Creative Arts Therapies Improve QOL in Cancer Patients

Roxanne Nelson

May 14, 2013

Participating in creative arts therapies (CATs) appears to improve the quality of life of cancer patients, and reduce anxiety, depression, pain, and fatigue. However, the effect of these therapies is not long lasting, according to an analysis published online May 13 in JAMA Internal Medicine.

In a systematic review of 27 randomized clinical trials that evaluated the effect of CATs (music, art, dance, and expressive writing) on psychological outcomes, pooled estimates revealed that they significantly reduced anxiety, depression, and pain and improved quality of life in cancer patients. The effect was less pronounced for fatigue.

The researchers, led by Timothy W. Puetz, PhD, MPH, from the National Institutes of Health in Bethesda, Maryland, also found that these effects were greatly diminished at follow-up.

"Future well-designed [randomized clinical trials] are needed to address the methodological heterogeneity found within this field of research," Dr. Puetz and colleagues conclude.

In an accompanying invited commentary, a pair of experts note that although they "value and applaud the use of the arts and creative processes" across the continuum of therapies and patients, research on the effectiveness of these interventions requires clarity about the nature of the interventions themselves.

It is unfortunate that the current analysis offers no operational definition of CATs, write Joke Bradt, PhD, MT-BC, and Sheryl Goodill, PhD, BC-DMT, NCC, LPC, both from the Department of Creative Arts Therapies at Drexel University in Philadelphia, Pennsylvania. Instead, they note, the researchers use the term "creative arts therapies" as a generic term, referring to true CATs and to interventions that are administered by non-CAT healthcare professionals or artist volunteers.

"This limitation compromises the analysis at its foundation: the understanding of the independent variable in the included studies," they write.

However, despite this and other limitations, Drs. Bradt and Goodill emphasize that they are excited to see yet another systematic review that confirms the health benefits of arts interventions in cancer patients. "We hope that this rapidly expanding evidence will inspire cancer patients to include the arts and/or CATs in their treatment regimen so that their psychosocial well-being can be safeguarded during the challenging treatment and recovery period," they write.

Only Pain Reduced at Follow-up

Dr. Puetz and colleagues note that 40% of adults in the United States have reported using at least 1 complementary and alternative medicine (CAM) therapy. The prevalence of CAM use reported by cancer patients ranges considerably, from 18% to 91%. Various CAM therapies are reported to improve psychological symptoms frequently associated with cancer and its treatment, including cancer-related fatigue, pain, anxiety, and depression.

However, the researchers point out that the CATs have received less empirical examination than other types of CAM.

In this review, the researchers examined the effect of CATs on several psychological symptoms and on quality of life in cancer patients. From the 27 studies, 1576 patients met the inclusion criteria.

Although all symptoms except fatigue were significantly reduced after exposure to CATs, only pain was significantly reduced during the follow-up period. Reductions in anxiety were most pronounced in studies in which a non-CAT therapist administered the intervention, as opposed to those in which a creative arts therapist administered the intervention and those in which a waiting-list or usual-care comparison was used.

Reductions in pain were greatest during treatment that took place in the inpatient setting and for homogeneous cancer groups in outpatient settings. Reductions in pain were significantly smaller in heterogeneous groups in outpatient environments.

"This systematic review offers a unique look into the potential benefits of CAT that may guide further hypothesis-driven investigation into adjuvant treatments to improve conventional disease management," the researchers conclude.

The authors have disclosed no relevant financial relationships.

JAMA Intern Med. Published online May 13, 2013. Abstract, Commentary

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