A cancer diagnosis can be terrifying and devastating one for anyone—and for singers, there are important aspects to consider.
“You have cancer.” I had almost completed my undergraduate voice degree when I was given that terrible diagnosis: testicular cancer with metastases in my liver, lymph nodes, and left lung. As I stared directly down the barrel of chemotherapy, I sought advice from my network of colleagues about protecting my vocal health. I discovered that one of my vocal heroes, Gregory Kunde, had defeated my disease; I immediately sent a Facebook message asking for his advice. He responded within minutes with an incredible message that gave me hope that I would survive to sing again.
I interviewed three great singers: soprano Capucine Chiaudani (breast cancer), tenor Gregory Kunde (testicular cancer), and mezzo-soprano Clara O’Brien (Hodgkin’s Lymphoma). Each of these incredible artists battled cancer at the peak of their careers and continued singing post cancer to great acclaim! They have generously shared their experiences with me in hopes that together we could help others who are battling this terrible disease with advice and encouragement. It is the hope of this article to bring awareness and alleviate fear for current and future cancer survivors and give them courage to sing again.
Disclaimer: Despite our combined first-hand experience, we are not licensed medical professionals. Please utilize any of the following advice in consultation with your medical team.
Know Your Disease
Your medical team will be incredibly knowledgeable about your disease; however, the vocal implications of your disease and treatment will not be their primary concern. Many doctors are simply incognizant of the needs of our instrument. Inform your doctors that you’re a singer and need to protect your voice as much as possible. For surgical interventions requiring intubation, inform your surgical team that you’re a singer and request a child’s tube. This will ensure minimum interference with your vocal folds, recommends Kunde.
During the initial weeks of your diagnosis, you will receive a library of information, many of these terms likely being new to you. Never attend any meetings with your doctor alone, always bring someone to help you take notes. This becomes critical as you progress through your treatments because the fog of “chemo brain” will also intensify. After your initial diagnosis shock has waned, research all aspects of your disease so you will be able to make truly informed decisions about your health care. Ask your singing network for advice; I honestly believe it saved my life and my voice.
Chiaudani: It was written in the manual that my voice would be affected. My doctors had no experience with opera singers. They said, “We’re very sorry; you’re an exceptional case for us.” It took a long time to find my voice again; it took enormous patience, enormous faith.
Kunde: The initial shock of cancer diagnosis is so bad; I always recommend people come and help record what the doctor says. If you’re taking chemotherapy and the drug doesn’t agree with you, there are more drugs! Don’t just stay with the one you have. If it’s not doing anything, get another one.
O’Brien: Make yourself part of the process. Educate yourself as much as you can about your disease, about your treatment. I think that not being a part of it, saying, “I’ll let the doctor do what he thinks he needs to do,” breeds fear and uncertainty. Be as clear as you can going in about what’s going to happen. Of course, we don’t know everything, but doing research helps to rid so much conflated dread and uncertainty.
Sing during Treatment?
We know that cancer treatment can cause a host of vocal issues. Chemotherapy’s various side effects include nerve damage, hearing loss, lung damage, digestive issues, inflammation of the mouth, inflammation of the esophagus, alterations in blood quality, kidney damage, liver damage, and hormonal alterations, which may affect length and thickness of vocal folds. The vocal implications of these side effects can be aggravated by extended voice use. I recommend refraining from singing while actively undergoing cancer treatment.
Cancer treatment regimens have days and weeks scheduled between cycles. During that off-time, you may begin to feel “back to normal.” Be advised that chemotherapy, hormone therapy, and anti-hormone therapy will still be in your system, causing vulnerability of the vocal fold mucosa and putting you at risk of damage. When considering singing during cancer treatment, please consult with your oncologist.
To protect your voice during treatment, you can employ these common vocal hygiene protocols: consume plenty of fluids, avoid alcohol, avoid smoking, avoid loud spaces, and limit overall voice use. Avoid caffeinated beverages and carbonated beverages. Cancer treatment disturbs the body’s pH balance; carbonated beverages will exacerbate that disturbance.
Chiaudani: Did I sing during treatment? No, no, no! It takes time to recuperate your energy and sing again.
Kunde: Don’t sing; you have to take time off. When you’re done with all your treatments, your voice is going to be fresh! You might have vocal issues if you sing during chemo. Don’t do it. My first oncologist said I could continue singing. Then another oncologist said, “No! I don’t want you to make a sound. We’re killing all the cells around your vocal folds. We’re killing all the blood cells in your body and making new ones. If you talk too much or sing, you’re going to burst your blood vessels.” So, I didn’t sing a note for four months. After I finished chemo, the doctor looked at my vocal folds and said, “My God, like a baby! They’re pure as silk.”
