Effect of Music Intervention on Fear of Cancer Recurrence and Quality of Life in Breast Cancer Patients Undergoing Postoperative Adjuvant Therapy: A Randomized Controlled Trial
Objective: Explore the improvement effects of music therapy on cancer recurrence fear (FCR), negative emotions, and quality of life in patients undergoing adjuvant therapy after breast cancer surgery. Methods: This study initially randomized 121 eligible breast cancer patients into the music therapy (MT) group and the care-as-usual (CAU) group. After follow-up, 103 participants completed all assessments and were included in the final analysis. Over a 12-week timeframe, the MT group participated in four sessions of music therapy. The primary outcome was fear of cancer recurrence (FCR), assessed by the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) at the primary endpoint T4 (post-fourth intervention, 12 weeks). Secondary outcomes included quality of life (Functional Assessment of Cancer Therapy-Breast, FACT-B), anxiety/depression (Hospital Anxiety and Depression Scale, HADS), and psychological distress (Distress Thermometer, DT). Assessments were conducted at baseline (T0) and after each intervention (T1 - T4). Generalized estimating equations (GEE) were used to evaluate the intervention effects and their potential mediating effects. Results: GEE analysis demonstrated a significant time × group interaction effect for the primary outcome (FCR at T4, Wald χ2 = 168.527, p < 0.001). Significant interaction effects were also found for quality of life (Wald χ2 = 62.371, p < 0.001), anxiety (Wald χ2 = 410.105, p < 0.001), depression (Wald χ2 = 259.211, p < 0.001), and psychological distress (Wald χ2 = 73.187, p < 0.001). From T0 to T4, quality of life improved in the MT group but declined in the CAU group; meanwhile, FCR, anxiety, depression, and psychological distress decreased over time in the MT group but increased in the CAU group. The three negative emotions significantly mediated the link between MT and FCR (p ≤ 0.001), whereas only depression and psychological distress mediated the effect on quality of life (p < 0.05). Conclusions: Music therapy reduced FCR, improved emotional status, and enhanced quality of life in breast cancer patients receiving postoperative adjuvant therapy. Further analyses revealed that distinct negative emotional symptoms exerted differential mediating effects. Relief of these emotional symptoms serves as a key indirect pathway through which MT improves FCR and quality of life.
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