Music Therapy Versus Cognitive Behavioral Therapy via Telehealth for Anxiety in Survivors of Cancer: A Randomized Clinical Trial

Abstract

PURPOSE Anxiety is prevalent, disruptive, and undertreated among survivors of cancer. Cognitive behavioral therapy (CBT) is the first-line treatment, but not all individuals have access, respond to treatment, or prefer this option because of stigma. Music therapy is effective for short-term anxiety reduction, but it is unknown whether it is noninferior to first-line CBT for long-term anxiety reduction. METHODS This comparative effectiveness trial randomly assigned English- or Spanish-speaking survivors of cancer to seven weekly telehealth sessions of music therapy or CBT. The coprimary end points were changes in the Hospital Anxiety and Depression Scale (HADS) anxiety score at weeks 8 and 26. The noninferiority margin was 0.35 standard deviations, informed by a minimal clinically important difference (MCID) of 1.7 points. Secondary outcomes included fatigue, depression, insomnia, pain, cognitive dysfunction, and health-related quality of life. RESULTS Among N = 300 patients, 74.7% was female, 76.5% was White, and 19.0% was Hispanic. At week 8, the mean change in HADS anxiety score was –3.12 (95% CI, –3.59 to –2.65) in music therapy and –2.97 (95% CI, –3.45 to –2.50) in CBT; the between-group difference was –0.15 (95% CI, –0.78 to 0.49), within the noninferiority margin of 1.20 ( P < .001). At week 26, the mean change was –3.31 (95% CI, –3.78 to –2.85) in music therapy and –3.00 (95% CI, –3.47 to –2.53) in CBT; the between-group difference was –0.31 (95% CI, –0.95 to 0.32), within the noninferiority margin of 1.28 ( P < .001). Both groups produced anxiety reductions exceeding the MCID and showed similar improvements in secondary outcomes. CONCLUSION Music therapy is noninferior to CBT for anxiety in survivors of cancer. Both telehealth interventions produced clinically meaningful, durable improvements in anxiety.