Edelweiss: Psychiatry Open Access (ISSN 2638-8073)

Introduction

Patients undergoing cancer treatment may have physical and psychological problems. Chemotherapy is often considered the most stressful of the treatment modalities primarily as a result of the myriad of side effects that the patient has to endure [1]. It can affect the patient’s physical, psychological and spiritual well-being [2]. Salivary alpha-amylase is a useful biomarker that can be used in assessing human psychobiological and social behavioral processes [3].

Assessment of pre-treatment anxiety is challenging and mainly based on lengthy questionnaires or plasma biomarkers that cannot be used for bedside decision-making. There is a potential role for noninvasive, real-time, and point-of-care biomarkers such as salivary amylase to identify anxious patients and to target pre-treatment pharmacologic or non-pharmacologic interventions in patients undergoing chemotherapy.

Salivary Amylase is the principal saliva protein and is mainly secreted by the parotid glands. An association between changes in Salivary Amylase during exposure to a stressful stimulus and changes in blood nor-epinephrine or heart rate variability indices strongly suggests that Salivary Amylase is an accurate marker of sympathetic nervous system activity [4]. The purpose of this study was to evaluate the effect of patients preferred music on levels of salivary amylase before and after chemotherapy administration.

Material and Methods

Quasi experimental repeated measure design was adopted to conduct this study. The study was approved by the university ethics committee (YUEC 155/2016).

Study Participants

Patients with all types and all stages of cancer were included in the study between the age group of 19-65. Oncology units of two different hospitals were selected as one for experimental group and another for control group. Patients who were 18 years of age or older, who did not have hearing deficiencies and the chemotherapy infusion lasts for a minimum of 3 hours duration was the inclusion criteria whereas patients who were unable to listen to music due to hearing problems, who had head and neck cancer and had diabetes, hypertension, and thyroid problems were excluded from the study. All patients were provided informed consent and were informed that they could withdraw from the study at any time [5-9].

Intervention

The music intervention included 10 different variety of instrumental music library. Each library had slow, instrumental music collections of 3 hours length which was recorded and stored in Sony portable mp3 players. They were selected by the investigator as research demonstrates them to be more relaxing. The selected music libraries were sent for the validation to the experts in the field of music. The study participants first selected one of the 10 libraries by listening to it, and then they were given with Sony portable mp3 player with 3.5 mm port.

The study participants were also provided with "sleep tune musical pillow" developed by Reliance comforts which had two mini electronic speakers embedded in the pillow connected through a wire with 3.5 mm jack. The benefit of using a pillow in this study was to make study participants feel comfortable and to avoid keeping headphones for a long time in the ears which is uncomfortable while undergoing chemotherapy. The pillow covers were changeable and washable for infection control. The period of unsupervised activity consisted of any activity that the patient desired [10-12].

Data Collection Procedure

The baseline assessment of salivary amylase was done on the 1^st day before starting the chemotherapy. Music was administered to the experimental group by following the protocol for 3 hours of duration. The post-tests were done on day 1 i.e.; soon after the intervention for the experimental group and after three hours of chemotherapy for the control group. Post-tests were also done on, day 3 and day 5 for both the groups [13-17].

Salivary Amylase Assay

Salivary amylase Assay was carried out by following the protocol provided by the AGAPPE technologies, India.

Results

A total of 160 patients were included in the study. 80 were in intervention and 80 were in control group. The baseline and clinical characteristics of the patients are presented in table 1. No differences were found between the groups in their baseline characteristics.

Comparison of Amylase Scores Over a Different Period of Time within the Experimental and Control Groups

The data presented in table 2 shows that the salivary amylase level decreased within the experimental (F=181.69, p˂0.001) group at different time points and slightly increased in the control (F=5.68, p˂0.05) group. Further, post hoc analysis was done by Bonferroni test to compare the effect between different times of observation of amylase score. The data in the table 3, Post hoc analysis using Benferroni test shows significant changes in mean difference over different time points in both the groups (p˂0.05). Therefore, the null hypothesis is rejected and concluded that there is a significant difference in the mean baseline and post test scores of amylase in experimental and control group. The data in the table 4 shows that the salivary amylase levels decreased in the experimental group from baseline (398.3 ± 108.9 IU/mL) to post-test day 5 (323.7 ± 106.9 IU/mL). However, in the control group, there was a slight increase from baseline (386.1 ± 111.8 IU/mL) to post-test day 3 (389.6 ± 112.4 IU/mL) and day 5 (393.93 ± 111.7 IU/mL). Comparison of the salivary amylase levels between the experimental and control groups showed a statistically significant decrease (p˂0.01) on post-test day 3 and on day 5 (˂0.001). The differences were not significant (p˃0.05) at baseline.

Table 1: Patient baseline and clinical characteristics.

Table 2: Amylases scores at different times of observations within experimental and control groups.

Table 3: Intragroup comparison of amylase scores at different times of observation in experimental and control groups.

Table 4: Comparison of Salivary amylase scores between the experimental and control groups.

