The Effect of Art Therapy and Music Therapy on Breast Cancer Patients: What We Know and What We Need to Find Out—A Systematic Review

Table 2

Reviewed studies in music therapy according to sample, intervention, outcomes, and main findings.

Study; author, year	Sample	Intervention: content, duration and frequency	Outcome indicators: Primary [1]; Secondary [2]	Scale	Main findings and effect sizes (Cohen’s d if applicable)
Hanser et al., 2006 [36]	N = 70 (26–77 years).; IntGr n = 20, ConGr (usual oncology and supportive care) n = 22	(i) Individual sessions with music therapist; (ii) Up to 15 weeks (three 45 min sessions)	Quality of life [1]; Psychological distress [1]; Cardiovascular arousal [2]; Relaxation, comfort, mood [2]	FACT-G plus FACIT-Sp subscale; HADS; VAS	No significant differences in quality of life or psychological distress observed.; Music therapy was associated with improvement in secondary outcomes immediate after sessions: relaxation, comfort, happiness, heart rate ().
Bulfone et al., 2009 [37]	N = 60; IntGr (mean age 49.2 ± 6.9) n = 30, ConGr (standard assistance, mean age 52.7 ± 6.1) n = 30	(i) Listening to pretaped and recorded music in earphones; (ii) 15 min of music listening while waiting for the call for chemotherapy	Anxiety [1]	STAI-Y	Immediately after music therapy (STAI-Y mean score) reduction in anxiety state () was observed.
Binns-Turner et al., 2011 [38]	N = 30 (42–70 years).; IntGr n = 15, ConGr (standard care) n = 15	(i) Listening to pretaped music in the perioperative period; (ii) Duration not described	Anxiety [1]; Hemodynamics [1]; Pain [1]	SAI; VAS	Postoperatively music therapy (SAI mean score) was associated with improvement in; (i) Levels of MAP : IntGr 83.6 (±13.0), ConGr 96.6 (±14.3); (Cohen’s d: 0.95).; (ii) Anxiety symptoms: IntGr 30.7 (±12.3), ConGr 49.7 (±18.9); (Cohen’s d: 1.19).; (iii) Pain symptoms: IntGr 41.5 (±30.2), ConGr 64.9 (±20.9); (Cohen’s d: 0.90).
Li et al., 2011 [39]	N = 120 (25–65 years); IntGr n = 60, ConGr (routine nursing care/no intervention) n = 60	(i) Self-selected music from preselected 202 items through MP3 player; (ii) Listening to music twice a day (30 min per session), in the morning and in the evening	Pain [1]	SF-MPQ (including PRI-Total, VAS, PPI); General questionnaire	Music therapy (PRI-total mean score) was associated with improvement in pain symptoms in three measured time points: (i) The day before discharge from hospital: IntGr 2.25 (±1.17); ConGr 4.70 (±1.50); <0.05 (Cohen’s d: 1.82).; (ii) The second time of admission to hospital for chemotherapy: IntGr 1.72 (±1.32); ConGr 4.17 (±1.34); (Cohen’s d: 1.84).; (iii) The third time of admission to hospital for chemotherapy: IntGr 0.71 (±0.69); ConGr 2.62 (±0.96), (Cohen’s d: 2.28).
Li et al., 2012 [40]	As above	As above	Anxiety [1]	SAI; General questionnaire	Music therapy (SAI mean score) was associated with improvement in anxiety in three measured time periods: (i) The day before discharge from hospital after radical mastectomy: IntGr 37.77 (±5.96), ConGr 42.35 (±6.09); (Cohen’s d: 0.76).; (ii) The second time of admission to hospital for chemotherapy: IntGr 34.39 (±4.26); ConGr 43.10 (±6.07); (Cohen’s d: 1.66).; (iii) The third time of admission to hospital for chemotherapy: IntGr 30.87 (±2.71); ConGr 40.35 (±4.44); (Cohen’s d: 2.58).
