660527

research-article2016
WJNXXX10.1177/0193945916660527Western Journal of Nursing ResearchBilgiç and Acaroğlu

Intervention Studies
Western Journal of Nursing Research
2017, Vol. 39(6) 745­–762
Effects of Listening to © The Author(s) 2016
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DOI: 10.1177/0193945916660527
Chemotherapy Patients journals.sagepub.com/home/wjn

Şebnem Bilgiç1 and Rengin Acaroğlu2

Abstract
The symptoms of an illness that requires chemotherapy and the
corresponding effects of such treatment exacerbate the pain and
discomfort that patients typically experience. Listening to music may help
patients cope with chemotherapy symptoms, thereby contributing to
their physical ease and well-being. Seventy patients who were receiving
treatment at the outpatient chemotherapy unit were invited to participate
in this work. During chemotherapy sessions and the week after the
sessions, the patients listened to music with headphones. The occurrence
of chemotherapy symptoms such as pain, tiredness, nausea, depression,
anxiety, drowsiness, lack of appetite, not feeling well, and shortness of
breath in the intervention group was statistically significant after listening to
music (p < .05). Improvements in total general comfort, as well as physical,
psychospiritual, and sociocultural comfort, were also statistically significant
(p < .05). These findings indicate that listening to music effectively reduces
the severity of chemotherapy symptoms and enhances the comfort of
patients receiving the treatment.

Keywords
chemotherapy, comfort, listening to music

1Namik Kemal University, Tekirdag, Turkey

2Istanbul University, Istanbul, Turkey

Corresponding Author:
Şebnem Bilgiç, Department of Nursing, School of Health, Namik Kemal University, Namık
Kemal Mah. Kampüs Cad. No: 1, 59030 Tekirdağ, Turkey.
Email: sbilgic@nku.edu.tr
746 Western Journal of Nursing Research 39(6)

Chemotherapy, which is administered to cancer patients, can cause severe

symptoms that lead to major discomfort (Hintistan, Çilingir, Nural, & Gürsoy,
2012; Li, Zhou, Yan, Wang, & Zhang, 2011). Limited studies have been devoted
to validating the effectiveness of listening to music in alleviating the severity of
the symptoms associated with chemotherapy, but qualitative research has dem-
onstrated the benefits of this intervention on patient comfort (Besel, 2006).
Chemotherapy drugs prolong the lives of cancer patients and improve
quality of living by preventing or minimizing toxicity that damage normal
cells, in addition to exerting therapeutic benefits. Along with healing, how-
ever, come unwanted consequences, such as pain, nausea, vomiting, fatigue,
lack of appetite, anxiety, and depression (Erdoğan, 2011; Yeter, 2012).
Effectively managing these symptoms facilitates patient compliance with
treatment and increases its efficiency while improving quality of life and
comfort (Hintistan et al., 2012; Sadırlı & Ünsar, 2009).
Comfort is a basic necessity and one of the cornerstones of holistic nursing
care. Ensuring and maintaining patient well-being necessitate attention to not
only bio-physiological aspects (e.g., symptom management) but also the psy-
chological, social, environmental, and economic dimensions of healing
(Kolcaba & Kolcaba, 1991; Whyte, 2010). A key target of nursing care is to
guarantee the comfort of patients and their families (Kim & Kwo, 2007).
Nurses, who are integral members of a health care team, must identify a
patient’s comfort-related requirements, implement plans for ensuring his or
her physical well-being, and apply and evaluate the nursing practices designed
to fulfill the patient’s needs. These are only some of the fundamental roles of
nurses in adopting a holistic approach to treating an individual (Küçük,
Yıldırım, & Özkan, 2015; Yıldırım, 2009).
Listening to music, which is an embodiment of holistic nursing, is a type
of intervention characterized by controlled listening to music. Such exercise
has been found to pose beneficial physiological and psychological effects on
patients (Arslan, 2007). Music has been known to exert healing effects on
humans since ancient times and is recognized in different cultures as one of
the oldest methods of treating disease. It has recently been used as a medium
through which therapeutic intervention and care are provided (Conrad, 2010;
Suhartini, 2008; Uyar & Korhan, 2011).
Listening to music has found a range of applications, including the educa-
tion of autistic children (Moreno & Dona, 2013), the treatment of patients in
intensive care units (Almerud & Petersson, 2003), the reduction of psycho-
logical problems (Castillo-Perez, Gomez-Perez, Velasco, Perez-Campos, &
Mayoral, 2010), and the treatment of Alzheimer’s disease and dementia
(Özdemir, 2007; Sung, Chang, & Lee, 2010). In all such applications, listen-
ing to music has yielded positive outcomes. Research has also shown that
Bilgiç and Acaroğlu 747

music-based intervention minimizes a patient’s pain (Gutgsell et al., 2013;

Huang, Good, & Zauszniewski, 2010) and anxiety (Li et al., 2011; Stanczyk,
2011), prevents the nausea and vomiting that result from chemotherapy
(Olofsson & Fossum, 2009), and facilitates sleep and relaxation (Cooper &
Foster, 2008). With these benefits, listening to music may be used to manage
the symptoms that are experienced by patients undergoing chemotherapy and
accordingly enhance their comfort (Uyar & Korhan, 2011). The other advan-
tages presented by this form of treatment are that it is cost-effective, causes
no unfavorable effects, and fosters physical, psychological, social, emotional,
and moral recovery. For these reasons, listening to music is a preferred inter-
vention in nursing practice (Cooper & Foster, 2008; Li et al., 2011; Suhartini,
2008; Yıldırım & Gürkan, 2007).
As previously stated, a few quantitative and qualitative studies have been
carried out to determine the effectiveness of listening to music in easing the
severity of chemotherapy symptoms (Besel, 2006). Despite the insights pro-
vided by such research, however, listening to music and its effects have not
been explored in the context of the Turkish population.
Accordingly, the current research is aimed at investigating the effects of
listening to music on the comfort levels of Turkish chemotherapy patients.
This study follows a quasi-experimental design, and the collected data are
expected to provide guidance for planning interventions designed to mini-
mize the severity of chemotherapy symptoms and improve patient comfort.

