Effect of Music Therapy on Anxiety and Depression in Breast Cancer Patients: Systematic Review and Meta-Analysis

Effect of Music Therapy on Anxiety and Depression in Breast Cancer Patients: Systematic Review and Meta-Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Effect of Music Therapy on Anxiety and Depression in Breast Cancer Patients: Systematic Review and Meta-Analysis Zhihui Xu, Cong Liu, Wenjun Fan, Shufan Li, xing wang, Yuzhang Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4093072/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Jul, 2024 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Background: ABSTRACT: to systematically evaluate the intervention effect of music therapy on anxiety and depression in breast cancer patients. METHODS: Randomised controlled literature on music therapy for anxiety and depression in breast cancer patients was searched from 7 major databases, PubMed, Embase, the Cochrane Library, WOS, CNIC, Wanfang, and Wipro, spanning the period of library construction to 23 October 2023, and the literature screening of music therapy for anxiety or depression in breast cancer patients was carried out by 2 experimentalists, each of whom conducted a literature screening randomised controlled trial independently of the other. anxiety or depression in a randomised controlled trial. Methodological quality was evaluated using the PEDro scale; GRADE profiler software for quality of evidence; and RevMan 5.3.5 was used for effect size merging and forest plots; publication bias tests and sensitivity analyses were performed using Stata 17.0; and standardised mean difference (SMD) and 95% CI were used as the effect statistics. RESULTS: A total of 13 RCTs with 1278 subjects (aged 18-70 years) were included in the literature, with a mean PEDro score of 6.8, and the literature was overall of good methodological quality.Meta-analysis showed that music therapy improved anxiety in breast cancer patients (841 cases), with a combined effect size (SMD=-0.82, 95% CI [-1.03,-0.61] and P<0.00001); and improved depression in breast cancer patients (387 cases) with a combined effect size (SMD=-0.76, 95% CI [-1.15,-0.38], P<0.00001). Subgroup analyses showed that music intervention with off-site music (757 cases) and music choice of non-self-selected music (537 cases) had the best effect on anxiety improvement, with corresponding combined effect sizes (SMD=-0.88, P<0.001; SMD=-0.83, P<0.001), respectively; followed by an intervention length of <30 min (589 cases), a frequency of 2 times/day ( 382 cases), and intervention period of 2-3 weeks (101 cases) had the best effect on anxiety improvement, and the corresponding combined effect sizes were (SMD=-0.80, P<0.001; SMD=-0.91, P<0.001; SMD=-1.02, P<0.001), respectively; and the music selection was the choice of one's own favourite music among the expert recommendations (219 cases) (270 cases ) had the best effect on the improvement of depressed mood, with combined effect sizes of (SMD=-1.15, P<0.001; SMD=-0.71, P<0.001) and music with an intervention duration of 30 min (287 cases), an intervention frequency of 1 time/day (348 cases), and an intervention period of 2-4 weeks (120 cases), respectively, with corresponding combined effect sizes of (SMD=-0.75, p<0.001; SMD=-0.86, p<0.001; SMD=-1.06, p<0.001), respectively. DISCUSSION: Music therapy improves anxiety and depression in breast cancer patients and has a high level of evidence. The literature was overall of good methodological quality, but heterogeneity between studies was high, and the heterogeneity of anxiety and depression was explored by subgroup analyses, with anxiety derived from treatment phase, music duration and music cycle; and depression [Liberati, 2009 #2560]derived from intervention cycle and music duration. Sensitivity analyses also identified music duration and music cycle as contributing to the heterogeneity. Also this study has some limitations due to the fact that the included literature did not take into account the duration of the disease, education, family economic status and did not categorise the age stages. This study found that music therapy improves anxiety and depression in breast cancer patients and the results can be used as a basis for clinical practice and researcher enquiry. FUNDING AND REGISTRATION: This research has been registered on the INPLASY platform (https://inplasy.com/contact/) under the number: INPLASY2023100057. Health sciences/Oncology/Cancer/Breast cancer Health sciences/Oncology/Cancer/Gynaecological cancer music therapy cancer Anxiety depression Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction The incidence of female breast cancer often ranks first among female malignant tumours [1] , accounting for 7-10% of all malignant tumours in the body. In the past 20 years, the incidence of breast cancer in China has increased by 37.6%, with an average annual growth rate of 2.3% [2] . Breast cancer patients are the phenomenon of uncontrolled proliferation of breast epithelial cells under the action of multiple carcinogenic factors; physiologically, early stage often manifests symptoms such as breast lumps and enlarged axillary lymph nodes, and in the late stage, due to distant metastasis of the cancer cells, multi-organ lesions may occur, and even threaten the patients' lives [3] . Patients need to endure the pain and side effects of chemotherapy during treatment, and psychologically they often show emotional instability, anxiety and depression, etc., and most of them have psychological problems such as moderate and severe anxiety levels. Music therapy is an emerging psychotherapeutic modality in which the unique physiological and psychological effects of music enable patients to regulate their psychological disorders through musical experience and distraction. Music therapy is considered to be one of the most effective psychotherapeutic methods for clinical non-pharmacological treatment to eliminate psychosomatic disorders [4] . Music can affect patients' heart rate, blood pressure, respiratory rate, and blood cortisol levels through rhythm and tone [5] , thus relieving emotions such as anxiety or depression [6] . A study by Zhi Yanhong et al. found that patients use the sonic vibrations of music to produce beneficial resonance with certain physiological structures of the human body and achieve the elimination of psychological barriers [7] ; a study by LAGATTOLLA F et al. [8] showed that music can promote relaxation in patients with breast cancer, lower anger, heart rate, respiratory rate, reduce pain, reduce the need for anaesthesia, analgesia [9] and other recourse, and shorten the recovery time, thus reducing anxiety and depression [10] . Previous research has shown that music therapy can effectively improve anxiety and depression symptoms in breast cancer patients [11, 12] , but the specific intervention protocol is unclear, especially the choice of music, intervention duration, intervention period, and intervention frequency need to be further clarified. The results of some of the previous research are controversial, such as studies found that the duration of music intervention is most effective when it is less than 30 min, and some research has also shown that the longer the duration, the better the effect. Based on this, this research intends to further explore the effects of music selection, intervention mode, intervention duration, intervention period, and intervention frequency on anxiety and depression in breast cancer patients on the basis of previous studies, so as to provide precise music intervention programmes for clinics and references for researchers. Methods 1.1 Literature search strategy This study was reported in accordance with PRISMA (Preferred Reporting Items for Systematic Evaluation and Meta-Analysis) guidelines to ensure transparency of the research [13] .The research protocol was registered on INPLASY No.INPLASY2023100057. Data sorting and statistical analysis were conducted for the included literature in accordance with the requirements of the International Guidelines for Writing Systematic Reviews [14] . Two researchers independently searched the six databases of China Knowledge, Wanfang, PubMed, Embase, The Cochrane Library and Web of Science for randomised controlled trials of exercise on working memory in patients with depression using a computer, and the search date was up to 23 October 2023 for each database. The search was conducted by combining subject terms with free words, using the Boolean symbols "AND" and "OR" for combinatorial concatenation, and was determined after repeated pre-testing. In case of disagreement between two researchers, the decision was discussed with the third researcher. This was supplemented by tracking down the relevant systematic reviews and references of the included literature. Table 1. Table 1 Literature search steps Database search step PubMe and The Cochrane Libraryhe retrieval strategy #1“Therapy, Music”[Mesh]OR“Music”[Title/Abstract]OR“Timbre”[Title/Abstract] OR “Music therapy” [Title/Abstract] #2 “breast cancer” [Mesh] OR “breast neoplasms” [Title/Abstract] OR “breast carcinoma” [Title/Abstract] OR “breast” [Title/Abstract] OR “tumor” [Title/Abstract] #3 “anxiety” [Mesh] OR “Depression” [Title/Abstract] OR “psychology” [Title/Abstract] #4 Randomized controlled trial[Publication Type] OR “Randomized” [Title/Abstract] OR “controlled”[Title/Abstract] OR “Trial” [Title/Abstract] #5 #1 AND #2 AND #3 AND #4 Web of Science retrieval strategy #1 TS=（“Therapy, Music” OR “Music” OR “Timbre” OR “Music therapy”） #2 TS=（“breast cancer” OR “breast neoplasms” OR “breast carcinoma” OR “breast” OR “tumor”） #3 TS=（“anxiety” OR “Depression” OR “psychology” ） #4 TS=（“Randomized controlled trial” OR “Randomized” OR “Controlled” OR “Trial”） #5 #1 AND #2 AND #3 AND #4 Embase retrieval strategy #1“Therapy,Music”[exp]OR“Music”[ab,ti]OR“Timbre”[ab,ti] OR “Music therapy” [ab,ti] #2 “breast cancer”[exp] OR “breast neoplasms” [ab,ti] OR “breast carcinoma” [ab,ti] OR “breast ” [ab,ti] OR “tumor” [ab,ti] #3 “anxiety” [exp] OR “Depression” [ab,ti] OR “psychology”[ab,ti] #4 “Randomized controlled trial” [exp] OR “Randomized” [ab,ti] OR“Controlled” [ab,ti] OR “Trial” [ab,ti] #5 #1 AND #2 AND #3 AND #4 CNIC retrieval strategy (music therapy + music + tones + pieces + non-pharmacological treatments) and (breast cancer + breast cancer patients + breast tumours + breast tumours) and (anxiety + depression + emotional + psychological) Wan fang retrieval strategy (music therapy or music or non-pharmacological therapy or tone or music) and (breast cancer or breast cancer patients or breast tumours or breast tumours) and (anxiety or depression or executive function or emotion or psychology) 1.2 Inclusion criteria This research is based on the ICD and ACJJ classification system to construct a PICO framework for systematically evaluating and analysing the intervention effect of music therapy on anxiety and depression in breast cancer patients, and the research shows that the intervention effect of music therapy on anxiety and depression in breast cancer patients is significant. Table 2. Table 2 PICOS strategy - inclusion criteria PICOS Inclusion criteria Research target Compliance with the International Classification of Diseases（International Classification of Disease,ICD）-10 and the American Joint Committee on Cancer(American Joint Committee on Cancer，AJCC)Anyone of the diagnostic criteria Intervention The experimental group intervention was music therapy. Comparison The control group was treated conventionally. Outcome indicator Mood-related indicators: 1. anxiety 2. depression Type of research Randomised controlled trial 注：P：Population；I：Intervention；C：Comparison；O：Outcome；S：Study design； 1.3 Exclusion Criteria 1) Non-Chinese and English literature; 2) Repeated publications or low-quality literature; 3) No detailed data is provided, and specific data cannot be obtained. 4) The experimental group received a combination intervention, such as music therapy combined with aerobic exercise. 