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自体干细胞移植后症状管理的音乐疗法:一项随机研究的结果

Music Therapy for Symptom Management After Autologous Stem Cell Transplantation: Results From a Randomized Study.

作者信息

Bates Debbie, Bolwell Brian, Majhail Navneet S, Rybicki Lisa, Yurch Melissa, Abounader Donna, Kohuth Joseph, Jarancik Shannon, Koniarczyk Heather, McLellan Linda, Dabney Jane, Lawrence Christine, Gallagher Lisa, Kalaycio Matt, Sobecks Ronald, Dean Robert, Hill Brian, Pohlman Brad, Hamilton Betty K, Gerds Aaron T, Jagadeesh Deepa, Liu Hien D

机构信息

Arts and Medicine Institute, Cleveland Clinic, Lyndhurst, Ohio.

Taussig Cancer Institute, Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio.

出版信息

Biol Blood Marrow Transplant. 2017 Sep;23(9):1567-1572. doi: 10.1016/j.bbmt.2017.05.015. Epub 2017 May 19.

DOI:10.1016/j.bbmt.2017.05.015
PMID:28533058
Abstract

High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is frequently performed in patients with hematologic malignancies. ASCT can result in significant nausea, pain, and discomfort. Supportive care has improved, and pharmacologic therapies are frequently used, but with limitations. Music has been demonstrated to improve nausea and pain in patients undergoing chemotherapy, but little data are available regarding the effects of music therapy in the transplantation setting. In a prospective study, patients with lymphoma or multiple myeloma undergoing ASCT were randomized to receive either interactive music therapy with a board-certified music therapist or no music therapy. The music therapy arm received 2 music therapy sessions on days +1 and +5. Primary outcomes were perception of pain and nausea measured on a visual analog scale. Secondary outcomes were narcotic pain medication use from day -1 to day +5 and impact of ASCT on patient mood as assessed by Profile of Mood States (POMS) on day +5. Eighty-two patients were enrolled, with 37 in the music therapy arm and 45 in the no music therapy arm. Patients who received MT had slightly increased nausea by day +7 compared with the no music therapy patients. The music therapy and no music therapy patients had similar pain scores; however, the patients who received music therapy used significantly less narcotic pain medication (median, 24 mg versus 73 mg; P = .038). Music therapy may be a viable nonpharmacologic method of pain management for patients undergoing ASCT; the music therapy patients required significantly fewer morphine equivalent doses compared with the no music therapy patients. Additional research is needed to better understand the effects of music therapy on patient-perceived symptoms, such as pain and nausea.

摘要

大剂量化疗后进行自体干细胞移植(ASCT)常用于血液系统恶性肿瘤患者。ASCT可能导致严重的恶心、疼痛和不适。支持性护理有所改善,药物治疗也经常使用,但存在局限性。音乐已被证明可改善化疗患者的恶心和疼痛,但关于音乐疗法在移植环境中的效果的数据很少。在一项前瞻性研究中,接受ASCT的淋巴瘤或多发性骨髓瘤患者被随机分为接受与有资质的音乐治疗师进行互动音乐治疗组或不接受音乐治疗组。音乐治疗组在第+1天和第+5天接受2次音乐治疗。主要结局是用视觉模拟量表测量的疼痛和恶心感受。次要结局是从第-1天到第+5天的麻醉性止痛药物使用情况,以及通过第+5天的情绪状态剖面图(POMS)评估的ASCT对患者情绪的影响。共纳入82例患者,音乐治疗组37例,非音乐治疗组45例。与未接受音乐治疗的患者相比,接受音乐治疗的患者到第+7天时恶心略有增加。音乐治疗组和非音乐治疗组患者的疼痛评分相似;然而,接受音乐治疗的患者使用的麻醉性止痛药物明显较少(中位数分别为24 mg和73 mg;P = 0.038)。音乐疗法可能是ASCT患者一种可行的非药物性疼痛管理方法;与未接受音乐治疗的患者相比,接受音乐治疗的患者所需的吗啡等效剂量明显更少。需要进一步研究以更好地了解音乐疗法对患者感知症状(如疼痛和恶心)的影响。

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