Making Music in the Hospital Aids Rehab, Raises Spirits

COLUMBUS, Ohio—Many aspects of cancer patient care can be improved or enhanced with the use of music therapy, said Deforia Lane, PhD, resident director of music therapy, University Hospitals of Cleveland-Ireland Cancer Center/Rainbow Babies & Children’s Hospital, and assistant clinical professor of medicine, Case Western Reserve University. Dr. Lane, a board-certified music therapist, spoke at a conference on cancer survivorship sponsored by the Ohio State University’s James Cancer Center and Solove Research Institute.

Music can contribute to patient comfort before and after surgery, even decreasing the amount of analgesia needed, Dr. Lane said. After surgery, music can encourage a reluctant patient to move sore limbs. Music can also banish anxiety and raise depressed spirits.

“Allowing patients to choose a particular piece of music from a range of selections offers patients control even in situations where otherwise little else is within their control,” she said.

Music therapy is the structured use of music in the treatment of illness and disease. Music therapists are certified by the Certification Board for Music Therapists and have their own membership organization, the American Music Therapy Association. Dr. Lane estimates that about 5,500 board-certified music therapists are currently working in a variety of settings, including hospices and hospitals.

“Clinicians are taught that it takes several repetitions for a patient to absorb information,” Dr. Lane said. Not only must the message be restated several times, but ideally it should be restated in several different ways. “One of those ways is music,” she said.

In her address, she demonstrated how she integrates music into patient care. While singing, “When You’re Smiling,” she led conference attendees in some simple movements that could accompany the song, including bending at the trunk and flexing the arms. In this manner, she suggested, music therapists and occupational therapists could work together to choreograph songs with body movements that encourage extension, flexion, and rotation.

In situations where a patient is balking at occupational or physical therapy, the music therapist can “come in the back door” to encourage participation, she said. By combining the movements the patient needs to learn with the music the patient prefers, the exercise becomes more appealing to the patient. With this approach, Dr. Lane has found that patients do more repetitions with less complaining, and their perception of pain drops.

Dr. Lane brings music into patients’ hospital rooms with her trained singing voice and her frequent use of an omnichord, an electronic instrument she referred to as “my right arm.” Lightweight and portable, an omnichord provides musical accompaniment in a wide variety of chords and rhythms. It can also be strummed like a guitar by running a finger along a touch-sensitive area known as a “strum-plate.”

Dr. Lane recalled one especially angry patient who refused to move her arm after surgery for breast cancer. Frustrated, the woman’s physician asked Dr. Lane to intercede. She described how she pulled in nurses, physicians, and the woman’s daughter to sing “One!” from the musical A Chorus Line and to gesture with paper plates as if they were top hats. (The conference audience, well supplied with paper plates, also participated in this demonstration. See photo) Faced with such an enthusiastic crowd of singers, the patient reluctantly joined in, lifting her paper plate and, thus, her arm.

Music can also soothe feelings of anxiety and ease the frustration of hospitalization. For example, a leukemia patient in her 20s who dreaded the hours after midnight found comfort in the company of a nurse who sat with her and played the guitar. Frequent music sessions with Dr. Lane and the omnichord provided diversion for a 4-year-old girl who dreaded a thrice-daily blood draw.

Music During Surgery

“A recent study demonstrated that patients who were able to listen to music during surgery required 43% less analgesia,” Dr. Lane said. The Yale study examined awake patients undergoing urologic procedures who were able to control their own sedative and analgesic requirements with patient-controlled pumps (Anesthesiology 89(2):300-306, 1998).

Dr. Lane herself has provided the music during surgery at the University Hospitals of Cleveland. She has sung the “Hallelujah Chorus” and “My Girl” for patients who were awake and aware during their operations, and in some cases has even asked the surgeon to sing along with her. She said that her research has shown that music therapy significantly affects the immune system (Lane D: Effects of music therapy on immune function of hospitalized patients. Quality of Life: A Nursing Challenge 3(4):74-80, 1994).

Dr. Lane has also given patients headsets for listening to music during surgery. This has been especially useful, she said, in those instances when the surgeon planned to listen to music that the patient disliked.

Music for Celebration

Music, traditionally used for celebration and tribute, can also function in that manner in the hospital. Dr. Lane has written songs for the discharge day of oncology patients who have undergone long hospitalizations. She has also helped dying patients write songs.

A tape recording of Dr. Lane singing the patient’s song can become the patient’s final gift to family and loved ones. “I enter a person’s life at a vulnerable state and offer them the simple gift of music,” Dr. Lane said.

She urged the audience to make music part of routine patient care. She said that nurses can invite their patients to listen to music with headsets as they give baths, change dressings, or administer injections. “Music can be used in many places and instances to give patients a little bit more control,” she said.

Dr. Lane also encouraged her audience to promote the idea of having a music therapist on staff at their hospitals. The average starting salary for a music therapist in the Midwest is $32,000. If the cost of a full-time therapist is prohibitive, she said, then the hospital can consider hiring one part-time or consulting occasionally with a music therapist.

“Don’t ever underestimate what one voice can do,” Dr. Lane concluded. As an example, she described how she came to record the song “We Can Cope” for the American Cancer Society in 1983. The song was originally written simply to honor the breast cancer support group Dr. Lane attended after her own cancer treatment. Unbeknown to her, the social worker leading the group contacted the ACS who, in turn, contacted Dr. Lane.

At the conference, Dr. Lane expressed gratitude to that social worker and urged the audience, in closing, to follow her example of making music in hospital rooms. “I’m no one special,” she said, “no more special than you.”