Relieving Symptoms in Cancer Innovative Use of Art Therapy

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Support Care Cancer. 2021; 29(5): 2289–2298.

The effects of art therapy on anxiety, depression, and quality of life in adults with cancer: a systematic literature review

J. T. Bosman

^aneSection of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9; D3-312, 1105 AZ Amsterdam, The Netherlands

Z. K. Bood

ⁱDepartment of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9; D3-312, 1105 AZ Amsterdam, Kingdom of the netherlands

M. Scherer-Rath

²Faculty of Philosophy, Theology and Religious Studies, Radboud University–Nijmegen, Nijmegen, The Netherlands

H. Dörr

³University of the Art Utrecht, Utrecht, Holland

N. Christophe

³University of the Art Utrecht, Utrecht, Holland

Thou. A. Grand. Sprangers

⁴Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Academy of Amsterdam, Amsterdam, The Netherlands

H. W. Thousand. van Laarhoven

¹Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9; D3-312, 1105 AZ Amsterdam, The Netherlands

Received 2020 Jul 28; Accepted 2020 October 29.

Abstruse

Purpose

While there is increasing evidence for the effectiveness of psychosocial back up programs for cancer patients, little attention has been paid to creativity or art equally a way of addressing their psychological issues and improving quality of life. This review provides an overview of interventional studies that investigate the effects of art therapy interventions on anxiety, low, and quality of life in adults with cancer.

Methods

We conducted a literature review with a systematic search. The databases PubMed/MEDLINE, PsycINFO, and EMBASE were searched for articles on fine art therapy among adult (xviii years and above) cancer patients, published between September 2009 up to September 2019. Search terms were established for each database specifically. A total of 731 publications was assessed for relevance by title and abstract. The remaining 496 manufactures were examined using three inclusion criteria: interventions were guided by an artist or fine art therapist, participants were actively involved in the creative process, and anxiety, depression, and/or quality of life were included as outcome measures. Methodological quality of the included studies was appraised using specific checklists.

Results

Seven papers met the inclusion criteria. Information was extracted from three non-randomized intervention studies and 4 randomized controlled trials. All studies used a quantitative design with validated outcome measures. Iv articles described positive effects of fine art therapy on anxiety, depression, or quality of life in adults with cancer.

Conclusion

Art therapy could possibly help decrease symptoms of anxiety and depression, and improve quality of life in adult cancer patients. However, because of the heterogeneity of the interventions and limited methodological quality of the studies, farther inquiry using stringent methods is needed.

Supplementary Information

The online version contains supplementary material bachelor at 10.1007/s00520-020-05869-0.

Keywords: Cancer, Oncology, Patients, Quality of life, Fine art therapy

Introduction

Background

Receiving the diagnosis cancer may evoke strong emotions of anger and anxiety and tin be considered traumatic [one]. When the emotional brunt of beingness seriously sick stretches beyond patients' power to cope, it may even result in mental disorders [2]. Indeed, anxiety and depression disorders are mutual among cancer patients [3, 4], equally they affect x% and xx% of the cancer population respectively, which is 2 to 3 times higher compared to the general population [5]. Symptoms that are clinically relevant, but do non encounter the DSM-criteria for an anxiety or depressive disorder, such as insomnia or distractibility, are fifty-fifty more frequent among cancer patients [6, seven]. These symptoms of low and anxiety affect quality of life (QoL) adversely [8, 9].

The relevance of interventions that accost psychological symptoms is increasingly recognized [x], and several supportive care interventions have been shown to be effective amidst cancer patients [11–thirteen]. An example of such a supportive intervention is art therapy. Several definitions of fine art therapy are bachelor, which are partly not-overlapping. The British Association of Art Therapists (BAAT) defined fine art therapy as "a form of psychotherapy that uses art media every bit its primary way of advice" [14]. Similarly, art therapy is seen by Pamela et al. as a form of psychotherapy, adept by trained art therapists, aiming at therapeutic goals [xv]. Rather than an arroyo to enhance self-expression, others emphasize the creative process in art therapy that has healing effects and enhances patients' well-being [sixteen, 17].

A forensic psychiatry study showed the beneficial utilise of art therapy in the handling of destructive aggression [xviii]. Haeyen et al. [nineteen] constitute improvements in self-expression amongst patients with personality disorders undergoing art therapy. Some other study highlighted the value of fine art therapy programs on emotion regulation in active duty military service members with post-traumatic stress disorder and traumatic brain injury [20].

