Burrai 2014

F E AT U R E S
Effects of Live Sax Music on Various

Physiological Parameters, Pain Level, and
Mood Level in Cancer Patients
A Randomized Controlled Trial
■ Francesco Burrai, PhD, RN ■ Valentina Micheluzzi, MSN, RN ■ Valentina Bugani, MSN, RN
Background: Few randomized controlled trial studies have focused on the effect of music in cancer patients, and
there are no randomized controlled trials on the effects of live music with saxophone in cancer patients. Objectives:
To determine the effects of live saxophone music on various physiological parameters, pain level, and mood level.
Design: A randomized controlled trial study. Participants: 52 cancer patients were randomized to a control group
(n = 26), an experimental group (n = 26) whose members received 30 minutes of live music therapy with
saxophone. Measurements: Systolic and diastolic blood pressure, pulse rate, glycemia, oxygen saturation, pain
level, and mood level were measured before and after the live music performance. Results: There was a statistical
difference between the groups for oxygen saturation (0.003) and mood level (0.001). Conclusions: Live music
performed with a saxophone could be introduced in oncology care to improve the oxygen saturation and mood in
cancer patients. KEY WORDS: cancer patients, music therapy, nursing, research Holist Nurs Pract 2014;28(5):301–311
For centuries, man has understood the therapeutic another person.7 Music may provide resources for the
and psychosomatic effects of music.1 Music therapy recovery of self-identity8 and may contribute to the
uses music and musical activity as a therapeutic quality of life through the awareness of feelings. It
instrument to improve the patient’s physical, mental, may provide vitality and develop agency and
and spiritual well-being,2 contributing to the treatment empowerment, as a resource in building social
of somatic and mental diseases.3 Music therapy, in the networks, and as a way of providing meaning and
category of “mind-body medicine,”4 can therefore be coherence in life.9
described as an allied health profession and one of the In cancer patients, music therapy has been used
expressive therapies, focusing on an interpersonal mainly during procedures in adult and pediatric
process in which a trained music therapist uses music care,10,11 in the treatment of cancer symptoms and
in all its aspects—physical, emotional, mental, social, adverse effects of chemotherapy,12 and in different
aesthetic, and spiritual—to help clients improve or oncology nursing settings.13-17
maintain their health.5 Music answers the holistic Randomized controlled trials have been used to
needs of patients,6 and music is linked to human inner study the effects of the music interventions mainly on
dimension, maybe especially significant for 1 person, physiological outcomes, such as systolic blood
and most pieces of music may speak directly to pressure, diastolic blood pressure, pulse rate, glycemia
level, oxygen saturation level and pain level, and on
Author Affiliations: School of Medicine and Surgery, University of psychological outcomes especially mood level.
Bologna (Dr Burrai); and Villa Della Salute Hospital (Mss Micheluzzi and Randomized controlled trials have showed a reduction
Bugani), Bologna, Italy.
in systolic blood pressure and in diastolic blood
The authors have disclosed that they have no significant relationships with,
or financial interest in, any commercial companies pertaining to this article.
pressure,18-21 in pulse rate,22-25 in glycemia level,26-28
in pain level,5,15,29-31 and in increments in oxygen
Correspondence: Francesco Burrai, PhD, RN. AOSP S’Orsola Malpighi-
School of Medicine and Surgery, University of Bologna, Viale G.B. Ercolani saturation level.32,33 Several trials have shown that
6, 40138 Bologna ([email protected]). music interventions improve the state of mood level
DOI: 10.1097/HNP.0000000000000041 during chemotherapy,23 during hospitalization in
301
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
302 HOLISTIC NURSING PRACTICE • SEPTEMBER/OCTOBER 2014
cancer patients undergoing stem cell transplantation,34 respiration, activating the noradrenergic neurons in the
in people diagnosed with terminal cancer,11 in women brainstem and midbrain,50 which activate the
undergoing mastectomies,35 in children,36 and in cholinergic system.51 Cardiovascular parameters such
adults.19,37,38 as pulse rate, systolic blood pressure, and diastolic
The choice of saxophone for this study is because blood pressure are controlled by cholinergic
this musical instrument has very interesting mechanisms in the central nervous system and
