http://jnms.mazums.ac.

ir
[ DOI: 10.18869/acadpub.jnms.1.2.24 ]

Journal of Nursing and Midwifery Sciences 2014: 1(2): 24-30

Original article

Studying music effect on children's stress following chemotherapy:

a randomized clinical trial

Maryam Nikkhah1, Ali Asghar Abbasi Esfajir2, Mohammad Ali Heidari Gorji3,*, Naiereh Aghaei4

(Received: 25 July 2014; Accepted 14 sep 2014)

Abstract
Background and Purpose: Due to adverse effects of cancer on children's mental health, relaxation, chemotherapy side-effects
and positive effects of music therapy on stress, this study was performed with the goal to determine the effect of music therapy
on children's stress after chemotherapy.
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Methods: The present study is a randomized clinical trial done on 32 children undergoing cancer chemotherapy in Bu-Ali
Sina hospital in Sari in the 2012-2013. By convenience sampling method and then allocation, they were randomly divided into
two groups (16 people) as control and experimental. The data included the demographic questionnaires and self-assessment
questionnaire stress of Sharrer -Wenger. In the intervention group, after recounting how to perform music for the child and
the mother and select the songs chosen by the child for 20 minutes, half an hour before and after starting and completing
chemotherapy, based on child's bearing, the was music of relaxing sounds of nature and the music for children was played. In
the test group, the stress questionnaire was executed before and after music therapy before chemotherapy and after the treatment
course. In the control group, before starting chemotherapy and after a course of chemotherapy treatment, the questionnaire was
completed. The data was analyzed using statistical software SPSS 18 and the t-test and ANOVA with repeated measures and
Pearson correlation.
Results: No Significant difference was found between the control and experimental stress scores in the two groups (after a music
therapy session) before chemotherapy (p=0/240), but after chemotherapy, the average stress score in the experimental group, after
the music therapy was significantly lower, and the difference was statistically significant (p=0/000).
Conclusion: Due to a substantial reduction in stress scores of music therapy in children undergoing chemotherapy, the music
therapy can be an effective intervention for reducing stress and helping the children to better cope with life after being afflicted
by cancer.

Keywords: Stress, Children, Chemotherapy, Music therapy

Introduction
The most common malignant cancer in increasing to reduce and kill pain and anxiety out of
pediatrics is locum which includes two thirds of which music therapy is an effective method (2).
children's cancers (1). Cancer is a disease that In nursing action, music therapy as an effective
disturbs the children's and their families' mental medium can be a part of the patients' care program and
comfort. Based on its symptoms and treatment, also can be used as a treatment method to lower pain
cancer causes anxiety and depression and their and anxiety, to increase relaxation, body immunity and
families and it is worse in children due to their to decrease blood pressure, pulse and breath. Listening
age. Since stress and also the mental experiences to music results in secreting endorphins and making
of the patients may have negative effects on the patient calm and relaxed (3).
their treatment. Using non-medicinal methods is The results of the study done by O'Callaghan et al.

1
Department of Islamic Azad University.Babol, Iran.
2
Department of Islamic Azad University.Amol, Iran.
3,*
corresponding Author: Department of Medical Surgical Nursing, Nasibeh Nursing & Midwifery School, Mazandaran University of
Medical Sciences, Sari, Iran. Email: [email protected]
4
Department of Medical Surgical Nursing, Nasibeh Nursing & Midwifery School, Mazandaran University of Medical Sciences, Sari,
Iran.

JNMS 2014; 1 (2) 24

[ DOI: 10.18869/acadpub.jnms.1.2.24 ]

