Music therapy versus cognitive behavioral therapy for anxiety in cancer survivors: A telehealth-based randomized clinical trial
Abstract
12003
Background:
Anxiety is prevalent, disruptive, and under-treated among cancer survivors. While the pandemic exacerbated the mental health crisis, it also accelerated telehealth adoption, creating opportunities to expand access. Cognitive behavioral therapy (CBT) is the gold standard for anxiety, but not all survivors respond to it, have access, or prefer this option due to stigma. Music therapy (MT) has demonstrated short-term anxiety reduction, but its long-term effectiveness relative to other treatments is unknown. This study evaluated whether MT is noninferior to first-line CBT when both are delivered remotely.
Methods:
In this randomized clinical trial, English- or Spanish-speaking survivors of any cancer type or stage with anxiety lasting ≥1 month were randomized 1:1 to MT or CBT. Participants received 7 weekly sessions of a standardized protocol via Zoom and were followed for 26 weeks. Co-primary endpoints were Hospital Anxiety and Depression Scale (HADS) anxiety subscale changes at weeks 8 and 26. Secondary outcomes included depression, fatigue, insomnia, pain, cognitive function, and quality of life. Data were analyzed with linear mixed-effects models following intention-to-treat. Assuming 15% attrition and 1-sided p < 0.025, the trial had 80% power to detect noninferiority within a margin of D = 0.35*standard deviations (SDs). The margin was informed by an expected SD of 4.2 and the minimum clinically important difference (MCID) of 1.7 points for the HADS…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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