Purpose <p>Many cancer survivors experience long-term cancer-related psychosocial effects like anxiety, depression, and isolation, yet their ongoing needs for effective supportive care are frequently unmet. Songwriting during music therapy sessions can help cancer survivors process and communicate their thoughts and feelings about their needs and challenges. The purpose of this qualitative descriptive study was to analyze songs written by cancer survivors with elevated anxiety as part of their participation in a randomized controlled trial aimed at reducing anxiety.</p> Methods <p>We performed a reflexive thematic analysis of 26 songs to explore the needs and challenges cancer survivors expressed in them. We used clinical session information to supplement our interpretation of the song lyrics.</p> Results <p>Through our analysis, we generated four themes: (1) the need to use time wisely, (2) personal influences on coping, (3) the need to feel others’ support, and (4) existential needs. Connections between the themes and categories highlighted how coping with one challenge typically activated another, often impacting participants’ relationships.</p> Conclusions <p>Our results suggest that songwriting helped participants process and communicate a range of needs and challenges, including those regarding self-concept, relationships, and existential concerns. Better understanding and communicating these needs may enable participants to address challenges and meet their needs more effectively.</p> Implications for Cancer Survivors <p>Findings suggest that cancer survivors who are experiencing anxiety may find that songwriting with a music therapist helps them understand, work through, and share thoughts and feelings about their needs with others.</p>