We wish we could sing the praises of a study about how choir participation may strengthen the immune systems of cancer patients, but we find this news release missing its fundamental notes. This study of 193 singers includes both cancer patients and caregivers in choirs organized by the nonprofit Tenovus Cancer Care in the United Kingdom. They measured levels of biomarkers in subject’s saliva before and one hour after they sang, but the release gives us no numbers at all for the results. Reading it is like hearing a singer fail to hit the high note — it’s painful to know how close she came without reaching it. With numbers and some context about how immune systems are measured, it could have made a clearer case for a very small study. Measuring immune markers just one hour after singing does not mean they will remain elevated long enough to make a material change in the person’s response to disease. We also have to point out that being with other people — just that social contact — may accomplish the same thing without singing.
Supporting cancer patients is essential to millions of people dealing with this family of diseases. Depression and other mental health issues are known to influence the immune system, which is vital to maintaining health. But this news release about a study that only measured 55 patients (others were caregivers and grieving people) after one hour of singing does not give readers proof of its claims. As it is written, it might raise hopes for people or mislead them into thinking that by singing they could prevent a recurrence of their cancer. We don’t think this sentence is supported by evidence in the release: “singing in choir rehearsals could help to put people in the best possible position to receive treatment, maintain remission and support cancer patients.” What does “put people in the best possible position” mean? We think that a one-hour study does not prove singing could “maintain remission” in a majority of patients, especially since it isn’t clear if different diagnoses were grouped together. Cancer is not a single disease, but hundreds.
Because cancer diagnoses and treatment are so stressful, it is important that we are clear-headed when doing scientific appraisal of treatments, including things that might appear benign. People who do not participate may feel they are missing something essential for them.
The release does not mention any costs. While the non-profit Tenovus makes choir singing available to people for free that doesn’t mean such an activity would be free to people everywhere if they wished to access it. If a cancer treatment center needed to establish a new choir program, with a director, that would require resources — financial and otherwise.
The actual benefits in the results section of the manuscript were very modest, albeit statistically significant. This needed attention in the news release. The release does not use any numbers to give us a firm grasp on benefits for the study group. The release claims study participants had “significant reductions in stress hormones,” but does tell us the significance. Here is an excerpt that tantalizes but disappoints:
“The study tested 193 members of five different choirs. Results showed that singing for an hour was associated with significant reductions in stress hormones, such as cortisol, and increases in quantities of cytokines — proteins of the immune system — which can boost the body’s ability to fight serious illness.”
We wish this paragraph — explaining how samples were taken — had included some numbers for at least one of what it calls the “changes:”
“Choir members gave samples of their saliva before an hour of singing, and then again just after. The samples were analysed to see what changes occurred in a number of hormones, immune proteins, neuropeptides and receptors.”
We’d also like to see the findings put into context. Since these biomarkers have been studied for many years by others, it would be appropriate to explain how the research community agrees on the significance of a change. What level of cortisol change, for example, is considered “significant?”
The release does not mention harms but it’s very unlikely there’s any harm in this activity.
This research may show some statistically significant evidence, but the release does not give us enough information to determine that. There is very little detail about the conduct of the study and no numbers are provided for the benefits.
We are also disappointed that the release uses the total number of study subjects, 193, but doesn’t specify that there were only 55 actual cancer patients, according to the published study. The others (the vast majority) were caregivers or “bereaved” caregivers.
There is no disease mongering.
The release notes that the non-profit Tenovus conducted the research, in collaboration with The Centre for Performance Science, which is a new partnership of the Royal College of Music and Imperial College London.
Many studies have given cancer patients access to meditation, massage and other forms of stress-reduction in order to influence their immune systems. Choir singing should be compared to those existing results to show us — does it lower cortisol as much as meditation, for example? This comparison would have helped make the release much better.
Patients who do not already belong to a choir or sing regularly may in fact benefit more from other types of interventions to improve emotional well-being.
We think choir-singing is widely available. The news release provides a link to 17 Tenovus Cancer Care centers that offer group singing in England and Wales. However, it’s worth noting that most people do not have access to choirs that are meant to support people in cancer treatment and their caregivers.
The release does not clearly explain whether this is the first study ever to measure stress hormones in the blood of singers before and after singing. The release makes the findings appear more novel than they are. As we’ve said above, there are hundreds of research articles about the impact of stress-reduction techniques of all sorts on people, including cancer patients. This territory is not new.
Music therapy is widely available in many cancer centers across the country, as well as pet therapy and art therapy. All of these modalities are aimed at easing stress.
We think the release skated very close but escaped using unjustifiable language. It is important not to overstate findings and raise unrealistic hopes. We thought this sentence with the reference to “possibility” helped keep the study in perspective:
“The research raises the possibility that singing in choir rehearsals could help to put people in the best possible position to receive treatment, maintain remission and support cancer patients.”
We agree it raises a possibility, but it is equally possible that the hypothesis is not true.