Abstract
There is growing evidence that psychosocial interventions can have psychological benefits for people affected by cancer, including improved symptoms of mental health and wellbeing and optimised immune responses. However, despite growing numbers of music interventions, particularly singing, in cancer care, there is less research into their impact. We carried out a multicentre single-arm preliminary study to assess the impact of singing on mood, stress and immune response in three populations affected by cancer: carers (n = 72), bereaved carers (n = 66) and patients (n = 55). Participants were excluded if pregnant or if they were currently being treated with chemotherapy, radiotherapy or oral immunosuppressive drugs. Participants were regular participants in five choirs across South Wales and took part in one hour of group singing. Before and after singing, visual analogue mood scales, stress scales and saliva samples testing for cortisol, beta-endorphin, oxytocin and ten cytokines were taken. Across all five centres and in all four participant groups, singing was associated with significant reductions in negative affect and increases in positive affect (p < .01) alongside significant increases in cytokines including GM-CSF, IL17, IL2, IL4 and sIL-2rα (all p < .01). In addition, singing was associated with reductions in cortisol, beta-endorphin and oxytocin levels. This study provides preliminary evidence that singing improves mood state and modulates components of the immune system. Further work is needed to ascertain how this differs for more specific patient groups and whether repeat exposure could lead to meaningful, longitudinal effects.
Highlights
Over the past 50 years, more than 300 studies have explored the combined psychological and biological value of psychosocial interventions, from mindfulness to yoga to the arts, for cancer patients, survivors and carers [1,2,3]
There is growing evidence of the impact of music-making on neuroendocrine and immune responses in other patient populations [7], with previous studies showing that singing in particular can reduce levels of stress hormones such as cortisol, cortisone and progesterone and increase social bonding including the release of oxytocin [8,9,10,11]
Across all three groups, the results showed a significant decrease in cortisol and neuropeptide levels accompanied by an acute increase in cytokine and receptor activity (GM-CSF, IL17, IL2, IL4, TNFα, sIL-2rα and soluble tumour necrosis factor receptor 1 (sTNFr1)) suggestive of a general activation of the cytokine network
Summary
Over the past 50 years, more than 300 studies have explored the combined psychological and biological value of psychosocial interventions, from mindfulness to yoga to the arts, for cancer patients, survivors and carers [1,2,3]. Psychosocial interventions for all three populations have been found to reduce symptoms of depression and anxiety, increase social support networks, improve quality of life and raise perceptions of care [2] These positive states have, in turn, been linked to optimised immune responses including the lowering of inflammation, enhanced cellular function and other longer term health outcomes [4,5]. Negative psychological states and limited social interactions have been linked to lower white blood cell activity, reduced numbers of antibodies and increased stress hormone response [2, 4,5] Such evidence suggests that psychosocial interventions could play an important role in optimising health in people affected by cancer, helping to put patients in the best position to receive treatment or maintain remission and supporting staff and relatives who care for someone with cancer. Animal research has shown that music played to rodents reduces the suppressive immune effects of stress associated with cancer, enhances anti-tumour response and improves white blood cell function [12], further paving the way for biological studies in humans
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