CSN Perceptions Of Children And Adolescents In Palliative Care discussion

Has anyone read a report of a qualitative study before reading the one in this chapter? Where did you encounter it? What can you tell us about it? The point of reading research reports at this point is to understand them and extract essential information. Appraisal will come later.

Discussthe Why–How–What of one of the qualitative studies listed below and respond to the questions below:

Why did the researchers think it was important to do this study?

What did their study do that those other studies did not do

Esc Anna Nery 2021;25(5):e20210012
EAN
www.scielo.br/
RESEARCH | PESQUISA
Music therapy in oncology: perceptions of children and
adolescents in palliative care
A musicoterapia em oncologia: percepções de crianças e adolescentes em cuidados paliativos
Musicoterapia en oncología: percepciones de niños y adolescentes en cuidados paliativos
Julia Helena Machado Franco1 
Carla Braz Evangelista 1,2 
Mariana de Sousa Dantas Rodrigues1,2 
Ronny Anderson de Oliveira Cruz1,2 
Indaya da Silva Machado Freire Franco3 
Mayara Limeira Freire 3,4 
Abstract
Objective: to analyze the perceptions of children and adolescents with cancer in palliative care about music therapy. Method:
field research with a qualitative approach, conducted with seven children and adolescents. The drawing-story technique was
initially carried out based on drawings on feelings about hospitalization and the drawing story. Then there was the musical
interaction, drawing on the meaning of music in the face of the hospitalization process, and the story of the drawing. For analysis,
the content analysis technique was used. Results: before music therapy, the children and adolescents expressed feelings of
sadness, fear and longing related to the breaking of the family bond during the hospitalization process. After receiving music
1. Centro Universitário de João Pessoa. João
Pessoa, Paraíba, Brasil.
therapy, they expressed feelings of pleasure and well-being that this experience can provide them, allowing them to express their
deepest feelings. Conclusion: music therapy can benefit children and adolescents with cancer as it allows for the expression
of feelings, enables the rescue of memories and provides hope in the face of the situation experienced, in addition to pain relief.
2. Universidade Federal da Paraíba, Programa
Implications for the practice: music therapy contributes to the palliative process and can offer better quality of life to children
de Pós-Graduação em Enfermagem. João
and adolescents with cancer.
Pessoa, Paraíba, Brasil.
Keywords: Music Therapy; Palliative Care; Cancer; Child; Adolescent.
3. Universidade Federal da Paraíba. João
Resumo
Pessoa, Paraíba, Brasil.
4. Faculdade Brasileira de Ensino, Pesquisa e
Extensão. João Pessoa, Paraíba, Brasil.
Objetivo: analisar as percepções de crianças e adolescentes com câncer em cuidados paliativos sobre a musicoterapia.
Método: pesquisa de campo, com abordagem qualitativa, realizada com sete crianças e adolescentes hospitalizadas. A técnica
de desenho-estória foi realizada inicialmente a partir do desenho sobre os sentimentos diante da hospitalização e a estória do
desenho. Em seguida, houve a interação musical, desenho sobre o significado da música diante do processo de hospitalização,
e a estória do desenho. Para análise, utilizou-se a técnica de análise de conteúdo. Resultados: antes da musicoterapia, crianças
e adolescentes expressaram sentimentos de tristeza, medo e saudade relacionados ao rompimento do vínculo familiar durante
o processo de hospitalização. Após receberem a musicoterapia, elas expressaram as sensações de prazer e bem-estar que
essa vivência pode proporcionar, permitindo-lhes a expressão dos sentimentos mais profundos. Conclusão: a musicoterapia
pode beneficiar a criança e o adolescente com câncer uma vez que permite a expressão de sentimentos, possibilita o resgate
de lembranças e proporciona esperança diante da situação vivenciada, além do alívio da dor. Implicações para a prática: a
musicoterapia contribui no processo paliativista, podendo conferir uma melhor qualidade de vida às crianças e adolescentes
com câncer.