psychoacoustic, music psychological, and music dopaminergic neurotransmission, and the sensory and
therapeutic characteristics. In fact, from a musical motor function can also be activated through
point of view, the saxophone shows a very wide range, epinephrine, norepinephrine, and serotonin.52 Some
which can be up to 5 octaves, can makes over acute, authors indicated that music exerts its effect through
has wide timbre and texture, which can vary from dark the entrainment of body rhythms,53,54 defining
to bright enough to be very brilliant in the higher entrainment as the tendency of 2 oscillating bodies to
octaves,39 and can be played very gently at extremely lock into phase and thus vibrate in harmony,32 similar
low volume.40 to individual pulsing heart muscle cells that begin
The saxophone can play any piece of music with a pulsing in synchrony when they are brought close
greater range of interpretation compared to the vast together. When a person is experiencing discomfort,
majority of other music instruments, with extremely stress or anger, their body rhythms (breathing,
different emotional colors.41 From the psychoacoustic heartbeat, and blood flow) will change55 and
and psychological point of view, the saxophone adrenaline is released from the adrenal medulla,56
produces frequencies, amplitudes, and harmonics and which affects heart rate and breathing, leading to a
envelopes sound that can easily and efficiently change in blood pressure, heart rate, respiratory rate,
influence the brain physiology with psychological and oxygen saturation.57 Music influences the levels
effects.42-44 of morphine-6-glucuronide and interleukin-6,52 raises
There are several music therapy schools and music endorphin and serotonin levels, reduces catecholamine
therapist associations that teach the use of the levels,53 increases activity of alpha brain waves, and
saxophone for therapeutic uses and its application in creates a cheerful atmosphere; it also induces a state of
hospitals, for example, American Music Therapy psychological relaxation by activating beneficial
Association, Music Therapy Association, Infinity cognitive, emotional, and imagination-related
Music Therapy Services, and North American processes54,58 that improve mood.32,55,56 According to
Saxophone Alliance. the neurophysiologic model, the relaxing effects in a
There are interesting live music therapy patient’s mood is interconnected to pleasant music and
applications with saxophones in hospitals,45-47 but unpleasant music.57-60 Neuroimaging technology gives
there are no randomized controlled trials on the effects us the answer about the neuroanatomical basis for
of live music with saxophones in cancer patients, and musical emotion and neural correlates of musical
this study seeks to answer this research question. pleasure. Under positron emission tomography and
functional magnetic resonance imaging, chill-inducing
music was associated with a significant increase in
THEORETICAL FRAMEWORK regional cerebral blood flow in the ventral striatum
and midbrain61 and in the nucleus accumbens, insula,
The conceptual framework that will guide this study and hippocampus62,63 and an increase in dopamine in
and the choice of the primary outcome and secondary the nucleus accumbens and in the caudate.64 Pleasant
outcomes is based on neurophysiologic perspective. In music shows a significant increase of the regional
the neurophysiologic perspective, the music acoustic cerebral blood flow in the ventral striatum, and
projection has 2 centers of elaboration: the primary decrease in amygdala, hippocampus, parahippocampal
auditory projection center on the temporal lobes, in gyrus, and temporal poles.65 These findings are very
areas 41 and 42, and the secondary auditory projection important, because the deactivations in the amygdala,
center, always on the temporal lobes, in area 22.48,49 hippocampus, parahippocampal gyrus, and the
However, these distinctions are not so clear and cannot temporal poles in response to pleasant music are
be generalizable. According to the neurophysiologic linked at the response to stress, and this deactivation
model, music can influence the pulse rate, systolic may be related to modulation of the stress hormone
blood pressure, diastolic blood pressure, and cortisol in response to pleasant music, influencing
Effects of Live Sax Music in Cancer Patients 303
pulse rate, systolic blood pressure, diastolic blood other similar processes distracting from pain-related
pressure, glycemia, pain, and mood level.66 Another thoughts,82 and encourage music enjoyment.83
