This study is a quantitative content analysis of information about MBIs found on public-facing web pages of NCI-designated CCs [42,43]. Content analysis is a systematic method to code and quantify written, visual, or oral content [44]. For ease of reading, we will use the term “CC” to refer to both CCs and CCCs, except in instances where the distinction between CCs and CCCs is important to highlight.

Websites were included in this study based on these criteria: (1) they belonged to an NCI-designated CCC or an NCI-designated CC. and (2) they contained MBI-related information. Websites were excluded from this study based on this criterion: (1) they were from an NCI-designated CC that was categorized as a basic laboratory.

Six members of our research team executed the search strategy and data extraction (CAB, SB, AM, KS, ML, and KM). These team members included a postdoctoral researcher, as well as high school, undergraduate, and graduate students. Data extraction was completed in pairs with one person handling the initial data extraction and the second person checking the data extraction for accuracy. We reviewed 64 NCI-Designated CCs listed on the NCI website [45] between November 2022 and January 2023, excluding the seven CCs identified as basic laboratories. Following the methods from similar studies, [46,47] we used three different search strategies to identify CCs that offer MBIs: (1) keyword searching with search terms “music,” “music therapy,” “musician,” “therapeutic music,” “harp,” and “sing” using the CC website’s search function; (2) tab searching, which entailed systematically reviewing each menu tab or link on the website’s home page (eg, “patient information” tab or “services” tab) for MBI-related information; and (3) the first page of results from Google searching using the aforementioned search terms combined with the name of the CC (Figure 1). Mentions of music that were irrelevant to MBI (eg, music fundraisers) were removed. Duplicate web pages were also removed. Individual web pages within each specific website were consolidated. Two coders used each search strategy. An Excel (Microsoft Corp) spreadsheet was used for data abstraction, with a priori determined categorical data entries as well as open text fields to allow for entry of more detailed descriptions. The team met biweekly to peer-check the coding and resolve search discrepancies through discussion.

We extracted the following MBI-related information from the public-facing websites of NCI-designated CCs: (1) type of MBI offered (eg, MT or MS) and the specific music activities involved (eg, music listening or group drumming), (2) format (eg, individual or group), (3) method of delivery (eg, in person or remotely delivered), (4) setting (eg, inpatient or outpatient), (5) target population (eg, pediatric or adult), (6) MBI practitioner qualifications (eg, board-certified music therapist, volunteer musician, etc), (7) clinical indications or treatment benefits (eg, reducing anxiety), (8) presence of testimonials about MBIs, (9) cost or fees, and (10) information about scheduling MBIs or referring patients for MBI.

We used the Theory of Planned Behavior (TPB) to inform our data extraction [48]. The TPB posits that an individual engages in a specific health behavior (eg, use of MBI) as a result of three key factors: (1) expected benefits or outcomes of the behavior (eg, symptom burden reduction), (2) perceived barriers to engaging in the behavior (eg, unfamiliarity or lack of knowledge about what MBIs entail, high costs associated with MBI use, limited availability of qualified MBI providers), and (3) social norms regarding the behavior (eg, information regarding for which patient populations MBIs are intended, testimonials from other patients with cancer, and recommendations from oncologists). Prior research demonstrated that these TPB factors predict the use of complementary alternative medicine by patients with cancer [49,50]. Thus, by extracting information across the three TPB domains, we were able to not only capture the scope of MBIs offered at CCs but also determine whether websites contain the critical information that influences patients’ decision to seek MBIs.

Given that over 60% of patients experience frustration while searching for health-related information online [38,39], we evaluated findability of MBI-related information by first identifying CCs with a website home page that contained an easily identifiable link or drop-down menu to direct patients to MBI-related information. For CCs that did not contain an easily identifiable direct link or drop-down menu, we quantified the success path, a common website navigation metric, which we define here as the number of clicks needed to reach MBI-related information from a CC’s home page [51,52]. Similar approaches have been used in other research to evaluate the findability of information on CC websites [41].

We used the scope and findability of MBI-related information to assign an overall information quality rating for each CC website (Table 1). Our scale for rating the quality of MBI-related information was adapted from the approach used by Silver et al [41] who similarly used findability and scope of information to assign a quality rating.