Purpose
As discussed earlier, the key purpose of this research is to compare treatment
and control groups by which listening to music affects patients suffering from
the undesirable consequences of chemotherapy. The hypotheses pursued
were as follows:

Hypothesis 1: Listening to music diminishes the severity of chemother-

apy symptoms (pain, tiredness, nausea, depression, anxiety, drowsiness,
lack of appetite, not feeling well, shortness of breath).
Hypothesis 2: The comfort of patients undergoing listening to music is
higher than those who are not administered this intervention.

Method
Study Design
A quasi-experimental two-group pre-test and post-test design was adopted.
748 Western Journal of Nursing Research 39(6)

Setting and Sample

The research was conducted at the outpatient chemotherapy unit of a public
hospital in Turkey. The sample comprised patients receiving chemotherapy
treatment between February and October 2014. The G-Power was used to
estimate the required sample size, and the sample size calculation included
comfort variability as the key outcome and the effect size determined in a
previous study on a similar topic (Koçaşlı, 2006). Therefore, we estimated
the large effect size to be 0.81 and, based on the parameters of alpha = .05
(two-sided) and power value = 0.88, calculated a priori sample size of 32
people per group. The convenience sample (70 patients) included participants
who met the following criteria: be 18 years or older; be communicative and
cooperative; be literate; not be receiving psychiatric treatment; not be in the
terminal phase, with chemotherapy sessions amounting to a minimum of
three sessions; and be willing to take part in the research. The final sample
consisted of 70 patients, of which 35 were classified in the control group and
the remaining 35 were categorized under the intervention group to prevent
the participants from influencing one another.

Measures
Data were collected using a patient information form, a patient monitoring
form, the Edmonton Symptom Assessment System (ESAS), and the General
Comfort Questionnaire (GCQ). The forms were filled out during one-on-one
interviews and telephone conversations.

Patient information form.  This instrument was developed by the researchers on

the basis of the related literature. It is intended to derive individual and ill-
ness-related information, such as age, sex, educational level, marital status,
profession, and diagnosis.

Patient observation form.  The patient observation form for the control group
consists of a chart used to record the dates at which the patients began expe-
riencing chemotherapy symptoms. Details regarding researcher–patient com-
munication are also included in the form. The form for the intervention group
contains data related to listening to music (days of treatment and duration).
This form was delivered to each patient so that he or she could complete it at
home.

Edmonton Symptom Assessment System (ESAS).  The ESAS, which was devel-
oped by Bruera et al., assesses nine common symptoms observed in cancer
Bilgiç and Acaroğlu 749

patients (Bruera, Kuehn, Miller, Selmser, & Macmillan, 1991). These symp-
toms are pain, exhaustion, nausea, depression, anxiety, lethargy, lack of appe-
tite, well-being, and shortness of breath. The evaluation is initiated by asking
a patient to indicate the number that corresponds to the severity of a given
symptom. The instrument was adapted to the context of Turkish society by
Sadırlı and Ünsar. In this work, the reliability coefficient of the scale was .83
at pre-treatment and .76 post-treatment (Sadırlı & Ünsar, 2009). The Cron-
bach’s alpha coefficients of the scale were .70 and .88 before and after inter-
vention, respectively.

General Comfort Questionnaire (GCQ).  The GCQ was developed by Kolcaba

(1992) to identify the comfort-related needs of patients and assess nursing
practices that are designed to provide and/or improve physical ease and well-
being. The scale was created on the basis of a taxonomic structure that com-
prises three levels and four dimensions of the theoretical components of
comfort. The GCQ is a 4-point Likert-type scale consisting of 48 items and
comfort dimensions, namely, physical (12 items), psychospiritual (13 items),
environmental (13 items), and sociocultural (10 items) dimensions. In terms
of level, comfort is categorized as “relief (15 items),” “ease (17 items),” and
“transcendence (15 items).” To use the scale that consists of positive and
negative items, the latter are added by reverse coding. The total score obtained
is divided by the number of scale items to determine the mean value. The
lowest score that can be allocated (i.e., 1) indicates low comfort, whereas
the highest value (i.e., 4) reflects high comfort. The GCQ was adapted to the
Turkish context by Kuğuoğlu and Karabacak. With the original scale, the
Cronbach’s alpha coefficient was .88, but in Kuğuoğlu and Karabacak’s
study, this value was .85 (Kuğuoğlu & Karabacak, 2008). The present study
derived a Cronbach’s alpha coefficient of .79 prior to intervention and .86
after intervention.

Procedure
After obtaining ethical approval, the primary investigator contacted the clin-
ics and informed them about the study. Chemotherapy people with chemo-
therapy sessions amounting to a minimum of three sessions were invited to
participate in the study. The first 35 patients to meet the study inclusion cri-
teria were included in the control group, and the next 35 patients were
included in the intervention group. This division was necessary to prevent the
patients from being influenced by one another. During the first interview ses-
sion, the intervention and control groups were asked to fill out the patient
information form, ESAS, and GCQ to obtain basic data. The intervention
750 Western Journal of Nursing Research 39(6)

group was then asked to listen to music for 20 to 30 min during their chemo-
therapy sessions. Routine unit care was provided to the control group. The
patients were called 1 week after the chemotherapy session and were again
asked to fill out the ESAS and GCQ. The patients in both groups returned the
patient observation forms on their next chemotherapy session.

