BEFORE PURSUING A CAREER in medicine, Jessica Burlile was a multi-instrumentalist who received a degree in music. Now chief radiation oncology resident at Mayo Clinic in Rochester, Minnesota, Burlile’s background has left her particularly attuned to the pain and challenges faced by musicians undergoing cancer treatments.

“I have encountered other musicians who told me that they had to stop playing and teaching during their cancer treatments,” Burlile says. “Then I met a cellist early on in residency who asked me how her treatments would affect her ability to continue playing in chamber groups and orchestra. My best guess was that there would be side effects, but I didn’t know exactly how her abilities would be affected.”

Finding the existing medical literature lacking, Burlile decided to investigate the question herself. In a study published in JCO Oncology Practice this January, Burlile and colleagues surveyed over 1,800 people who were receiving or had previously received treatment for breast cancer to assess “musical toxicity,” or negative impact on musical abilities. Burlile expected to find a connection, but the scale of the results surprised her: Of those who self-identified as a musician, more than 1 in 4 reported experiencing musical toxicity, and of that group, more than half reported their musical abilities had not returned to normal as of the time of the survey. Those who experienced musical toxicity also felt their musical abilities had, on average, diminished by 40% due to treatment.

For Burlile, the study results raise significant questions about how well health care systems address loss of fine motor skills and dexterity, not just for musicians but for all hobbyists and professionals undergoing cancer treatments who depend on their hands or voice.

“I’ve also met patients who have had difficulty typing, which is critical for many jobs, and met folks for whom farming became extremely challenging due to the general fatigue and cumulative effects of treatments from different cancers,” Burlile says. “I think there is room for improvement in terms of asking patients how things like fine motor movement, range of motion and pain affect their hobbies and their ability to work.”

How Cancer Treatment Impacts Musicians

For her study, Burlile created a matrix of variables including type of instrument played (including the voice), cancer treatment received, and negative impact experienced. Those who played bowed string instruments experienced the greatest likelihood of musical toxicity, with 30% of players reporting an effect, followed by 29% of plucked string players, 25% of woodwind musicians and 21% of singers.

When asked which side effects had the greatest impact on their abilities, about half of all those who reported musical toxicity included fatigue. About a third said pain and discomfort, while numbness or tingling, arm or hand weakness, and voice changes were included in 1 in 5 responses.

More on Music and Cancer

Music therapy can be used to ease anxiety and improve quality of life in cancer patients.

Nicole Stout, a physical therapist, researcher and senior director of survivorship and wellness at the American Cancer Society, says there are a number of ways cancer treatments could impact musicians. Certain kinds of chemotherapies can affect the inner ear, potentially diminishing a musician’s sense of tone. Other treatments can lead to subtle changes in sensation in the fingers that may impact the highly precise movements needed to pluck strings. And any treatment that brings fatigue or pain of movement, such as a mastectomy, can lead to impairments.

“Radiation can impact your rib cage. If your rib cage is tight and you can’t take a deep breath in, you can’t hold a long note or blow a long note on an instrument,” Stout says.

Among those who reported musical toxicity, Burlile found, about 70% felt that chemotherapy was among the most negatively impactful treatments, followed by radiation (34%), surgery (28%), and endocrine therapy (25%).

Early Physical Therapy Is Key

Both Burlile and Stout say the study results indicate room for improvement within the health care system.

In 2020, Stout and colleagues published a systematic review of rehabilitation recommendations in oncology guidelines. They found that while such recommendations were common, there appeared to be a disconnect in practice: Earlier research found that more than 60% of those who receive cancer treatment reported physical impairments but less than 10% were referred to rehabilitation services.

Stout believes health care systems can better adhere to guidelines by embedding a physical therapist within oncology care teams from the start of treatment, in the same way that patients often automatically receive consultation from a social worker.

“These resources are already there … rehabilitation services are present in pretty much every hospital system in the United States,” Stout says. “So the idea is to embed a provider, so that they see the patient early and follow them in a prospective manner.”

For patients who find physical therapy isn’t prioritized by their providers, Stout encourages them to make the effort to seek out those services, especially if they are concerned about musical toxicity or similar challenges.

“From the point of diagnosis, patients should be saying, ‘Where’s my therapist?’” Stout says. “The squeaky wheel is going to get the referral.”

Kyle Bagenstose is a Philadelphia-based reporter specializing in health and environmental topics.