Discussion

The present study findings highlights that listening to the patient preferred recorded music while receiving chemotherapy was related with decrease in salivary alpha amylase level in patients with cancer (p=0.001). this relation is confirmed with other study done by (Andreas Charalambous, 2015) based on a randomized control trial, examine the effect of progressive muscle relaxation and guided imagery along with music as anxiety reducing intervention for patients with breast cancer undergoing chemotherapy. Salivary cortisol and amylase levels were assessed before and after intervention.

Conclusion

Present study result showed that there was a significant difference in salivary amylase levels before and after chemotherapy in experimental group compared to control group. Hence assessment of stress provoking biomarkers like salivary amylase is important to assess the pre-treatment induces anxiety and stress.

References

1. Bilgic S and Acroglu R. Effects of Listening to Music on the Comfort of Chemotherapy Patients (2017) West J Nurs Res 39: 745-762. https://doi.org/10.1177/0193945916660527
2. Bareh S and D’silva F. Effect of music on pain and quality of life among cancer survivors (2017) NUJHS 7: 25-29.
3. Weaver C, Varvares M, Ottenlips E, Christopher K and Dwiggins A. Live Music to Decrease Patient Anxiety During Chemotherapy Treatments (2019) JNCCN 17: 19-58. https://doi.org/10.6004/jnccn.2018.7132
4. Alacacioglu A, Dissiz G, iris S, Usluoglu A and ASIK N. The Effect of Music on the Instant Anxiety Levels of Oncologic Patients Receiving Chemotherapy Treatment (2018) Ann Oncol 29: 558. https://doi.org/10.1093/annonc/mdy296.003
5. Bro ML, Johansen C, Vuust P, Enggaard L, Himmelstrup B, et al. Effects of live music during chemotherapy in lymphoma patients: a randomized, controlled, multi-center trial (2019) Support Care Cancer 27: 3887-3896. https://doi.org/10.1007/s00520-019-04666-8
6. Krishnaswamy P and Nair S. Effect of music therapy on pain and anxiety levels of cancer patients: A Pilots study (2016) Indian J Palliat Care 22: 307-311. https://doi.org/10.4103/0973-1075.185042
7. Manson H, Manderin M and Johnson M. Chemotherapy; thoughts and images of patients with cancer (1993) Oncol Nurs Forum 20: 527-532.
8. Alejandra J and Ferrer MM. The effect of live music on decreasing anxiety in patients undergoing chemotherapy treatment (2007) J Music Ther 15: 242-255. https://doi.org/10.1093/jmt/44.3.242
9. Andreas C, Margarita G, Evangelose b and Lefkios P. A randomized controlled trial for the effectiveness of progressive muscle relaxation and guided imagery as anxiety reducing interventions in breast and prostate cancer patients undergoing chemotherapy (2015) Evid Based Complement Alternat Med 2: 1-7. https://doi.org/10.1155/2015/270876
10. Rashkova MR, Ribagin LS and Toneva NG. Correlation between salivary alpha-amylase and stress-related anxiety (2012) Folia Med 54: 46-51. https://doi.org/10.2478/v10153-011-0088-4
11. Robert MT, Dehoux M, Longrois D and Guglielminotti J. Salivary Amylase as a Stress Biomarker (2015) General Methods in Biomarker Research and their Applications 2015: 1-17. https://doi.org/10.1007/978-94-007-7740-8_31-1
12. Kemper K and Danhauer SC. Music as therapy (2005) Southern Med J 98: 282-288. https://doi.org/10.1097/01.SMJ.0000154773.11986.39
13. Bulfone T, Quattrin R, Zanotti R, Regattin L and Brusaferro S. Effectiveness of music therapy for anxiety reduction in women with breast cancer in chemotherapy treatment (2009) Hosp Nurs Pract 23: 238-242. https://doi.org/10.1097/hnp.0b013e3181aeceee
14. Smith M, Casey L, Johnson D, Gwede C and Riggn OZ. Music as a therapeutic intervention for anxiety in patients receiving radiation therapy (2001) Oncol Nurs Forum 28: 855-862.
15. Nightingale CL, Rodriguez C and Carnaby G. The Impact of Music Interventions on Anxiety for Adult Cancer Patients: A Meta-Analysis and Systematic Review (2013) Integr Cancer Ther 12: 393-303. https://doi.org/10.1177/1534735413485817
16. Jafari H, Zeydi AE, Khani S, Esmaeili R and Soleimani A. The effects of listening to preferred music on pain intensity after open heart surgery (2012) Iran J Nurs Midwifery Res 17: 1-6.
17. Chen LC, Wang TF, Shih YN and Wu LJ. Fifteen-minute music intervention reduces pre-radiotherapy anxiety in oncology patients (2013) Eur J Oncol Nurs 17: 436-441. https://doi.org/10.1016/j.ejon.2012.11.002

*Corresponding author:

Syed Imran, Yenepoya Nursing College, Yenepoya University, India, E-mail: syed_vinu@yahoo.co.in

Citation:

Imran S, Moosabba MS and Ancheril A. Effect of music on salivary amylase in patients undergoing chemotherapy (2020) Edelweiss Psyi Open Access 4: 15-17.