in their mood. This is great…The sessions were excellent. [The therapist] has such a therapeutic effect on children and families."

There were also negative and neutral comments, ranging from "I don't understand what [the therapist] does," to “I can't believe that music that I heard, so inappropriate."

The majority of the responses, though, were positive, wrote the authors. While it is difficult to define the actual meaning of music therapy, they wrote, music's meaning is "significantly personal and profound."

While the authors conclude that more studies are needed, their findings here suggest children are responsive to music therapy. "Their mood during hospitalization for cancer treatment seems to improve [with this therapy]," wrote the authors. It may help children — and their parents — cope with the discomfort that comes with diagnosis and help them face a life-threatening illness, they said.

"As a result of our study," Barrera said, "music therapy is now an ongoing part of the services we provide in the hospital." The hospital also has a program involving the therapeutic use of clowns, which she is evaluating.