Anxiety in cancer patients is a major problem in clinical practice that nurses have to tackle in their day to day treatment plans. Traeger et al. (2012) describes anxiety in cancer patients as a dynamic response due to a perceived threat, and emphasizes that it has a behavior of fluctuating at various points of the disease and treatment process. While there are many etiological factors associated with anxiety in chronic patients like those suffering from cancer, a good proportion of the patients are likely to suffer anxiety due to the uncertainty of their disease prognosis. The methods of interventions are varied, from medications to psychotherapy. In cancer patients, anxiety counts as one of the major issues that nurses deal with on a daily basis. An effective intervention is thus advisable for positive outcomes. The paper examines the interventions geared towards reducing anxiety in cancer patients.

Background information/Current Practice:

Despite the various ways used in treating and reducing anxiety in cancer patients, it has remained a daunting problem that nurses have to handle on a daily basis. A meta-analysis study by Traeger et al. (2012) concerning the effectiveness of treating anxiety in cancer patients support the use of medications and psychotherapeutic approaches. In an examination of evidence-based literature, Traeger et al. (2012) found that evidence-based literature pointed to the use of medications and psychotherapy to reduce anxiety in cancer patients. Paul et al. (2008) suggest that psychosocial interventions have been used in the treatment of anxiety in cancer patients, and that, to a greater extent, they are effective. Blackwell (2011) supports the use of music in the treatment of anxiety in cancer patients. He asserts that music and music therapy experiences are effective in promoting psychological well-being in patients suffering from anxiety related to a cancer diagnosis. However, such practices like music therapy have not been practiced much in the hospitals. Much of the interventions have majored on medications, psychological therapy and behavioral therapy. Since this problem is still prevalent, despite the many studies done in the area, it is prudent to investigate more on the most effective measures for reducing anxiety in cancer patients.

Literature Search/Evidence-Based Interventions:

i). Music Therapy

Blackwell (2011) conducted a study to investigate the effectiveness of music in the treatment of anxiety in the cancer patient. The study involved analyzing evidence from a total of 1891 patients, as well as, 13 control trials. Considering the clinical anxiety scores, the researchers found that music reduced anxiety in cancer patients to a very great extent. Blackwell (2011) notes that, in the experiments, much benefits were reported in some trials than others. Apart from reducing anxiety in patients, Blackwell notes that music therapy also has a significant effect on improving patient’s quality of life. Mood and pain also benefited from music therapy, according to the study. It was also established that there was a small benefit to blood pressure, respiratory rate and heart rate.

Stanczyk (2011) also supports the use of music therapy as a complementary measure for treating cancer, targeted at reducing anxiety. According Stanczyk, the traditional methods of treating anxiety in cancer patients using medications are very traumatizing for chemotherapy and radiotherapy patients. He thus argues that the psychological and emotional damage that a patient experiences after the diagnosis of cancer can be handled using music therapies, such as instrumental improvisation and singing. Additionally, receptive music techniques as listening to recorded music also serves to improve outcomes in the reduction of anxiety in cancer patients. Stanczyk (2011) thus suggests that music should be considered as an ingredient in the plan of care for cancer patients undergoing treatment.

ii) Psychosocial Care

A more practiced intervention in the treatment of cancer anxiety is psychosocial care. Paul et al. (2008) observes that psychosocial care has been observed as one of the core elements of a comprehensive treatment for cancer. The incorporation of psychosocial care is to target the reduction of anxiety, which is an essential component of the disease process in people suffering from cancer. The process of psychosocial intervention starts with good communication skills at the point of diagnosis. The perception with which a patient receives the news about cancer may predispose them to anxiety. The psychosocial intervention thus includes communication therapeutically to the patient to reduce anxiety.