Family-oriented empowerment model and quality of life

(2013) about musical therapy for children with cancer the two stages, the children would be sent to another
in peter McCollum Cancer Center in Melbourne, hospital to undergo treatment.
Australia showed that music causes relaxation, relief The data collection tool were two questionnaires of
from anxiety, promotes supporting relationships, demographic information and children stress symptom
active self-care increasing hope in these children(4). scale of Sharrer -Wenger (6) and two methods as
Ghaderi et al. did a review study on the effects of library and field were used to collect data.
music on pain and anxiety and mental effects of music. The demographic questionnaire included the
All results emphasized the effective music impacts patient's medical information, age, sex, the education
on reducing pain and anxiety (5). Since there is no level, weight, height, surgery background, diabetes
indexed study in our country about the effects of music background, blood pressure and hypertension
therapy on the cancerous children and also no indexed background, the previous illnesses duration, the living
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study in other countries about the effects of music place, and the present drugs daily dose. Also, the
on stress following chemical therapy, the present patients' heartbeat number, systolic and diastolic blood
researcher decided to do a research about determining pressure (by German Hinny blood pressure scale) and
music effects on child's stress after chemical therapy in respiration number were measured before and after
Bu-Ali Sina hospital in Sari. It is hoped that effective chemotherapy by the researcher.
measures be taken to cure the side effects after Children stress symptom scale of Sharrer-Wenger is a
chemical therapy thanks to this study. 24-item self-report questionnaire with 11 items about the
excitement symptoms and 13 items about the physical
Materials and Methods symptoms of stress, each question has two choices "
This is a random clinical trail single-blind study there is (1 score) and there is not (0 score)" (6).
Two other items as vomit and sadness were added to
performed among the children suffering from cancer
the questionnaire later after studying the other items.
that referred to Bu-Ali hospital in Sari for chemical
The scores of stress symptoms ranged from 0 to 26
therapy from March 2013 to June 2013 and had a file
and stress symptoms were reported in 3 levels of low,
there.
medium and high (Sharrer- Wenger, 2002). The validity
The criteria to be included in the research were
of this questionnaire's translation was determined and
one parent accompanying during chemotherapy in
confirmed by an English language translator and its
oncology ward, the patients & their family being
content reliability was confirmed and determined by
willing to enter, being in the children age range,
10 professors of nursing and midwifery faculty and the
having no other illness except cancer, having no
lecturers of psychiatry department of Tabriz university
hearing problem, the children having no present
and its reliability was determined by re-test method
surgery, lack of fever or pain while registering and
with correlation coefficient 76% (7).
filling out the vital symptoms forms, lack of mental To collect the data, the researcher went to Bu-Ali
disorder, not taking relaxing drugs based on the hospital in Sari Oncology ward with the permit from
doctors' prescription and having stress score of over Ayatollah Amoli University to study the samples.
10 in Sharrer -Wenger questionnaires. 32 children qualified to enter the study participated
If the patients and their families wanted to leave in the study with non-probability sampling method
the study, if the children got hearing problems by the and based on the goals regardless of their gender.
treatment side-effects, if the patients' treatment case After explaining the project to the parents and getting
changed from the kinds of chemotherapy medicine in their written permission, the first patient was chosen

25 JNMS 2014; 1 (2)

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Abbasi Esfajir AA, et al.

by tossing a coin, then the other ones were placed in

two groups as the music therapy group (N=16) and the
control group (N=16).
The relaxing & appropriate music (relaxing music
based on the sound of nature and music for children)
and regarding the soothing music in the papers
having the beat of 60 to 80 rounds per minute were
selected by Sari-based Culture Center affiliated music
instructor and played by rhythm meter and turner 30
made in China.
Before chemotherapy, the patients' demographic
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information was given by their families or taken

from their files and then stress questionnaire was
filled. The style on how to play the music was Flow chart describing the study participants
explained to the children and their mothers, then
Results
the music was played for children in the experiment
group for 1 to 2 minutes and after that the children The results suggest that the samples in both groups
were asked to choose their favorite music and listen were the same in terms of the type of disease, gender
to it for 20 minutes, 30 minutes before and after and the other demographic information of 32 patients
chemotherapy regarding their tolerance and patience. in our study, 56.25% were girls (75% in experimental
The stress questionnaire was filled for children in and 37.5% in control group) and 43% were boys (25%
the experiment group after music therapy and before in experimental group and 62.5% in control group).
The children age ranged from 5 to 15 years old.
chemotherapy. The questionnaire was also filled and
34% of the patients were over 9 years old and most
registered for children in the control group before
of them had severe lymphoid leukemia. According
chemotherapy and in the treatment period, the above
to Pearson correlation test, there was no significant
mentioned process was repeated for three times for
relationship between age and stress score (p>0.05).
three chemotherapy stages and again and again music
The independent T statistical test showed that there
therapy was conducted and the questionnaires were
was no significant statistical relationship between
filled and registered. For the control group, the stress
stress and gender scores (p>0.05).
questionnaire was filled but registered and evaluated
The results revealed that the mean score of stress
without music.
in pre-test(before music therapy) and post-test(after
These actions were performed between 9 A.M and 4
music therapy) before chemotherapy in the intervention
P.M because it was after the doctors' visit and office group were, respectively 12.81±2.68 and 13.93±2.51
hours, so quiet and peaceful, and with no disturbance. and in the control group, 13.81±1.97 and 12.87±2.6
It is worth mentioning that the single-blind study was and the mean pre-test and post-test stress score after 3
done by the researcher dealing whit filling in the sessions chemotherapy in the experimental group was
questionnaires and music therapy was done along as 7.37±2.44 and 18.62±2.44 and in the control group,
with the children's parents. it was 14.37±1.8 and 13.43±2.30, respectively.
The data were analyzed by the descriptive -analytical The statistical test of independent T displayed no
statistics and pair T test or dependent and independent meaningful relationship between the two groups of
T tests and SPSS 18 software. experimental and control after one session music