1.4 Data Extraction After retrieving the relevant literature, the literature was imported into Endnote for weight removal. Literature screening and data extraction were performed by 2 researchers using independent double-blind approach respectively. The extracted data from eligible studies were entered into RevMan 5.4.1 and double-checked for accuracy, and in case of disagreement, the 3rd researcher joined the discussion to decide whether to include them or not. The extraction included basic information about the literature (first author, year of publication), basic information about the experimental subjects (sample size, age, gender), music therapy (classical Chinese folk music, world famous music, soft, beautiful tracks, etc.), testing methods, specific outcome indicators: anxiety and depression, and extraction of baseline and posttest data. 1.5 Quality evaluation The quality of the literature was evaluated using a modified version of the PEDro scale [15] to assess the methodological quality of the included literature. The scale included 10 criteria: ITT intention-to-treat analysis, random allocation, allocation concealment, baseline similarity, blinding of the research subjects, blinding of the outcome assessment, dropout rate ≤ 15%, intention-to-treat analysis, blinding of the therapists, as well as the point measure and the discrepancy measure. A total of 10 points was assigned to the scale, with a score of less than 4 considered poor quality, 4 to 5 considered moderate quality, 6 to 8 considered good quality, and 9 to 10 considered high quality, and only literature with a score of 5 or higher was included. Quality of evidence evaluation [16] was done through GRADE profiler software, and the quality of evidence for outcome indicators was evaluated on five downgraded factors including publication bias, inconsistency, imprecision, indirectness, and limitations of the research. Among them, a downgrade of 3 was considered as very low level evidence, a downgrade of 2 was considered as low level evidence, a downgrade of 1 was considered as intermediate level evidence, and no downgrade was considered as high level evidence, and the final grade of evidence was categorised into 4 grades: high level, intermediate level, low level, and very low level. Quality ratings were conducted independently by two researchers, with a third researcher contributing to the discussion if there was disagreement. 1.6 Statistical Methods Review Manager 5.4 was used to statistically analyse the data. The outcome indicators of the literature included in this paper are all continuous variables, and the measurement tools are inconsistent across research, so the effect indicators were calculated using the effect size (Standard Mean Difference (SMD)); when the effect size is <0.2, it is a small effect, 0.20-0.49 is a medium-small effect, 0.50-0.79 is a medium effect, and ≥0.8 is a large effect [17] . Heterogeneity was quantified objectively by I2, and heterogeneity was quantified by the I2 statistic. 75%, 50%, and 25% were the boundary values of high, medium, and low heterogeneity, respectively [18] .If there was no statistical heterogeneity among the results, the fixed effect model was used. If heterogeneity exists, the random effects model is used to combine the effect sizes. And the Stata 17.0 Egger test is used to publication bias. If there is publication bias, the scission-supplement method is used to correct it. Results 2.1 Literature search results As shown in Figure 1, a total of 842 pieces of literature were retrieved through PubMed, Embase, Web of Science, Cochrane, CNKI, Wanfang, and VIP databases, and 48 pieces of literature were selected after preliminary screening by eliminating duplicates, reading titles, and abstracting. According to the inclusion and exclusion criteria, the full text was re-screened, and finally 13 articles were included in the meta-analysis. Fig. 1. Document retrieval flow chart 2.2 Basic features of the included literature The 13 articles [19-31] included were published between 2006 and 2022, with a total of 278 cancer patients. The intervention content of the experimental group was music therapy combined with conventional intervention, and the control group was conventional chemotherapy intervention. 2.3 Article quality evaluation All studies described ITT intention-to-treat analyses, statistical analyses were performed between groups, point measures and difference-in-difference scales, random allocation with similar baselines, dropout rates ≤15%, five studies described allocation concealment, three studies blinded study participants, three studies blinded outcome assessments, and no studies blinded therapists. Of the 13 studies included, the PEDro scale scores ranged from 6 to 8, with a mean of 6.8, giving good overall research quality (Table 2). Table 2 Methodological quality assessment included in the study（n=13) Study Random allocation Allocation concealment Baseline similarity Blinding of research subjects Therapists blind Result evaluation blinding Exit rate ≤ 15% ITT Intention to Treat Analysis Statistical analysis between groups Point measurement and difference magnitude Total score 1 Li et al.2011 1 0 1 0 0 0 1 1 1 1 6 2 Andrea et al.2019 1 0 1 1 0 1 1 1 1 1 8 3 Talita et al.2020 1 0 1 0 0 0 1 1 1 1 6 4 Suzanne et al.2006 1 0 1 1 0 1 1 1 1 1 8 5 Jaclyn et al.2015 1 0 1 0 0 0 1 1 1 1 6 6 ZHOU et al.2011 1 0 1 0 0 0 1 1 1 1 6 7 Hu et al.2013 1 1 1 0 0 0 1 1 1 1 7 8 Lu et al.2010 1 1 1 0 0 0 1 1 1 1 7 9 Fu et al.2009 1 0 1 0 0 0 1 1 1 1 6 10 Yu et al.2022 1 1 1 0 0 0 1 1 1 1 7 11 Liang et al.2010 1 1 1 0 0 0 1 1 1 1 7 12 Michael et al.2010 1 0 1 1 0 1 1 1 1 1 8 13 Lv et al.2008 1 1 1 0 0 0 1 1 1 1 6 Note: 1 represents meeting the entry, 0 represents not meeting the entry. 2.4 Results of meta-analysis 2.4.1 Meta-analysis of music therapy on anxiety in breast cancer patients As shown in Figure 2, among the included literature, 12 studies (1278 patients) evaluated the effect of music therapy on anxiety in breast cancer patients. Heterogeneity test I 2 = 75%, P < 0.01. There was a high degree of statistical heterogeneity among the studies, so the random effects model was used to combine the effect sizes. The results of the meta-analysis showed that the effect size was -0.82, 95%CI[-1.03,-0.61], and the difference between the experimental group and the control group was statistically significant. 0.00001, indicating that music therapy was effective in reducing anxiety in breast cancer patients compared to the control group. Fig. 2.Forest map of anxiety in breast cancer patients with music therapy In order to explore the source of heterogeneity, subgroup analysis was performed for the main outcome indicator, anxiety. The effect of music therapy on the anxiety of breast cancer patients may be influenced by factors such as average age, intervention duration, intervention cycle, intervention frequency, music selection, professional degree, and music style. The results of subgroup analysis showed that intervention cycle, intervention duration, intervention frequency, music selection, professionalism, period, average age and subgroup analysis of music style were statistically significant (P < 0.01). From the perspective of heterogeneity sources, intervention duration, average age, intervention period and intervention cycle may be the sources of heterogeneity(Table3). Table3 Subgroup analysis of the effect of music therapy on anxiety in breast cancer patients Research characteristics Group Effect size Heterogeneity SMD(95%CI) P I² P Intervention duration ＞30min -0.83 （-1.73，0.06） 0.07 94 ＜0.00001 ≤30min -0.80（-0.93，-0.67） ＜0.00001 19 0.24 Mean age ≥45 years old -0.65（-0.97，-0.33） ＜0.0001 0 0.68 <45 years old -0.81（-1.06，-0.55） ＜0.00001 50 0.06 Not included -0.86（-1.22，-0.49） ＜0.00001 85 ＜0.00001 Intervention cycle 0-2weeks -0.49（-0.80，-0.18） 0.002 0 0.81 2-3weeks -1.02 (-1.34,-0.70) ＜0.00001 17 0.27 More than 3 weeks -0.82 (-1.29,-0.35) 0.0006 86 ＜0.00001 Not included -0.94 (-1.18,-0.70) ＜0.00001 49 0.08 Intervention frequency ＜Twice a day -0.60（-0.94，-0.25） 0.0007 49 0.08 Twice a day -0.91（-1.28，-0.54） ＜0.00001 84 ＜0.00001 Not included -0.91（-1.23，-0.59） ＜0.00001 69 0.02 Music selection optional -0.82（-1.05，-0.58） ＜0.00001 51 0.06 His choice -0.83（-1.15，-0.51） ＜0.00001 82 ＜0.00001 Degree of specialization Expert recommendation -0.79（-1.01，-0.57） ＜0.00001 58 0.01 Non-expert recommendation -0.90（-1.30，-0.49） ＜0.0001 84 ＜0.00001 Intervention stage During chemotherapy -0.77（-1.00，-0.53） ＜0.00001 76 ＜0.00001 Perioperative period -1.15（-1.36，-0.94） ＜0.00001 0 0.75 Intervention mode Live music -0.32（-1.14，-0.50） 0.45 81 0.02 Off-live music -0.88（-1.10，-0.66） ＜0.00001 74 ＜0.00001 2.4.2 Meta-analysis of depression in breast cancer patients with music therapy As shown in Figure 3, six studies in the included literature evaluated the effect of music therapy on depression in breast cancer patients, including 411 patients. Heterogeneity test I2=84%, P < 0.01. There was a high degree of statistical heterogeneity among the studies, so the random effects model was used to combine the effect sizes. The results of meta-analysis showed that the effect size was -0.76, 95%CI[-1.15,-0.38], and the difference was statistically significant. 0.00001, indicating that music therapy was effective in alleviating depression in breast cancer patients compared to controls. Fig. 3 Music therapy for overall depression in breast cancer patients To explore the source of heterogeneity, subgroup analysis was performed for depression, the main outcome indicator. The effect of music therapy on anxiety and depression in breast cancer patients may be limited by the intervention cycle, music duration, professional degree, music choice and frequency. The results of subgroup analysis in the table showed that intervention cycle, intervention duration, age specialization, music selection and subgroup analysis of group music style were statistically significant. From the source of heterogeneity, intervention cycle and duration may be the main source of heterogeneity(Table 4). Table 4 Subgroup analysis of the effects of music therapy on depression in breast cancer patients Research characteristics group Effect size heterogeneity SMD(95%CI) P I² P Intervention cycle ≤2 Weeks -0.53（-0.86，-0.20） 0.002 35 0.21 2-4Weeks -1.06（-1.33，-0.79） ＜0.00001 0 0.43 More than 4 weeks -0.79（-1.64，-0.06） 0.07 91 ＜0.00001 Intervention duration ≤30min -0.75（-1.00，-0.51） ＜0.00001 48 0.07 ＞30min -0.83（-2.34，-0.68） 0.28 96 ＜0.00001 Degree of specialization Yes -1.15（-1.42，-0.88) ＜0.00001 95 ＜0.00001 No -0.26 (-0.53,0.01) 0.14 50 0.06 Music selection optional -0.71 (-1.10,-0.32) 0.0003 72 0.007 His choice -0.85 (-1.60,-0.09) 0.03 91 ＜0.00001 Intervention frequency Daily intervention -0.86 (-1.28,-0.44) ＜0.0001 86 ＜0.00001 Non-daily intervention -0.30 (-1.20,0.60) 0.51 73 0.06 2.5 Risk bias analysis As shown in Figure 4, it can be found that the funnel diagram of music therapy on the anxiety of breast cancer patients is basically symmetric. The Egger test result shows that Z = -0.22, P > |z| = 0.8224, indicating that there is no publication bias in the study. Fig. 4 Music therapy for breast cancer patients funnel diagram 2.6 Sensitivity analyses As shown in Figure 5, to investigate whether the heterogeneity between studies was caused by a single study, the combined effect was analysed by screening out single studies one by one. The magnitude of the combined effect of exercise on inhibitory function in depressed patients included in all studies was SMD = 0.48, 95% CI: 0.18,0.77, P < 0.001, I2 = 80.38%, and the paradigm value of the combined effect SMD after sifting out the single studies was in the range of (0.21 to 0.56), and the range of the I 2 was in the range of (79.64% to 83.33%), both P less than 0.001 The results of the analyses showed that the data sensitivity of the study was relatively low, and did not form a fundamental change to the results of the Meta-analysis, indicating that the results of this research have a certain degree of stability and reliability. Fig. 5 Sensitivity analysis of music therapy on anxiety in breast cancer patients 2.6 Evaluation of evidence quality level As shown in Figure 6, the GRADE pro evidence grading system was used to evaluate the quality of evidence for the outcome indicators, and the quality of evidence for each outcome indicator was classified into 4 categories, from high to low: high, intermediate, low and very low. The quality of evidence rating for the effect of music therapy on improving anxiety and depression in breast cancer patients was found to be high. These results suggest that the actual effects are likely to be close to the estimates. Details of the evaluation of the quality level of evidence are based on the GRADE criteria. Fig. 6 Quality of evidence for the effect of music therapy on improving anxiety and depression in breast cancer patients. 