Musical toxicity: Survey reveals cancer’s unique long-term impact on musicians
Key takeaways:
- More than a quarter of musicians with breast cancer experienced difficulties in their musical endeavors after treatment.
- In most cases, their musical abilities had not returned to baseline 1 year after treatment.
A survey of musicians with breast cancer revealed more than one-quarter experienced difficulties with their musical endeavors during or after cancer treatment.
In most cases, the abilities of those who experienced acute musical toxicity — characterized by a variety of symptoms that can affect fine motor or sensory control — never returned to baseline.
“Occupational outcomes are understudied in oncology. We don’t have much information about how a medical treatment could affect someone’s ability to continue their job or hobby,” Jessica Burlile, MD, radiation oncologist at Mayo Clinic in Rochester, Minnesota, told Healio. “I hope this kind of research can spark interest in further studies that evaluate this — either in general or in specific occupations — in terms of measurable impact on quality of life.”
As Healio reported earlier this year, research has showed music may help improve cognitive function among people undergoing chemotherapy. One study of 15 individuals who participated in group piano lessons demonstrated improvement in executive function.
However, the impact that cancer and its treatments have on the musical abilities of individuals who sing or play instruments has not been well studied.
Burlile and colleagues administered a nine-item musical toxicity questionnaire to 1,871 patients who had enrolled in the Mayo Clinic Breast Cancer Registry.
Slightly less than one-third (29%; n = 535) reported playing a musical instrument or singing during the last 10 years.
The questionnaire asked self-identified musicians whether they had struggled with musical skills during or after breast cancer treatment. Other questions assessed which side effects and specific cancer treatments had the greatest perceived impact on musical ability, which musical skills were most affected, and how much time elapsed prior to symptom resolution.
More than one-quarter of the self-identified musicians reported experiencing acute musical toxicity. Of these individuals, 57% (n = 82/144) reported that their musical abilities had not returned to baseline at the time of the survey.
Respondents identified chemotherapy as the treatment modality that most negatively impacted musical ability, with 63 of 89 (71%) patients who underwent chemotherapy reporting that this treatment was the most negatively impactful.
Musicians reported reduced endurance as the most common musical difficulty (64%), followed by decreased musical accuracy, struggles with singing or playing quickly, and difficulty using proper technique.
Healio spoke with Burlile about the rationale for this study, the importance of the findings and the next steps in research.
Healio: Prior to this study, what evidence existed about the impact of breast cancer and its treatments on musical ability?
Burlile: We certainly know quite a bit about the effects of breast cancer treatments in general, and there’s quite a bit published in the literature about peripheral neuropathy and shoulder dysfunction. However, there was very little published specifically about musical side effects.
Healio: What motivated you to conduct this study?
Burlile: When I was a new resident, I had a patient who was an amateur musician. She was extremely accomplished, and she played the cello in several chamber groups. She asked me how treatment might affect her ability to play cello in these groups because it was very important to her. I thought it would probably affect her, but I didn’t know what the chances of that were, nor did I know exactly what side effects or treatments might affect her most. I also studied music as an undergraduate — that was my first degree — so I have a personal interest, as well.
Healio: How did you conduct this study?
Burlile: We reached out to doctors in medical oncology, surgical oncology, psychology and music education. Based on input from these clinicians, we put together this survey study. Several of us on the medical side had musical backgrounds. We collaborated and went through several iterations of the survey, just to be sure it was friendly to different kinds of instrumentalists and vocalists.
Healio: What did you find?
Burlile: The survey’s first question asked if the respondent was a musician. For those who replied yes, we asked if they noticed difficulty singing or playing their instruments during or after receiving cancer treatments. We qualified that as acute musical toxicity. Of this cohort of more than 500 musicians, 27% experienced some difficulty with their music.
Interestingly, most of those who experienced musical toxicity did not see complete improvement in these symptoms. Even at 1 year after treatment, respondents were saying their musical abilities had not returned to normal. That was surprising.
Healio: What is the mechanism of musical toxicity, and why do you think it doesn’t improve?
Burlile: It’s hard to tease out factors like that from a survey but, from what we could gather, fatigue was the number one issue. People just didn’t feel like they had the endurance or the energy they used to have.
For folks who played stringed and percussion instruments, pain and discomfort were most impactful. These patients indicated surgery was more impactful for them, whereas respondents overall reported that chemotherapy was most impactful. I’m thinking that those who play stringed instruments are most active with their upper extremities, so they felt the effects of surgery in terms of pain, discomfort and mobility. This impacted them in a different way than singers, who comprised the majority of our population.
As far as why these symptoms did not improve over time, there was no way to control for that in the survey, and that is one of the shortcomings of the study. People’s musical ability could have declined because of age or injury, or other issues unrelated to breast cancer. I believe it is multifactorial.
Healio: How can oncologists or other members of the cancer care team prepare patients who are musicians for the possibility of acute musical toxicity?
Burlile: My hope is that this study encourages clinicians to have those conversations more often, and refer patients to physical or occupational therapy early. If someone indicates that they are a musician — or a mechanic, surgeon, tailor or any occupation requiring fine motor skills — it’s a good idea to have this conversation. We advise referring them to physical therapy for a baseline assessment, and then they can collaborate with the patient throughout treatment to maintain function and add exercises that might be helpful.
Healio: What are the next steps in research?
Burlile: We are working on a mixed-method study that incorporates in-person, in-depth interviews with musicians in an effort to dive deeper into some of the complexities of this. Although a survey might be trying to get at certain ideas, sometimes it is difficult to know exactly what a patient is thinking when they’re answering each question.
Reference:
For more information:
Jessica Burlile, MD, can be reached at jessica.burlile@gmail.com.
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