important variable is familiar pleasant music. Familiar
pleasant music shows an increase of the regional OBJECTIVES
cerebral blood flow in insula, in ventral striatum
(caudate nucleus), and the medial prefrontal cortex.67 In the current study, we will test the null hypothesis
When patients listen to pleasant music, there is a that there would be no differences in various
nucleus accumbens and ventral tegmental area physiological parameters, in pain-level and
activation. During musical pleasure, the emotional and mood-level outcomes between patients who
cognitive dimension are linked to orbitofrontal cortex experienced music therapy and patients who
with the mesocorticolimbic dopaminergic circuitry of experienced only standard care.
the nucleus accumbens and ventral tegmental area.63 Three hypotheses were generated from the
There is an association between sensation of chills by conceptual framework:
musical pleasure and dopamine release in the nucleus
1. It is hypothesized that patients who listen to live
accumbens with pain reduction level and mood
saxophone music will show a reduction in systolic
improvement.64 The pleasant music choices made by
and diastolic blood pressure, a reduction in pulse
the patients have effects on stress hormones levels
rate, a reduction in glycemia level, than those who
along the hypothalamic-pituitary-adrenal axis, with
don’t;
pain reduction level, and mood improvement, an
increase in oxytocin level and oxygen saturation,68-70
saxophone music will show a reduction in pain level
in the epinephrine level,71 in the beta-endorphin
than the those who don’t;
level,72 and in the interleukin 6.73 Listening to
pleasant music choices by patients can increase the
saxophone music will show a reduction in mood
growth hormone level,71 immunoglobulin A,74 and
level than the those who don’t.
5-Hydroxyindolacetic acid to cortisol ratio75 and can
decrease cytokine interleukin-10 and interferon-G
level.76
About cancer pain is often METHODS
categorized by determining whether the symptoms are
Trial design
neuropathic, caused by a lesion or dysfunction in the
nervous system, or nociceptive, occurring when the This pilot study is a monocenter, longitudinal,
nociceptors activate because of an actual or threatened nonstratified random controlled trial, with equal
damage to nonneural tissue.77,78 There are many randomization for the parallel group (1:1 for 2 groups).
different mechanisms that may be involved in music’s
ability to reduce pain. Gate control theory79 suggests Patients
that music activates type II sensory fiber (group Aβ),
which trigger the inhibitory interneurons that block the Eligible participants were all adults aged 18 or older
transmission of pain signals to the brain; thus the gate who met the eligibility criteria for diagnosis of cancer
is considered closed, and patients undergo a reduction on chemo treatment. Exclusion criteria were hearing
or neutralization of their pain perception.80 Another impairment, cognitive deficits, and life expectancy
possible explanation is that music requires powerful less than 1 month.
mental processes involved in concentration that
modify the transmission of pain impulses in the spinal Study settings
cord, as well providing stimuli that compete with The study took place at the Medical Oncology ward at
other peripheral nerve impulses, which arrive from Policlinico Sant’Orsola Malpighi in Bologna, Italy.
peripheral nervous system (PNS) to the central nervous
system (CNS) transferring the brain’s focus from the Outcomes
nociceptor to the sound signal.81 Music interventions
can mask environmental hospital stimuli that The primary endpoint is the mood level measured by
activate or increase the perception of pain, increase visual analog scale (VAS) for mood, which measures
endorphin levels, and encourage imagination and mood level on a scale from 0 to 10, where 0 would
describe “a great mood” and 10 would describe “the reasons. Fifty-two patients were randomly assigned to
worst mood possible.” The VAS scales provide either the music group (n = 26) or the control group
reliable, valid, tangible, and automatic measures of (n = 26). The patients were allocated randomly in the
subjective variables such as pain level and mood.84-86 2 groups by random numbers method. The flowchart
The secondary endpoints are as follows: pain level, of this study is shown in Figure 1.
measured by VAS for pain, which measures the
intensity of pain on a scale from 0 to 10, where 0 Data collected
would describe “absence of pain” and 10 would
describe “the worst pain possible”; systolic blood The study instrument consisted of 3 parts:
pressure, diastolic blood pressure, and pulse rate Part 1: Demographic and Clinical data: age, gender,
measured by Omron HEM-705CP Automatic Digital
R
marital status, level of education, religious beliefs,
Blood Pressure Monitor (OMRON Healthcare Europe musical preferences, pathology, and analgesic ther-
B.V., Hoofddorp,The Netherlands); glycemia apy;
measured by Precision Xceed Pro Blood Glucose R
Part 2: Physiological parameters: systolic blood pres-
(Abbott Diabetes Care Inc., Alameda, CA) and sure, diastolic blood pressure, pulse rate, glycemia,
oxygen saturation measured by Nonin 9550 Onyx II R
and oxygen saturation;
9550 fingertip pulse oximeter (Nonin Medical, Inc., Part 3: Pain level, using the VAS for pain, which mea-
Plymouth, MN). sures the intensity of pain on a scale from 0 to
10, where 0 would describe “absence of pain” and
Sample size 10 would describe “the worst pain possible.” Mood
level, using the visual analog scale for mood, which
On the basis of an expected incidence of the primary measures mood level on a scale from 0 to 10, where
endpoint of quality of life, we calculated that we 0 would describe “a great mood” and 10 would de-
would need a sample size of 52 patients to give 80% scribe “the worst mood possible.”
power to detect a significant difference between music
and control, with a 2-sided type 1 error level of 5%. In Procedure
this study, we used a nonparametric Mann-Whitney
test. The power of this nonparametric test is around This study is in accordance with the Declaration of
95.5% of the parametric test, so we estimated that a Helsinki statement. The research project has obtained
sample size of patients (n1 = n2 = 52) was necessary the ethical approval of the hospital. Participants signed
to achieve the desired statistical power. the informed consent form. The eligible patients were
informed about the type of study as well as its aim and
Randomization about the procedures regarding data collection.
Patients were assured about privacy and anonymity by
For the randomization sequence generation for identifying them only by case numbers. All parts of
allocation of the participants, a computer-generated the study instrument were administered by blinded
list of random numbers was used. For the outcome assessors. Part 1 of the study instrument was
randomization type, participants were randomly administered in the first week during baseline data
assigned following simple randomization procedures collection for all patients.
(computerized random numbers) to 1 of 2 groups. As
for the allocation concealment mechanism, the Music group
allocation sequence was concealed from the researcher A holistic nurse, with holistic nursing education and
enrolling and assessing participants in sequentially music skills, played the saxophone to the patient of the
numbered, opaque, sealed, and stapled envelopes. music group. All the saxophone music interventions
Envelopes were opened only after the enrolled were performed in a specified patient room, called
participants completed all baseline assessments, and it “the music room,” with only 1 bed, with the patient
was time to allocate the intervention. Seventy patients lying in bed, and the door closed. The location of this
recovering in oncology ward were chosen to hospital room, inside the oncology ward, prevented
participate in the study. Out of the 58 who were the sound of the saxophone to be heard in other rooms,
eligible, 6 patients did not meet the inclusion criteria, avoiding problems such as intrusive sounds, and
1 declined to participate, and 1 was excluded for other protecting people who did not consent to participate in
Assessed for eligibility (n= 58 )
Excluded (n= 6 )
Not meeting inclusion criteria (n= 6 )
Declined to participate (n= 1 )
Other reasons (n= 1 )
Randomized (n=52 )
At week 1 At week 1
Allocated to music intervention (n= 26) Allocated to non-music intervention (n= 26)
Received allocated intervention (n= 26) Received allocated intervention (n= 26)
Did not receive allocated intervention (n= 0 ) Did not receive allocated intervention (n= 0 )
Baseline demographic and Clinical data, Baseline demographic and Clinical data, psychological
psychological data, pain and mood data were collected data, pain and mood data were collected
At week 2 At week 2
Lost to follow-up (give reasons) (n= 0) Lost to follow-up (give reasons) (n= 0)
Discontinued intervention (n= 0 ) Discontinued intervention (n= 0 )
Psychological, pain and mood data were collected Psychological, pain and mood data were collected
At week 3 At week 3
At week 4 At week 4
Analyzed (n= 26) Analyzed (n= 26)