Zhou et al., 2011 [41]	As above	As above	Depression [1]; Duration of hospital stay [1]	ZSDS; General questionnaire	Music therapy (ZSDS mean score) was associated with improvement in depression in three measured time periods: (i) The day before discharge from hospital after radical mastectomy: IntGr 32.20 (±4.73), ConGr 35.76 (±5.80); (Cohen’s d: 0.67).; (ii) The second time of admission to hospital for chemotherapy: IntGr 30.00 (±4.89); ConGr 35.50 (±4.90); (Cohen’s d: 1.12).; (iii) The third time of admission to hospital for chemotherapy: IntGr 25.67 (±2.74); ConGr 32.15 (±3.86); (Cohen’s d: 1.93).
Romito et al., 2013 [42]	N = 62 (25–65 years); IntGr n = 31, ConGr (standard psychosocial care) n = 31	(i) Integrated group intervention of music therapy and emotional expression.; (ii) Single session (2.5 h)	Stress [1]; Anxiety [1]; Depression [1]; Anger [1]; “Need for help” variable [1]	“Emotion thermometers tool”	Postintervention music therapy (“Emotion thermometers tool” mean score) was associated with improvement in stress, anxiety, depression, and anger () in the experimental group.
Palmer et al., 2015 [43]	N = 201 (mean age 59.4 ± 15.7); IntGr-1 (live music) n = 69, IntGr-2 (recorded music) n = 68, ConGr (usual care) n = 65	(i) IntGr-1: listening to 5 min live singing preoperatively. Later—listening to recorded music.; (ii) IntGr-2: Listening to 5 min recorded music. Later—as IntGr-1.	Anesthesia requirements [1]; Anxiety [1]	GA-VAS	Music therapy (GA-VAS mean score) was associated with improvement in anxiety symptoms: (i) Live music group versus control: IntGr 40.7 (±36.7); ConGr 57.0 (±46.9); (Cohen’s d: 0.39).; (ii) Recorded music group versus control: IntGr 38.0 (±32.5); ConGr 57.0 (±46.9); (Cohen’s d: 0.47).
Moradian et al., 2015 [44]	N = 99 (27–82 years); IntGr-1 (Nevasic group) n = 34.; IntGr-2 (music group) n = 32, ConGr (no intervention) n = 33	(i) Listening to pretaped Nevasic music (IntGr-1) or other preselected music (IntGr-2) for 27 min once feelings of nausea/vomiting occur.; (ii) 6 days	Frequency and duration of nausea and amount of vomiting [1]; Quality of life [2]	Rhodes index of nausea, vomiting and retching (INVR); EORTC-QLQ-C30; EORTC-QLQ-BR23	Music therapy was not associated with frequency or duration of nausea and vomiting experiences.
Karadag et al., 2019 [45]	N = 60 (mean age 59.40 ± 13.28 years); IntGr n = 30, ConGr (no intervention) n = 30	(i) Pretaped and recorded music on MP3 player; (ii) 5 weeks (5 times a week for 20–40 min)	Anxiety [1]; Depression [2]; Comfort level [1]	HADS; RTCQ; questionnaire for sociodemographic and disease characteristics	Music therapy (HADS mean score) was associated with improvement in; (i) Anxiety symptoms: IntGr 5.20 (±2.83), ConGr 8.59 (±3.30); (Cohen’s d: 1.10).; (ii) Depression symptoms: IntGr 4.13 (±1.85); ConGr 8.33 (±4.02); (Cohen’s d: 1.34).; Music therapy (RTCQ mean score) was associated with improvement in comfort levels: IntGr 119.03 (±11.90); ConGr 96.53 (±16.64); (Cohen’s d: 1.55).
Hsieh et al., 2019 [46]	N = 60 IntGr n = 30 (mean age 52.2 ± 9.88), ConGr (active, listened ambient music, mean age 56.9 ± 10.68) n = 30	(i) Pretaped and recorded music on MP3 player; (ii) 24 weeks (five 30 min sessions per week)	Symptom severity [1]; Pain intensity [2]; Perceived fatigue [2]	TRSC NRS‐101 MFSI‐SF‐C	Music therapy (TRSC mean score) was associated with improvement in symptom severity, pain intensity, and fatigue () after 6, 12, and 24 weeks of intervention.

^×IntGr: intervention group; ConGr: control group.