Guo et al. (2013) supports this evidence-based practice and applauds psychotherapy as measures of reducing anxiety in cancer. The authors argue that, apart from reducing anxiety in cancer patients, psychotherapy also functions to improve the quality of life of the patients. They outline various ways of instituting psychotherapy, including psychoeducation, cognitive behavior therapy and supportive-expressive therapy. In line with psychotherapeutic interventions, Guo et al. (2013) recognize the role of training in the delivery of psychological care. They emphasize that, for good results to be realized, nurses ought to be trained in psychological techniques of delivering care. In addition, it is important for clinical nurses to portray excellent medical ethics and kindly attitude while dealing with the anxiety patients. This serves to prepare the patients to receive counsel from the nurses. The family is engaged in the care as the nurse leads the patient and the relatives in identifying the favorable factors for the treatment. Accordingly, the patient is advised and encouraged to maintain an optimistic mood towards life. The nurse also illustrates the importance of friendship and companionship in the course of treatment. The relatives serve as the very best of friends to the patient at such a time. A good patient education serves as the basis of the whole process of psychotherapy, including cognitive behavior therapy and supportive-expressive therapy.

iii). Medical Treatment

In a study of the effectiveness of integrated management of anxiety in advanced cancer patients, Roth and Massie (2007) applaud the combination of psychological therapy, medical management and behavioral therapy in the management of patients with anxiety related to cancer. The authors, in their emphasis on medical management, argue that it is difficult to differentiate psychological and somatic causes of anxiety in cancer patients. As a result, medical management, having a wide base of treatment, can effectively be used to treat many the various causes of anxiety in cancer. According to Roth and Massie (2007), pharmacological treatment of anxiety in cancer patients has been practiced in palliative settings and produced good results, and thus should be explored as a concrete option in the plan of care for cancer patients.

With the use of both psychotherapeutic measures, pharmacological measures and cognitive behavioral therapy interventions, anxiety remains a burning issue among patients suffering from cancer. The healthcare providers, under which bracket are the nurses, also strive to seek alternative measures, as well as, complementary measures to achieve the desirable outcomes for tackling anxiety in cancer patients. From the observations made by Blackwell (2011) and Stanczyk (2011), it is predominantly evident that music plays a vital role in reducing anxiety in cancer patients. In addition, it has been asserted that music serves to improve outcomes in the quality of life for the cancer patients. Going by these suggestions, music therapeutic intervention/measures can be adopted and developed to be used as therapy for anxiety in hospital clients with cancer. Unfortunately, many nurses, and as well, many settings for the cancer palliative care have not allowed or supported the notion of music as a means of reducing anxiety among patients suffering from cancer-related anxiety. As more research is carried out in this area, it is advisable to apply this new intervention for improving outcomes cancer therapy.

Databases and Key Terms:

The literature search to establish the interventions in practice was conducted in academic databases like CINHAL, PubMed, Google Scholar and Medline. The key terms that were applied in the search included: Anxiety, intervention for anxiety, anxiety in cancer patients, intervention for anxiety in cancer patients, psychotherapy in anxiety for cancer patients, medical management of anxiety in cancer patients, and managing anxiety in cancer patients.

PICOT Question:

Is music therapy effective in reducing anxiety in cancer patients compared to pharmacological therapy during the period of cancer treatment?

P-Population-Cancer Patients; Problem-Anxiety in cancer patients

I-Intervention-Music therapy

C-Comparison Intervention-Pharmacological therapy

O-Outcome-How effective music therapy is

T-Time- duration of cancer treatment.

References

Blackwell, W. (2011). Music reduces anxiety in cancer patients. Science Dalily. Retrieved from http://www.sciencedaily.com/releases/2011/08/110809212424.htm

Guo, Z., Ting, H., Li, H., Tan, S., Feng, K., Bu, Q., & Jiang, W. (2011). The benefits of psychosocial interventions for cancer patients undergoing radiotherapy. Health and Quality of Life Outcomes, 11, 121.

Jacobsen, P. B., & Heather, S. J. (2011). Psychosocial interventions for anxiety and depression for adult cancer patients: Achievements and challenges. CA: A Cancer Journal for Clinicians, 58(4), 214-230.

Roth, A. J., & Massie, M. J. (2007). Anxiety and its management in advanced cancer. Current Opinion in Supportive and Palliative Care, 1(1), 50-56.

Stanczyk, M. M. (2011). Music therapy in supportive cancer care. Reports of Practical Oncology and Radiotherapy, 16(5), 170-172.

Traeger, L., Greer, A. J., Fernandez, R. C., Temel, S. J., & Pirl, F. W. (2012).Evidence-based treatment of anxiety in patients with cancer. Journal of Clinical Oncology, 30(11), 39-56.

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