Excluded from analysis (give reasons) (n= 0 ) Excluded from analysis (give reasons) (n= 0 )
FIGURE 1. Flowchart of the trial.
the study or were enrolled in the control group. In this returned to his room in hospital. Part 2 and part 3 of
room, the patients of the music group were allowed to the instrument were administered as baseline before
choose 5 or 6 musical pieces of very different styles the 30-minute music intervention in week 1. For week
(including relaxing, cheerful, and lively pieces) and 2 to week 4, part 2 and part 3 of the instrument were
genres (pop, classical, film scores, folk, and jazz) administered after the music intervention.
among a playlist made up of hundreds of the most
famous national and international pieces. After
choosing, the patient listened to 5 or 6 pieces played Control group
with the saxophone for about 30 minutes. At the end For the control group, part 2 and part 3 of the
of the 30-minute live music performance, the patient instrument were administered in weeks 1 to 4 after a
30-minute rest period. The patient’s data was collected differences existed in the measured variables between
after the 30-minute rest period. the groups, from baseline to posttest measurements.
The Wilcoxon test was used to examine whether or not
Statistical analysis statistically significant differences existed within each
group, from baseline to posttest measurements.
Descriptive statistics were used to describe the Differences were considered statistically significant
demographic and clinical data using averages of the with values of P < .05, with a 2-tailed test. The
central tendency indexes, standard deviation and range statistical analysis was completed using Version 18.0
for the dispersion index, and frequencies and of SPSS for Windows (IBM Corporation, Armonk,
percentages for distribution indexes. The t test, NY).
chi-squared test, and Fisher exact test were used to test
the homogeneity between groups for demographic and
clinical data. Shapiro-Wilk test was used to examine
the normality of the continuous data. The results RESULTS
suggested that nonparametric tests were appropriate. Demographic and clinical data
To demonstrate the effect in patients, the changes in
the variables from baseline to after intervention and The average age of the sample participants was 64.5
nonintervention were measured after 30 minutes, (σ = 12.7), with 82.7% women (n = 43), and 76.9%
calculating the delta. Mann-Whitney U test was used (n = 40) were married. Most participants had attained
to examine whether or not statistically significant an average level of education (n = 23, 46.1%), and
TABLE 1. Demographic and Clinical Data Between Groups