Intervention
The intervention group was subjected to listening to music with songs from
the “Relaxation Exercises” CD, which was prepared by The Turkish
Psychological Association and used for research conducted in Turkey (Aydın,
2014; Büyükyılmaz, 2009; Topçu, 2008). A relaxation song of 30 min con-
sisting of wave sounds accompanied with harp and violin tunes and taking
place in the third part of the CD was used in the study. The Turkish
Psychological Association recommends that to be effective, it should be lis-
tened to at least 3 times a week. This music CD by Turkish Psychological
Association was used in similar studies carried out in Turkey. In addition,
when results of studies related to listening to music were analyzed, it was
found out that continuous listening caused irritation; whereas listening to
music 3 to 4 times a week of 15- to 30-min periods had therapeutic effect,
instrumental music provided more relaxation compared with music with lyr-
ics, and passive listening was the most used method. Therefore, listening to
music was used according to the related literature in this study. Each patient
was given a portable MP3 player with double earphones with this music
uploaded. The patients were instructed on how to operate the MP3 player
(e.g., switching on and off, adjusting volume) in an appropriate room within
the chemotherapy unit before the intervention. They were asked to use the
MP3 player prior to the commencement of the therapy session and provide
feedback. On discharge, each patient was provided an MP3 player so that he
or she could listen to music for 20 to 30 min at least once a day and no less
than 3 days a week. They were also asked to record the days and times at
which they began experiencing symptoms, as well as the days and times at
which they listened to music, on the patient observation form.

Ethical Considerations
Before the research was initiated, ethical approval was obtained from the Ethics
Board for Clinical Researches of the School of Medicine of Namık Kemal
University. Written permission was also obtained from the public hospital where
the research was conducted. The patients were informed about the research, and
written permission was obtained from them before data collection.
Bilgiç and Acaroğlu 751

Data Analysis
The data were analyzed using SPSS for Windows (Version 16.0). Descriptive
statistics, such as mean, SD, number, and frequency, were used to character-
ize the research participants. The baseline data of the two groups were com-
pared using the Mann–Whitney U test for continuous variables and the
chi-square test for categorical variables. The Mann–Whitney U test was also
performed to analyze the differences between the intervention and control
groups with regard to changes in outcome variables during the baseline
period and 7 days after the intervention. The p values of less than .05 were
considered statistically significant.

Results
The average age of the patients is 54.51 ± 10.35 years. Among them, 52.9%
are female, 80.0% are married, 60.0% are primary school graduates, 42.9%
are pensioners, and 32.9% had breast cancer. Prior to the intervention, no
statistically significant difference was found between the two groups in terms
of individual and clinical characteristics, chemotherapy symptoms, and com-
fort, which were similarly distributed across the patients (p > .05; Table 1).
No statistically significant difference was found between patients making
up the intervention and control group chemotherapy symptoms and comfort
prior to the intervention (p > .05).
The intervention patients began experiencing chemotherapy symptoms
(pain, tiredness, nausea, anxiety, drowsiness, lack of appetite, not feeling
well) at 2.14 ± 0.944 days on average, whereas the control patients experi-
enced such effects (pain, tiredness, nausea, anxiety, drowsiness, lack of appe-
tite, not feeling well) at 2.20 ± 1.051 days on average. No statistically
significant difference was found between the groups (p > .05).
An examination of the total amount of time devoted to music listening
showed that the intervention group listened to music for 4.26 ± 1.31 days per
week on average and 37.00 ± 15.68 min per day on average.
The difference between the evaluation of pre-test and post-test results of
control and experimental groups was compared to assess the effect of listen-
ing to music on chemotherapy symptoms. The comparison revealed a statisti-
cally significant mean difference between the groups in terms of the scores
allocated to pain (p = .002), exhaustion (p < .001), nausea (p = .019), anxiety
(p = .002), lethargy (p < .001), lack of appetite (p = .001), and not feeling well
(p < .001; Table 2). No significant difference between the groups was found
in terms of the mean scores assigned to depression (p = .058) and shortness
of breath (p = .182; Table 2).
752 Western Journal of Nursing Research 39(6)

Table 1.  Individual and Clinical Characteristics of Patients (N = 70).

Intervention Control group Total

Characteristics group (n = 35) (n = 35) (n = 70) p
Sex
 Female 20 (57.1) 17 (48.6) 37 (52.9) .316
 Male 15 (42.9) 18 (51.4) 33 (47.1)
Marital status
 Married 27 (77.1) 29 (82.9) 56 (80.0) .817
 Single/widow 8 (22.9) 6 (17.1) 14 (20.0)
Education
  Primary school 20 (57.1) 22 (62.8) 42 (60.0) .922
  Middle school 4 (11.4) 4 (11.4) 8 (11.4)
  High school 9 (25.7) 8 (22.9) 17 (24.3)
  Higher education 2 (5.8) 1 (2.9) 3 (4.3)
Profession
 Housewife 15 (42.9) 9 (25.7) 24 (34.3) .305
 Employee 5 (14.3) 5 (14.3) 10 (14.3)
 Pensioner 11 (31.4) 19 (54.2) 30 (42.9)
 Other 4 (11.4) 2 (5.8) 6 (8.5)
Diagnosis
  Lung cancer 8 (22.9) 14 (40.0) 22 (31.4) .264
  Breast cancer 14 (40.0) 9 (25.7) 23 (32.9)
  Colon cancer 6 (17.1) 3 (8.6) 9 (12.8)
 Other 7 (20.0) 9 (25.7) 16 (22.9)

The difference between the evaluation of pre-test and post-test results of con-
trol and experimental groups was compared to assess the effect of listening to
music on comfort. The results revealed statistically significant differences
between the groups with regard to the mean scores allocated to total general com-
fort (p = .001) and physical (p < .001), psychospiritual (p = .002), and sociocul-
tural (p = .019) comfort. No significant difference between the groups was found
with respect to the mean scores assigned to the environmental dimension of com-
fort (p > .05; Table 3). An examination of intra-group variations in comfort level
showed a statistically significant difference at all levels, with the highest differ-
ence registering at “relief” in favor of the intervention group (p < .001; Table 3).