2.7 Adverse events No adverse events resulting from music therapy were reported in any of the 13 included papers. Discussion 3.1 Influence of music therapy on anxiety of breast cancer patients The results of this study show that music therapy can significantly improve anxiety in breast cancer patients, and the results are consistent with previous studies. Previous meta-analyses found that music therapy eliminated psychological barriers through unique effects. Longitudinal studies [21, 32] have found that music can reduce pain [33] and shift attention away from negative stimuli to things that are familiar, soothing, and pleasant [10, 11] . It has also been confirmed that music therapy can reduce the anxiety and depression of patients with other diseases [34-39] . A Total of 13 papers were included in this study to systematically evaluate the intervention effect of music therapy on anxiety and depression in breast cancer patients using PEDro scale to evaluate the risk of bias of the included papers in 9 aspects, with a mean score of 6.8, which was found to be of good quality, but this study did not carefully classify the condition and type of the breast cancer patients in the included papers, and with an I2 > 50%, there was a high degree of heterogeneity among the studies, and the existence of a considered some inconsistency. In the research, a dose-effect relationship was found for the effects of music therapy on anxiety and depression in breast cancer patients, which raised the level of evidence to one. Limitations of the research:The types of music selected for the interventions included in the literature were different, with no fixed criteria, whether it was recommended by the experts in English or selected by their own favourite music, and the repertoire selected was more often than not classified specifically, which inspired the expectation of more high-quality RCT articles to be further developed. 3) The study was conducted to identify the effects of music therapy on anxiety and depression in patients with breast cancer. RCT articles on music categorisation to further complement and demonstrate. In conclusion, music therapy is given high-level quality of evidence for both anxiety and depression intervention effects in breast Cancer patients. This study found that perioperative patients had the best improvement effect on anxiety when the music was their favourite music recommended by experts, the intervention method was non-live music, the intervention duration was less than or equal to 30 minutes, the intervention frequency was 2 times per day, and the intervention cycle was 2-3 weeks. Anxiety in breast cancer patients is mostly induced by low oestrogen levels, and the decrease in oestrogen levels is accompanied by a decline in serotonin transmitters. The possible mechanism by which music can improve anxiety in patients may be as follows: Music can increase the levels of estrogen [40] and oxytocin [41] , and also reduce the concentration of serum cortisol in women, so that the value of serum cortisol in breast cancer patients can return to normal [42] . In terms of the nervous system, music can increase the dopamine activity of nucleus accumbens (NAc) and ventral tegmental cortex (VTA), alter the structural changes of the mesolimbic brain (e.g., nucleus accumbens [NAc], ventral tegmental area [VTA]), and effectively control the influence of emotional stimuli on the autonomic and physiological responses of the hypothalamus and insula [43] . Inhibition of sympathetic nervous system reactivity reduces negative emotional experiences [42, 44] , thereby reducing anxiety. Choosing their favourite music has a better effect on perioperative patients [45] to perform non-live music, which may be because patients can get into the state more quickly when choosing their favourite music and local music, so that patients can resonate the cranial cavity, chest cavity, or a certain tissue cavity through rhythm, frequency, and regular sound wave vibration. It directly affects people's brain waves, heart rate, and breathing rhythm [46] , thereby reducing anxiety. It may also be because, when listening to recorded music, patients can enter the music environment faster by restricting light, sound, visitors, and phone calls [47] , thus regulating their emotional state. A music intervention with a duration of no more than 30 minutes, a frequency of 2 times per day, and a cycle of 2–3 weeks is more effective for breast cancer patients. PALMER [21] also found that music therapy can reduce anxiety within only 5 minutes and can significantly reduce anxiety during 15–30 minutes of hypnotic intervention. The effect of music intervention on patients' anxiety may present an inverted "U" curve, and the intervention effect is the best at the hour, followed by more than 3 weeks, and the effect is not good within 2 weeks [8] . This study also found that the duration of the intervention was inconsistent with that of Fu Yanzhi et al. [23, 25, 26] . The duration of music intervention did not become more effective with the passage of time, and the range of change from pre-treatment to post-treatment did not decrease with the passage of time [23] . At the same time, it also brings inspiration to future generations to further explore the impact of music duration on anxiety in breast cancer patients and look forward to more high-quality RCT articles to further supplement and prove. 3.2 Influence of music therapy on depression in breast cancer patients This study found that music selected as expertly recommended music, an intervention duration of 30 minutes, an intervention frequency of 1 time per day, and an intervention cycle of 2-4 weeks had the best effect on improving depression in breast cancer patients. This is consistent with previous results [14, 15] . Longitudinal studies [48] have found that music can stimulate the cerebral cortex in many ways, evoking pleasant thought associations and emotions in patients. Patients with breast cancer are more prone to depression symptoms, subsyndromic depression due to circadian rhythm disturbance and fatigue, and higher intrinsic melatonin secretion than normal people. Musical stimulation can activate or increase specific pathways in several brain regions related to emotional behaviour, such as the insular and cingulate cortex [49, 50] , hypothalamus, hippocampus, amygdala and prefrontal cortex [51] . Thus, some biochemical mediators, such as increased endorphins [51, 52] , endocannabinoids and dopamine [53-55] and decreased nitric oxide [56] regulate positive emotional states [56] . In this study, it was found that, in terms of music selection, the effect of music suggested by experts is better. It may be that experts choose according to the current physiological and psychological state of each patient and the different personality of the patient so as to solve the emotional problems of the patient in a targeted way [57, 58] . In terms of intervention cycle, 2-4 weeks is the best effect size for the music intervention cycle [59] , The effect size is moderate when the intervention cycle is less than or equal to 2 weeks, and the effect size is second when the intervention cycle is more than 4 weeks. Qishou Tang also said in the study [60] that the effect of short-term and medium-term interventions is higher than that of long-term interventions [20, 25, 31] . Intervention duration of 30 minutes and frequency of 1 time per day had a better effect on depression relief in breast cancer patients [61-62] , which may be related to the timeliness of behavioural habits. It may also be that the frequency of intervention once a day can regulate the stress response of the hypothalamic-pituitary-adrenal axis [63-64] , which has the effect of regulating the spirit, pleasing the heart, and relieving depression in patients. In summary, based on the literature of high quality controlled trials, each intervention element has different effects on anxiety and depression in breast cancer patients, providing clinical practice and researchers with more precise music intervention programmes. Meanwhile an increasing number of healthcare organisations and government departments are incorporating music therapy into guidelines and policies for breast cancer treatment, and music therapy professionals are being trained and accredited to provide appropriate music interventions for patients. These policy measures help to increase the recognition and acceptance of music therapy interventions by patients and promote the psychological recovery of breast cancer patients. As scientific research continues, we can further understand the specific mechanisms of action and effects of music therapy on patients, and how to better apply music therapy for personalised interventions. Declarations This research has been registered on the INPLASY platform (https://inplasy.com/contact/) under the number INPLASY2023100057. Conflict of interest: the authors declare no conflict of interest Acknowledgements We thank all of the staf who contributed their time to our research. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Registration and protocol Stay https://inplasy.com/contact/ Register and search on the website. Declarations Consent for publication All authors agreed the possible publication of our article on journal of clinical nursing. The participant has consented to the submission of the article to the journal. Competing Interests and Competing Interests statement The authors declare that there is no confict of interest. Author Contributions XZH designed the study and search strategy. XZH and LC performed abstract and full-text screening, methodological quality, and GRADE assessment, and contributed to the completion of screening and data extraction for all data within this manuscript. XZH and YMY designed and calculated meta-analyses, subgroup analyses, sensitivity analyses, and publication bias, and created images and tables. XZH wrote the original draft preparation, performed review and editing, and prepared the final draft. WX contributed to the critical evaluation of the findings and the drafting of the manuscript. XZH, YMY, LC, WX, and LYZ contributed to editing and revising the manuscript in its final version. All authors read and approved the final version of the manuscript and agree with the order of presentation of the authors. References He L, Luhong H, Jinrui Cui, et al. Status quo of self advocacy ability of chemotherapy patients with breast cancer and analysis of influencing factors [J] Chinese Journal of Nursing, 2023, 58(07): 788–93. 