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.

The findings come from a qualitative analysis of 26 original songs written by adult cancer survivors during the Music Therapy Versus Cognitive Behavioral Therapy for Cancer-related Anxiety, or MELODY, trial. The study, led by Sarah Biedka, a PhD candidate in Drexel’s Music, Creativity and Wellness Lab, examined the lyrics, recordings and songwriting materials produced during music therapy sessions. Published in the Journal of Cancer Survivorship, the research found that participants used music to express concerns extending well beyond anxiety symptoms, including disrupted identities, strained relationships, difficulty prioritizing self-care and the search for meaning after cancer.

The songs were created as part of a larger clinical trial involving 300 cancer survivors experiencing anxiety. Participants received one of two telehealth interventions: cognitive behavioral therapy, widely regarded as the standard psychological treatment for anxiety, or music therapy delivered by credentialed music therapists. In the music therapy sessions, participants engaged in structured musical activities and wrote songs collaboratively with a therapist. The MELODY trial reported that music therapy helped reduce cancer-related anxiety, while the new analysis explored what participants were actually trying to process through their creative work.

According to the researchers, songwriting revealed a network of challenges that conventional symptom-based assessments can miss. Several participants described a conflict between responding to their own needs and maintaining stability in their relationships. After cancer, survivors may need rest, emotional support, new boundaries or changes in family roles, yet they may hesitate to ask for these things because they fear burdening loved ones. The resulting tension can produce isolation and resentment. In some songs, participants portrayed themselves as choosing the comfort of the existing relationship over their own recovery, even when that choice left important needs unaddressed.

Music may be particularly useful for exploring these conflicts because it combines verbal and nonverbal forms of communication. A lyric can state a fear directly, while melody, rhythm, harmony and vocal delivery can convey uncertainty, anger, grief or hope that may be difficult to describe in ordinary conversation. The researchers analyzed not only the written lyrics but also song recordings, brainstorming notes and notes from meetings between participants and therapists. This broader approach helped them interpret metaphors and musical decisions within the context of each survivor’s experience rather than treating the words as isolated text.

The structure of a song can also function as a psychological organizing system. Participants may place related thoughts in a verse, return repeatedly to a central concern in the chorus or introduce a contradiction through a bridge. In therapeutic terms, that structure can make conflicting experiences visible without forcing a person to choose one interpretation. A survivor can feel grateful to be alive and angry about what cancer has taken away; hopeful about the future and frightened by medical uncertainty; deeply connected to family and simultaneously lonely. By arranging these experiences into a coherent musical form, songwriting may help participants recognize patterns in their emotional lives.

The process also appeared to strengthen agency and identity. Participants reported feelings of accomplishment, pride and satisfaction after completing their songs. Creating a finished work gave them ownership over an experience that had often made them feel controlled by medical procedures, treatment schedules and unpredictable symptoms. Some described feeling seen and heard through collaborative songwriting. The researchers suggest that this response may be important because cancer can disrupt a person’s sense of identity, shifting attention from professional, family or creative roles toward the status of “patient.” Making an original song can provide a concrete way to reclaim authorship of one’s story.

Sharing the songs created another route for difficult communication. Survivors who might avoid a direct conversation with a partner, friend or family member could use the song as an emotional intermediary. Instead of explaining every feeling in real time, they could present a finished piece that communicated several layers of experience at once. The researchers noted that this may be especially relevant for people who fear being misunderstood, rejected or perceived as a burden. Music does not eliminate the need for conversation, but it can create a safer starting point for conversations that might otherwise never happen.

A related qualitative study led by Drexel professor Joke Bradt, published in the European Journal of Integrative Medicine, found that participants viewed music therapy as useful not only for managing moments of acute anxiety but also for engaging with the personal, relational and societal experiences that shaped their distress. Interviews indicated that participants valued music-based strategies they could carry into everyday life, including techniques applicable in different settings. Together, the studies suggest that anxiety during survivorship may not be merely an episodic symptom to suppress. It may also be a signal connected to unresolved grief, altered relationships, changing priorities and existential questions about the future.

The researchers emphasize that music therapy is not being presented as a replacement for cognitive behavioral therapy or other established mental health care. Cognitive behavioral therapy remains a first-line treatment for anxiety management, and further studies are needed to determine how music therapy can be implemented, for whom it works best and whether it offers economic advantages. Nevertheless, the MELODY findings point to a potentially powerful addition to comprehensive cancer survivorship care. By helping survivors reduce anxiety while also examining the experiences beneath it, songwriting may turn private distress into something recognizable, shareable and actionable. The team hopes the work will encourage healthcare providers and decision-makers to treat creative therapies as legitimate components of long-term cancer care rather than optional extras.

Subject of Research: Music therapy, songwriting and mental health challenges among adult cancer survivors.

Article Title: “This is my voice; this is my story”: a thematic analysis of needs and challenges expressed in songs by adult cancer survivors.

News Publication Date: 7-Jul-2026.

Web References: https://link.springer.com/article/10.1007/s11764-026-02071-9#Abs1; https://www.mskcc.org/cancer-care/clinical-trials/21-516; https://www.sciencedirect.com/science/article/pii/S1876382026001034?via%3Dihub

References: Journal of Cancer Survivorship, DOI: 10.1007/s11764-026-02071-9; European Journal of Integrative Medicine; Journal of Clinical Oncology, DOI: 10.1200/JCO-25-00726.

Keywords: Cancer survivorship, music therapy, songwriting, anxiety, mental health, cognitive behavioral therapy, psychotherapy, oncology, creativity, cancer patients.