Background: Although people self-administer music for affect enhancement and self-regulation, there is a dearth of empirical inquiry investigating whether music-based regulatory factors and healthy and unhealthy music use explain coping strategies in adults hospitalized with cancer. Purpose: The purpose of this study was to determine whether music-based affect regulation and healthy and unhealthy music use explain coping strategies in adults hospitalized with cancer. Method: Participants ( N = 139) were adults hospitalized on oncology units at a large teaching hospital. Participants completed the Brief Music in Mood Regulation scale, the Healthy-Unhealthy Music Scale, and the Brief COPE. Correlational and ensuing multiple regression analyses were conducted to determine whether music-based affect regulation factors and healthy and unhealthy music use explained coping strategies. Results: Regression results indicated that discharge explained humor and religion. Unhealthy music use explained self-distraction, denial, behavioral disengagement, venting, and self-blame. Healthy music use explained active coping, instrumental support, positive reframing, planning, and acceptance. Conclusions: Music use can explain both adaptive and maladaptive coping strategies for adults with cancer. Education may enable people with cancer to make effective self-administered music listening choices that augment mood, quality of life, and recovery. Implications, limitations, and suggestions for future research are provided.