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Kai-Na Z, Xiao-Mei L I .Effect of music therapy on pain of breast cancer patients after radical mastectomy[J].Chinese Journal of Nursing, 2010, 26(28): 55–7. LIU C H, LV X Y, GUO Z P, et al. Enhanced functional connectivity between insular subregions correlates with the efficacy of music and instruction-guided relaxation in depression [J]. Neuroreport, 2020, 31(17): 1215–24. USUI C, KIRINO E, TANAKA S, et al. Music Intervention Reduces Persistent Fibromyalgia Pain and Alters Functional Connectivity Between the Insula and Default Mode Network [J]. Pain Med, 2020, 21(8): 1546–52. LIU C H, LV X Y, GUO Z P, et al. Enhanced functional connectivity between insular subregions correlates with the efficacy of music and instruction-guided relaxation in depression [J]. Neuroreport, 2020, 31(17): 1215–24. USUI C, KIRINO E, TANAKA S, et al. Music Intervention Reduces Persistent Fibromyalgia Pain and Alters Functional Connectivity Between the Insula and Default Mode Network [J]. Pain Med, 2020, 21(8): 1546–52. BOSO M, POLITI P, BARALE F, et al. Neurophysiology and neurobiology of the musical experience [J]. Funct Neurol, 2006, 21(4): 187–91. KANG J, SCHOLP A, JIANG J J. A Review of the Physiological Effects and Mechanisms of Singing [J]. J Voice, 2018, 32(4): 390–5. BONASSI G, LAGRAVINESE G, BOVE M, et al. How Music Moves Us: Music-induced Emotion Influences Motor Learning [J]. Neuroscience, 2023, 526(246 – 55. FERRERI L, MAS-HERRERO E, ZATORRE R J, et al. Dopamine modulates the reward experiences elicited by music [J]. Proc Natl Acad Sci U S A, 2019, 116(9): 3793–8. VIK B M D, SKEIE G O, SPECHT K. Neuroplastic Effects in Patients With Traumatic Brain Injury After Music-Supported Therapy [J]. Front Hum Neurosci, 2019, 13(177. ORAK Y, BAKACAK S M, YAYLALI A, et al. [Effects of music therapy on pain and oxidative stress in oocyte pick-up: a randomized clinical trial] [J]. Braz J Anesthesiol, 2020, 70(5): 491–9. Weiwei S, Lili Z, Min L, et al. Observation on the effect of personalized music therapy on alleviating the adverse psychological reaction of chemotherapy in breast cancer patients [J] Anhui Pharmaceutical, 2013, 17(08): 1441–3. Wanting J, Xing W, et al. Research progress on the impact of exercise on depression and brain plasticity; The 11th National Conference on Sports Psychology, Beijing, China, F, 2018 [C]. VAN ASSCHE E, DE BACKER J, VERMOTE R. [Music therapy and depression] [J]. Tijdschr Psychiatr, 2015, 57(11): 823–9. TANG Q, HUANG Z, ZHOU H, et al. Effects of music therapy on depression: A meta-analysis of randomized controlled trials [J]. PLoS One, 2020, 15(11): e0240862. ZHAO K, BAI Z G, BO A, et al. A systematic review and meta-analysis of music therapy for the older adults with depression [J]. Int J Geriatr Psychiatry, 2016, 31(11): 1188–98. Additional Declarations No competing interests reported. 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18:25:01","extension":"jpeg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":78248,"visible":true,"origin":"","legend":"\u003cp\u003eQuality of evidence for the effect of music therapy on improving anxiety and depression in breast cancer patients.\u003c/p\u003e","description":"","filename":"floatimage7.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4093072/v1/763cdf41b2884de28d7d53c9.jpeg"},{"id":61595030,"identity":"1ba0b3b0-3cd1-469c-bab4-662db4b4cb5b","added_by":"auto","created_at":"2024-08-01 17:19:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":957771,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4093072/v1/8919947d-fd5d-489c-90d0-c9abc58a2248.pdf"},{"id":53675049,"identity":"3c25bf7b-2d82-4e80-bf96-cf8790ae7374","added_by":"auto","created_at":"2024-03-28 18:33:01","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":128728,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixA.docx","url":"https://assets-eu.researchsquare.com/files/rs-4093072/v1/ad07675bb3770b30438ab7c1.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of Music Therapy on Anxiety and Depression in Breast Cancer Patients: Systematic Review and Meta-Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe incidence of female breast cancer often ranks first among female malignant tumours \u003csup\u003e[1]\u003c/sup\u003e, accounting for 7-10% of all malignant tumours in the body. In the past 20 years, the incidence of breast cancer in China has increased by 37.6%, with an average annual growth rate of 2.3% \u003csup\u003e[2]\u003c/sup\u003e. Breast cancer patients are the phenomenon of uncontrolled proliferation of breast epithelial cells under the action of multiple carcinogenic factors; physiologically, early stage often manifests symptoms such as breast lumps and enlarged axillary lymph nodes, and in the late stage, due to distant metastasis of the cancer cells, multi-organ lesions may occur, and even threaten the patients\u0026apos; lives \u003csup\u003e[3]\u003c/sup\u003e. Patients need to endure the pain and side effects of chemotherapy during treatment, and psychologically they often show emotional instability, anxiety and depression, etc., and most of them have psychological problems such as moderate and severe anxiety levels.\u003c/p\u003e\n\u003cp\u003eMusic therapy is an emerging psychotherapeutic modality in which the unique physiological and psychological effects of music enable patients to regulate their psychological disorders through musical experience and distraction. Music therapy is considered to be one of the most effective psychotherapeutic methods for clinical non-pharmacological treatment to eliminate psychosomatic disorders \u003csup\u003e[4]\u003c/sup\u003e. Music can affect patients\u0026apos; heart rate, blood pressure, respiratory rate, and blood cortisol levels through rhythm and tone\u003csup\u003e\u0026nbsp;[5]\u003c/sup\u003e, thus relieving emotions such as anxiety or depression\u003csup\u003e\u0026nbsp;[6]\u003c/sup\u003e. A study by Zhi Yanhong et al. found that patients use the sonic vibrations of music to produce beneficial resonance with certain physiological structures of the human body and achieve the elimination of psychological barriers\u003csup\u003e\u0026nbsp;[7]\u003c/sup\u003e; a study by LAGATTOLLA F et al. \u003csup\u003e[8]\u003c/sup\u003e showed that music can promote relaxation in patients with breast cancer, lower anger, heart rate, respiratory rate, reduce pain, reduce the need for anaesthesia, analgesia \u003csup\u003e[9]\u0026nbsp;\u003c/sup\u003eand other recourse, and shorten the recovery time, thus reducing anxiety and depression \u003csup\u003e[10]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003ePrevious research has shown that music therapy can effectively improve anxiety and depression symptoms in breast cancer patients \u003csup\u003e[11, 12]\u003c/sup\u003e, but the specific intervention protocol is unclear, especially the choice of music, intervention duration, intervention period, and intervention frequency need to be further clarified. The results of some of the previous research are controversial, such as studies found that the duration of music intervention is most effective when it is less than 30 min, and some research has also shown that the longer the duration, the better the effect. Based on this, this research intends to further explore the effects of music selection, intervention mode, intervention duration, intervention period, and intervention frequency on anxiety and depression in breast cancer patients on the basis of previous studies, so as to provide precise music intervention programmes for clinics and references for researchers.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e1.1 Literature search strategy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reported in accordance with PRISMA (Preferred Reporting Items for Systematic Evaluation and Meta-Analysis) guidelines to ensure transparency of the research\u003csup\u003e[13]\u003c/sup\u003e.The research protocol was registered on INPLASY No.INPLASY2023100057.\u003c/p\u003e\n\u003cp\u003eData sorting and statistical analysis were conducted for the included literature in accordance with the requirements of the International Guidelines for Writing Systematic Reviews\u003csup\u003e[14]\u003c/sup\u003e. Two researchers independently searched the six databases of China Knowledge, Wanfang, PubMed, Embase, The Cochrane Library and Web of Science for randomised controlled trials of exercise on working memory in patients with depression using a computer, and the search date was up to 23 October 2023 for each database. The search was conducted by combining subject terms with free words, using the Boolean symbols \u0026quot;AND\u0026quot; and \u0026quot;OR\u0026quot; for combinatorial concatenation, and was determined after repeated pre-testing. In case of disagreement between two researchers, the decision was discussed with the third researcher. This was supplemented by tracking down the relevant systematic reviews and references of the included literature. Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1 Literature search steps\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"550\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.42622950819672%\" valign=\"top\"\u003e\n \u003cp\u003eDatabase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"65.57377049180327%\" valign=\"top\"\u003e\n \u003cp\u003esearch step\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.42622950819672%\" valign=\"top\"\u003e\n \u003cp\u003ePubMe and The Cochrane Libraryhe\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eretrieval strategy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"65.57377049180327%\" valign=\"top\"\u003e\n \u003cp\u003e#1\u0026ldquo;Therapy, Music\u0026rdquo;[Mesh]OR\u0026ldquo;Music\u0026rdquo;[Title/Abstract]OR\u0026ldquo;Timbre\u0026rdquo;[Title/Abstract] OR \u0026ldquo;Music therapy\u0026rdquo; [Title/Abstract]\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e#2 \u0026ldquo;breast cancer\u0026rdquo; [Mesh] OR \u0026ldquo;breast neoplasms\u0026rdquo; [Title/Abstract] OR \u0026ldquo;breast carcinoma\u0026rdquo; [Title/Abstract] OR \u0026ldquo;breast\u0026rdquo; [Title/Abstract] OR \u0026ldquo;tumor\u0026rdquo; [Title/Abstract]\u003c/p\u003e\n \u003cp\u003e#3 \u0026ldquo;anxiety\u0026rdquo; [Mesh] OR \u0026ldquo;Depression\u0026rdquo; [Title/Abstract] OR \u0026ldquo;psychology\u0026rdquo; [Title/Abstract]\u003c/p\u003e\n \u003cp\u003e#4 Randomized controlled trial[Publication Type] OR \u0026ldquo;Randomized\u0026rdquo; [Title/Abstract] OR \u0026ldquo;controlled\u0026rdquo;[Title/Abstract] OR \u0026ldquo;Trial\u0026rdquo; [Title/Abstract]\u003c/p\u003e\n \u003cp\u003e#5 #1 AND #2 AND #3 AND #4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.42622950819672%\" valign=\"top\"\u003e\n \u003cp\u003eWeb of Science\u003c/p\u003e\n \u003cp\u003eretrieval strategy\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"65.57377049180327%\" valign=\"top\"\u003e\n \u003cp\u003e#1 TS=（\u0026ldquo;Therapy, Music\u0026rdquo; OR \u0026ldquo;Music\u0026rdquo; OR \u0026ldquo;Timbre\u0026rdquo; OR \u0026ldquo;Music therapy\u0026rdquo;）\u003c/p\u003e\n \u003cp\u003e#2 TS=（\u0026ldquo;breast cancer\u0026rdquo; OR \u0026ldquo;breast neoplasms\u0026rdquo; OR \u0026ldquo;breast carcinoma\u0026rdquo; OR \u0026ldquo;breast\u0026rdquo; OR \u0026ldquo;tumor\u0026rdquo;）\u003c/p\u003e\n \u003cp\u003e#3 TS=（\u0026ldquo;anxiety\u0026rdquo; OR \u0026ldquo;Depression\u0026rdquo; OR \u0026ldquo;psychology\u0026rdquo;\u0026nbsp;）\u003c/p\u003e\n \u003cp\u003e#4 TS=（\u0026ldquo;Randomized controlled trial\u0026rdquo; OR \u0026ldquo;Randomized\u0026rdquo; OR \u0026ldquo;Controlled\u0026rdquo; OR \u0026ldquo;Trial\u0026rdquo;）\u003c/p\u003e\n \u003cp\u003e#5 #1 AND #2 AND #3 AND #4\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.42622950819672%\" valign=\"top\"\u003e\n \u003cp\u003eEmbase\u003c/p\u003e\n \u003cp\u003eretrieval strategy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"65.57377049180327%\" valign=\"top\"\u003e\n \u003cp\u003e#1\u0026ldquo;Therapy,Music\u0026rdquo;[exp]OR\u0026ldquo;Music\u0026rdquo;[ab,ti]OR\u0026ldquo;Timbre\u0026rdquo;[ab,ti] OR \u0026ldquo;Music therapy\u0026rdquo; [ab,ti]\u003c/p\u003e\n \u003cp\u003e#2 \u0026ldquo;breast cancer\u0026rdquo;[exp] OR \u0026ldquo;breast neoplasms\u0026rdquo; [ab,ti] OR \u0026ldquo;breast carcinoma\u0026rdquo; [ab,ti] OR \u0026ldquo;breast \u0026rdquo; [ab,ti] OR \u0026ldquo;tumor\u0026rdquo; [ab,ti]\u003c/p\u003e\n \u003cp\u003e#3 \u0026ldquo;anxiety\u0026rdquo; [exp] OR \u0026ldquo;Depression\u0026rdquo; [ab,ti] OR \u0026ldquo;psychology\u0026rdquo;[ab,ti]\u003c/p\u003e\n \u003cp\u003e#4 \u0026ldquo;Randomized controlled trial\u0026rdquo; [exp] OR \u0026ldquo;Randomized\u0026rdquo; [ab,ti] OR\u0026ldquo;Controlled\u0026rdquo; [ab,ti] OR \u0026ldquo;Trial\u0026rdquo; [ab,ti]\u003c/p\u003e\n \u003cp\u003e#5 #1 AND #2 AND #3 AND #4\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.42622950819672%\" valign=\"top\"\u003e\n \u003cp\u003eCNIC\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eretrieval strategy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"65.57377049180327%\" valign=\"top\"\u003e\n \u003cp\u003e(music therapy + music + tones + pieces + non-pharmacological treatments) and (breast cancer + breast cancer patients + breast tumours + breast tumours) and (anxiety + depression + emotional + psychological)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.42622950819672%\" valign=\"top\"\u003e\n \u003cp\u003eWan fang\u003c/p\u003e\n \u003cp\u003eretrieval strategy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"65.57377049180327%\" valign=\"top\"\u003e\n \u003cp\u003e(music therapy or music or non-pharmacological therapy or tone or music) and (breast cancer or breast cancer patients or breast tumours or breast tumours) and (anxiety or depression or executive function or emotion or psychology)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Inclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research is based on the ICD and ACJJ classification system to construct a PICO framework for systematically evaluating and analysing the intervention effect of music therapy on anxiety and depression in breast cancer patients, and the research shows that the intervention effect of music therapy on anxiety and depression in breast cancer patients is significant. Table 2.