Discussion
Patients receiving chemotherapy experience many undesirable symptoms
during the treatment process and a deterioration in their comfort, depending
 Table 2.  Effect of Listening to Music on Chemotherapy Symptoms.

Intervention group (n = 35) Control group (n = 35)

Baseline After 7 days Differencea Baseline After 7 days Differencea

Outcome variable M ± SD M ± SD M ± SD M ± SD M ± SD M ± SD pb
Pain 0.600 ± 0.881 0.829 ± 1.465 0.229 ± 1.416 0.829 ± 1.271 2.829 ± 2.833 2.000 ± 2.473 .002
Tiredness 2.114 ± 2.632 2.429 ± 2.704 0.315 ± 1.922 2.171 ± 2.065 5.057 ± 2.449 2.886 ± 2.518 .000
Nausea 0.714 ± 1.426 1.629 ± 2.237 0.915 ± 2.063 0.686 ± 0.631 2.971 ± 2.538 2.285 ± 2.480 .019
Depression 1.400 ± 1.897 0.943 ± 1.282 −0.457 ± 1.821 2.400 ± 2.452 2.829 ± 2.515 0.429 ± 2.019 .058
Anxiety 1.686 ± 2.298 0.800 ± 1.183 −0.886 ± 2.069 2.314 ± 2.742 2.800 ± 2.621 0.486 ± 2.020 .002
Drowsiness 2.486 ± 2.063 1.314 ± 1.623 −1.172 ± 1.817 2.543 ± 2.758 4.429 ± 2.758 1.886 ± 2.898 .000
Lack of appetite 1.743 ± 2.616 1.686 ± 2.410 −0.057 ± 2.376 1.143 ± 1.033 3.114 ± 2.774 1.971 ± 2.294 .001
Not feeling well 2.000 ± 1.163 1.286 ± 1.341 −0.714 ± 1.362 1.943 ± 1.211 3.029 ± 1.978 1.086 ± 1.837 .000
Shortness of breath 0.743 ± 1.738 0.914 ± 1.502 0.171 ± 1.774 1.086 ± 1.463 1.857 ± 2.088 0.771 ± 1.629 .182

a. İntra-group pre-test and post-test difference.

b. The comparison between groups of intro-groups difference: Mann–Whitney U Test.

753
754
Table 3.  Effect of Listening to Music on Comfort.

Intervention group (n = 35) Control group (n = 35)

Baseline After 7 Days Differencea Baseline After 7 Days Differencea

Outcome variable M ± SD M ± SD M ± SD M ± SD M ± SD M ± SD pb
GCQ total 3.172 ± 0.288 3.521 ± 0.176 0.349 ± 0.271 3.069 ± 0.216 3.198 ± 0.201 0.129 ± 0.177 .001
Comfort dimensions
  Physical comfort 3.312 ± 0.377 3.433 ± 0.296 0.121 ± 0.341 3.154 ± 0.338 2.938 ± 0.370 −0.216 ± 0.360 .000
  Psychospiritual comfort 3.431 ± 0.313 3.589 ± 0.192 0.158 ± 0.291 3.334 ± 0.282 3.284 ± 0.245 −0.050 ± 0.220 .002
  Environmental comfort 2.765 ± 0.460 3.631 ± 0.156 0.866 ± 0.471 2.686 ± 0.287 3.393 ± 0.184 0.707 ± 0.318 .065
  Sociocultural comfort 3.197 ± 0.316 3.394 ± 0.324 0.197 ± 0.433 3.140 ± 0.266 3.143 ± 0.228 0.003 ± 0.239 .035
Comfort levels
 Relief 2.804 ± 0.314 3.241 ± 0.236 0.437 ± 0.305 2.759 ± 0.337 2.886 ± 0.292 0.127 ± 0.243 .000
 Ease 3.385 ± 0.365 3.625 ± 0.207 0.240 ± 0.342 3.291 ± 0.266 3.292 ± 0.227 0.001 ± 0.276 .003
 Transcendence 3.320 ± 0.320 3.701 ± 0.191 0.381 ± 0.336 3.211 ± 0.195 3.423 ± 0.201 0.212 ± 0.190 .014

Note. GCQ = General Comfort Questionnaire.

