Cancer is one of the most important health problems of our time for both women and men and brings serious physical and psychological challenges, especially for women.1,2 According to the GLOBOCAN 2020 data, although breast cancer is the most common cancer in women worldwide, the incidence of female gynecological cancers is 29.8% and the most common types are cervix, uterus, and ovarian cancer, respectively.3,4 While gynecological cancers cause various problems depending on the affected organ, methods such as chemotherapy and radiotherapy (RT) applied for treatment also cause side effects and negatively affect the physical health of women, fear, anxiety, problems in family and work life, and uncertainty about the future harm psychosocial well-being.5

RT is one of the standard treatment modalities for gynecological cancers and provides advantages in both local control and survival. However, RT to the pelvic region may cause serious side effects and complications.6 Women experience pain during the insertion, removal, and handling of the applicator during the brachytherapy treatment, and pain also negatively affects the psychological state.7 Studies have shown that there is a significant relationship between anxiety before brachytherapy and pain during treatment and between anxiety and depression before brachytherapy.8, 9, 10 Elimination of physical and psychosocial problems experienced by women is important in terms of the prevention of psychological disorders as it will increase the quality of life. In this direction, complementary and alternative methods as well as pharmacological methods are frequently used today.8,11,12

Music therapy, one of the complementary or alternative treatment methods, is a treatment method aiming to benefit from the therapeutic and healing effects of music.13 Music is a powerful tool that can affect people's emotional, psychological, and physical states.14 In addition, music therapy can improve patients' overall quality of life by offering a nonpharmacological approach to symptom management and psychological support throughout the cancer process. However, it has been reported that music therapy reduces stress, alleviates anxiety, decreases depression, controls pain, and provides a general feeling of relaxation.15,16 In the United States, 12.5% of patients diagnosed with gynecological cancer used music therapy among the TAT methods.17 In a randomized controlled trial investigating the effect of music therapy on reducing fatigue during RT in women with gynecological and breast cancer in Brazil, it was reported that music was effective in improving the quality of life of women undergoing RT as well as reducing fatigue due to cancer and depression symptoms.14

Physiologically, music therapy contributes to reducing heart rate, blood pressure, and pain perception.18, 19, 20 Possible mechanisms underlying these effects are thought to be the activation of neurobiological pathways associated with the regulation of music perception, emotional processing, and stress responses. Studies have indicated that music therapy can be used as an effective method to reduce the pain perception of patients with cancer. Music can reduce focus on pain and alleviate the sensation of pain by directing attention mechanisms in the brain.19,21 Furthermore, music can reduce the tension and stress associated with pain, evoking emotional and relaxation responses. Another mechanism by which music therapy is effective in pain management is to increase the release of natural painkillers called endorphins. In the study conducted by Krishnaswamy and Nair (2016), while a significant decrease was observed in the pain scores of patients with cancer who underwent music therapy for 20 minutes, no significant decrease was observed in the pain scores of patients engaged in talking for 20 minutes, and a significant decrease was found in the pain level of patients after music therapy compared to the pain level of patients engaged in talking.18 Bareh and D'Silva (2017) reported that music therapy significantly decreased the pain level in patients with cancer and increased the quality of life in physical and psychological aspects.19 Bradt et al (2016) determined that listening to music decreased anxiety, pain, and fatigue and increased quality of life in patients with cancer.21

In a meta-analysis examining the effect of music in patients with cancer, it was reported that music therapy had a positive effect on well-being, anxiety, depression, mood, and pain.22 Investigating the effect of playing music on anxiety in patients receiving RT treatment, Rossetti et al (2017) reported that playing music before RT and during the procedure reduced anxiety and distress, patients felt better and relaxed, and their tension decreased.23 Alcântara-Silva et al (2018) evaluated the effects of music therapy during RT and found improvements in quality of life, fatigue, and depression.14

Music therapy can be performed in two main forms, active and receptive treatments, under the supervision of a clinician. Active music therapy allows patients to become highly involved in the creation of music by singing or playing musical instruments. Conversely, receptive music therapy refers to passively listening to live music or recorded music selected by the clinician or patient.24 Receptive music therapy is more accessible and easier to administer in hospitals. The speed and melody of music distract patients from potentially invasive and painful clinical procedures in cancer treatment, such as biopsy, surgery, chemotherapy, or RT.25 Various types of music are used in receptive music therapy. One of them, pentatonic music, is a type of music based on a scale of five notes and generally has a calming and soothing effect. This type of music, which has a relaxing effect on patients with cancer, can reduce stress hormone levels and promote relaxation by triggering relaxation responses. Pentatonic music played to patients diagnosed with cancer can reduce anxiety levels and alleviate depressive symptoms thanks to its calming and soothing qualities. Pentatonic music, which has a distracting effect thanks to its melodic and rhythmic features, can draw the patient's attention away from the pain and help reduce the feeling of pain. These effects suggest that pentatonic music may have a positive effect for patients with cancer.26

When the effect of music in gynecological oncology is examined in the literature, very few studies are encountered.14,27,28 No study was found to investigate the effects of pentatonic music started before brachytherapy and played during the brachytherapy procedure in women diagnosed with gynecological cancer. This study is important as it is the first study to investigate the effect of music in the brachytherapy process. The study was conducted to investigate the effect of music played to brachytherapy patients on anxiety and pain levels and physiological parameters (temperature, pulse, blood pressure, respiratory rate, SpO2).

H1: Music has an effect on the vital signs (temperature, pulse rate, blood pressure, respiratory rate, SpO2) in women undergoing brachytherapy.

H2: Music has an effect on the anxiety level in women undergoing brachytherapy.

H3: Music has an effect on the pain level in women undergoing brachytherapy.