This study analyzed publicly available information from websites in the public domain. No human subjects were involved in this study, and no personal identifiers or confidential data were collected. Therefore, approval from an institutional review board was not required for this type of research.

Of the 64 CCs, we identified 31 (48%) CCs that had information about MBIs on their public-facing website. Table 2 summarizes the NCI designation and regions for the 31 CCs that offered MBIs at the time of data collection. Links to the websites of these CCs can be found at this NCI directory [45].

Of the 31 CCs that offered MBIs, none (0%) had a tab or link on their home page that led directly to information about MBI. Relevant information about MBIs was found with an average of 4 (SD 1) clicks for 29 (94%) websites. Tab searching for MBIs was unsuccessful for two (6%) CCs. The success path for finding information about MBIs through tab searching took many forms but most often started in the “for patients” tab on the home page, then to “support services,” “integrative services,” or “rehabilitative services” tabs where MBI-related links were often present. Information regarding MBIs was sometimes found in additional tabs such as “child life,” “creative arts,” “palliative care,” or “wellness.” Keyword searching using the home page search function led to successful identification of information about MBIs for 28 (90%) CCs. For three (10%) CCs, keyword searching yielded marketing or media stories and event calendars but no further information about the types of MBIs provided or how to access them. Finally, Google searching (entering the name of the CC and the aforementioned keywords) produced MBI-related search results for 29 (94%) CCs. However, Google searching often produced results irrelevant to finding center-specific MBI-related information, such as benefit concerts, news reports, fundraising events for the hospital, or outdated promotional materials.

Using our quality rating scale (Table 1), we found that 9 (29%) CCs qualified for a high rating, 18 (58%) for a moderate rating, and 4 (13%) for a low rating.

People with cancer often experience high symptom burden and are increasingly turning to the internet to find treatment options [37,54]. MBIs have a growing evidence base for cancer symptom management and are currently offered in various oncology settings [19,20,25,26,46,47,55], but there is a paucity of research on what types of MBI-related information are available on the internet. This is the first comprehensive study to examine the scope, findability, and quality of MBI-related information on the public-facing websites of NCI-designated CCs.

At the time of this study, the public-facing websites of 31 of 64 NCI-designated CCs offered information about MBIs at their respective CC. MBIs described on the CC websites varied widely by activities offered, practitioner, format, target population, and settings. These findings highlight the clinical versatility and adaptability of MBIs but also underscore the need for developing strategies and resources to help patients and families navigate the wide range of MBI-related options.

While the evidence base for MBIs continues to grow, additional research is still necessary to better understand the role of MBIs in cancer symptom management. Most websites indicated that MBIs improve outcomes in physical, psychological, spiritual, and social domains. Evidence from recent systematic reviews demonstrate that MBIs improve some physical (eg, pain or fatigue) and psychological (eg, anxiety or quality of life) outcomes listed on the websites [20,55]. However, several listed outcomes related to physical (eg, respiratory outcomes) and psychological (eg, sense of self, bereavement, self-expression, or executive function skills) domains are not yet supported by randomized controlled trials in oncology. Some CC websites also claimed that MBIs can improve outcomes in social (eg, familial bonds) and spiritual domains. These claims, however, are not yet supported by research evidence. Further, only two websites supported their stated treatment benefits with research evidence. As patients attempt to make informed treatment decisions for cancer symptom management, it is important for CCs to present accurate, evidence-informed information about the treatment benefits and clinical indications of MBIs in oncology.

At most centers, MBIs were provided by board-certified music therapists. These centers may additionally have volunteers, musicians, or other nonmusic therapist health care professionals who offered MS to patients such as listening to prerecorded or live music. Offering MS can increase access to MBIs, particularly in settings with limited availability of board-certified music therapists. However, prior research has shown that MS may produce inconsistent benefits relative to MT [19,20]. Furthermore, without proper guidance from a trained therapist, musical engagement can evoke strong emotions and memories that are undesirable or even harmful to people with cancer [19,56]. Public-facing websites often neglected to mention these risks when offering services by nonmusic therapists. Greater emphasis should be placed on educating patients about the distinction between MT and MS, as well as their relative benefits and risks.

