Music a perioperative aide for lung cancer patients?

Individuals with resectable stage IA to IIIB non-small cell lung cancer (NSCLC) who plan to receive minimally invasive lung surgery may benefit from intensity-based personalized music therapy (IBP-MT) suggests the phase II Music of Lung Health II study.

The study showed that IBP-MT alleviates perioperative anxiety, helps manage pain in lung surgery, and relieves respiratory difficulty symptoms, said Yuan Yuan, professor of classical music from the School of Art, Sun Yat-sen University, Guangzhou, Guangdong, PR China, at WCLC 2024.

Compared with standard care, IBP-MT was associated with a lower oxycodone-weight ratio (1 vs 1.83 mg/kg; standardized mean difference [SMD], –0.93; p<0.001). This effect was consistently seen across subgroups, with more pronounced effects among those with stage 1 disease (SMD, –1.18), patients <60 years (SMD, –1.26), and those who had sublobe resection (SMD, –1.75).

Statistical significance was not achieved in the subgroups of patients with stage II (SMD, –0.62) and III (SMD, –0.21) disease and those who had open surgery (SMD, –0.80). [WCLC 2024, abstract OA07.03]

Fewer IBP-MT than standard-care recipients required rescue analgesics (14.7 percent vs 45.5 percent; relative risk, 0.63; p=0.004). IBP-MT recipients also had a lower visual analogue scale (VAS) for pain score than those on standard care (median 2.3 vs 3.4; p=0.04 [24 hours] and 1.3 vs 3.4; p<0.001 [48 hours]).

IBP also fared better than standard care in reducing anxiety as reflected by the median VAS for anxiety (VAS-A) scores after treatment (1.5 vs 3; p=0.045), at the operating room (2 vs 5; p=0.042), and at 24 (1.67 vs 2.83; p=0.003), 48 (0.67 vs 3; p<0.001), and 60 hours (2 vs 3; p=0.029) postop.

“IBP-MT can also effectively alleviate dyspnoea in the rehabilitation period by reducing anxiety levels,” said Yuan. These were evident in the significantly lower dyspnoea score in the IBP vs standard-care arm (26.3 vs 41.2; SMD, –3.3; p<0.001).

“Mediation analysis further indicated that the alleviation of anxiety is a potential key mediator between MT and the alleviation of dyspnoea. This means that the effect of music on dyspnoea alleviation [is mostly due to] anxiety relief rather than pain relief,” explained Yuan.

A practical approach

“Multimodal analgesia strategies are generally adopted in minimally invasive surgery. Yet, more than half of patients experience moderate-to-severe pain after thoracic surgery, with 8 percent developing chronic pain,” Yuan said. Moreover, 80 percent of patients report negative emotions in the perioperative phase, and drugs may be insufficient to address these issues. [Reg Anesth Pain Med 2021;46:893-903]

“Music could be a noninvasive, safe, and cost-effective perioperative management approach that may address patients’ physical and emotional needs,” she continued. IBP-MT consists of personalized music libraries designed and selected via a musical profile questionnaire, with loudness set to a 5-dB signal-to-noise ratio.

The team randomized 66 participants (53 percent women) 2:1 to undergo IBP-MT or standard care. The 40-minute session was scheduled an hour before surgery. Considering the music component of the trial, participants should have normal or mild hearing loss. Sixty hours after surgery, participants resumed their respective regimens and received IV patient-controlled analgesia (oxycodone 1 mg/kg). The postop sessions were given 30 minutes thrice daily.

Over 90 percent of participants underwent video-assisted or robotic-assisted thoracoscopic surgery. More patients had lobe resection (51.3 percent in the IBP arm and 86.4 percent in the standard-care arm).

QoL is just as important as survival

According to discussant Darcy Burbage, an oncology clinical nurse specialist from Christiana Care Health System Newark, Delaware, US, these improvements correlate with improved quality of life (QoL) in individuals undergoing surgery for NSCLC.

“For many individuals living with lung cancer, QoL is as important as survival. [The study found that] music can reduce pain and anxiety, improve dyspnoea during the perioperative phase, and indeed soothe the soul,” said Burbage.