A pilot study of improved psychological distress with art therapy in patients with cancer undergoing chemotherapy

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Abstract

Background

Art therapy may improve the physical, mental, and emotional wellbeing of individuals for a variety of purposes. It remains understudied and underutilized in cancer care. We sought to determine the ability of a pilot art therapy program to improve the physical, mental, and emotional well-being of cancer patients.

Methods

Chemotherapy-recipients, age 18 years and older, diagnosed with any type or stage of cancer, were considered eligible to participate in this single arm, pilot study, using four visual analog scales (VAS) with visually-similar, 0–10 scale (10 being worst) thermometers assessing: 1) pain, 2) emotional distress, 3) depression, and 4) anxiety. Participants were asked to complete all 4 metrics, pre-treatment, post-treatment, and at 48–72 h follow-up, after an hour-long art therapy session. Primary endpoints included post-intervention changes from baseline in the 4 VAS metrics.

Results

Through a reasonable pilot sample ( n = 50), 44% had breast cancer, 22% gastrointestinal cancers, 18% hematological malignancies, and 20% had other malignancies. A decrease in all VAS measures was noted immediately post-treatment but remained low only for pain and depression, not for emotional distress and anxiety upon follow up. There was a significant difference between the depression VAS scores of Hispanics (32%) compared to non-Hispanics (56%) ( p = 0.009) at baseline. However, compared to non-Hispanics, Hispanics exhibited higher levels of depression after art therapy ( P = 0.03) and during the follow-up intervals ( p = 0.047).

Conclusion

Art therapy improved the emotional distress, depression, anxiety and pain among all cancer patients, at all time points. While depression scores were higher pre-intervention for Hispanic patients, Hispanic patients were noted to derive a greater improvement in depression scores from art therapy over time, compared to non-Hispanics patients. Discovering simple, effective, therapeutic interventions, to aid in distress relief in cancer patients, is important for ensuring clinical efficacy of treatment and improved quality of life.

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Most cited references 44

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Associations of social networks with cancer mortality: a meta-analysis.

Martin Pinquart, Paul Duberstein (2010)

This meta-analysis integrates results of 87 studies on the associations of perceived social support, network size, and marital status with cancer survival. In controlled studies, having high levels of perceived social support, larger social network, and being married were associated with decreases in relative risk for mortality of 25%, 20%, and 12%, respectively. Moderator analyses revealed that never married patients had higher mortality rates than widowed and divorced/separated patients. Associations of social network with mortality were stronger in younger patients, and associations of marital status with mortality were stronger in studies with shorter time intervals, and in early-stage cancer. Relationships varied by cancer site, with stronger associations of social support observed in studies of patients with leukemia and lymphomas and stronger associations of network size observed in studies of breast cancer. Further randomized intervention studies are needed to test causal hypotheses about the role of social support and social network for cancer mortality. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

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Pooled results from 38 analyses of the accuracy of distress thermometer and other ultra-short methods of detecting cancer-related mood disorders.

Marcia Mitchell (2007)

Ultra-short screening tools involving fewer than five questions have been recommended as a simple method of detecting distress, anxiety, or depression in cancer settings. Such methods have practical appeal, but their diagnostic accuracy is unclear. A literature search limited to diagnostic validity studies of ultra-short screening in cancer settings identified 38 analyses, including 19 assessing the Distress Thermometer alone, involving a total of 6,414 unique patients. The pooled ability of ultra-short methods to detect depression was given by a sensitivity of 78.4%, a specificity of 66.8%, a positive predictive value (PPV) of 34.2%, and a negative predictive value (NPV) of 93.4%. Thus these tools were very good at excluding possible cases of depression but poor at confirming a suspected diagnosis. The pooled ability of ultra-short methods to detect anxiety was given by a sensitivity of 77.3% and a specificity of 56.6% (PPV, 55.2%; NPV, 80.25%) and for distress a sensitivity of 78.3% and a specificity of 66.5% (PPV, 59.7%; NPV, of 82.8%). Results using the Distress Thermometer alone were similar. Scores of integrated accuracy, using the Youden index and diagnostic odds ratio, suggested modest overall accuracy with least success in diagnosing anxiety disorders. Ultra-short methods were modestly effective in screening for mood disorders. Their rule-in ability was poorer than their rule-out ability. Ultra-short methods cannot be used alone to diagnose depression, anxiety, or distress in cancer patients but they may be considered as a first-stage screen to rule out cases of depression.