Palavras-chave: Musicoterapia; Cuidados Paliativos; Câncer; Criança; Adolescente.
Resumen
Objetivo: analizar las percepciones de niños y adolescentes con cáncer en cuidados paliativos sobre la musicoterapia. Método:
investigación de campo con enfoque cualitativo, realizada con siete niños y adolescentes. La técnica del dibujo-cuento se llevó
a cabo inicialmente basándose en el dibujo de los sentimientos sobre la hospitalización y en el cuento del dibujo. Luego hubo
interacción musical, con dibujo sobre el significado de la música durante el proceso de hospitalización y el cuento del dibujo.
Para el análisis, se utilizó la técnica de análisis de contenido. Resultados: antes de la musicoterapia, los niños y adolescentes
expresaron sentimientos de tristeza, miedo y anhelo relacionados con la ruptura del vínculo familiar durante el proceso de
hospitalización. Después de recibir musicoterapia, manifestaron las sensaciones de placer y bienestar que esta experiencia
les puede brindar, permitiéndoles expresar sus sentimientos más profundos. Conclusión: la musicoterapia puede beneficiar a
niños y adolescentes con cáncer ya que permite la expresión de sentimientos, posibilita el rescate de recuerdos es fuente de
esperanza ante la situación vivida, además de aliviar el dolor. Implicaciones para la práctica: la musicoterapia contribuye al
Corresponding author:
Carla Braz Evangelista.
E-mail: carlabrazevangelista@gmail.com.
proceso paliativo y puede brindar una mejor calidad de vida a los niños y adolescentes con cáncer.
Palabras clave: Musicoterapia; Cuidados Paliativos; Cáncer; Niño; Adolescente.
Submitted on 02/01/2021.
Accepted on 06/02/2021.
DOI:https://doi.org/10.1590/2177-9465-EAN-2021-0012
Escola Anna Nery 25(5)2021
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Music therapy and childhood/youth cancer
Franco JHM, Evangelista CB, Rodrigues MSD, Cruz RAO, Franco ISMF, Freire ML
INTRODUCTION
importance of conventional treatment associated with nonpharmacological therapy to improve quality of life in view of
the health situation9.
In the context of the non-pharmacological therapies, music
therapy stands out, since this intervention may allow for the
relief of manifestations such as anxiety, pain and fatigue and
side effects of the cancer treatment, consequently improving
the quality of life of cancer patients. It can also reduce the need
for anesthetic drugs, analgesics, and recovery and hospital
stay time11.
In this context, it is important to consider that nonpharmacological therapies can help children and adolescents
with cancer to reduce the physical, psychological, social and
spiritual symptoms, and that music can be one of the therapies
used to alleviate suffering, pain and its tension, also allowing
for a moment of relaxation and leisure. Thus, this research aims
at analyzing the perceptions of children and adolescents with
cancer in palliative care about music therapy.
Palliative care is an approach that helps to improve the quality
of life of patients who suffer from life threatening diseases and of
their family members, through prevention, research and treatment
of pain and other psychological, social and spiritual symptoms1.
In pediatrics, palliative care becomes a specific field, being
provided at any care level, requiring a wide-ranging assessment
from the multidisciplinary team that encompasses the physical,
psychological, social and spiritual dimensions. It is initiated at the
time of diagnosis and continues throughout the illness process,
regardless of whether conventional therapy is performed or not,
being adapted to the values of the patient and the family, which
is also included in the service. These are an important reality
in the health area and of great relevance in the care of children
and adolescents2.
It is noteworthy that not all children and adolescents can
benefit from curative cancer treatment, but the relief of suffering
provided by palliative care can be achieved3. This approach
becomes indispensable, especially given the impossibility of
cure, because the cancer diagnosis is a situation that generates
a lot of stress and involves a painful treatment4.
