Complementary Therapies in Medicine (2010) 18, 224—226

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SHORT COMMUNICATION

Effects of music therapy on subjective sensations

and heart rate variability in treated cancer
survivors: A pilot study
Chih-Yuan Chuang, Wei-Ru Han, Pei-Chun Li, Shuenn-Tsong Young ∗

Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan

KEYWORDS Summary
Music therapy; Objective: Data on the effects of music therapy on subjective sensations and the physiological
Cancer survivor; parameters of heart rate variability (HRV) in treated cancer survivors are scarce. The aim of
Heart rate variability this study was to determine whether or not music therapy affects the sensations of fatigue,
comfort, and relaxation in cancer survivors, and affects the activities of the sympathetic and
parasympathetic nervous systems as indicated by HRV parameters.
Methods: Twenty-three patients aged 30—67 years and with cancer that had been treated at
least 6 months previously received music therapy for about 2 h, which included singing, listening
to music, learning the recorder, and performing music. Subjective sensations and electrocardio-
gram were recorded before and after the music therapy. The low-frequency and high-frequency
components of HRV were assessed by the frequency analysis of sequential R wave to R wave
intervals of electrocardiogram obtained from 5-min recordings. Subjective sensations were
quantitatively assessed using a visual analog mood scale.
Results: Two hours of music therapy significantly increased relaxation sensations and signifi-
cantly decreased fatigue sensation in treated cancer survivors. Moreover, the HRV parameters
showed that parasympathetic nervous system activity increased and sympathetic nervous sys-
tem activity decreased.
Conclusion: This study provides preliminary evidence that music therapy may be clinically useful
for promoting relaxation sensation and increasing parasympathetic nervous system activity in
treated cancer survivors.
© 2010 Published by Elsevier Ltd.

Introduction

∗
Corresponding author at: No.155, Sec.2, Linong Street, Depart-
ment of Institute of Biomedical Engineering, National Yang-Ming
University, Taipei 11221, Taiwan. Tel.: +886 2 2826 7000x7022;
fax: +886 2 2821 0847.
E-mail addresses: g39304001@ym.edu.tw (C.-Y. Chuang),
wilu.han@gmail.com (W.-R. Han), ankhli@gmail.com (P.-C. Li),
styoung@ym.edu.tw (S.-T. Young).
The diagnosis or suspicion of cancer can affect the patient’s
physical, psychological, and spiritual well-being.1 Accord-
ing to the American Society of Clinical Oncology, up to 30%
of people with cancer experience significant anxiety. The
afflicting pain, treatments administered, physical and psy-
chological changes, disease recurrence, and the possibility
of facing death can provoke an anxiety response.2

0965-2299/$ — see front matter © 2010 Published by Elsevier Ltd.

