Document Type

Article

Publication Date

1-6-2026

Comments

This article is the author’s final published version in Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Volume 44, Issue 5, 2026, Pages 375-385.

The published version is available at https://doi.org/10.1200/JCO-25-00726. Copyright © 2026 by American Society of Clinical Oncology.

 

Abstract

PURPOSE: Anxiety is prevalent, disruptive, and undertreated among survivors of cancer. Cognitive behavioral therapy (CBT) is the first-line treatment, but not all individuals have access, respond to treatment, or prefer this option because of stigma. Music therapy is effective for short-term anxiety reduction, but it is unknown whether it is noninferior to first-line CBT for long-term anxiety reduction.

METHODS: This comparative effectiveness trial randomly assigned English- or Spanish-speaking survivors of cancer to seven weekly telehealth sessions of music therapy or CBT. The coprimary end points were changes in the Hospital Anxiety and Depression Scale (HADS) anxiety score at weeks 8 and 26. The noninferiority margin was 0.35 standard deviations, informed by a minimal clinically important difference (MCID) of 1.7 points. Secondary outcomes included fatigue, depression, insomnia, pain, cognitive dysfunction, and health-related quality of life.

RESULTS: Among N = 300 patients, 74.7% was female, 76.5% was White, and 19.0% was Hispanic. At week 8, the mean change in HADS anxiety score was –3.12 (95% CI, –3.59 to –2.65) in music therapy and –2.97 (95% CI, –3.45 to –2.50) in CBT; the between-group difference was –0.15 (95% CI, –0.78 to 0.49), within the noninferiority margin of 1.20 (P < .001). At week 26, the mean change was –3.31 (95% CI, –3.78 to –2.85) in music therapy and –3.00 (95% CI, –3.47 to –2.53) in CBT; the between-group difference was –0.31 (95% CI, –0.95 to 0.32), within the noninferiority margin of 1.28 (P < .001). Both groups produced anxiety reductions exceeding the MCID and showed similar improvements in secondary outcomes.

CONCLUSION: Music therapy is noninferior to CBT for anxiety in survivors of cancer. Both telehealth interventions produced clinically meaningful, durable improvements in anxiety.

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Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

Additional Files
PROTOCOL.pdf (631 kB)
Data Sharing Statement Questionnaire.pdf (136 kB)

PubMed ID

41494146

Language

English

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