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Review Article |

Effects of Creative Arts Therapies on Psychological Symptoms and Quality of Life in Patients With Cancer

Timothy W. Puetz, PhD, MPH; Christopher A. Morley, MPH; Matthew P. Herring, PhD
JAMA Intern Med. 2013;173(11):960-969. doi:10.1001/jamainternmed.2013.836.
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Importance Creative arts therapies (CATs) can reduce anxiety, depression, pain, and fatigue and increase quality of life (QOL) in patients with cancer. However, no systematic review of randomized clinical trials (RCTs) examining the effects of CAT on psychological symptoms among cancer patients has been conducted.

Objectives To estimate the effect of CAT on psychological symptoms and QOL in cancer patients during treatment and follow-up and to determine whether the effect varied according to patient, intervention, and design characteristics.

Evidence Review We searched ERIC, Google Scholar, MEDLINE, PsycInfo, PubMed, and Web of Science from database inception to January 2012. Studies included RCTs in which cancer patients were randomized to a CAT or control condition and anxiety, depression, pain, fatigue and/or QOL were measured pre- and post-intervention. Twenty-seven studies involving 1576 patients were included. We extracted data on effect sizes, moderators, and study quality. Hedges d effect sizes were computed, and random-effects models were used to estimate sampling error and population variance.

Findings During treatment, CAT significantly reduced anxiety (Δ = 0.28 [95% CI, 0.11-0.44]), depression (Δ = 0.23 [0.05-0.40]), and pain (Δ = 0.54 [0.33-0.75]) and increased QOL (Δ = 0.50 [0.25-0.74]). Pain was significantly reduced during follow-up (Δ = 0.59 [95% CI, 0.42-0.77]). Anxiety reductions were strongest for studies in which (1) a non-CAT therapist administered the intervention compared with studies that used a creative arts therapist and (2) a waiting-list or usual-care comparison was used. Pain reductions were largest during inpatient treatment and for homogeneous cancer groups in outpatient settings; significantly smaller reductions occurred in heterogeneous groups in outpatient settings.

Conclusions and Relevance Exposure to CAT can improve anxiety, depression, and pain symptoms and QOL among cancer patients, but this effect is reduced during follow-up.

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Figures

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Figure 1. Flowchart of study selection. CAT indicates creative arts therapies; k, number of effects; QOL, quality of life; and RCT, randomized clinical trial.

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Figure 2. Forest plots of the unweighted distribution of Hedges d effect sizes (95% confidence intervals) for studies assessing anxiety (A) and depression (B).

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Figure 3. Forest plots of the unweighted distribution of Hedges d effect sizes (95% confidence intervals) for studies assessing pain (A) and fatigue (B). NA indicates not applicable.

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Figure 4. Interaction of cancer group (homogeneous vs heterogeneous) and intervention setting. Error bars indicate standard error.

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Figure 5. Forest plot of the unweighted distribution of Hedges d effect sizes (95% confidence intervals) for studies related to quality of life.

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Figure 6. Mean delta effect size for posttreatment and follow-up assessments across psychological symptoms and quality of life. * P < .05.

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