A number of research studies have been verifying the
benefits of non-pharmacological interventions for cancer patients
and/or in palliative care, with an emphasis on children and
adolescents5-9. A review study aimed at identifying the Nursing
interventions used in palliative care targeted at children and
adolescents with cancer and showed that massage, music
therapy, physical exercises and the use of therapeutic toys
are highly relevant therapies in palliative care, especially when
directed to a specific symptom5.
A study aiming to identify non-pharmacological interventions
for fatigue in children and adolescents with cancer showed positive
results for the practice of physical exercises, exercises accompanied
by leisure activities, therapeutic touch and acupuncture6. Diverse
scientific evidence on non-pharmacological therapies for the
management of fatigue and psychological stress in children and
adolescents with cancer also verified the benefit of interventions
in the face of these problems7.
A systematic review study evaluated the use of complementary
therapies to treat pain in cancer patients who were undergoing
palliative care and verified the benefits of therapeutic massage,
progressive muscle relaxation and guided imagery. However,
it inferred the need for new research studies to assess the
effectiveness of acupuncture10. In turn, a research study evaluated
the association between the clown intervention and the levels
of psychological stress and fatigue in children and adolescents
with cancer and verified that this therapy can be beneficial for this
population, considering that the total stress and fatigue level were
improved8. In addition to the aforementioned, other interventions
are also considered: hypnosis, meditation, art therapy, yoga,
acupuncture, reiki and therapeutic touch2.
Evidence on non-pharmacological interventions aimed
at the child/youth population with cancer arouses interest
in the topic, stimulates the professionals and highlights the
METHOD
This is a field research, with a qualitative approach,
carried out in the Pediatrics sector of a hospital located in
the city of João Pessoa/Paraíba. The research followed the
recommendations of the Consolidated criteria for reporting
qualitative research (COREQ), allowing for the improvement
of research rigor12.
This institution was chosen for being a reference hospital
for cancer treatment that has several sectors, including
outpatient clinic, intensive care unit, operating room, urgency
and pediatrics; and due to the fact that the main researcher
carried out a volunteer project in the Pediatrics sector of this
locus, based on art therapy and music therapy practices, which
facilitated access to the service and closer contact with the
professionals who worked there.
The sample was selected for convenience, and comprised
seven participants who met the research inclusion criteria: being
aged between eight and nineteen years old; being admitted
to the hospital; and being in adequate clinical conditions to
participate in the research activities. Those who were being
monitored in the outpatient clinic, in the Intensive Care Unit,
or who had previously participated in music therapy were
excluded. It is noteworthy that the research was completed
considering the proposed time interval for data collection,
material quality, analysis of the connection between the each
participant’s empirical material, absence of new information
and, consequently, data saturation.
In turn, the choice of the age group was due to the ease of
understanding the questions by this population, considering that
younger children might not understand what was asked or even
be unable to express their feelings.
Data collection with the population aged over seven years
old allows for better cognitive development and, consequently,
enables greater approach to the experience4.
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Music therapy and childhood/youth cancer
Franco JHM, Evangelista CB, Rodrigues MSD, Cruz RAO, Franco ISMF, Freire ML
The data were collected from March to April 2019, using
an instrument based on a number of studies13-14, and involving
a script of questions for the drawing-story (D-S) technique.
The D-S technique was developed by Walter Trinca and is a
tool that unites free drawing and storytelling, thus allowing
the individuals to reveal conflicting situations and emotional
problems on a sheet of paper15. It is noteworthy that an adaptation
was made to the D-S technique and that the sequence of five
drawings was not used. Before data collection was initiated, the
main researcher was properly trained to perform this activity.
To characterize the sociodemographic data, an instrument
with data on gender, age, race, schooling and diagnosis was
also used.
The technique was performed at two moments: in the first, a
drawing was requested on how each child and adolescent was
feeling regarding their hospitalization; subsequently, they were
asked to tell a story of the drawing they had made. Afterward,
at the second moment, the musical interaction was conducted,
through pre-selection by the participants themselves, the delivery
mode being live, voice and guitar. When it was not possible due
to the music choice, presentation of the music was made through
a sound device. To choose the music, the collector asked about
the music the participant would like to hear.