Groups, n (%)
Variables Total (n = 52), n (%) Controlled (n = 26) Experimental (n = 26) P
Age, average ± SD, y 64.5 ± 12.7 64.6 ± 12.8 64.3 ± 12.9 .940a
Gender
Male 9 (17.3) 8 (30.7) 1 (3.8) .024b
Female 43 (82.7) 18 (62.3) 25 (96.2)
Marital status
Married 40 (76.9) 20 (76.9) 20 (76.9) .940c
Single 5 (9.6) 3 (11.6) 2 (7.7)
Separated 2 (3.9) 1 (3.8) 1 (3.8)
Widow/Widower 5 (9.6) 2 (7.7) 3 (11.6)
Level of education
None 1 (1.9) 0 (0.0) 1 (3.5) .530c
Elementary school 12 (23.0) 7 (26.9) 5 (19.3)
Middle school 24 (46.1) 11 (42.4) 13 (50.0)
High school 9 (17.4) 6 (23.1) 3 (11.6)
University 6 (11.6) 2 (7.6) 4 (15.4)
Religious belief
Catholic 51 (98.1) 26 (100.0) 25 (96.2) 1.000b
Others 1 (1.9) 0 (0.0) 1 (3.8)
Music listening
Yes 51 (98.0) 25 (96.1) 26 (100.0) 1.000b
No 1 (2.0) 1 (3.9) 0 (0.0)
Pathology
Metastatic cancer 45 (86.6) 24 (92.3) 21 (80.7) .419b
Nonmetastatic cancer 7 (13.4) 2 (7.7) 5 (19.3)
Analgesic therapy
Yes 32 (61.5) 13 19 153b
No 20 (38.4) 13 7
a
T test.
b
Fisher exact test.
c
Chi-squared test.
nearly all participants were Catholic (n = 51, 98.1%). Pain and mood level
Of them, 98% participants (n = 51) listen to music
regularly, and most patients had metastasis (n = 45, As shown in Table 2, there were statistical differences
86.6%). More than half of the participants took part in between the groups for mood level (P = .001), with a
analgesic therapy (n = 32, 61.5%). There were no significant reduction of 70% (P = .001), as shown in
statistically significant differences between the groups Figure 2.
with regard to the demographic and clinical variables There were no statistically significant differences
as demonstrated in Table 1. between groups for pain level (P = .136). Only within
music group, the pain level showed a statistically
significant difference at posttest for VASP (P = .001).
Physiological parameters
As shown in Table 2, there were no statistically
significant differences in the physiological variables DISCUSSION
between groups, except for oxygen saturation, where
statistical differences were found between the groups This study shows a statistically significant increase in
(P = .003) with a significant reduction of 1.2% (P = oxygen saturation. The most recent version of the
.003) as shown in Figure 2. Cochrane systematic review,87 which included 30
TABLE 2. Outcomes Comparisons Between Groups

