Friday, May 30, 2008

Music Therapy and Bone Marrow Transplants

In some medical settings, such as mental health services, music therapy has been used widely to decrease patients' perception of pain, anxiety and depression, and boost their feelings of relaxation. It's also used in hospice to comfort terminally ill patients. But it's not commonly used with bone marrow transplant patients, who are often hospitalized for a month or more. Because their immune systems have been wiped out, visits are kept to a minimum to avoid infections, and feelings of isolation often set in. Patients can have a variety of side effects, including pain, nausea, fatigue, anemia and dehydration. 'One reason we began this study was because patients were requesting new ways of treatment,' says Sahler, a behavioral pediatrician who works with children who have chronic and terminal illnesses. 'The patients told the staff, 'I know I'm about to go through a major challenge that will be very painful and isolating. What do you have to offer me to help me get through this?' Music therapy was one answer. We originally began the study with children but quickly decided to enroll adults as well.' Sahler teamed up with Bryan Hunter, Ph.D., an associate professor of music and the coordinator of music therapy at Nazareth College and adjunct associate professor of pediatrics at the Golisano Children's Hospital at Strong, who has established music therapy programs in several hospitals. Hunter's students visited patients at the Wilmot Center's Samuel E. Durand Blood and Marrow Transplant Center, providing a range of music-therapy services. Sometimes students simply brought and played music the patients requested; other times they helped the patients play music themselves, or write their own songs, or talk about a favorite set of lyrics. Patients were also encouraged to visualize a peaceful and joyful setting during each session. 'The program has been very well received,' says Hunter. 'When a program like this is first introduced, typically we get mixed reactions. Some in the health care field are skeptical at first. But when they see the positive effects on patients, they usually change their mind. And other doctors and nurses are excited when it's introduced - they think it's a great idea right from the beginning.' An early problem with the study, Sahler says, was that staff members frequently turned the music therapists away, saying the patients were too ill. 'It's taken awhile for staff members to recognize that music therapy can be very helpful to people when they feel most distressed,' Sahler says. 'Nurses and doctors originally thought that the patient had to be playing an instrument or singing along, but passive listening or simply the presence of the therapist providing music itself can be therapeutic.' Now with funding from the National Institutes of Health, the team is conducting a larger study to check its results. In the current study, scientists will also measure the amount of medicine that patients receive for pain and nausea, and they'll monitor levels of the patients' cytokines - molecules in the body that are key to helping a patient's immune system establish itself after a transplant. In addition to Sahler and Hunter, immunologist Jane Liesveld, M.D., medical director of the bone marrow transplant unit, helped direct the study.Contact: Tom Rickeytrickey@admin.rochester.edu585-275-7954University of Rochester Medical Center

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