\u003c/p\u003e\n\u003cp\u003eTable 2 PICOS strategy - inclusion criteria\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.806509945750452%\"\u003e\n \u003cp\u003ePICOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"81.19349005424955%\" valign=\"top\"\u003e\n \u003cp\u003eInclusion criteria\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.806509945750452%\"\u003e\n \u003cp\u003eResearch target\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"81.19349005424955%\"\u003e\n \u003cp\u003eCompliance with the International Classification of Diseases（International Classification of Disease,ICD）-10 and the American Joint Committee on Cancer(American Joint Committee on Cancer，AJCC)Anyone of the diagnostic criteria\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.806509945750452%\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"81.19349005424955%\"\u003e\n \u003cp\u003eThe experimental group intervention was music therapy.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.806509945750452%\"\u003e\n \u003cp\u003eComparison\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"81.19349005424955%\"\u003e\n \u003cp\u003eThe control group was treated conventionally.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.806509945750452%\"\u003e\n \u003cp\u003eOutcome indicator\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"81.19349005424955%\"\u003e\n \u003cp\u003eMood-related indicators: 1. anxiety 2. depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.806509945750452%\"\u003e\n \u003cp\u003eType of research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"81.19349005424955%\"\u003e\n \u003cp\u003eRandomised controlled trial\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"2\"\u003e\n \u003cp\u003e注：P：Population；I：Intervention；C：Comparison；O：Outcome；S：Study design；\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003e1.3 Exclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1) Non-Chinese and English literature; 2) Repeated publications or low-quality literature; 3) No detailed data is provided, and specific data cannot be obtained. 4) The experimental group received a combination intervention, such as music therapy combined with aerobic exercise.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4 Data Extraction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter retrieving the relevant literature, the literature was imported into Endnote for weight removal. Literature screening and data extraction were performed by 2 researchers using independent double-blind approach respectively. The extracted data from eligible studies were entered into RevMan 5.4.1 and double-checked for accuracy, and in case of disagreement, the 3rd researcher joined the discussion to decide whether to include them or not. The extraction included basic information about the literature (first author, year of publication), basic information about the experimental subjects (sample size, age, gender), music therapy (classical Chinese folk music, world famous music, soft, beautiful tracks, etc.), testing methods, specific outcome indicators: anxiety and depression, and extraction of baseline and posttest data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.5 Quality evaluation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe quality of the literature was evaluated using a modified version of the PEDro scale\u003csup\u003e[15]\u0026nbsp;\u003c/sup\u003eto assess the methodological quality of the included literature. The scale included 10 criteria: ITT intention-to-treat analysis, random allocation, allocation concealment, baseline similarity, blinding of the research subjects, blinding of the outcome assessment, dropout rate \u0026le; 15%, intention-to-treat analysis, blinding of the therapists, as well as the point measure and the discrepancy measure. A total of 10 points was assigned to the scale, with a score of less than 4 considered poor quality, 4 to 5 considered moderate quality, 6 to 8 considered good quality, and 9 to 10 considered high quality, and only literature with a score of 5 or higher was included.\u003c/p\u003e\n\u003cp\u003eQuality of evidence evaluation\u003csup\u003e\u0026nbsp;[16]\u0026nbsp;\u003c/sup\u003ewas done through GRADE profiler software, and the quality of evidence for outcome indicators was evaluated on five downgraded factors including publication bias, inconsistency, imprecision, indirectness, and limitations of the research. Among them, a downgrade of 3 was considered as very low level evidence, a downgrade of 2 was considered as low level evidence, a downgrade of 1 was considered as intermediate level evidence, and no downgrade was considered as high level evidence, and the final grade of evidence was categorised into 4 grades: high level, intermediate level, low level, and very low level. Quality ratings were conducted independently by two researchers, with a third researcher contributing to the discussion if there was disagreement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.6 Statistical Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eReview Manager 5.4 was used to statistically analyse the data. The outcome indicators of the literature included in this paper are all continuous variables, and the measurement tools are inconsistent across research, so the effect indicators were calculated using the effect size (Standard Mean Difference (SMD)); when the effect size is \u0026lt;0.2, it is a small effect, 0.20-0.49 is a medium-small effect, 0.50-0.79 is a medium effect, and \u0026ge;0.8 is a large effect\u003csup\u003e[17]\u003c/sup\u003e. Heterogeneity was quantified objectively by I2, and heterogeneity was quantified by the I2 statistic. 75%, 50%, and 25% were the boundary values of high, medium, and low heterogeneity, respectively\u003csup\u003e[18]\u003c/sup\u003e.If there was no statistical heterogeneity among the results, the fixed effect model was used. If heterogeneity exists, the random effects model is used to combine the effect sizes. And the Stata 17.0 Egger test is used to publication bias. If there is publication bias, the scission-supplement method is used to correct it.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e2.1 Literature search results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Figure 1, a total of 842 pieces of literature were retrieved through PubMed, Embase, Web of Science, Cochrane, CNKI, Wanfang, and VIP databases, and 48 pieces of literature were selected after preliminary screening by eliminating duplicates, reading titles, and abstracting. According to the inclusion and exclusion criteria, the full text was re-screened, and finally 13 articles were included in the meta-analysis.\u003c/p\u003e\n\u003cp\u003eFig. 1. Document retrieval flow chart\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Basic features of the included literature\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 13 articles\u003csup\u003e[19-31]\u003c/sup\u003e included were published between 2006 and 2022, with a total of 278 cancer patients. The intervention content of the experimental group was music therapy combined with conventional intervention, and the control group was conventional chemotherapy intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Article quality evaluation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll studies described ITT intention-to-treat analyses, statistical analyses were performed between groups, point measures and difference-in-difference scales, random allocation with similar baselines, dropout rates \u0026le;15%, five studies described allocation concealment, three studies blinded study participants, three studies blinded outcome assessments, and no studies blinded therapists. Of the 13 studies included, the PEDro scale scores ranged from 6 to 8, with a mean of 6.8, giving good overall research quality (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2 Methodological quality assessment included in the study（n=13)\u003c/p\u003e\n\u003ctable width=\"133%\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003eStudy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003eRandom allocation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003eAllocation concealment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003eBaseline similarity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003eBlinding of research subjects\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003eTherapists blind\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003eResult evaluation blinding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003eExit rate \u0026le; 15%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003eITT Intention to Treat Analysis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003eStatistical analysis between groups\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003ePoint measurement and difference magnitude\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"3%\"\u003e\n\u003cp\u003eTotal score\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003eLi et al.2011\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"2%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"10%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"3%\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003eAndrea et al.2019\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"2%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"10%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"3%\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003eTalita et al.2020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"2%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"10%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"3%\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003eSuzanne et al.2006\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"2%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"10%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"3%\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003eJaclyn et al.2015\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"2%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"10%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"3%\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003eZHOU et al.2011\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"2%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"10%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"3%\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003eHu et al.2013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"2%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"10%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"3%\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003eLu et al.2010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"2%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"10%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"3%\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003eFu et al.2009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"2%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"10%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"3%\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003eYu et al.2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"2%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"10%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"3%\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003eLiang et al.2010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"2%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"10%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"3%\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003eMichael et al.2010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"2%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"10%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"3%\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"14%\"\u003e\n\u003cp\u003eLv et al.2008\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"2%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"10%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"3%\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: 1 represents meeting the entry, 0 represents not meeting the entry.