Music therapy
6:25 am
Wed March 7, 2012

Instruments of Healing: Fighting cancer with medicine and music

At first glance, the Saint Louis University Cancer Center and the St. Louis Symphony seem to have vastly different missions. One seeks to provide the best care possible following an often devastating diagnosis. The other seeks to spread the beauty of music wherever it can.

But a unique collaboration looks to combine those two missions as often as possible in the region's first comprehensive music therapy program – to the benefit of both organizations and the people they serve.

The St. Louis Symphony doesn’t rehearse on Mondays, so cellists Bjorn Ranheim and Anne Fagerburg are getting ready to play a concert instead. The preparations are the same as if the duo was at Powell Hall on a Saturday night - set up the stands, arrange the music, adjust the chairs, tighten the bow, tune the instrument, watch for the cue, and play.

But their stage today is an open patch of floor in the Saint Louis University Cancer Center’s infusion room.

Ranheim and Fagerburg’s music can’t fully drown out the beeping of machines or the snap of tourniquets and gloves. But there’s a marked change in the atmosphere as they begin to play. One man gets a far-away look, as if the music has triggered a memory of better days.

And Mary Maune leans back in her chair and closes her eyes.

"I was picturing springtime, and sunshine and all good things," she says after her chemotherapy treatment.

Maune is intimately familiar with the drudgery of chemotherapy - she comes to SLU from Union, Mo. three days a week to treat her acute myeloid leukemia. The concerts, she says, help pass the time.

"Usually, if you're just in there sitting, getting fluids or waiting for blood tests, there's nothing to do," she says. "But this gives you something to listen to and focus on. It just makes you feel better."

A collaboration starts

The Symphony’s monthly performances came out of a 2010 committee that studied ways to manage the pain of cancer treatment, says SLU Cancer Center director Dr. Mark Varvares. The discussion launched several projects, including some involving medication. But alternate relief was also a topic.

"The more we learned about music therapy, the more we decided we wanted to know more about it and establish a program here," Varvares said.

A St. Louis Symphony staffer on the committee brought the idea back to the Symphony, and about two years later, a music therapy program was born.

"This program is incredible in that it is really multi-institutional," Varvares said. "If you think about who is involved, we have the Saint Louis University Cancer center, which includes then the School of Medicine, and the music program at St. Louis U. Maryville's music program, is going to send interns. There's a Washington University student who's going to come and help us with research. The School of Nursing at Saint Louis University is involved, and we've got the St. Louis Symphony. I think the fact that we've got all this interest speaks to the need in the region."

SLU isn't the first cancer center to collaborate with a local orchestra, says music therapist Crystal Weaver. But the depth of the commitment, plus the scope of the program, make it unique.

"I think that would be a nice feather in our cap if some day we were the gold standard for other cancer centers to follow throughout the United States of how to have a comprehensive music therapy program," she says.

How it works

Patients who must be hospitalized during treatment receive one on one music therapy sessions. The SLU music students play in the infusion center on the weeks the Symphony musicians do not.

The Maryville University students help Weaver - a Maryville graduate - with the individual sessions. Weaver also helps the musicians select their repertoire.

The resting heart rate for the average human is about 60 beats per minute, Weaver said. She encourages musicians to select pieces set at about that tempo, or slow a piece down to that speed. The body, she says, will generally relax to match the pace of the music.

Weaver says one leukemia patient who receives one-on-one sessions is using music therapy as an appetite stimulant.

"She thinks that if she can pair that unpleasant stimulus of eating right now with the more pleasant stimuli of the music, that they'll balance each other out and she won't be so aware of the negative stimulus of eating. So we kind of have a bargain set up that I'll keep playing the music as long as she keeps eating," Weaver said.

Proving that it works    

Research dating back to the 1940s has found that music reduces anxiety. But Varvares, the cancer center director, says there aren’t a lot of well-designed studies that evaluate the effect it has on pain. So with money from a fund controlled by SLU's president, the Rev. Lawrence Biondi,  Varvares will try to determine if patients who receive music therapy need less pain and anti-anxiety medication.

"We can tell that these intervention do make a difference," he said. "We just want to be able to further show medical professionals that this is a real intervention, that it's not entertainment, because not everybody believes in it."

Varvares says he expects positive results, and says reducing the amount of pharmacological intervention needed saves the cancer center and the patient money.

But Varvares says SLU remains committed to the program even without scientific evidence of its success.

"Best way to go beyond the boundaries of Powell Hall."

That's good news for Symphony cellist Bjorn Ranheim. Any public performance is its own reward, he said, but the cancer center is already among his favorite venues, even after just one show.

"A lot of us do education work, which is wonderful," he says. "But what a better way to help the community than actually helping people who are going through so much pain. I think it's a really wonderful chance to give a little gift."

The infusion center concerts also give the musicians a rare opportunity to play duets, which Ranheim says he especially enjoys doing with Anne Fagerburg.

Fagerburg returned the compliment. She says she selected one piece because of Ranheim.

"I wanted to do 'The Swan' (by Camille Saint-Saëns)," she said. "That was my highest priority. [Bjorn] plays the solo part so beautifully, and just the image of the swan floating on the water is such a lovely one."

Though music therapist Crystal Weaver and other SLU Cancer Center staff had helped prepare the musicians for what they might encounter, Fagerburg says she was still nervous about breaking down if she saw something upsetting. But any apprehension vanished the second she touched bow to strings.

"The clapping at first, I thought 'oh, you don't have to do that,'" she said. "But then I thought, you know, they should do whatever they feel comfortable doing. It was perfect."

Both cellists  say if the opportunity presented itself again, they would return to the temporary stage, bows and cellos in hand, to once again help the audience escape just for a little while.