After the musical interaction, the interview involved questions
about what the musical moments represented for each participant.
To answer, the participants made a new drawing, telling the story.
Both moments were carried out individually and were recorded
on an MP3 player. It is to be noted that the sequence of stages
was carried out in a single day, in the place where the child or
adolescent was, and with a mean duration of approximately
60 minutes per participant.
The speeches and drawings were coded using primary and
secondary colors (yellow, blue, light blue, purple, pink, green,
red) chosen by the children and adolescents in order to maintain
anonymity and confidentiality of the information.
Data analysis was performed using the content analysis
technique, in accordance with the phases of pre-analysis,
exploration of the material and treatment of results (inference
and interpretation)16.
In this research, the ethical aspects pertinent to research
studies involving human beings were considered, in accordance
with Resolution No. 466/12, especially with regard to the
Free and Informed Consent Form addressed to the person
responsible for the child and to the Assent Form for the children
and adolescents17, being approved by the Ethics Committee of
the João Pessoa University Center-UNIPÊ (CEP/UNIPÊ) with
CAAE No. 07136819.4.0000.5176.
had completed Elementary School I, with four (57%), followed by
those who were in Elementary School II, with one (14%), and only
two (29%) were in High school. Three (43%) of the participants
had leukemia and the others presented lymphoma, lower limb
sarcoma, renal malignancy and thyroid cancer (14.3%).
With regard to the research data, the analysis of the
empirical material allowed elaborating two categories that will
be presented below:
CATEGORY I – Understanding the hospitalization
process
In this category, the children and adolescents understood
the hospitalization process based on negative feelings, as shown
in Figure 1 and reports below.
In relation to the feeling of sadness for being hospitalized, it
can be observed in the drawings, and especially in the statements
by interviewees Green and Purple. Deponent Green shows
several clouds and the presence of rain, meaning the tears
and sadness of being ill and hospitalized, and deponent Purple
verbalizes about the sadness in discovering the disease and in
her hospitalization process.
When I was hospitalized for the first time, I cried every
day, today I feel sad, but I don’t cry anymore (VERDE).
This is me, and this is the hospital. I’m outside the hospital.
I’ve already felt very sad to be in the hospital, but I got
used to it (AZUL-CLARO).
Of course I don’t like being here in the hospital, as much
as I know this is where I’ll be better […] (AMARELO).
[…]. I’m in the hospital because I’m ill, and my mother is
waiting if I can go home (VERMELHO).
This is me in bed, and this other bed is my brother’s; I
miss him so much. The hospital is not a bad place, there
are people here who are taking care of us, but it’s not my
home, I feel alone here. This bed is empty because he’s
not here with me (AZUL).
I feel very lonely in this hospital. My mother can’t come
with me because I have a little brother and she has to
stay with him, normally; the one comes is my aunt. I miss
home and my mother (ROSA).
This is me crying. When I found out I was ill, I felt sad and
groundless. When I’m admitted to the hospital, it’s like I’m
getting sicker (ROXO).
In the testimony by deponent Pink, we were able to perceive
the homesickness and loneliness caused by moving from home
to an environment in which the child does not have the presence
of all family members and friends. In addition to that, her drawing
represents the princess (deponent Pink) in a prison (hospital), that
is, it represents the hospital as a solitary environment, in which
the child does not feel free. Interviewee Light Blue also shows
that she does not want to be in the hospital. In her drawing, she
RESULTS
The study participants were seven children and adolescents
aged between eight and seventeen years old, of which three
(43%) were female and four (57%) were male. Most of them,
six (86%), were brown-skinned, and only one (14%) was whiteskinned. All the children were attending school, and the majority
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Music therapy and childhood/youth cancer
Franco JHM, Evangelista CB, Rodrigues MSD, Cruz RAO, Franco ISMF, Freire ML
Figure 1. Drawing made before music therapy about how children and adolescents were feeling regarding the hospitalization
process. Survey Data. João Pessoa, 2019.
