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Music as a Living Legacy: Song-writing in oncology

musicandcreativetherapyby SarahRose Black, MMT, MTA


“Music is what life sounds like.” – Eric Olson

When I first introduce the idea of song-writing to patients and their families, the most common response I receive is “I don’t know how to write music”. I am always delighted when patients exceed their own expectations and create a remarkable living legacy.

As a music therapist, I use multiple musical modalities to support people as they navigate their cancer experiences. These modalities include improvisation, active listening, guided meditation through music, and song-writing. It always amazes me when people who initially hesitate to engage in a song-writing process end up creating a meaningful piece of art that ultimately speaks to their own experience. A personalized song can be used to help people deepen their understanding of their journey, and can function as a representation of a particular time within that journey. When someone writes a song that reflects something deeply personal and meaningful, it is often shared with loved ones and can act as a legacy piece, a narrative that will forever represent that which is significant at a particular time.

Who writes the songs?

The songs are written by patients at the hospital where I work, family members, and/or staff members in collaboration with myself, the music therapist. Patients have written songs at various stages of their disease, at various points in their lives. I also run group workshops for staff in which a particular team, nursing unit or department will get together and I will lead them through a song-writing exercise. On occasion, a family member will want to write a song with me at the hospital to express themselves to their loved one.

What are the songs about?

Songs have been written on a wide range of topics, including a person’s love for their family, the need to be forgiven, the need to forgive, the need to say I’m sorry or I love you or I will miss you, as well as songs of gratitude, thankfulness and joyfulness. One person whom I worked with wrote a humorous song about the incessant beeping of his intravenous infusion pump, and how annoying he found the perpetual beeping to be.  Staff have collectively written songs with their colleagues about how much they value their work, how intense they find their experiences in oncology care, and how grateful they are to be able to learn from those with whom they work.

What does song-writing look like?

Depending on one’s own personal experience with music, song-writing can take many different shapes. Most people I work with have never written a song, so I guide them through a four-step process which can take anywhere from half an hour to several days, depending on that person’s energy levels and length of stay in the hospital. The four steps follow a trajectory that includes a) choosing a topic, b) choosing a mood, c) organizing the lyrics, if applicable, and d) recording the song. These four steps vary greatly depending on the intent of the song. Some people choose not to use words, others choose to put original words to a pre-existing melody, such as “Hey Jude” by the Beatles, or a folk song. Here is an example of a person I have worked with (a pseudonym is used), who put her own distinct mark on these four steps. She had no prior experience with song writing.


Barbara was a 48 year old woman who was admitted to one of our hospital units for pain and symptom management. After several music therapy sessions which focused on improvisation and creative self-expression through drumming and singing, she told me she really wanted to finish a letter she was writing to her three children. Although she was almost finished with the content of the letter, she felt something was missing. I gently suggested that she consider putting music to the words, thus creating a song. She laughed and said, “Oh I don’t think I could ever do something like that”. I told Barbara that I would support her and help her along the way, and that it was totally possible for her to write a song within the next 24 hours. So we chose the topic- her children, and how much they mean to her. Next, we chose the mood. “What do you want to feel when you listen to this song?” I asked Barbara. “Warm”, she responded. “Warm, hopeful, kind of wistful but always with an undertone of hope”.  I tried a few chord progressions, asking for Barbara’s opinion after each one. “There, that one!” she exclaimed when I played a progression based in A major. “That’s the one”.  With Barbara’s permission, I took the letter she had written and spent time searching for the theme within the letter, which ultimately ended up as “be together, stay together”. I used these words to form the chorus, and used her other sentences as verses. I brought back the lyrics the following day, and together we experimented with a melody. I sang the words to the chorus multiple times using different melodic patterns until she found a melody she liked. Once we established the melody, I used my small recording device to record the song. Barbara insisted she did not want to be recorded, so asked me to sing and play. Once we recorded it, I uploaded it to my computer and burned several copies, one for each of her children and one for her to keep.

The people whom I work with in the hospital have told me that they like the idea of using their time as an inpatient to create something for their family and friends. The finished product can provide a sense of comfort in knowing that loved ones can have a personalized recording that goes beyond words.

Songs as representation

The songs that people write are a physical and emotional manifestation of their experiences, and once written, these songs can be looked at from various angles. What are the lyrics saying? What might be the subtext behind the lyrics? Who are the lyrics addressing? What kind of mood does the song create? How does it feel to listen to the song? The song-writers often tell me that they feel a deep sense of catharsis as a result of manifesting their emotions and their experiences through song.

How can song-writing techniques be used in everyday life?

While the full song-writing process is often easier to complete with the support of a music therapist or another song-writer, there are several techniques that can be used on one’s own.

–          Try writing a letter to a loved one, a close friend, a companion. When the letter is complete, look back at the words and notice if any particular themes pop up. Are any words re-used multiple times? Are any sentiments repeated?

–          Try putting original words to a pre-composed song. For example, some people choose a familiar folk song and either re-write the lyrics completely to represent their own experience or use a “fill-in-the-blank” method. For instance, the folk song You Are My Sunshine could be changed to You Are My Best Friend, or You Are My True Love.

–          Let go of self-criticism; songs we write or take part in creating do not have to sound like songs we hear on the radio. They do not have to sound like anything in particular. They just have to reflect our experiences at any given time.


Song-writing can be a wonderful way of connecting to your own experience, or to someone else’s experience. The process can serve as a cathartic and healing journey that can support and sustain life’s most wonderful and most difficult moments, and all that lies in between.



SarahRoseBlackCentredSarahRose holds a Masters degree in music education from the University of Toronto, and a Masters degree in music therapy at Wilfrid Laurier University. She is the founder and coordinator of the first music therapy programs at the Princess Margaret Cancer Centre and Kensington Hospice in Toronto. Her clinical work and research is focused mainly on quality of life for acute palliative care, hematology, and hospice populations. She is also a Suzuki music educator, piano accompanist and singer / songwriter.




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One Response to Music as a Living Legacy: Song-writing in oncology

  1. What a wonderful idea, and a real gift to recipients of SaraRose’s generosity.

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