In oncology, all the same, art therapy every bit a supportive intendance intervention is a relatively new and previous literature studies in this field incorporate some limitations. For instance, Geue et al. [thirty] and Woods et al. [31] use a variety of study designs, making it hard to depict conclusions considering of the heterogeneity of the studies included. Furthermore, Ennis et al. [33] focus on the beneficial effects only, thus, non paying attention to potential negative outcomes. Most importantly, all reviews indicate that more enquiry is needed in this field and since upcoming literature about art therapy in cancer care is increasing rapidly, more reviews may be relevant. Therefore, the nowadays review provides a systematic literature overview of the available effectiveness of this form of therapy in developed cancer patients.

In this review, nosotros will define art therapy as an art intervention, aimed at decreasing symptoms of feet, low, and/or increasing QoL, which is delivered by someone with expertise in arts (an artist or professional art therapist). This ensures that there is professional person guidance in the utilise and making of the fine art, although this does non necessarily involve professional psychotherapeutic involvement. An art therapy intervention may include all sorts of disciplines, similar singing, drawing, painting, coloring, sculpting, writing, or poetizing. Our aim is to provide an overview of interventional studies that investigate the effects of art therapy interventions on feet, depression, and quality of life in adults with cancer. We focus on the making of art and will leave out passive forms, such as listening to music or looking at paintings.

Methods

Systematic literature review

We conducted a literature review with a systematic search to provide a summary of the prove on the utilize of art therapy in cancer care.

Search strategy and inclusion criteria

We performed a search in the databases PubMed/MEDLINE, PsycINFO, and EMBASE, because we deemed these to exist most relevant to our research topic. We searched for publications from September 2009 up to September 2019 and no restrictions regarding publication type were made at this phase. We only included publications that were available in English. The search contained the post-obit search terms: "fine art therapy" OR "art-making" AND "cancer" OR "oncology". Search terms were adjusted for each database specifically and can be found in Supplementary Material. Using this strategy, nosotros obtained a total of 968 articles. Of this entire search, 280 publications were derived from PubMed/MEDLINE: 256 from PsycINFO and 432 from EMBASE. After, 237 indistinguishable articles were removed. Ii reviewers (HB and ZB) first screened the remaining articles past championship and excluded clearly irrelevant articles. The remaining 496 publications were assessed by HB and ZB based on their title and abstruse, using the following inclusion criteria: Studies including adults above the age of eighteen with cancer who were involved in art making in the presence of an creative person or art therapist, employing anxiety, depression, and/or QoL as outcomes. To increase the validity of our results, we only included prospective accomplice studies with a controlled blueprint.

Disquisitional appraisement

The Critical Appraisement Tools by the Joanna Briggs Institute (JBI) were used to examine the methodological quality of the studies [21]. For the non-randomized intervention studies, we used the JBI Disquisitional Appraisal Checklist for Quasi-Experimental Studies and for the randomized controlled studies we used the JBI Disquisitional Appraisal Checklist for Randomized Controlled Trials.

Data extraction and analysis

The post-obit data was extracted from each report paper: authors, year, report design, number of patients, female person to male ratio, number of patients in the intervention/control group, cancer diagnosis, duration and methods of the art therapy intervention, type of instructor of the art therapy intervention, result measures, and main findings. A descriptive assay was performed to evaluate the results.

Results

Overview of articles

Twenty-6 articles were read in full text of which 19 manufactures were excluded because they did non come across the inclusion criteria, for case, they did not focus on art making or did not include an creative person or art therapist. Hence, vii articles were suitable for further analysis. These included three non-randomized intervention studies and iv randomized controlled trials. An overview of our selection strategy can exist institute in Fig. ​ one.

The number of participants reported in the manufactures varied between 24 and 183. Vi out of seven papers included more than 50 patients. Three studies focused on female cancer patients merely [22–24]. In the remaining articles, patents with a diverseness of cancer diagnoses were included. In general, more women than men participated in the art therapy trials. A consummate overview of the sociodemographic characteristics was given in all studies, except for Radl et al. [24] who only reported historic period and race of the participants. Iv articles described the diagnosis of the patients and their clinical characteristics [24–27].