a. İntra-group pre-test and post-test difference.
b. The comparison between groups of intro-groups difference: Mann–Whitney U Test.
Bilgiç and Acaroğlu 755

on the presenting symptoms (Hintistan et al., 2012; Sadırlı & Ünsar, 2009).
Symptom management is critical to maintaining/improving the physical ease
and well-being of patients. Listening to music is a holistic, inexpensive, and
natural intervention that may help patients cope with symptoms because
music poses advantageous physiological and psychological effects (Cooper
& Foster, 2008; Suhartini, 2008; Yıldırım & Gürkan, 2007).
Studies have shown that patients more intensely suffer from chemother-
apy symptoms in the first 1 to 3 days after chemotherapy intervention
(Kutlutürkan, 2015; Sadırlı, 2008). This severity particularly applies to nau-
sea and vomiting. The onset of chemotherapy-associated symptoms for the
intervention (2.14 ± 0.944 days after treatment) and control (2.20 ± 1.051
days after treatment) groups in the current research is supported by the
literature.
The literature suggests that listening to music for 15 to 30 min is sufficient
for therapeutic applications; extended periods of listening may cause nega-
tive effects because of irritation (Arslan, 2007). The results of the present
study on the average periods that patients devoted to music listening (37.00 ±
15.68 min, 4.26 ± 1.31 days) align with the recommendations in the litera-
ture. Similar findings were derived by Çiftçi (2011) and Karadağ (2011) in
Turkey; Huang, Good, and Zauszniewski (2010) in Taiwan; and Li et al.
(2011) in China.
Pain, exhaustion, nausea, depression, anxiety, lethargy, lack of appetite,
not feeling well, and shortness of breath are the most commonly observed
symptoms in patients undergoing chemotherapy (Erkurt, Kuku, Kaya, &
Aydoğdu, 2009). As a treatment measure, listening to music has gained
importance in the past couple of years (Brown & Kroenke, 2009; Conrad,
2010; Pertl et al., 2013). Research in which listening to music is used dis-
cusses positive effects, including improved individual physical, emotional,
and social well-being; enhanced self-confidence; decreased stress, isolation,
pain, nausea, and anxiety; and improved comfort (Cooper & Foster, 2008;
Lafçı, 2009; Li et al., 2011; Suhartini, 2008; Uyar & Korhan, 2011; Yıldırım
& Gürkan, 2007). The statistically significant difference between the groups
in terms of symptoms other than depression and shortness of breath suggests
that listening to music effectively reduces the severity of chemotherapy
symptoms. Similar studies on cancer patients concluded that improvements
in pain (Huang et al., 2010; Jourt-Pineau et al., 2013; Lee, Song, & Kim,
2015), exhaustion (Chuang, Han, Li, & Young, 2010; Ferrer, 2005; Tsai et al.,
2014), nausea (Silva et al., 2014), anxiety (Bulfone, Quattrin, Zanotti,
Regattin, & Brusaferro, 2009; Chen, Wang, Shih, & Wu, 2013; Romito,
Lagattolla, Costanzo, Giotta, & Mattioli, 2013), lethargy (Lafçı, 2009), and
not feeling well (Barrera, Rykov, & Doyle, 2002; Burns, Harbuz, Hucklebridg,
756 Western Journal of Nursing Research 39(6)

& Bunt, 2001) occur as a result of listening to music. However, no research

has definitively indicated whether such intervention influences depression
and shortness of breath. In the current work, the absence of a statistically
significant difference between the intervention and control groups in depres-
sion is attributed to the fact that the diagnosis for the patients was not new;
they have undergone a minimum of three chemotherapy sessions. The
absence of a significant difference between the groups regarding shortness of
breath suggests that this side effect results from physiological rather than
psychological factors.
The symptoms experienced by patients receiving chemotherapy compro-
mise their comfort and diminish their compliance with treatment and, accord-
ingly, its effectiveness. Kolcaba states that comfort has physical,
psychological, social, and environmental dimensions and that the first two
are negatively affected by pain, homeostatic mechanisms, metabolic func-
tions, anxiety, confusion, receipt of negative information, deterioration of
body image, decreased self-respect, and violation of privacy (Erdemir &
Çırlak, 2013; Karabacak, & Acaroğlu; Kolcaba, 2003; Wilson & Kolcaba,
2004). As previously discussed, managing undesirable effects is critical to
improving the physiological and psychological comfort of patients (Hintistan
et al., 2012; Sadırlı & Ünsar, 2009). The physiological and psychological
effects of listening to music may advance coping with the adverse conse-
quences of chemotherapy and elevate the level of comfort experienced by
patients. The literature indicates that listening to music eases pain, facilitates
sleep, and enables relaxation (Gutgsell et al., 2013; Huang et al., 2010; Li
et al., 2011). The increase in the scores for total general comfort in the inter-
vention group suggests the efficacy of listening to music in enhancing patient
comfort. The fact that the most significant change occurred in the physical
and psychological dimensions is considered an indication of the beneficial
effects of listening to music on these aspects. Ferrer (2005) and McClean,
Bunt, and Daykin (2012) similarly found that music-based intervention
enhanced the comfort of cancer patients.
The analysis of the patients’ comfort levels points to “relief” as the level
with the most significant change. Kolcaba describes “relief” as the feeling of
satisfaction by people who need a specific type of comfort. Satisfying a
patient’s basic comfort requirements is closely related to the restoration of
the functions that he or she could execute before disease onset; it also there-
fore guarantees the continuity of treatment (Kolcaba, 1991). The findings of
the present study suggest that the effectiveness of listening to music in
reducing the severity of a symptom leads to improved patient relief. In a
similar vein, Whyte’s (2010) study on patients undergoing intraperitoneal
chemotherapy against gynecological cancer showed that patients experience
Bilgiç and Acaroğlu 757

