Randomized clinical trial of music therapy versus cognitive behavioral therapy via telehealth for anxiety in cancer survivors

Anxiety is prevalent, disruptive, and undertreated among cancer survivors. Cognitive behavioral therapy (CBT) is the first-line treatment, but not all survivors have access, respond to treatment, or prefer this option because of stigma. Music therapy is effective for short-term anxiety reduction, but is is unknown whether it is noninferior to first-line CBT for long-term anxiety reduction. A two-arm, parallel-group randomized trial at Memorial Sloan Kettering Cancer Center (New York, NY) and Baptist Health Miami Cancer Institute (Miami, FL) compared seven weekly telehealth sessions of music therapy or CBT among 300 survivors with anxiety symptoms. The coprimary endpoints were changes in the HADS anxiety scores at weeks 8 and 26, with a noninferiority margin of 0.35 SDs. At both time points, music therapy was noninferior to CBT. Both groups produced anxiety reductions exceeding the minimal clinically important difference and showed similar improvements in the secondary outcomes fatigue, depression, insomnia, pain, cognitive dysfunction, and health-related quality of life. The authors conclude that music therapy is noninferior to CBT for anxiety reduction in cancer survivors.