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

ecancer 10 631 / DOI: 10.3332/ecancer.2016.631


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

Daisy Fancourt1, 2, 3, Aaron Williamon1, 2, Livia A Carvalho3, Andrew Steptoe3, Rosie Dow4 and Ian Lewis4

1Centre for Performance Science, Royal College of Music, London SW7 2BS, UK

2Faculty of Medicine, Imperial College, London SW7 2AZ, UK

3Psychobiology Group, Department of Epidemiology and Public Health, UCL, London WC1E 6BT, UK

4Tenovus Cancer Care, Gleider House, Ty-Glas Rd, Cardiff CF14 5BD, Wales, UK

Correspondence to: Daisy Fancourt. Email:


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.

Keywords: singing, cancer, cortisol, oxytocin, cytokine, beta-endorphin, inflammation, stress, mood, music

Copyright: © the authors; licensee ecancermedicalscience. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Published: 05/04/2016; Received: 18/12/2015



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Keywords: singing, cancer, cortisol, oxytocin, cytokine, beta-endorphin, inflammation, stress, mood, music