the highest level of relief when their need for physical and psychospiritual
comfort is satisfied.
The assessment of the findings revealed reduced severity of various
chemotherapy symptoms (e.g., pain, exhaustion, nausea, anxiety, lethargy,
lack of pain, appetite, feeling bad) among the patients subjected to listen-
ing to music. The physical, psychospiritual, and sociocultural comfort
dimensions and relief levels in the total general comfort of the patients
also improved.
This research confirmed that as a holistic nursing practice, listening to
music diminishes the severity of the symptoms experienced by patients
receiving chemotherapy and improves their comfort levels. The findings con-
tribute to the nursing literature in that they highlight the importance of listen-
ing to music in elevating the quality of life of cancer patients. Music-based
intervention should be included in treatment plans and incorporated as an
essential component of holistic nursing. Application would be particularly
beneficial in chemotherapy units. Finally, further research should be con-
ducted on patients with the same diagnoses and treatments over a longer
study period.
To prevent patients to affect each other, data were collected first from the
control group, and then from the experimental group; thus, it prevented the
matter of randomization. However, the patients being observed at one ses-
sion, including patients with different types of cancer and severity into the
study, the medication of the patients being different from each other, and not
interrogating whether any comfort-enhancing methods were used are the
limitations of the study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding
The author(s) disclosed receipt of the following financial support for the research,
authorship, and/or publication of this article: This study was funded by the Research
Fund of Istanbul University (Project 40731).

References
Almerud, S., & Petersson, K. (2003). Music therapy—A complementary treatment
for mechanically ventilated intensive care patients. Intensive and Critical Care
Nursing, 19, 21-30.
Arslan, S. (2007). Dokunma, müzik terapi ve aromaterapinin yoğun bakım hastalarının
fizyolojik durumlarına etkisi [Touching, music therapy and aromatherapy’s effect
758 Western Journal of Nursing Research 39(6)

on physiological situation of the patients in intensive care unit] (Doctoral thesis).

Surgical Nursing Department, Health Sciences Institute, The Republic of Turkey
Atatürk University, Erzurum, Turkey.
Aydın, S. (2014). Gebelerde gevşeme egzersizlerinin gebelerin uyku kalitesine etkisi
[The effect of relaxation exercises on sleep quality in pregnant women] (Doctoral
thesis). Women’s Health and Diseases of Nursing Department, Health Sciences
Institute, İstanbul University, Turkey.
Barrera, M. E., Rykov, M. H., & Doyle, S. L. (2002). The effects of interactive music
therapy on hospitalized children with cancer: A pilot study. Psycho-Oncology,
11, 379-388.
Besel, J. M. (2006). The effects of music therapy on comfort in the mechanically
ventilated patient in the intensive care unit (Master’s thesis). Montana State
University, Bozeman.
Brown, L. F., & Kroenke, K. (2009). Cancer-related fatigue and its associations with
depression and anxiety: A systematic review. Psychosomatics, 50, 440-447.
Bruera, E., Kuehn, N., Miller, M. J., Selmser, P., & Macmillan, K. (1991). Edmonton
Symptom Assessment System (ESAS): A simple method for the assessment of
palliative care patients. Palliative Care, 7, 6-9.
Bulfone, T., Quattrin, R., Zanotti, R., Regattin, L., & Brusaferro, S. (2009).
Effectiveness of music therapy for anxiety reduction in women with breast cancer
in chemotherapy treatment. Holistic Nursing Practice, 23, 238-242.
Burns, S. J., Harbuz, M. S., Hucklebridg, F., & Bunt, L. (2001). A pilot study into the
therapeutic effects of music therapy at a cancer help center. Alternative Therapies
in Health and Medicine, 7(1), 48-56.
Büyükyılmaz, F. E. (2009). Total kalça veya diz protezi ameliyatı olan hasta-
lara uygulanan gevşeme egzersizleri, sırt masajının ağrı ve anksiyete üzerine
etkisi [The effect of relaxing tecnique and back massage on postoperative
pain and anxiety in total hip or knee arthroplasty patients] (Doctoral thesis).
Fundamentals of Nursing Department, Health Sciences Institute, İstanbul
University, Turkey.
Castillo-Perez, S., Gomez-Perez, V., Velasco, M. C., Perez-Campos, E., & Mayoral,
M. A. (2010). Effects of music therapy on depression compared with psycho-
therapy. The Arts in Psychotherapy, 37, 387-390.
Chen, L. C., Wang, T. F., Shih, Y. N., & Wu, L. J. (2013). Fifteen-minute music inter-
vention reduces pre-radiotherapy anxiety in oncology patients. European Journal
of Oncology Nursing, 17, 436-441.
Chuang, C. Y., Han, W. R., Li, P. C., & Young, S. T. (2010). Effects of music therapy
on subjective sensations and heart rate variability in treated cancer survivors: A
pilot study. Complementary Therapies in Medicine, 18, 224-226.
Çiftçi, H. (2011). Müziğin yoğun bakım ünitesinde serebro vasküler olay tanısıyla
yatan hastalarda konfor, anksiyete ve ağrıya etkisinin incelenmesi [Examination
of the effect of music on comfort, anxiety and pain at the cerebrovascular acci-
dent patients in critical care unit] (Master’s thesis). Health Sciences Institute, The
Republic of Turkey Çukurova University, Adana, Turkey.
Bilgiç and Acaroğlu 759

