The clinical stakes are considerable. Breast cancer accounts for the largest proportion of cancer cases among women, and the pathway from suspicion of disease to diagnosis and surgical treatment generates tremendous psychological distress. Previous research indicates that between roughly 36 and 80 percent of patients undergoing breast-related procedures report moderate pre-operative anxiety, while 7 to 17.6 percent experience high levels. Qualitative work has shown that patients describe the experience as fighting an unknown, losing part of oneself, and adjusting to changes in physical appearance. Younger patients tend to suffer more, and a longitudinal study of 250 patients found that nearly 30 percent of those with high pre-operative anxiety continued to experience persistent anxiety after surgery and were more likely to develop new anxiety during subsequent treatments. Even less invasive procedures, such as ultrasound-guided vacuum-assisted biopsies performed under local anesthesia, can push distress to a clinical threshold, and higher pre-operative anxiety typically amplifies perceived pain during and after the operation.

Music-based interventions come in several forms, and the distinction matters. When medical staff administer passive music listening, it is called music listening as medicine; when musicians deliver it, it falls under other intervention types; and when a credentialed music therapist provides it, usually live and intertwined with verbal processing, it qualifies as music therapy. Systematic reviews have consistently supported the approach. A review of 26 randomized and quasi-randomized trials found music listening reduces pre-operative anxiety, while a meta-analysis in The Lancet reported that music lowered post-operative pain, anxiety, and analgesia use while raising satisfaction. A meta-analysis of 81 randomized controlled trials concluded that music interventions before, during, or after surgery significantly reduced anxiety and pain, with the greatest benefit observed when patients were offered a list of music options during selection. Studies in China have reported similar gains, including reduced inflammatory marker levels when music was combined with aromatherapy, and lower depression, anxiety, and shorter hospital stays when music listening was paired with progressive muscle relaxation after radical mastectomy.

What remained unknown, and what the Guangzhou team set out to investigate, was how patients themselves perceive these interventions and which implementation factors, such as duration, music selection, and the identity of the interventionist, actually drive the benefits. The researchers enrolled 40 patients undergoing breast-related procedures at Guangzhou Concord Cancer Center, where a music listening as medicine program had been embedded into the standard operative protocol since October 2023. Before the program launched, every nurse in the surgical department received training from a certified music therapist over an eight-month period, learning to select music according to the patient’s state and preference and to guide brief breathing exercises with music. Thirty-nine patients completed the post-operative electronic survey, which was deliberately administered only after surgery and the intervention, so that gathering feedback would not bias the care itself.

The intervention followed a structured four-step protocol. Upon entry into the operating room, each patient’s vital signs and anxiety level were assessed using a 0 to 10 visual analog scale. Music then played before the procedure and during anesthesia administration, resumed as the patient awakened from anesthesia, and a final assessment of vitals and anxiety took place right before discharge. The music library, pre-edited and pre-arranged by the music therapist in collaboration with trained nurses, mixed new age, light classical, and popular instrumental tracks chosen for relaxation and stress alleviation, with each piece scaled and rated for its overall energy level. Music played through a single in-ceiling speaker near the operating bed, with volume adjusted to patient comfort and ambient noise, ranging from 20 to 70 decibels. Patients could request their own music or let the nurses choose, though in practice all participants in the study had nurse-selected music.

The physiological and psychological results were striking. Patients showed an average decrease of nearly 3 points on the 10-point anxiety scale between the pre-operative and post-operative periods, a statistically significant reduction with a p-value below 0.001. Pre-operative heart rate and respiration rate both fell significantly, suggesting that music helped downregulate the sympathetic nervous system as patients awaited surgery. Post-operative heart rate also dropped significantly, indicating sustained relaxation during recovery. Intriguingly, however, both systolic and diastolic blood pressure rose during the post-operative period. The authors attribute this to residual surgical stress, discomfort, and the gradual reactivation of the autonomic nervous system after anesthesia, factors that may overwhelm music’s calming influence when patients are emerging from anesthesia with diminished consciousness and reduced cognitive processing of the music itself.

