Evidence Explorer · MS-N049

Music therapy compared with CBT for anxiety in cancer survivors

Family: Music-based and psychological supportive care
Clinical question: For adult cancer survivors with clinically significant anxiety, is a structured telehealth music-therapy program no worse than cognitive behavioral therapy (CBT) for reducing anxiety?
Evidence label: Promising active-comparator evidence; no untreated-control estimate.

Evidence at a glance

• Benefit: In the 300-person MELODY trial, both programs produced anxiety improvements that exceeded the prespecified minimal clinically important difference.
• Certainty: One well-sized noninferiority trial with an active comparator; it cannot tell us how much either program adds over usual care or attention alone.
• Risk: Generally low physical risk, but emotional material can surface and severe or urgent distress still needs clinical assessment.
• Cancer control: Not studied. Anxiety improvement is not evidence of tumor response, recurrence prevention, or longer survival.

What was studied

MELODY randomized 300 English- or Spanish-speaking adult cancer survivors to seven weekly telehealth sessions of music therapy or CBT. Hospital Anxiety and Depression Scale anxiety scores were coprimary outcomes at weeks 8 and 26. The noninferiority margin was 1.7 points, chosen to reflect a minimal clinically important difference.

What the evidence shows

At week 8, mean anxiety changed by −3.12 points with music therapy and −2.97 with CBT; the between-group difference was −0.15 (95% CI −0.78 to 0.49). At week 26, changes were −3.31 and −3.00; difference −0.31 (95% CI −0.95 to 0.32). Both confidence intervals stayed within the noninferiority margin. This supports music therapy as a potentially useful anxiety-care option when delivered by a trained therapist; it does not establish superiority to CBT.

What this does not show: The study does not establish benefit over no intervention, nor does it test cancer outcomes.

Limits and uncertainty

• Active-versus-active design, with no usual-care or attention control.
• The sample was 74.7% female and 76.5% White; access to telehealth and trained therapists may limit generalizability.
• The abstract did not provide a complete adverse-event table; detailed harms were not independently verified in this appraisal.
• Noninferiority depends on the prespecified margin and the quality of the active comparator.

Safety and practical context

Music therapy here meant a structured clinical program, not simply listening to a playlist. Ask who is delivering it, how distress is monitored, and how it fits with psycho-oncology care. New suicidal thoughts, panic, or inability to function require prompt clinical help.

Questions for the care team

• Is a board-certified or otherwise appropriately trained music therapist available?
• Would CBT, medication, combined care, or another evidence-based anxiety treatment fit better?
• How will anxiety severity and response be measured?
• What is the plan if distress worsens?

Related Missing Script review

A connected narrative review is available: Music Therapy for Cancer-Related Anxiety: What the MELODY Trial Adds.

Sources

• MELODY trial (J Clin Oncol; PMID 41494146)
• MELODY full text (PMCID PMC12879169)
• ClinicalTrials.gov NCT05215353
• DOI 10.1200/JCO-25-00726

Identifiers: PMID 41494146; PMCID PMC12879169; NCT05215353; DOI 10.1200/JCO-25-00726
Last literature search: October 17, 2026
Record appraised: October 17, 2026

Educational information, not personal medical advice. Decisions about symptoms, supplements, movement, or psychological care during cancer treatment should be made with the oncology team.