Conrad, C. (2010). The art of medicine music for healing: From magic to medicine.
The Lancet, 376, 1980-1981.
Cooper, L., & Foster, I. (2008). The use of music to aid patients’ relaxation in a radio-
therapy waiting room. Radiography, 14, 184-188.
Erdemir, F., & Çırlak, A. (2013). Rahatlık kavramı ve hemşirelikte kullanımı [The
concept of comfort and its utilization in nursing]. Dokuz Eylul University School
of Nursing Electronic Journal, 6(4), 224-230.
Erdoğan, G. Y. (2011). Kemoterapi alan kanser hastalarında semptomların
değerlendirilmesi ve semptom yönetiminde eğitimin rolü [Evaluation of che-
motherapy and symptom management training role of the symptoms of cancer
patients] (Master’s thesis). Health Sciences Institute, The Republic of Turkey
Cumhuriyet University, Sivas, Turkey.
Erkurt, M., Kuku, İ., Kaya, E., & Aydoğdu, İ. (2009). Kanser kemoterapisi ve böbrek
[Cancer chemotherapy and kidney]. Journal of Inonu University Medical Faculty,
16, 63-68.
Ferrer, A. J. (2005). The effect of live music on decreasing anxiety in patients under-
going chemotherapy treatment. Journal of Music Therapy, 44, 242-255.
Gutgsell, K. J., Schluchter, M., Margevicius, S., Degolia, P. A., Mclaughlin, B.,
Harris, M., . . . Wiencek, C. (2013). Music therapy reduces pain in palliative
care patients: A randomized controlled trial. Journal of Pain and Symptom
Management, 45, 822-831.
Hintistan, S., Çilingir, D., Nural, N., & Gürsoy, A. A. (2012). Hematolojik kanserli
hastaların kemoterapiye bağlı yaşadıkları semptomlara yönelik uygulamaları
[Applications of patients with hematologic cancers for experienced symptoms
due to chemotherapy]. Gümüşhane University Journal of Health Sciences, 1,
153-164. (In Turkish)
Huang, S. T., Good, M., & Zauszniewski, J. A. (2010). The effectiveness of music
in relieving pain in cancer patients: A randomized controlled trial. International
Journal of Nursing Studies, 47, 1354-1362.
Jourt-Pineau, C., Guétinb, S., Védrinea, L., Le Mouleca, S., Poiriera, J. M., &
Ceccaldia, B. (2013). Effets de la musicothérapie sur la douleur et l’anxiété
des patients atteints de cancer hospitalisés et/ou suivis en service d’oncologie
[Effects of music therapy on pain and anxiety in treating cancer patients: A feasi-
bility study]. Douleurs: Evaluation–Diagnostic–Traitement, 14, 200-207.
Karabacak, Ü., & Acaroğlu, R. (2011). Konfor kuramı [Theory of comfort]. Maltepe
University Journal of Nursing Science and Art, 4(1), 197-202.
Karadağ, E. (2011). Hemodiyaliz tedavisi uygulanan kronik böbrek yetmezlikli
hastalarda müziğin uyku kalitesi ve yaşam bulgularına etkisi [The effect of
music on the quality of sleep and vital signs of the chronic renal failure patients
who are getting hemodialysis treatment]. Department of Internal Medicine,
Nursing, Health Sciences Institute, The Republic of Turkey Ege University,
İzmir, Turkey.
Kim, K. S., & Kwo, S. H. (2007). Comfort and quality of life of cancer patients. Asian
Nursing Research, 1, 125-135.
760 Western Journal of Nursing Research 39(6)

Koçaşlı, S. (2006). Cerrahi girişim sonrası radyoterapi alan erken evre meme kan-
serli kadınlarda konfor düzeyi [The comfort level of women with early stage
breast cancer why received radiotherapy after surgical intervention] (Doctoral
thesis). Department of Surgical Medicine, Nursing, Health Sciences Institute,
The Republic of Turkey Istanbul University, İstanbul, Turkey.
Kolcaba, K. (1991). A Taxonomic structure for the concept comfort. IMAGE: Journal
of Nursing Scholarship, 23, 237-240.
Kolcaba, K. (1992). Holistic comfort: Operationalizing the construct as a nurse-sensitive
outcome. Advances in Nursing Science, 15(1), 1-10.
Kolcaba, K. (2003). Comfort theory and practice: A vision for holistic health care and
research. New York, NY: Springer.
Kolcaba, K., & Kolcaba, R. (1991). An analysis of the concept of comfort. Journal of
Advanced Nursing, 16, 1301-1310.
Küçük, L., Yıldırım, N. K., & Özkan, M. (2015). Depresyon [Depression]. In G.
Can (Ed.), Onkoloji Hemşireliğinde Kanıttan Uygulamaya Konsensus 2014
[Application of Evidence in Oncology Nursing Consensus 2014] (pp. 299-310).
İstanbul, Turkey: Nobel Tıp Kitabevleri.
Kuğuoğlu, S., & Karabacak, Ü. (2008). Genel konfor ölçeğinin Türkçeye uyarlanması
[Turkish Version of the General Comfort Questionaire]. University Florence
Nightingale Journal of Nursing, 16, 16-23.
Kutlutürkan, S. (2015). Bulantı ve Kusma [Nausea and vomiting]. In In G. Can (Ed.),
Onkoloji Hemşireliğinde Kanıttan Uygulamaya Konsensus 2014 [Application of
Evidence in Oncology Nursing Consensus 2014] (pp. 145-158). İstanbul, Turkey:
Nobel Tıp Kitabevleri.
Lafçı, D. (2009). Müziğin kanser hastalarının uyku kalitesi üzerine etkisi [Effect of the
music on the sleeping quality of cancer patients] (Master’s thesis). Department
of Nursing, Health Sciences Institute, Çukurova University, Adana, Turkey. (In
Turkish)
Lee, S. H., Song, E., & Kim, S. K. (2015). Effects of oriental medicine music ther-
apy in an ovarian cancer patient with So-Eum-type constitution: A case report.
Integrative Medicine Research, 4, 48-52.
Li, X. M., Zhou, K. N., Yan, H., Wang, D. L., & Zhang, Y. P. (2011). Effects of music
therapy on anxiety of patients with breast cancer after radical mastectomy: A
randomized clinical trial. Journal of Advanced Nursing, 68, 1145-1155.
McClean, S., Bunt, L., & Daykin, N. (2012). The healing and spiritual proper-
ties of music therapy at a cancer care center. The Journal of Alternative and
Complementary Medicine, 18, 402-407.
Moreno, D. M., & Dona, L. A. (2013). Effect of a combined dance/movement
and music therapy on young adults diagnosed with severe autism. The Arts in
Psychotherapy, 40, 465-472.
Olofsson, A., & Fossum, B. (2009). Perspectives on music therapy in adult cancer
care: A hermeneutic study. Oncology Nursing Forum, 36, 223-231.
Özdemir, L. (2007). Hafif Alzheimer hastalarına uygulanan çoklu duyusal uyaran
yönteminin kognitif durum, depresyon ve anksiyete üzerine etkisi [Multi sensorial
Bilgiç and Acaroğlu 761

