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 andQOLin 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.
Weextracted 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 (= 0.28 [95% CI, 0.11-0.44]),
depression (=0.23 [0.05-0.40]), and pain (=0.54
[0.33-0.75]) and increased QOL (= 0.50 [0.25-
0.74]). Pain was significantly reduced during
follow-up (= 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 andQOL
among cancer patients, but this effect is reduced during
follow-up.