Figure 2. Drawing made after music therapy about what the musical moments meant for the children and adolescents. Survey
Data. João Pessoa, 2019.
presents herself outside the hospital, although she is already
used to the environment. In turn, deponent Yellow verbalizes
not wanting to be in that place, but recognizes that it is the only
place that can help him improve his health.
The testimonies by the children and adolescents show
different effects related to music therapy on their current health
conditions. As it can be seen, when listening to the music, most of
the participants remember their homes. Interviewees Red, Blue and
Light Blue incorporate this perspective into their drawings, when
the painting of the house is present. However, the perception of
interviewee Light Blue is associated with maternal care, performed
through musicalization for pain relief. It has an affective (maternal/
family) and technical (promoting pain relief) characteristic. Also
regarding the maternal bond, participant Yellow highlights it as a
foundation for coping with the clinical condition and hospitalization
and, based on music therapy, he feels strong not to give up and
reminds him of his mother who never gave up on him.
CATEGORY II – Perception about the effects of
music therapy on your health condition
In this category, the effects of music therapy for children
and adolescents with cancer in palliative care will be presented.
In the interviewees’ perception, music helps them to forget what
they are going through and not to give up on life, making them
remember their home and family members, feel free and allow
pain relief, as shown in Figure 2.
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Music therapy and childhood/youth cancer
Franco JHM, Evangelista CB, Rodrigues MSD, Cruz RAO, Franco ISMF, Freire ML
When I hear this music, I close my eyes, I’m taken to the
sea. The sea, the beach is where I feel good. I like to listen
to this song, mainly when I’m hospitalized, or when I get
bad news about my treatment. It makes me forget what
I’m going through (VERDE).
followed, which generates a series of negative feelings, such
as sadness and anxiety, associated with painful technical
procedures (administration of medications and examinations),
hospital restrictions, isolation, institutional routines, and missing
friends and the family environment14.
The diagnosis of child/youth cancer and the hospitalization
process affect the entire family structure and bring different
reactions to the family. Reactions of surprise, denial, sadness,
fear, anxiety, suffering, unpreparedness to deal with the situation,
anger, depression and uncertainty surround this moment20.
A study aimed at investigating the meaning of playing for
children in hospital isolation found that loneliness, sadness and
imprisonment define the environment. In addition to that, it was
evidenced that, in this place, the patient suffers as a result of the
disease and of the existing restrictions, feeling threatened by the
presence of the health professional because they understand
him as a performer of procedures21.
Although they are able to communicate what they feel,
children and adolescents may need help expressing their
feelings19. The offer of psychological support, practices that
improve patient and family care, and that encourage playing
can have great relevance for the well-being of children and
adolescents18.
However, the implementation of measures that can improve
the quality of life of this population by health professionals is still a
challenge. There is a limitation on the part of health professionals
to manage manifestations of child/youth cancer and, consequently,
the lack of professional training to assist them22.
In this context, the drawing technique stands out, so that
children and adolescents express their feelings and thoughts14.
This technique can be implemented in different environments,
whether the house or the hospital, to assist in diagnosis and
treatment and allows for the revelation of valuable sensations
for their life, whether positive or negative23, which can assist the
health professionals tin understanding the real needs of children
and adolescents, so that targeted and individualized care can
be planned.
This research evidenced that music therapy can be
beneficial during the hospitalization process of children and
adolescents with cancer. From an iconographic point of view,
this study showed a differentiated tendency in the content of
the drawings made after the musical intervention, since a larger
number of elements and colors arranged on the sheets of paper
was explained. As for the characters, the imagery and affective
connotation about the possibility of living outside the hospital
context is notorious, especially in the home environment, with
greater proximity to the family members who have a significant
participation in the lives of the children and adolescents in this
research.