O’Brien: I could not sing. It had less to do with my voice itself and more to do with the condition of my body, which was very weakened. I had debilitating fatigue. And my esophagus was pretty inflamed from the treatment. I had a lot of trouble swallowing. I am sure that contributed to the fatigue and a general feeling of unwellness, so I wouldn’t have had the energy to perform.
Clara O’Brien
Singing after Cancer
“You’re in remission.” The three most exhilarating words of your cancer journey! Depending upon your disease and treatment, you may experience various post-cancer vocal issues. Some side effects of cancer and its treatment are permanent; however, you can sing around them—that is part of the journey.
Post-cancer vocal habilitation must be slow and steady. Begin with easy vocalises, small scales, and semi-occluded exercises. Avoid jumping back into your most difficult repertoire and sing easier pieces with limited range. There is no set time for post-cancer vocal habilitation; it varies person to person. Just remember that you are a cancer survivor. You have beaten the odds and won the fight against a potentially deadly disease—you can do anything!
Gregory Kundel
Chiaudani: After my experience, I believe that you can rehabilitate virtually any voice. I had to relearn singing. It took time to recuperate my energy. I began with glissandos and sirens. At the beginning I had no control. Even vocal fold adduction was difficult. I had truly lost everything and I had to really work to bring my voice back to habilitation. It’s possible if you’re strongly motivated. Wonders are possible when you have a strong will. However, there must be effort behind that.
Kunde: The round of stronger chemo gave me tinnitus, background noise. Everything was just so loud and overwhelming. I thought, “my goodness, how can I do this with the orchestra?” You adjust, that’s how you survive. At the beginning, my post-cancer goal was to not stretch the voice too much—taking it easy, not worrying about high notes, just feeling healthy again. It took one year before I was back to normal. So, don’t overdo it. If you feel tired, sit down. This can be the advantage if you tell people.
O’Brien: Mostly, I had to get my body back in shape because I was so weakened. I did a lot of walking and hiking too. Cardio exercise and feeling the expansion in the lungs. That’s where I spent a lot of time. And there’s the lack of stamina from not having sung regularly. You must build your stamina back up. I used five-note scales—not too high, just trying to feel the resonance, get the folds together. Easy intervals, arpeggios, octaves. All depending on how things would feel. The next step was trying to stretch those scales, keeping the resonance even. Some semi-occluded work to keep that expansion there just to help stretch the folds.
Capucini Chiaudani
Epilogue: Newfound Wisdom and Purpose
Chiaudani: People said to me, “You’re so brave, so courageous!” No, I did what I had to do. In that, you become courageous. Anyone who goes through cancer will discover that courage within themselves; it’s our only choice. I never fell into doubt; it was critical to my survival. You must believe that you will make it; that is how you will survive. We are the manifestation of our thoughts; I believe that positive thoughts helped my survival.
I’ve always had a natural voice; it was always easy. I had lost that ease after cancer. To find it again, I had to analyze every movement within my body during singing. In rebuilding my voice, I found a new consciousness and awareness, which allowed me to become a teacher who can help others. After cancer, I received this new, unexpected calling! You are more than your voice; we all have multiple gifts. If you don’t return to the stage and your life direction changes, that is OK! We are made of so much more than our voices. Never forget this.
Kunde: It just changes your whole outlook. You see what’s important in your life. And that’s being alive…and anything that came along was like “I can handle this; I went through cancer.” So, it does change your life. And you’re thankful for every day…you kneel and thank God for being alive.
O’Brien: You don’t view life the same way after you have an experience like this. I don’t think I was ever a kind of “pie in the sky” type of person, and yet you don’t expect this kind of thing to happen. It gave me a realistic way to think. I have always been a perfectionist; I call myself a recovering perfectionist now.
Even when things go desperately wrong and horrible things happen, you can still do what you need to do—and that surprised me about myself, my own resilience. I felt stronger about it than I thought I would and I just took it on as a challenge. I didn’t look back or consider the possibility that I wasn’t going to survive. It gave me a lot of courage and changed my outlook on life in general.
I will always be grateful for the wisdom that cancer has given me. I wake up every day thankful to be alive. I am a better singer, a better teacher, a better person. This is the most important thing that I learned: live life fully and sing with all your heart; do this and your voice will certainly be beautiful. Nothing will ever take your artistry away. Every note that you sing will be a rebellion against cancer and a shimmer of hope for others.