The COVID-19 pandemic has accelerated the adoption of telehealth. However, only eight centers mentioned remotely delivered MBIs as an option on their websites. A growing body of research has documented that people with cancer experience time toxicity, which is conceptualized as the substantial amount of time spent in coordinating medical care, undergoing tests and treatments, and traveling to and from in-person appointments [57-63]. Offering more remotely delivered MBI options and emphasizing online services on CC websites may reduce time toxicity barriers and encourage patients with cancer to seek supportive care in the form of MBIs.

In parallel to increasing adoption of telehealth services, patients and families are more frequently turning to online sources for health-related information. Despite these trends in digitalization, the paucity of direct links to MBI-related information may result in fragmentation of information across multiple pages, increasing frustration for people who search online for MBI information. Furthermore, 22 CCs received a moderate or low rating for quality of MBI-related information, indicating that key pieces of information were lacking on their public-facing websites. For example, four or more websites lacked information on MBI format, delivery method, setting, target population, practitioner qualifications, scheduling, or referrals. Moreover, only three websites included patient testimonials even though testimonials have been shown to affect health behavior change [64-67]. Similarly, only five websites included information on the cost of MBIs despite costs being a well-described factor when considering the use of complementary therapies [68,69].

CCs should continually evaluate their websites for scope, findability, and quality of MBI-related information. Behavioral frameworks, such as the TPB, can help identify the key pieces of information that drive patients’ treatment decision-making and their willingness to seek MBIs [70]. We recommend that CCs have a dedicated web page for MBI that is easily findable from the CC home page and includes the following information:

While websites represent a key source of information that may drive treatment-seeking behavior, it is also important to consider other factors (eg, health care providers’ knowledge and beliefs) that may influence the use of MBIs. For example, one study found that only 56% of health care providers in oncology settings knew about the role of MT in cancer symptom management and knew how to make referrals to MT [71]. Since most patients with cancer look to their primary oncology team to provide information about complementary or integrative health options [72], future dissemination efforts should focus on targeting health care professionals’ knowledge about MBIs and establishing clear pathways for referring patients to MBIs. Fostering more seamless interprofessional collaboration between music therapists and other health care providers may also help to increase knowledge of MBIs and promote greater uptake of MBIs in oncology settings [73].

Our study has some limitations. First, the time period of data extraction may not reflect the current website landscape. Next, descriptions on the websites may not be indicative of real-world availability of MBIs at the NCI-designated CCs. Additionally, the search strategy we employed was limited to the websites made publicly available by the CCs. Several CCs were also housed within multiple hospitals. Therefore, we may have missed some descriptions of MBIs. Furthermore, CCs may have not updated their websites with their current MBI offerings. In addition, the generalizability of our findings may be limited because we only searched the websites of NCI-designated CCs, all of which are located in the United States. Finally, a validated scale for rating the quality of MBI-related information found on websites does not exist in the literature, so we adapted a rating scale that other researchers used to evaluate public-facing websites of NCI-designated CCs [41]. While the findings should be interpreted as preliminary, our study could potentially inform future research to develop a rigorous, validated scale for rating health information found on public-facing websites.

Despite these limitations, our study is the first to provide a comprehensive review of MBI-related information on public-facing websites at NCI-designated CCs. NCI-designated CCs are often viewed by patients, families, and community providers as the gold standard for sources of information. In an increasingly digital world, it is critical for NCI-designated CCs to maintain a robust online presence and update their public-facing websites with evidence-informed information about MBIs. As the evidence for MBIs grows, translation of this research into accessible, actionable knowledge is critical to the real-world delivery and use of MBIs. While our study showcases the wide range of MBIs described in various oncology settings, the findings also highlight that NCI-designated CCs need to provide more detailed information about MBIs on their public-facing websites to promote the dissemination and implementation of this evidence-based option for cancer symptom management [20].

In addition to NCI-designated CC websites, future research should evaluate other key avenues through which information about MBIs is disseminated to the public. Most patients with cancer receive care in community settings [74], so it will be important to research how MBI-related information is presented in community-based clinics, hospitals, and cancer advocacy organizations. Music represents a multicultural resource [35,36], and research on the use of MBIs in cancer care has been conducted in various countries around the world [20]. Future studies should examine how MBIs are presented to the public in this global context. Researchers should also strive to develop culturally attuned approaches to disseminating MBI-related information so that patients with cancer from all cultures and backgrounds could learn about this evidence-based modality.