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Results of meta-analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4.1 Meta-analysis of music therapy on anxiety in breast cancer patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Figure 2, among the included literature, 12 studies (1278 patients) evaluated the effect of music therapy on anxiety in breast cancer patients. Heterogeneity test \u003cem\u003eI\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e= 75%, P \u0026lt; 0.01. There was a high degree of statistical heterogeneity among the studies, so the random effects model was used to combine the effect sizes.\u0026nbsp; The results of the meta-analysis showed that the effect size was -0.82, 95%CI[-1.03,-0.61], and the difference between the experimental group and the control group was statistically significant. 0.00001, indicating that music therapy was effective in reducing anxiety in breast cancer patients compared to the control group.\u003c/p\u003e\n\u003cp\u003eFig. 2.Forest map of anxiety in breast cancer patients with music therapy\u003c/p\u003e\n\u003cp\u003eIn order to explore the source of heterogeneity, subgroup analysis was performed for the main outcome indicator, anxiety.\u0026nbsp; The effect of music therapy on the anxiety of breast cancer patients may be influenced by factors such as average age, intervention duration, intervention cycle, intervention frequency, music selection, professional degree, and music style.\u0026nbsp; The results of subgroup analysis showed that intervention cycle, intervention duration, intervention frequency, music selection, professionalism, period, average age and subgroup analysis of music style were statistically significant (P \u0026lt; 0.01). From the perspective of heterogeneity sources, intervention duration, average age, intervention period and intervention cycle may be the sources of heterogeneity(Table3).\u003c/p\u003e\n\u003cp\u003eTable3 Subgroup analysis of the effect of music therapy on anxiety in breast cancer patients\u003c/p\u003e\n\u003ctable width=\"99%\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"70\"\u003e\n\u003cp\u003eResearch characteristics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"115\"\u003e\n\u003cp\u003eGroup\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"229\"\u003e\n\u003cp\u003eEffect size\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"155\"\u003e\n\u003cp\u003eHeterogeneity\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003eSMD(95%CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003eI\u0026sup2;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003eIntervention duration\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003e＞30min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-0.83 （-1.73，0.06）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e94\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003e\u0026le;30min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-0.80（-0.93，-0.67）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e0.24\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003eMean age\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003e\u0026ge;45 years old\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-0.65（-0.97，-0.33）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e0.68\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003e\u0026lt;45 years old\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-0.81（-1.06，-0.55）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003eNot included\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-0.86（-1.22，-0.49）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003eIntervention cycle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003e0-2weeks\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-0.49（-0.80，-0.18）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e0.81\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003e2-3weeks\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-1.02 (-1.34,-0.70)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003eMore than 3 weeks\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-0.82 (-1.29,-0.35)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e0.0006\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003eNot included\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-0.94 (-1.18,-0.70)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003eIntervention frequency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003e＜Twice a day\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-0.60（-0.94，-0.25）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e0.0007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003eTwice a day\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-0.91（-1.28，-0.54）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003eNot included\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-0.91（-1.23，-0.59）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003eMusic selection\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003eoptional\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-0.82（-1.05，-0.58）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003eHis choice\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-0.83（-1.15，-0.51）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003eDegree of specialization\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003eExpert recommendation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-0.79（-1.01，-0.57）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003eNon-expert recommendation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-0.90（-1.30，-0.49）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003eIntervention stage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003eDuring chemotherapy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-0.77（-1.00，-0.53）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003ePerioperative period\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-1.15（-1.36，-0.94）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e0.75\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003eIntervention mode\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003eLive music\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-0.32（-1.14，-0.50）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e0.45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003eOff-live music\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26%\"\u003e\n\u003cp\u003e-0.88（-1.10，-0.66）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e2.4.2 Meta-analysis of depression in breast cancer patients with music therapy\u003c/p\u003e\n\u003cp\u003eAs shown in Figure 3, six studies in the included literature evaluated the effect of music therapy on depression in breast cancer patients, including 411 patients. Heterogeneity test I2=84%, P \u0026lt; 0.01. There was a high degree of statistical heterogeneity among the studies, so the random effects model was used to combine the effect sizes. The results of meta-analysis showed that the effect size was -0.76, 95%CI[-1.15,-0.38], and the difference was statistically significant. 0.00001, indicating that music therapy was effective in alleviating depression in breast cancer patients compared to controls.\u003c/p\u003e\n\u003cp\u003eFig. 3 Music therapy for overall depression in breast cancer patients\u003c/p\u003e\n\u003cp\u003eTo explore the source of heterogeneity, subgroup analysis was performed for depression, the main outcome indicator. The effect of music therapy on anxiety and depression in breast cancer patients may be limited by the intervention cycle, music duration, professional degree, music choice and frequency. The results of subgroup analysis in the table showed that intervention cycle, intervention duration, age specialization, music selection and subgroup analysis of group music style were statistically significant. From the source of heterogeneity, intervention cycle and duration may be the main source of heterogeneity(Table 4).\u003c/p\u003e\n\u003cp\u003eTable 4 Subgroup analysis of the effects of music therapy on depression in breast cancer patients\u003c/p\u003e\n\u003ctable width=\"101%\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"19%\"\u003e\n\u003cp\u003eResearch characteristics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"13%\"\u003e\n\u003cp\u003egroup\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"43%\"\u003e\n\u003cp\u003eEffect size\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"23%\"\u003e\n\u003cp\u003eheterogeneity\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003eSMD(95%CI)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003eI\u0026sup2;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003eIntervention cycle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e\u0026le;2 Weeks\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003e-0.53（-0.86，-0.20）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e2-4Weeks\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003e-1.06（-1.33，-0.79）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e0.43\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003eMore than 4 weeks\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003e-0.79（-1.64，-0.06）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e91\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003eIntervention duration\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e\u0026le;30min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003e-0.75（-1.00，-0.51）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＞30min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003e-0.83（-2.34，-0.68）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003eDegree of specialization\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003e-1.15（-1.42，-0.88)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e95\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003e-0.26 (-0.53,0.01)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003eMusic selection\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003eoptional\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003e-0.71 (-1.10,-0.32)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.0003\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e0.007\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003eHis choice\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003e-0.85 (-1.60,-0.09)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e91\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003eIntervention frequency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003eDaily intervention\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003e-0.86 (-1.28,-0.44)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e＜0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e＜0.00001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"19%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003eNon-daily intervention\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"27%\"\u003e\n\u003cp\u003e-0.30 (-1.20,0.60)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Risk bias analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Figure 4, it can be found that the funnel diagram of music therapy on the anxiety of breast cancer patients is basically symmetric. The Egger test result shows that Z = -0.22, P \u0026gt; |z| = 0.8224, indicating that there is no publication bias in the study.