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Social networks, social support mechanisms, and quality of life after breast cancer diagnosis.

Candyce Kroenke, Marilyn L Kwan, Alfred I Neugut … (2013)

We examined mechanisms through which social relationships influence quality of life (QOL) in breast cancer survivors. This study included 3,139 women from the Pathways Study who were diagnosed with breast cancer from 2006 to 2011 and provided data on social networks (the presence of a spouse or intimate partner, religious/social ties, volunteering, and numbers of close friends and relatives), social support (tangible support, emotional/informational support, affection, positive social interaction), and QOL, measured by the FACT-B, approximately 2 months post diagnosis. We used logistic models to evaluate associations between social network size, social support, and lower versus higher than median QOL scores. We further stratified by stage at diagnosis and treatment. In multivariate-adjusted analyses, women who were characterized as socially isolated had significantly lower FACT-B (OR = 2.18, 95 % CI: 1.72-2.77), physical well-being (WB) (OR = 1.61, 95 % CI: 1.27-2.03), functional WB (OR = 2.08, 95 % CI: 1.65-2.63), social WB (OR = 3.46, 95 % CI: 2.73-4.39), and emotional WB (OR = 1.67, 95 % CI: 1.33-2.11) scores and higher breast cancer symptoms (OR = 1.48, 95 % CI: 1.18-1.87) compared with socially integrated women. Each social network member independently predicted higher QOL. Simultaneous adjustment for social networks and social support partially attenuated associations between social networks and QOL. The strongest mediator and type of social support that was most predictive of QOL outcomes was "positive social interaction." However, each type of support was important depending on outcome, stage, and treatment status. Larger social networks and greater social support were related to higher QOL after a diagnosis of breast cancer. Effective social support interventions need to evolve beyond social-emotional interventions and need to account for disease severity and treatment status.

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Author and article information

Contributors

Z. A. Nahleh:

ORCID: http://orcid.org/0000-0002-2914-1646

nahlehz@ccf.org

Journal

Journal ID (nlm-ta): BMC Cancer

Journal ID (iso-abbrev): BMC Cancer

Title: BMC Cancer

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2407

Publication date (Electronic): 22 September 2020

Publication date PMC-release: 22 September 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 899

Affiliations

[1 ]GRID grid.418628.1, ISNI 0000 0004 0481 997X, Department of Hematology/Oncology, Maroone Cancer Center, , Cleveland Clinic - Florida, ; 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA

[2 ]GRID grid.65499.37, ISNI 0000 0001 2106 9910, Department of Radiation Oncology, , Dana-Farber Cancer Institute/ Brigham and Women’s Hospital, ; 75 Francis St, Boston, MA 02115 USA

[3 ]GRID grid.255951.f, ISNI 0000 0004 0635 0263, Charles E. Schmidt College of Medicine, , Florida Atlantic University, ; 777 Glades Road BC-71, Boca Raton, FL 33431 USA

Author information

Z. A. Nahleh http://orcid.org/0000-0002-2914-1646

Article

Publisher ID: 7380

DOI: 10.1186/s12885-020-07380-5

PMC ID: 7510066

PubMed ID: 32962660

SO-VID: 64e21a83-539f-4f05-8786-971200b696e2

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 19 September 2019

Date accepted : 4 September 2020

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ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: cancer,intervention development,art therapy,survivorship care,quality of life

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ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: cancer, intervention development, art therapy, survivorship care, quality of life

A pilot study of improved psychological distress with art therapy in patients with cancer undergoing chemotherapy

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Karger: Oncology

Most cited references 44

Associations of social networks with cancer mortality: a meta-analysis.

Pooled results from 38 analyses of the accuracy of distress thermometer and other ultra-short methods of detecting cancer-related mood disorders.

Social networks, social support mechanisms, and quality of life after breast cancer diagnosis.

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