Music therapy is considered as a resource for the reduction
of pain24-26, blood pressure, respiratory and heart rate11,26,
anxiety11,24-26, decrease in depressive symptoms25-26 and in the
consumption of anxiolytics25. It assists in cognitive, attention,
memory and dexterity development and, unlike other therapies,
I chose this song because it teaches me not to give up,
and this flower is for my mom because she didn’t give up
on me like my dad did […] (AMARELO).
This is me and my little sister at home, I miss her a lot,
playing with her. I chose this song because I always sang
it to her. I think that what I miss the most is her, and she
liked it a lot, I’ve seen you singing outside, I always wanted
to participate, but I couldn’t leave the room. I was happy
for this moment today (VERMELHO).
This is me at home playing, I miss home. I really like this
song, I feel free when I listen to it, free from this hospital.
My brother also likes it a lot, we used to listen to it together
(AZUL).
[…] My mother used to sing this song to me when I felt
a lot of pain. Sometimes, when she’s not here with me I
keep singing, until my pain goes away (AZUL-CLARO).
I drew myself crying again, but these tears are different
[…]. This cry is of hope, and this song helps me get up
and continue my treatment (ROXO).
I drew butterflies, because they symbolize freedom, I miss
playing, being free. When we get sick we can’t do anything
else. This song I chose makes me imagine that one day
I’ll have this freedom, that I can fly (ROSA).
In relation to deponent Purple, although she presents tears
in her drawing, she reports that they represent the hope in
restoring her health with the cancer treatment, which strengthens
her in the face of the current situation. The same can be seen
in deponent Pink’s drawing, in which she portrays butterflies, in
order to represent a feeling of freedom, of flying, which is not
present during hospitalization. In the statements by deponents
Pink and Purple, it can be observed that music helps to change
their perceptions about the hospital. For interviewee Green, music
provides well-being, even in the face of sadness and bad news
related to his health problem.
DISCUSSION
The hospitalization of children and adolescents can be
considered as a stressful situation that interferes in the behavioral
and emotional responses of these subjects, consequently
influencing the development and results achieved with the
assistance provided18.
Hospitalized children and adolescents, especially those with
cancer, have a series of physical and psychological symptoms
as a result of the illness process19. With hospitalization, daily
and family activities are disrupted, and a new routine must be
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Music therapy and childhood/youth cancer
Franco JHM, Evangelista CB, Rodrigues MSD, Cruz RAO, Franco ISMF, Freire ML
music is considered an efficient, non-invasive and painless
therapy modality that has few side effects24.
In vulnerable patients, as in the case of cancer patients,
music reduces the imbalance in the face of hospitalization and
the changes imposed by the new environment, routines, and
social interaction with other subjects and the loss of bonds with
close people, which may lead to recovery, as a result of its evident
effects on the body, heart, and mind24.
When music is listened to, differently than when there
is activity without music, the individuals are led to total body
relaxation and the body immediately releases natural morphine,
thus helping to relieve pain, similarly to what happens with
synthetic analgesics25.
Although music is connected with the limbic system,
which is responsible for emotions, motivation and affection,
there is scarce scientific production on the effects of music
on physiological, psychological and emotional changes,
which raises the need for more research studies in the field
of health26, especially aimed at children and adolescents with
life threatening diseases. Integrating the analysis of serum
biomarkers with psychological measures in patient care has
become increasingly emerging in the context of health, illness
and personalized care27.
In a study, the presence of hospital clowns during procedures
in children and adolescents proved to be beneficial and helped to
improve their psychological status, when compared to those who
received only standard care. In the study, it was recommended
to assess the impact of hospital clowns and its correlation with
clinical data and biomarkers28.
Other authors highlight the need for new studies to
assess common biomarkers in cancer in order to assist in
the use of interventions that contribute to the treatment of the
psychoneurological symptoms29.
A study with the objective of evaluating the effect of music
therapy on the stress of chemically dependent individuals verified
that, after the therapeutic intervention, there was a reduction in
the levels of salivary cortisol, a biochemical marker of stress,
thus reducing the stress of chemically dependent individuals,
showing the benefits of music therapy in assistance30.