JNMS 2014; 1 (2) 26

[ DOI: 10.18869/acadpub.jnms.1.2.24 ]

Family-oriented empowerment model and quality of life

therapy (P=0.240). In the intra-group comparison Table2. The comparison of average stress score after chemotherapy
in the experimental group before chemotherapy, separately in both the study and control groups
the statistical test of pair T showed no meaningful Group

decrease in the stress score after one session music Music therapy control Total

therapy (P=0.373) (Table1). Stress score Independent

after T-TEST

Frequency

Frequency

Frequency
chemotherapy Mean±SD Mean±SD Mean±SD

Table1: the comparison of average stress score before chemotherapy

T=10.45
separately in both the study and control groups Pre-test 16 18.62±2.44 16 13.43±2.3 32 16.03±3.52 df=30
p=0.0001
Group

t=10.45
Music therapy control Total Post-test 16 7.37±2.44 16 14.37±1.08 32 10.87±4.01 df=30
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p=0.0001

Stress score Independent

Frequency

Frequency

Frequency

Before of T-TEST pair t-test df=15 df=15

chemotherapy Mean±SD Mean±SD Mean±SD t=9.18 t=1.61
P=0.0001 p=0.127

t=1.307 Discussion
Pre-test 16 13.93±2.51 16 12.87±2.06 32 13.40±2.32 df=30
p=0.201
The fear of the side effects after chemotherapy in
t=1.19
cancerous patients leads to stress and anxiety that
Post-test 16 12.81±2.68 16 13.81±1.97 32 13.31±2.37 df=30
p=0.240
increases the disease pain, so the inpatients listening
to light music can make them calm and relaxed and
pair t-test
df=15
T=0/919
df=15
t=1.074
kills the pain.
P=0/373 p= 0.003
In the present study, there was no significant statistical
difference between the stress scores of two groups
The results suggest that in the experimental group, of control and experimental (after one session of
the average stress score before chemotherapy and chemotherapy) before chemotherapy stating that one
after music therapy was higher than that of the session chemotherapy is not effective in reducing the
control group and it was a meaningful difference stress of the children with cancer. But the difference in
(P=0.0001). The stress score of the experimental the stress scores of the two groups of the experimental
group after chemotherapy and music therapy and control after one session chemotherapy was
statistically significant and the experimental group's
decreased highly and the independent T test showed
stress scores decreased dramatically after music
a meaningful statistical difference (P=0.0001).
therapy following chemotherapy.
In an intra-group comparison in the experimental
In this study, in the intra-group comparison of the
group, the statistical pair statistical T-test revealed
experimental group, there was a significant statistical
a meaningful decrease in the stress score after the
difference in the stress scores. Also, there were 87.5%
whole period of chemotherapy (P=0.0001) but there of the patients with stress (with scores over 10) before
was no significant difference in the control group's stressful patients chemotherapy and after one session
stress score (P=0.127) (Table 2). The patients with of music therapy and it reduced to 18.75% after the
the stress score over 10 were 87.5% after one complete course of chemotherapy and performing all
session music therapy and after the music therapy sessions of musical therapy, which shows the positive
and chemotherapy; they were 18.75% (with the and efficient effects of music therapy in reducing the
stress score 10). stress following chemotherapy of the children. There

