AP9 – Singing for Lung Health

Mette Kaasgaard, PhD, MSc, classical singer and singing pedagogue

Link to english summary

Status oktober 2023
Patients with lung cancer are often left to themselves after treatment, they are often charaterised by impaired quality of life and high symptoms burden of is high, and many patients are socially and existentially vulnerable. However, there is a lack of targeted training offers that meet the challenges and needs of this group.

Lung choirs have become increasingly popular in most of the world and are perceived as a positive social activity with health-promoting benefits. In our previous project – Sing-a-Lung 1.0 -, we conducted an RCT comparing singing training – using the current best-practice approach for singing for people with respiratory conditions – Singing for Lung Health (SLH) – with standard physical exercise training (PExT) within 10 weeks’ community-based pulmonary rehabilitation. In total, 11 municipalities and 270 patients with COPD participated. The study  demonstrated that SLH improved both clinically relevant physiological and psychosocial aspects and was non-inferior to standard PExT. The main article was published in the ERJ with editorial (May Issue 2022), and in 2023, the project was awarded winner of ”Årets forskerinitierede forsøg” at the celebration of ”Årets bedste kliniske forsøg og afprøvninger 2023” (link: https://www.kliniskeforsoeg.dk/vinderne-kaares/).

Currently, I have started the specific projects and activities in my further research. Firstly, I have conducted a follow-up study – Sing-a-Lung 1.1 – within the RCT-cohort from my Ph.d. -project and am currently preparing manuscript for submission. Secondly, I have been preparing the next research project on singing as activity in rehabilitation for patients after surgical resection for non-small cell lung cancer (NSCLC) – Sing-a-Lung 2.0 -, including design and manuscript for the study protocol, fundraising, application for ethical approval, and building solid groups of researchers and collaborators around the project.

In Sing-a-Lung 2.0, we will include of both a randomised controlled trial (RCT) and a qualitative study. The project will be carried out across two Danish regions and we aim to include n=100 study participants. Again, we aim to compare SLH with standard PExT within a 10-weeks’ community-based rehabilitation programme. To evaluate the effect and significance of SLH  on physiological and psychosocial parameters, validated objective measurements such as walking test and lung function will be performed before and after the intervention. Furthermore, we will include subjective, validated, patient-reported questionnaires within quality of life, symptom burden, anxiety and depressive symptoms, and daily activity level. We expect singing to be non-inferior to the study comparator. To supplement, we plan to conduct a mechanistic study to gain greater insight into physiological changes during singing. In the qualitative study, we will explore patient perspectives in relation to singing and participating, focusing specifically on perceived relevance and meaning of singing, integration of breathing exercises, besides handling of symptoms, everyday life, and self-management. The study protocol has been accepted by the Ethical Committee, Zealand (VEK; SJ-1027).

However, under the preparation phase, we have had the lack of homogeneous, community-based rehabilitation offer confirmed, and, therefore, it is of high importance to conduct quality study in order to clarify setting, and content of the current offer. This pre-study will be carried out during Q4 of 2023 as a survey-based study among the last 300 patients who underwent surgical resection for NSCLC. After this study, we will be able to finally plan for design and setting of Sing-a-Lung 2.0, including definition and training protocol for the study comparator.