Research is important to us at Tenovus Cancer Care. We want to find out how and why the help we offer people is effective, as well as discovering more about cancer treatment and support. The more we understand, the more we can help.
Since 2010 we’ve launched eighteen Sing with Us choirs across Wales and England. As well as developing the service and supporting people, we’ve worked with Cardiff University, as well as the Royal College of Music in London, to find out more about the benefits of singing and how it helps people dealing with cancer. We now know that being in one of our choirs is much, much more than singing.
What we’ve investigated
Over the years we’ve used different methods to find out more about the benefits of our choirs. We’ve used tried and tested questionnaires, 1-2-1 and small group discussions and saliva samples. So far, ours are the only studies that have examined the impact of choirs specifically on people affected by cancer.
Quantitative data (Health-related Quality of Life (HRQoL))
In this study we worked with Cardiff University to examine choir members’ health-related quality of life. In other words, how much their health (mental and physical) affects their wellbeing and whether a choir could help.
We looked at this quantitatively, meaning we used numbers and statistics. Between 2012 and 2015, over 1,000 choir members completed validated questionnaires – the Short Form 36 and Hospital Anxiety and Depression Scale – upon joining the choir and again after three and six months. Cardiff University then analysed preliminary data from 149 choir members for trends.
They discovered that on joining the choir, patients had worse HRQoL and greater depression than non-patients. However, after three months in the choir, patients’ vitality, overall mental health and anxiety had improved and in non-patients choir participation improved anxiety. These positive changes were sustained after six months.
As well as looking at the numbers, we also wanted to find out more from choir members themselves about why these changes could be happening. If quantitative data is the ‘what’, qualitative data gives us the ‘why’ and ‘how’.
So Cardiff University ran group discussions and interviews with choir members between 2013 and 2015 and conducted a thematic analysis of the content of those interviews, meaning they drew out common themes, ideas and feelings.
The data showed that members experience the choirs as both an uplifting musical activity and a supportive community group. It told us that people got a feeling of self-worth and purpose from being a member of our choirs, as well as giving them an identity away from cancer. They felt choir helped them to ‘live life to the full’ regardless of cancer and they valued being with people who had been through, or were going through similar experiences.
This research shows that our members really feel that being part of a Sing with Us choir has many benefits. This wide range of benefits is important as it suggests that choirs can be an effective form of support, regardless of how cancer has affected someone and offers a form of support, personal to them.
Biological data (More than Singing – Part 1)
The positive results of the Cardiff University study meant we wanted to know more about why these changes were happening.
Then in 2014 we had the opportunity to work with the Centre for Performance Science (a partnership between Royal College of Music and Imperial College London) who were pioneering the use of saliva to test for biological changes due to musical activities. This would help us see whether there were biological changes, brought about by our Sing with Us rehearsals which could explain the positive effects our choir members experience.
We took saliva samples from 193 of our choir members from five of our Sing with Us choirs, before and after a one-hour choir rehearsal. We also asked them to complete questionnaires about how they felt, before and after.
We sent their saliva to a lab and measured changes in biomarkers. A biomarker is a naturally occurring chemical, protein or piece of DNA in your body that can be used as an indicator of how the normal processes in your body are functioning. We chose biomarkers which told us about changes in mood states, specifically the level of different stress hormones such as cortisol and other chemicals that indicate immune function.
The research showed that our Sing with Us choirs are effective at reducing peoples’ anxiety and depression, and have a positive impact on biological markers related to stress, immune function and inflammatory response.
- The study found that the level of choir members’ cortisol (a stress hormone) was lower after the rehearsal.
- There was also an impact on choir members’ endorphin and oxytocin levels, which relate to social bonding.
- Excitingly, there was also a positive change in a range of biomarkersrelated to immune function and inflammatory response in the body, both of which may be linked to the body’s ability to fight serious illnesses including cancer.
- The information from the questionnaires revealed that after singing choir members felt less afraid, confused, sad, angry, tired, tense, anxious, stressed and alone, and felt more energetic, happy and relaxed.
- We found that improvements in moodas a result of singing led to lower inflammation in the body. We know that high levels of inflammation are associated with many mental health conditions including depression.
- The study also found that those with the lowest levels of mental wellbeing and highest levels of depression experienced the greatest short-term improvement in mood across the singing session, and that these changes were associated with lower levels of inflammation.
This study only measured one hour of singing, at one point in time. We wanted to take the research further and find out whether singing on a regular basis could lead to larger and more sustainable improvements in mood and whether this affects inflammatory response.
Longer term benefits and results
Our latest research study (More than Singing – Part 2) measured choir members over 24 weeks, and looked at the effects on different groups of people affected by cancer (patients, carers, people who’d been bereaved) and compared results to a control group. Find out more about this study here.