doi:10.1016/j.ctim.2010.08.003
Effects of music therapy on subjective sensations and heart rate variability
Table 1 Measures of heart rate and heart rate variability (HRV).
Pretest
HR, beats/min 86.54 ± 2.63
HF power (ms2 ) 48.72 ± 11.86
LF power (ms2 ) 252.77 ± 68.64
%HF, nu 19.46 ± 2.81
%LF, nu 86.55 ± 3.12
LF/HF, ratio 6.40 ± 0.81
TP (ms2 ) 514.26 ± 111.59
Data are mean ± SE (standard error) values; HR, heart rate; LF, low frequency; HF, high frequency; LF/HF, ratio of LF to HF power; %LF,
normalized LF power in normalized units (nu) of HRV; TP, total power; p values: posttest vs. pretest by paired t-test.
* p < 0.05.
** p < 0.001.
However, most researches of music therapy have focused
on subjects awaiting surgical procedures, receiving treat-
ment, or immediately after surgery, with few researches
focusing on the effects of music therapy in treated cancer
survivors who finished their treatment. These cancer sur-
vivors need regular follow-up care, and they always face
to possible cancer recurrence that can provoke anxiety
response in their life time.
The present study aimed to determine the effects of
music therapy on subjective sensations and physiological
parameters of heart rate variability (HRV) in treated cancer
survivors. We hypothesized that music therapy significantly
affects the sensations of fatigue, comfort, and relaxation,
and the activities of sympathetic and parasympathetic ner-
vous systems.
Methods
Study participants
The participants in this study consisted of 23 females (19
with breast cancer, two with ovary cancer, one with cervical
cancer and one with bone cancer) recruited from the Hope
Society for Cancer Care, Taipei, Taiwan. Participants met the
following criteria: completed surgical and/or chemother-
apy treatment at least 6 months previously, no history of
acute psychiatric illness, and intact cognitive function. The
procedures used in this study were approved by the Insti-
tutional Review Board of National Yang-Ming University, and
all participants provided informed consent.
Procedure
Participants were asked to sit and rest for 5 min to stabilize
their heart and respiration rates when they first arrived in
the group-therapy room. An electrocardiogram (ECG) signal
was then measured for 5 min, and the fatigue, comfort, and
relaxation were rated subjectively on the VAMS as a pretest.
After participating in 2 h music therapy, the same procedure
was executed again as a posttest.
Music intervention program
The 2 h music therapy intervention consisted of three activi-
ties. In the first activity, the program aimed at establishing a
225
Posttest p
77.24 ± 2.65 0.000**
160.71 ± 34.77 0.001*
501.58 ± 151.09 0.022*
29.95 ± 3.37 0.011*
76.73 ± 3.67 0.029*
3.81 ± 0.66 0.001*
1251.50 ± 272.70 0.002*
rapport between therapists and participants through singing
and listening. The song for the first activity was a popular
Taiwanese song, named as ‘‘He is our treasure’’, which had
pleasant moderate rhythm and tempo. The second activity
was to learn how to play recorder. This activity was using
simple musical instrument learning to establish the partici-
pants’ self-confident. The third activity was to perform main
five notes of a familiar melody song ‘‘Grandfather’s clock’’
following therapist’s electric keyboard accompaniment and
conduct. This activity was to encourage the participants to
express themselves through playing recorder and to bring
light and joyful emotions.
Measures and apparatus
Measures included ECG monitoring and questionnaires. ECG
recordings were obtained from lead I of bipolar leads and
using a data-acquisition interface (VitalECG, Aescu Technol-
ogy, Taipei, Taiwan). The recorded data were digitized with
a sampling rate of 500 Hz and stored on a Secure Digital (SD)
memory card for later analysis. HRV analysis was processed
using a standard procedure.3
The questionnaires for subjective sensations employed
visual analog mood scales (VAMS),4 and assessed whether
or not the participants were fatigued, comfortable, and
relaxed. Scores on each scale was ranged from 0 (lack of
endorsement) to 100 (complete endorsement). The VAMS
have been found to be sensitive to mood change and have
proven to be both reliable and valid when it was adminis-
tered to healthy young and geriatric control subjects.5
Statistical analysis methods
Data were analyzed using the statistical software SPSS (ver-
sion 15.0). Data were expressed as mean and standard error
values. In order to test the study hypotheses, differences in
VAMS scores and HRV parameters between before and after
the music therapy were tested by paired t-test. Significance
was defined at p < 0.05.
Results
The study participants had a mean age of 49.9 years (SD = 9.2
years), and their age ranged from 30 to 67 years. Comparison
of the quantitative HRV measures at pretest and posttest
226
Table 2 Subjective fatigue, comfort, and relaxation
sensations.
Pretest Posttest p cancer survivors.
Fatigue level 4.00 ± 0.59 2.90 ± 0.50 0.046*
Comfort level 7.11 ± 0.43 7.38 ± 0.59 0.548
Relaxation level 6.50 ± 0.58 7.70 ± 0.55 0.032*
Data are mean ± SE values. p values: posttest vs. pretest by
paired t-test.
* p < 0.05.
revealed that the HF power and normalized HF power were
significantly higher and the LF/HF ratio and normalized LF
power of HRV were significantly lower at posttest than at
pretest (p < 0.05) (see Table 1).
The VAMS mean value for the fatigue level was signifi-
cant lower after music therapy (p < 0.05). The VAMS mean
value for relaxation level was significant higher after music
therapy (p < 0.05) (see Table 2).
Discussion
This study investigated the effects of music therapy on sub-
jective sensations and physiological parameters of HRV in
treated cancer survivors. We found that fatigue reduced
and relaxation increased significantly after music ther-
apy. These results are consistent with a previous study
showing that music therapy significantly decreases sub-
jective sensations of anxiety, and fatigue, and increases
comfort and relaxation in patients receiving chemotherapy
treatment.6
HRV is known to provide a unique viewpoint of autonomic
regulation of heart. The HF component of HRV is known to
represent parasympathetic regulation of heart, and the LF
component is jointly contributed by both sympathetic and
parasympathetic nerves. The %LF and the LF/HF ratio are
considered to reflect the sympathetic nervous system.7 The
HF component of HRV has been shown to be a sensitive index
for the effects of music on relaxation.8,9 In the present study,
the HF power was significantly higher and the LF/HF ratio
and %LF of HRV were significantly lower at posttest than
at pretest. These results suggest that music therapy facil-
itates parasympathetic activities related to the relaxation
sensation.
Music therapy is not popular for cancer patients in Taiwan
at present. It was the reason why only small number of par-
ticipants was included in the study. Taiwanese personality
is also very bashful, and many cancer survivors are feel-
C.-Y. Chuang et al.
ing shameful and unwilling to go outside. The study results
therefore represent preliminary data of subjective sensa-
tions and the physiological parameters of HRV in treated
Conclusion
This study provides preliminary evidence that music therapy
may be clinically useful for promoting relaxation sensation
and increasing parasympathetic nervous system activity in
treated cancer survivors.
Conflict of interest statement
No competing financial interests exist.
Acknowledgments
Special thanks to music therapist Ms. Mi-Yun Song and the
Hope Society for Cancer Care, Taipei, Taiwan, for their
experiment support of this research.
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