stimulation method’s effect on cognition, depression and anxiety which was

implemented to the mild alzheimer patients] (Doctoral dissertation). Department
of Nursing, Health Sciences Institute, Hacettepe University, Ankara, Turkey.
Pertl, M. M., Hevey, D., Boyle, N. T., Hughes, M. M., Collier, S., O’Dwyer, A.-M.,
. . . Connor, T. J. (2013). C-reactive protein predicts fatigue independently of
depression in breast cancer patients prior to chemotherapy. Brain, Behavior, and
Immunity, 34, 108-119.
Romito, F., Lagattolla, F., Costanzo, C., Giotta, F., & Mattioli, V. (2013). Music
therapy and emotional expression during chemotherapy: How do breast cancer
patients feel? European Journal of Integrative Medicine, 5, 438-442.
Sadırlı, S. (2008). Kanserli hastalarda semptom kontrolünün değerlendirilmesi
[Determination of symptom control with cancer patients]. (Master’s Thesis).
Department of Nursing, Health Sciences Institute, The Republic of Turkey.
Trakya University, Edirne, Turkey.
Sadırlı, S., & Ünsar, S. (2009). Kanserli hastalarda edmonton semptom tanılama
ölçegi (ESAS): Türkçe geçerlilik ve güvenirlik çalışması [Edmonton Symptom
Assessment Scale (ESAS) in patients with cancer: The Turkish study of validity
and reliability]. Journal of Euphrates Health Services, 4(11), 79-95.
Silva, G. J., Fonseca, M. D. S., Rodrigues, A. B., de Oliveira, P. P., Brasil, D. R., &
Moreira, M. M. (2014). Use of musical experiences as therapy for symptoms of
nausea and vomiting in chemotherapy. Revista Brasileira De Enfermagem, 67,
630-636.
Stanczyk, M. M. (2011). Music therapy in supportive cancer care. Reports of Practical
Oncology and Radiotherapy, 16(5), 170-172.
Suhartini, S. (2008). Effectiveness of music therapy toward reducing patient’s anxiety
in intensive care unit. Nurse Media Journal of Nursing, 2, 1-44.
Sung, H. C., Chang, A. M., & Lee, W. L. (2010). A preferred music listening interven-
tion to reduce anxiety in older adults with dementia in nursing homes. Journal of
Clinical Nursing, 19, 1056-1064.
Topçu, S. Y. (2008). Üst abdominal cerrahi girişim uygulanan hastalarda hemşireler
tarafından öğretilen gevşeme tekniklerinin ağrı kontrolü üzerine etkisi [The
effect of relaxation techniques that taught by the nurses on pain control in patients
with upper abdominal surgery] (Master’s thesis). Department of Nursing, Health
Sciences Institute, Trakya University, Edirne, Turkey.
Tsai, H. F., Chen, Y. R., Chung, M. H., Liao, Y. M., Chi, M. J., Chang, C. C., & Chou,
K. R. (2014). Effectiveness of music intervention in ameliorating cancer patients’
anxiety, depression, pain, and fatigue: A meta-analysis. Cancer Nursing, 37(6),
35-50.
Uyar, M., & Korhan, E. A. (2011). Yoğun bakım hastalarında müzik terapinin ağrı
ve anksiyete üzerine etkisi [The effect of music therapy on pain and anxiety in
intensive care patients]. Ağrı, 23, 139-146.
Whyte, D. (2010). Comfort levels of gynecology cancer patients receiving intra-
peritoneal chemotherapy: A pilot study (Master’s thesis). Universty of Calgary,
Alberta, Canada.
762 Western Journal of Nursing Research 39(6)

Wilson, L., & Kolcaba, K. (2004). Practical application of comfort theory in the peri-
anesthesia setting. Journal of PeriAnesthesia Nursing, 19, 164-173.
Yeter, G. (2012). Çocuk kanser hastalarında semptomlara yönelik tamamlayıcı ve
alternatif tedavi kullanımı [The use complementary and alternative medical
therapies symptom orientated on children with cancer treated] (Master’s thesis).
Department of Nursing, Health Sciences Institute, Mersin University, Turkey.
Yıldırım, S. (2009). Kemoterapi alan hastalarda kemoterapiye bağlı yan etkilerin
beslenme eğitimi öncesi ve sonrası değerlendirilmesi [Chemotherapy symptoms
linked to chemotherapy in patient evaluation before and after nutrition education]
(Master’s thesis). Department of Nursing, Health Sciences Institute, Zonguldak
Karaelmas University, Turkey.
Yıldırım, S., & Gürkan, A. (2007). Müziğin, kemoterapi yan etkilerine ve kaygı
düzeyine etkisi [The influence of music on anxiety and the symptoms of chemo-
therapy]. Anatolian Journal of Psychiatry, 8, 37-45.