Songs of adult cancer survivors reveal their needs and challenges

When words prove too heavy or too tangled to say aloud, melody can carry them instead. A new analysis of songs written by adults living through cancer’s aftermath suggests that the lyrics people compose in music therapy sessions function as a remarkably candid map of their unmet needs—from the desperate wish to feel “seen” by family members who underestimate their anxiety, to the struggle to set boundaries after a lifetime of putting others first, to the search for a renewed sense of self in the wake of illness. The study, published in the Journal of Cancer Survivorship, is the first to systematically examine the thematic content of songs written by cancer survivors who have completed primary treatment, and it offers oncology care teams an unconventional but intimate window into the psychosocial burdens that persist long after chemotherapy ends.

The research emerged from a larger randomized controlled trial, known as the MELODY trial, that enrolled 300 adult cancer survivors and compared telehealth-delivered music therapy with telehealth-delivered cognitive behavioral therapy—the first-line psychological treatment for anxiety—for the management of cancer-related anxiety. Participants were eligible only if they were free of oncological disease, had not received primary cancer treatment for at least one month, and had experienced anxiety symptoms for at least one month, as measured by a score of eight or higher on the anxiety subscale of the Hospital Anxiety and Depression Scale. The trial was approved by the Memorial Sloan Kettering Cancer Center Institutional Review Board, and participants were enrolled between February 2022 and December 2023.

Within the music therapy arm of the trial, 147 participants met individually with board-certified music therapists for seven sessions of sixty minutes each, delivered over video connections. The therapeutic arc was deliberately structured. Early sessions relied on receptive music experiences—listening to personally meaningful songs and discussing them—to build rapport and open emotional territory. As the sessions progressed, therapists introduced more active experiences such as improvisation, deepening the emotional exploration and helping participants refine ideas for their own compositions. These explorations culminated in the writing and recording of an original song, typically spread across two to three sessions.

The songwriting process itself followed five broad phases: reviewing emotions and thoughts expressed in prior sessions; brainstorming song ideas from that review; collaborating to select, expand, and arrange ideas into lyrics while identifying important song elements such as emphasis on particular words or musical style; experimenting with melody, chord progressions, and accompaniment while refining lyrics; and finally recording or sharing the completed song. Participants and therapists worked with acoustic and electronic instruments, handwritten notation, and composition software including GarageBand and Soundtrap. All but one of the participants whose songs were analyzed created entirely original music and lyrics, with varying degrees of independence—some refined their tracks between sessions on their own, while others relied more heavily on their therapist to offer choices during sessions. Crucially, therapists were trained to write songs “with” rather than “for” participants, calibrating the level of structure to each person’s therapeutic needs while maximizing creative ownership. To guard against therapists unduly shaping the content, the study team reviewed session videos as part of the trial’s treatment fidelity procedures and discussed songwriting processes in weekly meetings.

For the new analysis, researchers from Drexel University and Memorial Sloan Kettering Cancer Center reviewed all songs written through September 2023—eighty-two in total—and identified a subset of twenty-six songs that focused specifically on participants’ needs and challenges. Songs devoted exclusively to other topics, such as nostalgia, self-affirmation, or fatigue, were excluded. The research team treated the lyrics as its primary data but supplemented them with song recordings, brainstorming notes from therapy sessions, and brief synopses grounded in conversations with the music therapists who had witnessed each song’s creation. This contextual grounding was considered essential, since lyrics are dense with metaphor and deliberately encoded meaning. The team applied Braun and Clarke’s six-step reflexive thematic analysis, coding the material both semantically, for explicit content, and latently, for interpretive meaning, using MAXQDA software. A music therapist experienced in thematic analysis but uninvolved in the clinical sessions served as primary coder, with a graduate student in music therapy providing secondary coding on roughly thirty percent of the songs and a senior qualitative researcher supervising the work.

Four themes emerged from the analysis, and the researchers stress that together they reveal how coping with one challenge typically activated another, often with ripple effects on participants’ relationships. The first theme was the need to use time wisely. Confronted with their own mortality, many songwriters described time alive as a resource that should not be wasted, calling survivorship their “second chance.” One participant wrote, “I will do what I must do, to hold onto today/Through rain or sunshine, I’m staying present,” explaining that worry kept them from the present moment, particularly during family time. Others used the metaphor of listening to their bodies—attending to pain and fatigue as signals—to reallocate time away from energy-draining activities toward restorative ones like exercise, time outdoors, and connection with friends and family. Perhaps most poignantly, many participants described the conflict that arose when prioritizing their own needs required them to decenter others. One songwriter used birds as a metaphor for a new relational perspective: “Blue jays looking over me/Put yourself first, they say/Build a new nest/Make a safe landing.” For this person, insights gained in early therapy sessions led to reprioritizing their own well-being, which in turn required setting boundaries with an ex-spouse.