As a therapeutic resource, music stands out among
the integrative and complementary practices for promoting
biopsychosocial changes, helping to treat patients and improve
their quality of life. When used in patients with life-threatening
diseases, it promotes improvements in communication and in
the relationship between patient and family31.
Thus, from the drawings and testimonies it is possible to
perceive the effects of music therapy during the hospitalization
process of children and adolescents with cancer. Considering
that this resource could transform negative aspects related to the
situation experienced into positive aspects, helping the research
participants to forget the process of illness and hospitalization
and fight for life, to have hope in improving the condition, and
in pain relief, contributing to the improvement of their quality
of life, even in the face of a life threatening situation and the
hospitalization process.
FINAL CONSIDERATIONS AND IMPLICATIONS
FOR THE PRACTICE
It was found that, before receiving music therapy, the children
and adolescents expressed feelings of sadness, fear and longing
related to the breaking of the family bond in the home scenario
during the hospitalization process.
In turn, after receiving music therapy, they expressed the
sensations of pleasure and well-being that this experience could
provide them, allowing them to express their deepest feelings.
It was noticed that music therapy made it possible to
rescue positive memories and hope to live better; it provided
a space for communicating anxieties, fears and hopes; as
well as it promoted pain relief. All of this can provide better
quality of life for children and adolescents with cancer during
palliative care.
The study limitations are attributed to the fact that the research
was not carried out with children under eight years of age suffering
from cancer in palliative care; with a random sample; failure to
quantify the benefits of using music therapy in the illness of
children and adolescents; the non-standardization of the type of
music selected for the participants; and the reduced number of
participants. However, the quality and richness of the empirical
material in this study is highlighted, without compromising the
research evidence.
This study offers contributions to the practice, as it investigates
the perception of children and adolescents with cancer about
a resource that can be used in various health institutions to
benefit patients who are facing difficult situations, mainly those
who suffer from a life-threatening disease that also requires nonpharmacological therapies to relieve pain and other symptoms
they may come to experience.
AUTHOR’S CONTRIBUTIONS
Study design. Julia Helena Machado Franco. Carla Braz
Evangelista.
Data collection or production. Julia Helena Machado Franco.
Data analysis. Julia Helena Machado Franco. Carla Braz
Evangelista. Mariana de Sousa Dantas Rodrigues. Ronny
Anderson de Oliveira Cruz. Indaya Machado Freire Franco.
Mayara Limeira Freire.
Interpretation of the results. Julia Helena Machado Franco.
Carla Braz Evangelista. Mariana de Sousa Dantas Rodrigues.
Ronny Anderson de Oliveira Cruz. Indaya Machado Freire Franco.
Mayara Limeira Freire.
Writing and critical review of the manuscript. Julia Helena
Machado Franco. Carla Braz Evangelista. Mariana de Sousa
Dantas Rodrigues. Ronny Anderson de Oliveira Cruz. Indaya
Machado Freire Franco. Mayara Limeira Freire.
Approval of the final version of the article. Julia Helena
Machado Franco. Carla Braz Evangelista. Mariana de Sousa
Escola Anna Nery 25(5)2021
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Music therapy and childhood/youth cancer
Franco JHM, Evangelista CB, Rodrigues MSD, Cruz RAO, Franco ISMF, Freire ML
Dantas Rodrigues. Ronny Anderson de Oliveira Cruz. Indaya
Machado Freire Franco. Mayara Limeira Freire.
Responsibility for all aspects of the content and integrity
of the published article. Julia Helena Machado Franco. Carla
Braz Evangelista. Mariana de Sousa Dantas Rodrigues. Ronny
Anderson de Oliveira Cruz. Indaya Machado Freire Franco.
Mayara Limeira Freire.
12.
13.
14.
ASSOCIATE EDITOR
15.
Eliane Tatsch Neves 
SCIENTIFIC EDITOR
16.
17.
Ivone Evangelista Cabral 
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