Perhaps the most counterintuitive finding concerned duration. Patients listened to music for an average of 57 minutes across the peri-operative period, roughly 25 minutes before surgery and 32 minutes after under general anesthesia. Yet the total listening time showed no significant correlation with anxiety reduction, procedural satisfaction, or music selection satisfaction. A piecewise regression analysis, which segmented listening time into 10-minute blocks, revealed that the most significant decrease in anxiety scores occurred within the 70-to-80-minute interval, a window that corresponds closely to an American study of mastectomy patients whose intervention spanned pre-, intra-, and post-operative phases with an average duration of 77.7 minutes. The authors caution that these preliminary results require confirmation, particularly since the pre- and post-operative contributions to that window could not be separated.

What did matter enormously was the music itself. Satisfaction with music selection correlated strongly and positively with satisfaction with the entire procedure, with a correlation coefficient of 0.766 and the selection variable explaining nearly 59 percent of the variance in procedural satisfaction. Over half of the participants reported no preference between self-selected and interventionist-selected music, and all had received nurse-selected music, suggesting that the quality and appropriateness of the selection, rather than who made it, drives satisfaction. A chi-square test further showed that patients with higher music satisfaction were more likely to perceive a clear function for music-based interventions in medical settings, hinting that patient understanding of the intervention shapes how satisfying they find it. Nearly 70 percent of participants believed the intervention should be delivered by trained interventionists, and more than 92 percent preferred simple music listening over other formats such as song discussion, instrument playing, singing, or composition.

The survey also mapped the barriers that could keep such programs from spreading. Although almost 90 percent of participants believed music interventions helped alleviate anxiety and induce relaxation, and 84.6 percent said such services should be offered in more hospitals across China, 69.2 percent cited accessibility of services and 53.8 percent cited financial constraints as obstacles to future use. Only about a third had even heard of music-based interventions before their hospital encounter, and fewer than 18 percent had ever tried one. When asked to define the intervention in their own words, ten participants could not articulate a definition despite positive experiences, describing it simply as feeling good to have music as an accompaniment, which underscores how unfamiliar the concept remains even among patients who benefit from it.

The study has clear limitations that the authors acknowledge: a small sample of 39 respondents, predominantly female and highly educated, no control group, a single site, and a mix of minor and major procedures that may dilute the findings. Live music therapy could not be assessed because those patients were excluded. Even so, the research offers a practical roadmap for hospitals considering music-based care. The recommendations are concrete: train the interventionists, curate selections with a music therapist, tailor the music to the patient’s peri-operative state, and pay close attention to the selection process itself, because how the music feels to the patient may matter more than how long it plays. As music-based interventions gain momentum in Chinese oncology, this study suggests the path forward runs through education, access, and the deceptively simple act of choosing the right song at the right moment.

Subject of Research: Therapeutic music listening for peri-operative anxiety and patient satisfaction in breast-related surgery in China

Article Title: Exploring patient health index, perceptions and satisfaction: the role of understanding music listening in peri-operative care for breast-related surgical procedures in China

Article References: He, Y.-L., Nhan, J., Chen, K.-J., & Qian, C.-N. (2026). Exploring patient health index, perceptions and satisfaction: the role of understanding music listening in peri-operative care for breast-related surgical procedures in China. Holistic Integrative Oncology, 5(1), Article 36. https://doi.org/10.1007/s44178-025-00170-8

Image Credits: AI Generated

DOI: 10.1007/s44178-025-00170-8

Keywords: peri-operative anxiety, music-based interventions, breast cancer surgery, music listening as medicine, patient satisfaction, Guangzhou Concord Cancer Center, nurse-delivered intervention, visual analog scale, autonomic nervous system, music selection, music therapy, China