The second theme, personal influences on coping, captured how participants’ internal experiences shaped their responses to adversity. Songs invoked past difficulties, fear, and anxiety, often contrasting a longing for change with fear of the unknown. Some writers described resisting fear; others insisted on embracing it while clinging to hope. In a song titled “Stay Afloat,” one participant compared procedural anxiety to being submerged in water, with light—the view upon emerging from MRIs and surgeries—serving as a focal point for hope: “I’m afraid in the darkness/When will I thrive again? Will I ever thrive again?/The light guides me through…The light brings me comfort/To make it through the storms.” Others wrote of summoning courage against waves of panic attacks. “Negative thoughts wash over me/They can’t wash me away/The waves are always there/I can learn how to surf,” one participant composed, describing in sessions how the lyrics represented an inner resolve to reclaim life from daily panic. Several songs also asserted self-worth and self-confidence explicitly, frequently tying a sense of deserving support to a sense of deserving rest and self-care.

The third theme—the need to feel others’ support—was the most striking in its asymmetry. Although nearly every song touched on support, only a few participants described feeling genuinely supported, while many more disclosed profound loneliness, emptiness, and desperation. The disconnection arose from a painful gap between appearances and inner reality: others underestimated the severity of participants’ anxiety, believed faulty narratives that everyone fully recovers after primary treatment ends, or offered what the researchers call “toxic positivity”—the expectation that survivors should always maintain a cheerful, recovery-oriented attitude. The pressure to appear well only deepened the isolation. One participant pleaded in lyrics: “There’s a pain that lives within me/That you’ll never see, but I feel…How I wish you’d try to see/Hear me, understand me/If you really care, then show me/Don’t judge me, don’t make me feel unseen.” Another wrote, “I am lonely, hidden loneliness/OK on the outside, Blue on the inside/Where were you? Where are you? Do you see me?” These are not merely artistic expressions, the authors argue; they are explicit appeals to be seen, heard, and understood, articulated more openly than many survivors can manage in conversation. By contrast, the few songs that conveyed feeling supported—whether through steadfast loved ones or the memory of a deceased sister’s guitar pick kept in a pocket—suggested that even remembered support bolstered hope, strength, and confidence.

The fourth theme concerned existential needs: the search for meaning and purpose after cancer, the renegotiation of identity, and the difficult work of accepting permanent changes and uncontrollable symptoms. Participants frequently turned to metaphors of journeying and seeking to express these quests. Several wrote about finding or reclaiming their voice. One song contained the lines that gave the study its title: “This is my voice, this is my story/I honor my journey here/Who I am, as I am here.” Parents and mentors drew motivation from their relationships with children—a phenomenon the authors connect to prior research on biographical disruption, which holds that a cancer diagnosis profoundly interrupts a person’s sense of self and future, prompting a reexamination of values, identity, and relationships. Acceptance, several songs suggested, was a painful but essential ingredient in moving forward: some events and symptoms lie beyond one’s control, and symptoms may even carry crucial information about self-care needs.

Beyond cataloguing what survivors wrote, the study highlights why songwriting may be uniquely suited to this kind of expression. Metaphors—of battle, journey, freedom, and confinement—are well-established tools for communicating emotionally difficult topics, and composing original songs makes those metaphors personally potent in ways that listening to someone else’s music cannot replicate. Musical and lyrical structure acts as cognitive scaffolding: verses hold stories and details, choruses crystallize central emotions or insights, and the repetition and predictability of form help participants organize seemingly contradictory truths—such as constant worry about recurrence coexisting with confidence that one is loved. Elements of music itself, from rhythm to harmony, can be deployed to support or reshape meaning; one participant asked the therapist to place rhythmic emphasis on the words “I am me” in a song imploring others to “see” them, while another used harmonic structure to simulate the arc of a panic attack.

The findings carry practical weight for survivorship care. Under-communication of cancer-related concerns is associated with increased psychological distress, yet survivors tend to avoid emotionally challenging conversations. A finished song can make such communication tolerable for both speaker and listener, and sharing a song with family or clinicians may open dialogue that would otherwise remain closed. The authors caution that their participant group had limited racial and ethnic diversity and self-selected into an expressive-therapy trial, so further work is needed in more varied populations. Still, the message of the songs themselves is unambiguous: survivorship does not end when treatment does, and the need to be heard—softly, shakily, but authentically—persists long after the last infusion.