Music as a Perioperative Therapy in Breast Cancer Patients

Impact of Perioperative Music on Quality of Life Measures and Biomarker Levels in Breast Cancer Patients

Music has often been used in hospitals as a therapy but there is a limited amount of research looking at how music actually affects the different molecules in the body, such as cortisol (a marker of stress). There is especially a lack of research in the context of surgery. The hope is that this study will show that music can be used to minimize some of the side effects related to breast surgery and improve the patient experience.

In medical practice, an ideal therapy should have maximal benefit with minimal risk. While considerable effort is being placed into discovering more effective pharmaceuticals, there is a growing field of interest in alternative therapies. In the 1970's, George Engle put forward the idea of the biopsychosocial response in which the patient's social and psychological factors can influence the body's biologic function and vice versa. One such potential therapy that could work by this mechanism is music. Advantages of music include low cost, availability, no required expertise, and minimal side effects. Studies have shown that music leads to reduced postoperative pain, anxiety, and analgesic needs in surgical patients. It has also been shown that patient selected music has greater outcomes than researcher selected music. While there is a significant body of literature on changes in clinical measurements, there are only two studies known to us which try to examine the effects of music on a molecular level, measuring cortisol and blood glucose respectively. Neither of these studies have been performed in patients undergoing surgery for breast cancer. On the other hand, considerable research is currently being conducted to determine biomarkers in the context of surgery that are associated with poor outcomes, especially in the context of breast surgery. Stress, usually associated with cortisol levels, has been associated with increased sleep disruption, increased metabolism, increased risk of thromboembolic events, and impaired wound healing in patients. In breast cancer patients, it has been found that C-reactive protein levels correlated in fatigue postoperatively and decreased diurnal variation in cortisol has been associated with depression. Melatonin, in general, is a marker for circadian rhythm and would also be representative of sleep disruption. C-reactive protein is primarily a marker of inflammation which in turn is associated with disease progression and poorer clinical outcomes in breast surgery patients. This study aims to determine both if music affects molecular mechanisms through measurement of clinical biomarkers as well as if there is an association with significant quality of life measures. A positive association could provide evidence into music being used as an adjunct therapy peri-operatively.

There will be two groups. The intervention group will listen to music each night several days before and after surgery. The control group will not listen to music each night around the time of surgery.

This group will be given a subscription to Pandora Plus for the duration of the study. Beginning two nights before surgery, they will listen to a music playlist they created for 30 minutes prior to going to sleep. This will continue each night with the final time being 6 nights after surgery.

Music will be delivered through Pandora Plus radio via patient's computer or smartphone. The patient will choose a favorite song to create a playlist which will be used for the duration of the entire study. The subgenre of the initial song will be recorded.

Pain will be measured using select questions from the BREAST-Q model. The individual pain items will be measured on a 5 point Likert scale as follows: = None of the time = A little of the time = Some of the time = Most of the time = All of the time Total summed scores range from 12 to 60 in breast conserving modules and 16 to 80 for mastectomy modules. Higher scores are representative of more pain experienced by the patient.

Sleep quality will be measured by the Karolinska Sleepiness scale. The KSS is a 9-point Likert scale often used when conducting studies involving self-reported, subjective assessment of an individual's level of drowsiness at the time. The KSS Scores are defined as follows: 9. Extremely sleepy, fighting sleep 8. Sleepy, some effort to keep alert 7. Sleepy, but no difficulty remaining awake 6. Some signs of sleepiness 5. Neither alert nor sleepy 4. Rather alert 3. Alert 2. Very alert 1. Extremely alert Higher values indicate a higher level of drowsiness.

Depression will be measured with the Center for Epidemiologic Studies-Depression scale. The CES-D scale is a 20-item measure that measures how often over the past week one has experienced symptoms associated with depression, such as restless sleep, poor appetite, and feeling lonely. Response options range from 0 to 3 for each item (0 = Rarely or None of the Time, 1 = Some or Little of the Time, 2 = Moderately or Much of the time, 3 = Most or Almost All the Time). Total summed scores range from 0 to 60, with high scores indicating greater depressive symptoms.

Samples will be taken 30 minutes after awakening (AM) and 30 minutes prior to falling asleep (PM) on select days (except the evening of the day of surgery).

Samples will be taken two days before surgery (AM and PM), the day of surgery (AM only), one day after surgery (AM and PM), and seven days after surgery (AM and PM).

Samples will be taken 30 minutes after awakening (AM) and 30 minutes prior to falling asleep (PM) on select days (except the evening of the day of surgery).

Samples will be taken two days before surgery (AM and PM), the day of surgery (AM only), one day after surgery (AM and PM), and seven days after surgery (AM and PM).

Samples will be taken 30 minutes after awakening (AM) and 30 minutes prior to falling asleep (PM) on select days (except the evening of the day of surgery).

Samples will be taken two days before surgery (AM and PM), the day of surgery (AM only), one day after surgery (AM and PM), and seven days after surgery (AM and PM).

Inclusion Criteria: Diagnosis of stage 0 to stage III breast cancer as classified by the American Joint Committee on Cancer Undergoing a mastectomy or lumpectomy at Penn State Hershey Medical Center Fluent in written and spoken English Exclusion Criteria: Hearing loss or other difficulties hearing that, in the opinion of the research team, prevent the subject from listening to music Serious oral health or dental conditions that affect saliva production Patients who have undergone pre-operative chemotherapy or pre-operative radiation therapy Should not be taking supplements of melatonin or taking corticosteroids History of liver cancer History of liver disease or cirrhosis (based on MELD score) History of endocrine tumors Lack of electronic device (smartphone, computer, etc) on which to listen to music Cognitive impairment Prisoner

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