Groups
Controlled (n = 26) Experimental (n = 26) Mann-Whitney
Outcomes Average (SD) Median [Range] Average (SD) Median [Range] U Test Pa
Systolic blood pressure

Baseline 100.9 (13.4) 100.0 [70.0-130.0] 107.0 (19.2) 100.0 [80.0-160.0] 286.50 .334
Posttest 104.6 (14.2) 100.0 [80.0-130.0] 108.0 (12.0) 110.0 [80.0-130.0] 277.00 .253
Wilcoxon test Z = −1.480 P = .139 Z = −0.463 P = .644
Diastolic blood pressure
Baseline 66.5 (6.7) 70.0 [50.0-80.0] 71.1 (11.7) 70.0 [50.0-110.0] 265.00 .146
Posttest 68.4 (6.7) 70.0 [60.0-80.0] 70.7 (6.2) 70.0 [60.0-90.0] 281.00 .223
Pulse rate
Baseline 75.7 (13.4) 74.5 [50.0-104.0] 75.0 (9.2) 75.0 [54.0-97.0] 331.50 .905
Posttest 73.6 (11.6) 74.0 [55.0-98.0] 75.8 (9.1) 74.0 [56.0-84.0] 300.00 .486
Glycemia
Baseline 133.15 (56.2) 125.0 [46.0-293.0] 117.1 (34.3) 108.0 [65.0-201.0] 288.00 .360
Posttest 125.8 (46.4) 114.0 [75.0-274.0] 109.0 (24.8) 104.0 [74.0-157.0] 273.50 .238
Oxygen saturation
Baseline 97.3 (1.3) 97.0 [94.0-100.0] 97.2 (1.7) 98.0 [94.0-100.0] 335.50 .963
Posttest 96.9 (1.8) 97.0 [91.0-100.0] 98.2 (1.5) 99.0 [94.0-100.0] 178.00 .003
Wilcoxon test Z = −1.446 P = 0.148 Z = −3.335 P = 0.001
VASP
Baseline 1.3 (0.5) 1.6 [0.0-5.0] 1.8 (1.9) 2.0 [0.0-5.0] 292.50 .378
Posttest 1.4 (0.5) 1.6 [0.0-5.0] 0.7 (1.1) 0.0 [0.0-4.0] 265.00 .136
VASM
Baseline 3.8 (2.2) 3.5 [1.0-10.0] 5.0 (2.1) 5.4 [2.0-10.0] 194.50 .008
Posttest 4.1 (2.2) 4.0 [1.0-10.0] 2.2 (2.3) 2.0 [0.0-10.0] 161.50 .001
a
Significant at P < .005 two-sided test.
Abbreviations: VASM, visual analog scale for mood; VASP, visual analog scale for pain.
FIGURE 2. Mean differences between groups.
trials and 1891 patients, suggests that definitive from 1.8 to 0.7 on a 5-point VAS after a single music
conclusions can still not be drawn regarding the therapy session (P < .001). Other studies showed
effects of music on the level of oxygen saturation in improvements in mood level in adults with
adults with cancer. Even so, higher levels of oxygen cancer-related pain18 and in children with neoplasms
saturation have been observed in patients of some needing chemotherapy.36 Burns’ trial,10 with a
studies after listening to music. A systematic review, quantitative pre-post test study and
which included 13 randomized controlled studies and psychological/physiological measures, showed a link
2 meta-analyses, have shown a positive effect of some between listening to music and an improved state of
nonpharmacological interventions, including listening mood. Ratcliff’s trial93 showed that music listening
to music, on physiologic parameters, such as oxygen improves mood acutely. Kempler’s trial94 showed an
saturation in preterm and term newborns in a neonatal improved relaxation in music group than rest (P <
intensive care unit.88 One high-quality pilot study .01). Li’s trial95 showed a significant reduction in the
regarding neonates showed benefits of music on state of anxiety score in the music group than control
oxygen saturation at the end of the surgical group that only received routine nursing care.
procedure.89 In elderly patients on maintenance Chuang’s trial22 showed a significantly increased
hemodialysis, music interventions showed a relaxation sensation and significantly decreased
significantly increased oxygen saturation (P < .001),90 fatigue sensation in the music group.
and a statistically significant increase in oxygen
saturation (P = .001) was shown in patients after
open-heart surgery.91 CONCLUSIONS
In Nguyen’s trial,20 40 participants reported no
effects for music listening on oxygen saturation levels The results suggest that the use of live saxophone
in children with cancer undergoing lumbar puncture music increases the oxygen saturation and improves
compared to standard care. This study shows also a the state of mood in cancer patients recovering in an
statistically significant improvement in state of mood. oncology ward. Cancer patients, who have a better
Our data are in accordance with 6 trials. In oxygen saturation, show a reduction of fatigue, and
Cassileth’s trial patients in the music therapy group drowsiness, an increase of muscle strength and better
scored 37% lower (P = .01) on the total mood coordinated movements. Cancer patients with a better
disturbance score compared with controls. Gallagher’s state of mood show a reduction in anxiety, depression,
trial92 showed that among the 123 palliative care and pain level, better coping, better communication of
patients with mood disturbance in the single arm a their difficulties, and a different perception of their
mean self-reported mood disturbance scores improved own body.
There are important differences between recorded mood, improving better coping with hospitalization
music and live music in nursing cancer care. In a live and chemotherapy, promoting patient well-being, and
music intervention during the musical performance, improving the quality of their interactions with other
the relationship between player and patient is dynamic patients and the nursing team.
and continuous with verbal and nonverbal
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F E AT U R E S

Effects of Live Sax Music on Various

Assessed for eligibility (n= 58 )

Analyzed (n= 26) Analyzed (n= 26)

FIGURE 1. Flowchart of the trial.

TABLE 1. Demographic and Clinical Data Between Groups

TABLE 2. Outcomes Comparisons Between Groups

Systolic blood pressure

FIGURE 2. Mean differences between groups.

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