\u003c/p\u003e\n\u003cp\u003eFig. 4 Music therapy for breast cancer patients funnel diagram\u003c/p\u003e\n\u003cp\u003e2.6 Sensitivity analyses\u003c/p\u003e\n\u003cp\u003eAs shown in Figure 5, to investigate whether the heterogeneity between studies was caused by a single study, the combined effect was analysed by screening out single studies one by one. The magnitude of the combined effect of exercise on inhibitory function in depressed patients included in all studies was SMD = 0.48, 95% CI: 0.18,0.77, P \u0026lt; 0.001, I2 = 80.38%, and the paradigm value of the combined effect SMD after sifting out the single studies was in the range of (0.21 to 0.56), and the range of the I 2 was in the range of (79.64% to 83.33%), both P less than 0.001 The results of the analyses showed that the data sensitivity of the study was relatively low, and did not form a fundamental change to the results of the Meta-analysis, indicating that the results of this research have a certain degree of stability and reliability.\u003c/p\u003e\n\u003cp\u003eFig. 5 Sensitivity analysis of music therapy on anxiety in breast cancer patients\u003c/p\u003e\n\u003cp\u003e2.6 Evaluation of evidence quality level\u003c/p\u003e\n\u003cp\u003eAs shown in Figure 6, the GRADE pro evidence grading system was used to evaluate the quality of evidence for the outcome indicators, and the quality of evidence for each outcome indicator was classified into 4 categories, from high to low: high, intermediate, low and very low. The quality of evidence rating for the effect of music therapy on improving anxiety and depression in breast cancer patients was found to be high. These results suggest that the actual effects are likely to be close to the estimates. Details of the evaluation of the quality level of evidence are based on the GRADE criteria.\u003c/p\u003e\n\u003cp\u003eFig. 6 Quality of evidence for the effect of music therapy on improving anxiety and depression in breast cancer patients.\u003c/p\u003e\n\u003cp\u003e2.7 Adverse events\u003c/p\u003e\n\u003cp\u003eNo adverse events resulting from music therapy were reported in any of the 13 included papers.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003e3.1 Influence of music therapy on anxiety of breast cancer patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of this study show that music therapy can significantly improve anxiety in breast cancer patients, and the results are consistent with previous studies. \u0026nbsp;Previous meta-analyses found that music therapy eliminated psychological barriers through unique effects. Longitudinal studies\u003csup\u003e[21, 32]\u003c/sup\u003e have found that music can reduce pain\u003csup\u003e[33]\u003c/sup\u003eand shift attention away from negative stimuli to things that are familiar, soothing, and pleasant\u003csup\u003e[10, 11]\u003c/sup\u003e. It has also been confirmed that music therapy can reduce the anxiety and depression of patients with other diseases\u003csup\u003e[34-39]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eA Total of 13 papers were included in this study to systematically evaluate the intervention effect of music therapy on anxiety and depression in breast cancer patients using PEDro scale to evaluate the risk of bias of the included papers in 9 aspects, with a mean score of 6.8, which was found to be of good quality, but this study did not carefully classify the condition and type of the breast cancer patients in the included papers, and with an I2 \u0026gt; 50%, there was a high degree of heterogeneity among the studies, and the existence of a considered some inconsistency. In the research, a dose-effect relationship was found for the effects of music therapy on anxiety and depression in breast cancer patients, which raised the level of evidence to one. Limitations of the research:The types of music selected for the interventions included in the literature were different, with no fixed criteria, whether it was recommended by the experts in English or selected by their own favourite music, and the repertoire selected was more often than not classified specifically, which inspired the expectation of more high-quality RCT articles to be further developed. 3) The study was conducted to identify the effects of music therapy on anxiety and depression in patients with breast cancer. RCT articles on music categorisation to further complement and demonstrate. In conclusion, music therapy is given high-level quality of evidence for both anxiety and depression intervention effects in breast Cancer patients.\u003c/p\u003e\n\u003cp\u003eThis study found that perioperative patients had the best improvement effect on anxiety when the music was their favourite music recommended by experts, the intervention method was non-live music, the intervention duration was less than or equal to 30 minutes, the intervention frequency was 2 times per day, and the intervention cycle was 2-3 weeks. Anxiety in breast cancer patients is mostly induced by low oestrogen levels, and the decrease in oestrogen levels is accompanied by a decline in serotonin transmitters. The possible mechanism by which music can improve anxiety in patients may be as follows: Music can increase the levels of estrogen\u003csup\u003e[40]\u003c/sup\u003eand oxytocin\u003csup\u003e[41]\u003c/sup\u003e, and also reduce the concentration of serum cortisol in women, so that the value of serum cortisol in breast cancer patients can return to normal\u003csup\u003e[42]\u003c/sup\u003e. In terms of the nervous system, music can increase the dopamine activity of nucleus accumbens (NAc) and ventral tegmental cortex (VTA), alter the structural changes of the mesolimbic brain (e.g., nucleus accumbens [NAc], ventral tegmental area [VTA]), and effectively control the influence of emotional stimuli on the autonomic and physiological responses of the hypothalamus and insula\u003csup\u003e[43]\u003c/sup\u003e. Inhibition of sympathetic nervous system reactivity reduces negative emotional experiences\u003csup\u003e[42, 44]\u003c/sup\u003e, thereby reducing anxiety. Choosing their favourite music has a better effect on perioperative patients\u003csup\u003e[45]\u003c/sup\u003e to perform non-live music, which may be because patients can get into the state more quickly when choosing their favourite music and local music, so that patients can resonate the cranial cavity, chest cavity, or a certain tissue cavity through rhythm, frequency, and regular sound wave vibration. It directly affects people\u0026apos;s brain waves, heart rate, and breathing rhythm\u003csup\u003e[46]\u003c/sup\u003e, thereby reducing anxiety. It may also be because, when listening to recorded music, patients can enter the music environment faster by restricting light, sound, visitors, and phone calls\u003csup\u003e[47]\u003c/sup\u003e, thus regulating their emotional state. A music intervention with a duration of no more than 30 minutes, a frequency of 2 times per day, and a cycle of 2\u0026ndash;3 weeks is more effective for breast cancer patients. PALMER\u003csup\u003e[21]\u003c/sup\u003ealso found that music therapy can reduce anxiety within only 5 minutes and can significantly reduce anxiety during 15\u0026ndash;30 minutes of hypnotic intervention. The effect of music intervention on patients\u0026apos; anxiety may present an inverted \u0026quot;U\u0026quot; curve, and the intervention effect is the best at the hour, followed by more than 3 weeks, and the effect is not good within 2 weeks\u003csup\u003e[8]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThis study also found that the duration of the intervention was inconsistent with that of Fu Yanzhi et al.\u003csup\u003e[23, 25, 26]\u003c/sup\u003e. The duration of music intervention did not become more effective with the passage of time, and the range of change from pre-treatment to post-treatment did not decrease with the passage of time\u003csup\u003e[23]\u003c/sup\u003e. At the same time, it also brings inspiration to future generations to further explore the impact of music duration on anxiety in breast cancer patients and look forward to more high-quality RCT articles to further supplement and prove.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Influence of music therapy on depression in breast cancer patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study found that music selected as expertly recommended music, an intervention duration of 30 minutes, an intervention frequency of 1 time per day, and an intervention cycle of 2-4 weeks had the best effect on improving depression in breast cancer patients. This is consistent with previous results\u003csup\u003e[14, 15]\u003c/sup\u003e. Longitudinal studies\u003csup\u003e[48]\u003c/sup\u003ehave found that music can stimulate the cerebral cortex in many ways, evoking pleasant thought associations and emotions in patients.\u003c/p\u003e\n\u003cp\u003ePatients with breast cancer are more prone to depression symptoms, subsyndromic depression due to circadian rhythm disturbance and fatigue, and higher intrinsic melatonin secretion than normal people. Musical stimulation can activate or increase specific pathways in several brain regions related to emotional behaviour, such as the insular and cingulate cortex\u003csup\u003e[49, 50]\u003c/sup\u003e, hypothalamus, hippocampus, amygdala and prefrontal cortex\u003csup\u003e[51]\u003c/sup\u003e. Thus, some biochemical mediators, such as increased endorphins\u003csup\u003e[51, 52]\u003c/sup\u003e , endocannabinoids and dopamine\u003csup\u003e[53-55]\u003c/sup\u003eand decreased nitric oxide\u003csup\u003e[56]\u003c/sup\u003eregulate positive emotional states\u003csup\u003e[56]\u003c/sup\u003e. In this study, it was found that, in terms of music selection, the effect of music suggested by experts is better. It may be that experts choose according to the current physiological and psychological state of each patient and the different personality of the patient so as to solve the emotional problems of the patient in a targeted way\u003csup\u003e[57, 58]\u003c/sup\u003e. In terms of intervention cycle, 2-4 weeks is the best effect size for the music intervention cycle\u003csup\u003e[59]\u003c/sup\u003e, The effect size is moderate when the intervention cycle is less than or equal to 2 weeks, and the effect size is second when the intervention cycle is more than 4 weeks. Qishou Tang also said in the study\u003csup\u003e[60]\u003c/sup\u003e that the effect of short-term and medium-term interventions is higher than that of long-term interventions\u003csup\u003e[20, 25, 31]\u003c/sup\u003e. Intervention duration of 30 minutes and frequency of 1 time per day had a better effect on depression relief in breast cancer patients\u003csup\u003e[61-62]\u003c/sup\u003e, which may be related to the timeliness of behavioural habits. It may also be that the frequency of intervention once a day can regulate the stress response of the hypothalamic-pituitary-adrenal axis\u003csup\u003e[63-64]\u003c/sup\u003e, which has the effect of regulating the spirit, pleasing the heart, and relieving depression in patients.