Content uploaded by Filippo Giordano
Author content
All content in this area was uploaded by Filippo Giordano on Jun 08, 2021
Content may be subject to copyright.
1
GiordanoF, etal. World Jnl Ped Surgery 2021;4:e000307. doi:10.1136/wjps-2021-000307
Open access
Music therapy in children affected by
brain tumors
Filippo Giordano ,1 Raffaella Messina,2 Anna Riefolo,3 Chiara Rutigliano,4
Teresa Perillo,4 Massimo Grassi,4 Nicola Santoro,4 Francesco Signorelli2
To cite: GiordanoF, MessinaR,
RiefoloA, etal. Music therapy
in children affected by brain
tumors. World Jnl Ped Surgery
2021;4:e000307. doi:10.1136/
wjps-2021-000307
Received 9 May 2021
Accepted 25 May 2021
1School of Medicine, University
of Bari, Bari, Italy
2Department of Basic Medical
Sciences, Neurosciences and
Sense Organs, Division of
Neurosurgery, University of Bari,
Bari, Puglia, Italy
3Anesthesia and Intensive Care
Unit, Azienda Ospedaliero-
Universitaria Consorziale
Policlinico di Bari, Bari, Puglia,
Italy
4Pediatric Hemathology-
Oncology, Policlinico di Bari
Ospedale Giovanni XXIII, Bari,
Puglia, Italy
Correspondence to
Dr Raffaella Messina;
raffamessina@ gmail. com
Editorial
© Author(s) (or their
employer(s)) 2021. Re- use
permitted under CC BY- NC. No
commercial re- use. See rights
and permissions. Published by
BMJ.
Children affected by brain tumors experi-
ence significant levels of anxiety, nervousness,
and fear regarding surgery, especially in the
preoperative stages. The operating room can
be an intimidating environment for them,
and preoperative anxiety can adversely affect
postoperative pain.1
Interest is growing in finding non-
pharmacological means that may be used to
reduce these symptoms.
Music sessions are increasingly used in
patients undergoing neurosurgery for this
purpose.2
Regarding the relationship between music
and human brain, some studies compare
the functioning of the nervous system as the
ability of a large orchestra to express a full
range of melodies and rhythms, as well as
various and complex harmonic solutions.3
Passive listening to pre- recorded music
provided to the patient by nurses or by other
medical staff to offer additional comfort is
considered as music medicine. Instead, music
therapy (MT) involves the systematic use of
musical experiences aimed at achieving ther-
apeutic goals by a trained music therapist
(MTt) and implies the establishment of a
relationship among patient, music, and MTt.4
In a recent study, our multidisciplinary
team evaluated positively the influence of MT
on preoperative anxiety during lumbar punc-
ture and bone marrow aspiration in pedi-
atric oncology patients.5 Therefore, in the
last 18 months, we introduced and evaluated
prospectively MT in the preoperative setting
of all children affected by brain tumors
undergoing neurosurgery in our department.
When clinically feasible (it was been possible
to enroll 10 out of 23 patients), inpatient
children aged 1–18 years received from 1 to
3 bedside individual sessions of MT prior to
surgery by a certified MTt, with the collab-
oration of a psycho- oncologist. An interac-
tive relational approach, developed from
the model of “free improvisation therapy,”
was used.6 The MT intervention includes
both active techniques that involve the use
of various musical instruments, singing and
songwriting, and receptive techniques such
as preparing and listening to a personalized
playlist.
The choice of music was based on indi-
vidual assessment of each child.7
The MTt accompanied the patient and
parents into the operating theater and the
MT—both active and receptive—continued
until the patient was fully anesthetized.
MT was integrated into patient care before
anesthesia and also throughout the interac-
tive preparation for surgery. This enabled the
children to feel secure and confident during
the ensuing procedures.
Their attention was distracted from the
operation and the time spent waiting for it,
providing an impression of strong support
and making the patients into active partic-
ipants rather than passive recipients of the
surgical procedure.8 9
We found that all children receiving MT
interacted with the MTt undisturbedly and
independently were more compliant with
treatments, with accepting to enter the oper-
ating room comfortably, and with less fear.
The beneficial effect of MT reflected also on
the clinical staff, which felt more confident
and serene.
To our knowledge, this is the first report
on the application of MT on pediatric
oncological neurosurgery in the literature.
On the basis of this initial experience, we
designed a larger prospective study in chil-
dren affected by brain tumors to provide
reliable estimates of the effects of MT in
the preoperative and postoperative manage-
ment of these patients.
Contributors FG contributed to conceptualization, methodology
and investigation. RM was responsible for conceptualization and
methodology. AR carried out conceptualization and supervision. CR
performed conceptualization and investigation. TP contributed to
conceptualization. MG was responsible for supervision. NS and FS
organized project administration.
on June 8, 2021 by guest. Protected by copyright.http://wjps.bmj.com/World Jnl Ped Surgery: first published as 10.1136/wjps-2021-000307 on 8 June 2021. Downloaded from
2GiordanoF, etal. World Jnl Ped Surgery 2021;4:e000307. doi:10.1136/wjps-2021-000307
Open access
Funding The authors have not declared a specic grant for this research from any
funding agency in the public, commercial or not- for- prot sectors.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
Data availability statement Not required.
Open access This is an open access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which
permits others to distribute, remix, adapt, build upon this work non- commercially,
and license their derivative works on different terms, provided the original work is
properly cited, appropriate credit is given, any changes made indicated, and the
use is non- commercial. See:http:// creativecommons. org/ licenses/ by- nc/ 4. 0/.
ORCID iD
FilippoGiordano http:// orcid. org/ 0000- 0002- 6106- 1187
REFERENCES
1 Kühlmann AYR, van Rosmalen J, Staals LM, etal. Music interventions
in pediatric surgery (the music under surgery in children study): a
randomized clinical trial. Anesth Analg 2020;130:991–1001.
2 Mishra R, Florez- Perdomo WA, Shrivatava A, etal. Role of music
therapy in traumatic brain injury: a systematic review and meta-
analysis. World Neurosurg 2021;146:197–204.
3 Bernatzky G, Kreutz G curatori. Musik und medizin: chancen für
therapie, prävention und bildung [Internet]. Wien: Springer- Verlag,
2015. Available: https://www. springer. com/ de/ book/ 9783709115985
[Accessed 6 Feb 2021].
4 Bradt J, Dileo C, Shim M. Music interventions for preoperative anxiety.
Cochrane Database Syst Rev 2013;6:CD006908.
5 Giordano F, Zanchi B, De Leonardis F, etal. The inuence of music
therapy on preoperative anxiety in pediatric oncology patients
undergoing invasive procedures. Arts Psychother 2020;68:101649.
6 Bunt L, Stige B. Music therapy: an art beyond words. 2 edn. New
York: Routledge, 2014.
7 Robb SL, Burns DS, Carpenter JS. Reporting guidelines for music-
based interventions. J Health Psychol 2011;16:342–52.
8 Loewy J, Stewart K, Dassler A- M, etal. The effects of music therapy
on vital signs, feeding, and sleep in premature infants. Pediatrics
2013;131:902–18.
9 Ghetti CM. Music therapy as procedural support for invasive medical
procedures: toward the development of music therapy theory. Nordic
J Music Ther 2012;21:3–35.
on June 8, 2021 by guest. Protected by copyright.http://wjps.bmj.com/World Jnl Ped Surgery: first published as 10.1136/wjps-2021-000307 on 8 June 2021. Downloaded from