27 JNMS 2014; 1 (2)

[ DOI: 10.18869/acadpub.jnms.1.2.24 ]

Abbasi Esfajir AA, et al.

is no standard study about the effects of music therapy physiological parameters, pains and anxiety (13).
on stress in the cancerous children in Iran. The results of the study by Rafieean et al. showed
Motahedian et al. (2012) did a research on the effect that music therapy has a significant effect on the level
of music therapy on postoperative pain intensity in of anxiety, pain, vomit and vital signs of the patients
patients under spinal Anesthesia. Findings of the study under caesarian surgeries in Dr. Shariati hospital
showed that hearing the music during surgery with in Isfahan. Also, there was a meaningful difference
spinal anesthesia canreduce postoperative pain (8). between the sample and non-sample cases after music
Yousefi-Nejad (2005) observed the effects of music therapy in decreasing pain, anxiety, vital signs in
on the pain level in chronic cancer & suggested that caesarian women (14).
there is a meaningful relationship between the pain Vahhabi (2002) performed a research termed" the
level and the number of pain killers before and after effects of the music therapy and physical relaxation
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music therapy (9). on inpatients' anxiety in ICU". The results showed that
O'Callaghan et al. (2013) conducted a qualitative music therapy lowered anxiety meaningfully (15).
study on the relationship between music therapy Ghaderi et al. studied the effects of music on pain
and the children suffering from cancer in the Cancer and anxiety and mind. Out of 238 received articles,
Center of Peter McCallum in Melbourne, Australia. 20 were chosen randomly that their main titles were
They found out that music can help cancer and it the relationship of music with decreasing pain and
can make children calm, lower stress, promote care anxiety and the results proved that music therapy has
relationships, self-care and make them hopeful (4). significant effects on pain and anxiety (5).
Stanczyk (2011) performed a research on music The study results by Shaabani et al. (2005) about
therapy in supportive care of cancer in Poland. Some the non-medicinal methods of muscular relaxation
aspects of music functions in supportive care of cancer and music influencing the pain level of cancerous
are shown in this study and music therapy can be a patients suggested that a meaningful difference was
part of supplementary medicine in cancer to lower the seen in the pain level of the patients before and after
related stress, pain and raise life quality (10). relaxation and music therapy (P=0.001). Also there
Cantekin et al. (2013) did a study about the effects was a significant difference in relaxation groups and
of music on stressful factors and the level of anxiety music therapy groups which means pain has dropped
in hemodialysis patients in Meliksa University in a lot more in relaxation group than that of the music
Turkey. The findings suggested that music causes therapy (P=0.016)(16).
a meaningful decrease in anxiety level and stressful Mottahedian et al. (2012) performed a study on the
factors in hemodialysis patients and can be a part of impacts of music on post-surgery pain related to spinal
nursing actions to help meet the physical and mental anesthesia. The results implied that music therapy
needs of these patients (11). group patients displayed a meaningful decrease of
The study results of Nan-bakhsh et al. (2008) on pain level rather than the non-music group (P=0.05)
the effects of music on decreasing pain and stress of and taking petedine in both groups was meaningful
birth deliveries demonstrated that listening to light statistically (P=0.041) (17).
music decreases the pain and anxiety of women while Sheybani Tazraji et al. (2009) surveyed the effects
delivering baby (12). of music on depression and feeling of loneliness
Zengin et al. (2013) studied the effects of music on in the elderly people. The results indicated that the
the pain and anxiety of the patients under Catheter port depression decreased a lot after music therapy. Also,
surgery in Turkey. The findings suggested that music women's depression got improved meaningfully in
significantly decreased the stress hormone level, relationships and visiting their friends and family but

JNMS 2014; 1 (2) 28

[ DOI: 10.18869/acadpub.jnms.1.2.24 ]

Family-oriented empowerment model and quality of life

not in men (18). appreciate and acknowledge the Research Education

Generally, regarding the music therapy effects the and Technology Deputy of the University contributing
results stated are consistent with the findings of the in this study. Also, we appreciate you and appreciate
present research and all of them represent the positive the cancerous children of Sari based Bu-Ali hospital
effects of music therapy.The limitations of the present cooperating with us despite all their problems; we
study include the time limits of doing research and express our sincere love to them.
sampling duration being short.
The findings and results suggest that music therapy References
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