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Choir singing may boost immunity in people affected by cancer

Tuesday 5 April 2016

"Being in a choir could help the body fight cancer by boosting the immune system," the Daily Mail reports. 

The study involved 193 people from Wales who were affected by cancer in some way. This included people with a history of cancer, carers for people with cancer, and bereaved people who had lost someone to the disease.

The researchers had them take part in a 70-minute choir rehearsal.

Findings showed a decrease in stress levels and improvement in mood after the singing session compared to before. Levels of immune and inflammatory proteins that boost the body's ability to fight serious illness were also found to increase.

There are a number of limitations to the study.

Participants were already part of a choir – so clearly already found enjoyment in group singing – and there was no control group. The study also only assessed a single session, so we don't know whether effects would be replicated at other sessions.

The majority of the study population was made up of older white Welsh women, so the results may not be applicable to other populations.

Also, changes in levels of immune proteins alone are no evidence that this will "beat cancer". A longer follow-up period would be required to assess this claim.

Still, the results do support the opinion that taking part in a physical group activity you enjoy – whether it is singing, dancing, or joining a walking group – may improve both physical and mental wellbeing.

Where did the story come from?

The study was carried out by researchers from the Royal College of Music, Imperial College London, University College London and Tenovus Cancer Care (a Welsh cancer charity). Funding for the study was provided by Tenovus Cancer Care.

The study was published in the peer-reviewed medical journal ecancermedicalscience on an open-access basis, so you can read it for free online.

While the study was generally reported accurately by the UK media, many of the headlines overstated the findings. For example, The Daily Telegraph's headline "Singing in choir could help beat cancer" is currently unsupported by the available evidence.

That said, the Telegraph did provide an insightful quote from Diane Raybouldone, of the study participants, who is reported as saying that, "Singing in the choir is about more than just enjoyment, it genuinely makes you feel better. The choir leaders play a huge part of course, but so does the support of the other choir members, the inspirational programme and uplifting songs."

The science news website EurekAlert contains a link to a short video produced by the research team.

What kind of research was this?

This was a preliminary single arm (non-comparative) trial investigating whether people affected by cancer can benefit from singing in a choir.

The two main aims of the study were to compare changes across time in three different groups of people affected by cancer (carers, bereaved people and patients) and to assess whether responses differed between groups, to see if singing could be more beneficial to some than others.

While the study has found a link, it cannot prove that singing is responsible for any outcomes measured – mostly because there's no control group to compare against. However, as this is described as a preliminary study, it seems that more research will follow.

What did the research involve?

The researchers recruited five choirs in South Wales to participate in the study. Members of the choir were invited to take part if they were either a current carer of someone with cancer, a bereaved carer, or someone with cancer themselves – though not currently undergoing any cancer treatment, such as chemotherapy or radiotherapy. 

To participate in the study, people had to have attended at least one choir session and be over the age of 18.

Participants were to take part in the 70-minute choir rehearsal, which consisted of warm-up exercises, learning new songs as a group and singing familiar songs.

In the week before the rehearsal session, participants answered demographic and psychological questions in the form of a self-administered questionnaire, including assessments of:

  • wellbeing – using the Warwick-Edinburgh Mental Wellbeing Scale
  • anxiety and depression – using the Hospital Anxiety and Depression Scale
  • social function – using the Connor-Davidson Resilience Scale

Then, immediately before and after the rehearsal, visual analogue scales were filled in to assess mood and stress; this involved choosing a point on a line that runs from 0 (none) to 10 (extremely). Saliva samples were then taken for analysis of biological measures, such as levels of the stress hormone cortisol and cytokines, which are involved in the immune response.

What were the basic results?

There were 193 people in the study; the majority were white and female. Groups were split as below:

  • carers (72)
  • bereaved carers (66)
  • people with cancer (55)

On average, participants did not have symptoms of depression and had average levels of wellbeing. The study found a decrease in levels of the stress hormone cortisol and an increase in cytokines after the singing session compared to before, across all five of the centres and among all three groups.

Mood was seen to significantly improve overall and stress levels were found to decrease. Mood particularly improved for those with a lower state of mental wellbeing beforehand, and stress appeared to decrease the most in those who were initially more anxious and had higher depression levels.

No significant differences were observed across groups for psychological or biological measures.

How did the researchers interpret the results?

The researchers conclude: "This study demonstrates associations between singing and reduced negative and increased positive effect, reduced cortisol, oxytocin and beta-endorphin and increased levels of cytokines. This is the first study to demonstrate the widespread immune effects of singing, in particular its effects on cytokines."

They go on to say: "However, it would be of interest to ascertain whether such changes could be sustained with repeated exposure to the intervention over a longer time-span and with more specific patient groups. Such research could identify whether the psychosocial benefits of a communal activity such as group singing could lead to enhanced immune function in patients and carers affected by cancer."


This was a preliminary trial to assess whether singing in a choir can have a beneficial effect on the health and wellbeing of people affected by cancer.

The study found a decrease in stress levels and improvement in mood across all study groups after the single singing session, compared with before. The levels of immune and inflammatory proteins that boost the body's ability to fight serious illness were also found to increase.

This study, however, has some important limitations, many of which have been stated by the authors.

One is that it sampled a small population of mainly white women – who were already part of a choir, and therefore presumably already found enjoyment from singing. This reduces the generalisability to other groups. 

The study was uncontrolled, with no comparison group. It is possible that some of the results may have been seen even in the absence of singing; for example, if they had used the 70 minutes just to relax.

Participants in the study were a self-selected group who had low stress levels at the start of the study. Therefore, the same effect may not be seen in those who have higher stress levels.

The assessments were made only before and after a single singing session. We don’t know whether the same results would be replicated on repeat singing sessions, or for how long the effects would be sustained.

We also don't know whether any observed effects could be the result, not of singing itself, but of socialising and being together with other people in a group. It would be interesting to see whether the same results would be seen if an individual sang alone in their house, for example.

Despite the optimistic media headlines – changes in levels of immune proteins alone are no evidence that singing could "beat cancer".

Dr Ian Lewis of Tenovus Cancer Care said these are exciting findings: "We have been building a body of evidence over the past six years to show that singing in a choir can have a range of social, emotional and psychological benefits, and now we can see it has biological effects too."

It is too early to say whether these early findings have any solid foundation and many questions remain unanswered. More research will be needed to confirm these early findings. However, there is no harm in getting together with others and enjoying some singing, whether you have been affected by cancer or not.

A quick trawl of your favourite search engine should find a range of opportunities to take part in group activities, many of which are designed for older people who may be feeling isolated.

Read more about connecting with others when you are older

Analysis by Bazian
Edited by NHS Website

Links to the headlines

Being in a choir could help the body fight cancer by boosting the immune system

Daily Mail, 5 March 2016

Singing in choir could help beat cancer

The Daily Telegraph, 5 March 2016

Choir singing helps to boost immune system in cancer patients

ITV News, 5 March 2016

Could singing in a CHOIR help keep cancer at bay?

Daily Express, 5 March 2016

Links to the science

Fancourt D, Williamon A, Carvalho LA, et al.

Singing modulates mood, stress, cortisol, cytokine and neuropeptide activity in cancer patients and carers

ecancermedicaljournal. Published online April 5 2016