\u003c/p\u003e\n\u003cp\u003eIn summary, based on the literature of high quality controlled trials, each intervention element has different effects on anxiety and depression in breast cancer patients, providing clinical practice and researchers with more precise music intervention programmes. Meanwhile an increasing number of healthcare organisations and government departments are incorporating music therapy into guidelines and policies for breast cancer treatment, and music therapy professionals are being trained and accredited to provide appropriate music interventions for patients. These policy measures help to increase the recognition and acceptance of music therapy interventions by patients and promote the psychological recovery of breast cancer patients. As scientific research continues, we can further understand the specific mechanisms of action and effects of music therapy on patients, and how to better apply music therapy for personalised interventions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThis research has been registered on the INPLASY platform (https://inplasy.com/contact/) under the number INPLASY2023100057.\u003c/p\u003e\n\u003cp\u003eConflict of interest: the authors declare no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all of the staf who contributed their time to our research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ethe corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegistration and protocol\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStay https://inplasy.com/contact/ Register and search on the website.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors agreed the possible publication of our article on journal of clinical nursing. The participant has consented to the submission of the article to the journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests and\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCompeting Interests statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no confict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXZH\u0026nbsp;designed the study and search strategy.\u0026nbsp;XZH\u0026nbsp;and\u0026nbsp;LC\u0026nbsp;performed abstract and full-text screening, methodological quality, and GRADE assessment, and contributed to the completion of screening and data extraction for all data within this manuscript.\u0026nbsp;XZH\u0026nbsp;and\u0026nbsp;YMY\u0026nbsp;designed and calculated meta-analyses, subgroup analyses, sensitivity analyses, and publication bias, and created images and tables.\u0026nbsp;XZH\u0026nbsp;wrote the original draft preparation, performed review and editing, and prepared the final draft.\u0026nbsp;WX\u0026nbsp;contributed to the critical evaluation of the findings and the drafting of the manuscript.\u0026nbsp;XZH,\u0026nbsp;YMY,\u0026nbsp;LC,\u0026nbsp;WX,\u0026nbsp;and\u0026nbsp;LYZ\u0026nbsp;contributed to editing and revising the manuscript in its final version. All authors read and approved the final version of the manuscript and agree with the order of presentation of the authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHe L, Luhong H, Jinrui Cui, et al. Status quo of self advocacy ability of chemotherapy patients with breast cancer and analysis of influencing factors [J] Chinese Journal of Nursing, 2023, 58(07): 788\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOur editorial department The 5th National breast cancer Young and Middle aged Expert Forum and the 3rd Tianjin breast cancer Multidisciplinary Comprehensive Diagnosis and Treatment International Forum were successfully held [J] Clinical oncology in China, 2017, 44(21): 1107.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYU L, YANG S, ZHANG C, et al. 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Effects of yoga music on anxiety and pain of PICC catheterization in patients after breast cancer surgery [J] Contemporary Nurses (Later Issue), 2015, 02): 71\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKai-Na Z, Xiao-Mei L I .Effect of music therapy on pain of breast cancer patients after radical mastectomy[J].Chinese Journal of Nursing, 2010, 26(28): 55\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLIU C H, LV X Y, GUO Z P, et al. Enhanced functional connectivity between insular subregions correlates with the efficacy of music and instruction-guided relaxation in depression [J]. Neuroreport, 2020, 31(17): 1215\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUSUI C, KIRINO E, TANAKA S, et al. Music Intervention Reduces Persistent Fibromyalgia Pain and Alters Functional Connectivity Between the Insula and Default Mode Network [J]. 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Braz J Anesthesiol, 2020, 70(5): 491\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeiwei S, Lili Z, Min L, et al. Observation on the effect of personalized music therapy on alleviating the adverse psychological reaction of chemotherapy in breast cancer patients [J] Anhui Pharmaceutical, 2013, 17(08): 1441\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWanting J, Xing W, et al. Research progress on the impact of exercise on depression and brain plasticity; The 11th National Conference on Sports Psychology, Beijing, China, F, 2018 [C].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVAN ASSCHE E, DE BACKER J, VERMOTE R. [Music therapy and depression] [J]. Tijdschr Psychiatr, 2015, 57(11): 823\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTANG Q, HUANG Z, ZHOU H, et al. Effects of music therapy on depression: A meta-analysis of randomized controlled trials [J]. PLoS One, 2020, 15(11): e0240862.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZHAO K, BAI Z G, BO A, et al. A systematic review and meta-analysis of music therapy for the older adults with depression [J]. Int J Geriatr Psychiatry, 2016, 31(11): 1188\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"music therapy, cancer, Anxiety, depression","lastPublishedDoi":"10.21203/rs.3.rs-4093072/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4093072/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: ABSTRACT: to systematically evaluate the intervention effect of music therapy on anxiety and depression in breast cancer patients. METHODS: Randomised controlled literature on music therapy for anxiety and depression in breast cancer patients was searched from 7 major databases, PubMed, Embase, the Cochrane Library, WOS, CNIC, Wanfang, and Wipro, spanning the period of library construction to 23 October 2023, and the literature screening of music therapy for anxiety or depression in breast cancer patients was carried out by 2 experimentalists, each of whom conducted a literature screening randomised controlled trial independently of the other. anxiety or depression in a randomised controlled trial. Methodological quality was evaluated using the PEDro scale; GRADE profiler software for quality of evidence; and RevMan 5.3.5 was used for effect size merging and forest plots; publication bias tests and sensitivity analyses were performed using Stata 17.0; and standardised mean difference (SMD) and 95% CI were used as the effect statistics.\u003c/p\u003e\n\u003cp\u003eRESULTS: A total of 13 RCTs with 1278 subjects (aged 18-70 years) were included in the literature, with a mean PEDro score of 6.8, and the literature was overall of good methodological quality.Meta-analysis showed that music therapy improved anxiety in breast cancer patients (841 cases), with a combined effect size (SMD=-0.82, 95% CI [-1.03,-0.61] and P\u0026lt;0.00001); and improved depression in breast cancer patients (387 cases) with a combined effect size (SMD=-0.76, 95% CI [-1.15,-0.38], P\u0026lt;0.00001). Subgroup analyses showed that music intervention with off-site music (757 cases) and music choice of non-self-selected music (537 cases) had the best effect on anxiety improvement, with corresponding combined effect sizes (SMD=-0.88, P\u0026lt;0.001; SMD=-0.83, P\u0026lt;0.001), respectively; followed by an intervention length of \u0026lt;30 min (589 cases), a frequency of 2 times/day ( 382 cases), and intervention period of 2-3 weeks (101 cases) had the best effect on anxiety improvement, and the corresponding combined effect sizes were (SMD=-0.80, P\u0026lt;0.001; SMD=-0.91, P\u0026lt;0.001; SMD=-1.02, P\u0026lt;0.001), respectively; and the music selection was the choice of one's own favourite music among the expert recommendations (219 cases) (270 cases ) had the best effect on the improvement of depressed mood, with combined effect sizes of (SMD=-1.15, P\u0026lt;0.001; SMD=-0.71, P\u0026lt;0.001) and music with an intervention duration of 30 min (287 cases), an intervention frequency of 1 time/day (348 cases), and an intervention period of 2-4 weeks (120 cases), respectively, with corresponding combined effect sizes of (SMD=-0.75, p\u0026lt;0.001; SMD=-0.86, p\u0026lt;0.001; SMD=-1.06, p\u0026lt;0.001), respectively. DISCUSSION: Music therapy improves anxiety and depression in breast cancer patients and has a high level of evidence. The literature was overall of good methodological quality, but heterogeneity between studies was high, and the heterogeneity of anxiety and depression was explored by subgroup analyses, with anxiety derived from treatment phase, music duration and music cycle; and depression [Liberati, 2009 #2560]derived from intervention cycle and music duration. Sensitivity analyses also identified music duration and music cycle as contributing to the heterogeneity. Also this study has some limitations due to the fact that the included literature did not take into account the duration of the disease, education, family economic status and did not categorise the age stages. This study found that music therapy improves anxiety and depression in breast cancer patients and the results can be used as a basis for clinical practice and researcher enquiry.\u003c/p\u003e\n\u003cp\u003eFUNDING AND REGISTRATION: This research has been registered on the INPLASY platform (https://inplasy.com/contact/) under the number: INPLASY2023100057.\u003c/p\u003e","manuscriptTitle":"Effect of Music Therapy on Anxiety and Depression in Breast Cancer Patients: Systematic Review and Meta-Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-28 18:24:56","doi":"10.21203/rs.3.rs-4093072/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-04-19T07:27:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-17T21:15:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-15T17:04:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"d0c260e8-2a04-4302-a5f7-26228978e278","date":"2024-04-07T22:28:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"b6cf7134-663c-483b-86ad-dc73c7050471_SNPRID","date":"2024-04-06T09:49:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-04T09:42:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-04T09:39:03+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-03-25T03:24:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-25T03:22:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-03-13T12:44:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"96ac0052-28ca-46cd-acf2-f098273d6603","owner":[],"postedDate":"March 28th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":29869121,"name":"Health sciences/Oncology/Cancer/Breast cancer"},{"id":29869122,"name":"Health sciences/Oncology/Cancer/Gynaecological cancer"}],"tags":[],"updatedAt":"2024-08-01T16:17:33+00:00","versionOfRecord":{"articleIdentity":"rs-4093072","link":"https://doi.org/10.1038/s41598-024-66836-x","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2024-07-17 16:05:16","publishedOnDateReadable":"July 17th, 2024"},"versionCreatedAt":"2024-03-28 18:24:56","video":"","vorDoi":"10.1038/s41598-024-66836-x","vorDoiUrl":"https://doi.org/10.1038/s41598-024-66836-x","workflowStages":[]},"version":"v1","identity":"rs-4093072","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4093072","identity":"rs-4093072","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}