Sing-a-Lung 2.0: protocol for a multicentre randomised controlled trial to investigate the effects and mechanisms of online-delivered singing training versus usual care 6–18 months after surgical resection for non-small cell lung cancer (NSCLC)

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Introduction Patients who have undergone curative surgery for non-small cell lung cancer (NSCLC) often experience long-term reduced quality of life (QoL), high symptom burden, risk of physical deconditioning and comorbidity. Current Danish rehabilitation offers are heterogeneous and not specifically tailored to the disease-specific needs and no long-term targeted support is currently available. Previously, singing—delivered as a structured training modality—has conferred both physiological and psychological improvements in chronic obstructive pulmonary disease, which may likely be transferable to NSCLC, as the two conditions share overlapping symptoms and characteristics. We aim to explore whether a singing-based intervention improves physical function, QoL and symptom burden 6–18 months postsurgery in NSCLC. Moreover, we aim to explore the underpinning physiological mechanisms of singing. Methods and analysis We will conduct a multicentre randomised controlled trial, comparing 10 weeks’ online-delivered structured singing training to usual care. Trial outcomes include primary outcome, physical capacity (measure: Six-Minute Walking Test), and secondary outcomes, QoL and symptoms (measures: St. George’s Respiratory Questionnaire (SGRQ); the European Organisation for Research and Treatment of Cancer Questionnaire (QLQ-C30; QLQ-LC13); Hospital Anxiety and Depression Scale (HADS) and airway physiology (measure: forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC)). Explorative outcomes include aerobic fitness/maximal oxygen uptake (VO 2 -max); exercise-induced adaptations; respiratory muscle strength and control; inflammatory biomarkers. Analysis: Descriptive statistics, stratified analyses, regression models and association and independence between objective and subjective outcomes. Ethics and dissemination The trial was approved by the Committee on Health Research Ethics (SJ-1027) and the Danish Act on Processing of Personal Data (p-2024-19634). Results will be reported in peer-reviewed scientific journals. Trial registration number NCT07460999 .

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