Many patients with cancer report using at least one complementary and alternative medicine (CAM) therapy. Various CAM therapies appear to improve the psychological symptoms that are commonly linked to cancer and its treatment, including disease-related fatigue, pain, and symptoms of anxiety and depression.
Creative arts therapies (CATs)—which include drama therapy, writing therapy, music therapy, dance and movement therapy, and various forms of art therapy—have received less attention than other CAM therapies. Current clinical research on CATs has expanded from largely observational science to a wider, cross-disciplinary approach. Previous reviews have suggested that CATs may be useful adjuvant therapies to improve cancer- and treatment-related symptoms during and after treatment. To date, however, there has been no systematic review of randomized clinical trials (RCTs) examining the effects of CAT on psychological symptoms among cancer patients.
A Comprehensive Review
In JAMA Internal Medicine, my colleagues and I had a systematic review and meta-analysis published that used results from RCTs to evaluate the effect of CAT exposure on psychological symptoms and quality of life (QOL) in patients with cancer. In our review, we included 27 RCTs that involved more than 1,500 study participants. Our findings showed that CATs significantly reduced anxiety, depression, and pain and increased QOL after treatment. Pain appeared to remain significantly lower for patients using CAT when assessed at follow-up. Exposure to CAT did not appear to significantly reduce symptoms of fatigue after treatment or during follow-up, but these data are more difficult to interpret because the effects may be modality dependent.
More specifically, reductions in anxiety were strongest in RCTs that had a non-CAT therapist administer the intervention as opposed to those using a creative arts therapist. Reductions in anxiety were also strongest in studies using a waiting-list or usual-care comparison. For pain, the largest reductions were seen when CAT interventions were provided during inpatient treatment and for homogeneous cancer groups (eg, all breast cancer patients) in outpatient settings. Significantly smaller pain reductions occurred in heterogeneous groups (eg, breast and prostate cancer patients) in outpatient settings.
More to Come
As clinicians continue to take a more holistic approach to treating patients with cancer, it’s important to conduct more research on CATs and the potential beneficial effects the different CAT modalities may have on this patient population. We need more well- designed RCTs to address the methodological heterogeneity found within this field of research in order to improve conventional disease management.
Clinicians should recognize that their beliefs can factor into the likelihood of patients using CATs. Patients don’t necessarily need their providers to believe in the philosophy of CAM and CAT but do want their approval and the assurance that their choices are reasonable and safe. Materials to explain CAM and CAT should focus on the positive and preventive effects of these interventions
Readings & Resources (click to view)
Puetz TW, Morley CA, Herring MP. Effects of creative arts therapies on psychological symptoms and quality of life in patients with cancer. JAMA Intern Med. 2013 May 13 [Epub ahead of print]. Available at: http://archinte.jamanetwork.com/article.aspx?articleid=1687521.
Anderson JG, Taylor AG. Use of complementary therapies for cancer symptom management: results of the 2007 National Health Interview Survey. J Altern Complement Med. 2012;18:235-241.
Thyme KE, Sundin EC, Wiberg B, et al. Individual brief art therapy can be helpful for women with breast cancer: a randomized controlled clinical study. Palliat Support Care. 2009;7:87-95.
Wood MJM, Molassiotis A, Payne S. What research evidence is there for the use of art therapy in the management of symptoms in adults with cancer? A systematic review. Psychooncology. 2011;20:135-145.