All studies used a quantitative design with validated outcome measures. The Hospital Anxiety and Low Scale (HADS) and the EORTC-QLQ C-30 were used most frequently every bit outcome measures. One study added a qualitative questionnaire to explore the satisfaction with the art therapy intervention [26].

Critical appraisal

The non-randomized controlled trials were assessed based on nine questions about the methodological quality of the studies (Table ​ 1). In all manufactures, the examined causes and furnishings were articulate. The measurements were psychometrically robust and were applied both earlier and later on the interventions. However, the patients in the control group were only like to the patients in the intervention grouping in i study [26]. For example, in one written report, the command group consisted of patients who declined participation in the fine art therapy programme, which may accept caused selection bias [25]. Also, information technology was ofttimes unclear whether the control group and the intervention group received similar cancer treatment apart from the fine art therapy intervention [25, 27].

Table 1

JBI disquisitional appraisal¹

¹Green, respond is "Yes;" Orange, answer is "Unclear;" Red, answer is "No;" Blue, not applicable

The checklist regarding randomized controlled trials consisted of twelve questions. In all studies, true randomization was used; yet, blinding the treatment was cocky-patently not applicable in whatsoever of the studies [22, 23]. Porter and McConnell [28] noted that their outcome assessors were blinded. All seven manufactures used appropriate statistical analysis. Full elaboration of the answers to the questions on the checklists tin can be plant in Supplementary Cloth. No studies were excluded based on their methodological quality.

Description of the included articles

Bozcuk et al. [25]

Bozcuk and Ozcan [25] included participants from the outpatient chemotherapy unit Akdeniz University Medical Faculty in Antalya, Turkey. Patients were classified based on their previous exposure to painting art therapy and were divided into two intervention groups. Patients declining participation served every bit control group. An art therapist with experience in painting fine art therapy worked with everyone individually. Get-go, he provided data virtually the materials and techniques and then let the patients make every bit much watercolor paintings as they wanted during a chemotherapy date. Afterward, the art therapist encouraged the patients to elaborate on the meaning and bailiwick of their finished work. The number of finished paintings was registered as a representation of motivation.

De Feudis et al. [26]

De Feudis and Graziano [26] provided fine art therapy sessions of ninety min in the Medical Oncology Out-Patient unit of measurement of San Paolo, serving a population of adult cancer patients from Puglia, Italy. Each patient participated in ane group session. The control grouping was on a waiting list to receive art therapy and meanwhile received usual care. A psychotherapist skilled in art therapy guided the sessions, assisted by a psycho-oncology squad. The intervention took place in a room equipped with a large corporeality of art materials and groundwork music. Groups consisted of a maximum of viii people, varying in age, gender, and diagnosis. The therapy focused on three principles: production of spontaneous artwork, provocation of self-reflection, and sharing experiences with group members. After, all patients were offered the opportunity of additional psychosocial support.

Geue et al. [27]

The hemato-oncological patients in the study of Geue and Richter [27] were recruited from the Leipzig Academy Hospital, Germany. Hemato-oncological patients who lived too far away to participate formed the control group. Twenty-two weekly sessions of 90 min were held under the supervision of an art therapist. The groups included patients of unlike gender and age. The intervention consisted of three phases: becoming familiar with drawing, assisted past an artist, watercolor painting by oneself, and creating an private book to express feelings. All decisions regarding the content or pattern of the book were fabricated by patients themselves.

Jalambadani et al. [22]

Jalambadani and Borji [22] investigated Neyshabur women with breast cancer visiting the Razavi Hospital of Mashhad Metropolis, Iran. They conducted twelve weekly mindfulness-based art therapy (MBAT) sessions, lasting on average 90 min. The control group was on a waiting list to receive art therapy and was provided with usual cancer care. The MBAT-program focused on the procedure first used in Monti and Peterson [29], involving an introduction to fine art-making, self-picture assessment tasks, exploration of art materials and heed-trunk relationship, artistic problem-solving, meditation, free fine art-making, and group discussions. The interventions were guided by an artist with psycho-oncological preparation.

Jang et al. [23]

Jang and Kang [23] examined the effects of mindfulness-based fine art therapy (MBAT) in women with breast cancer, who had received surgery and radiation therapy at Wonkwang University Hospital, South-Korea. The patients in the MBAT-group were provided with twelve weekly sessions lasting 45 min each. The qualified art therapist encourages the patients to express their inner feelings. Both the intervention group and the control group connected to have standard post-handling care.

Porter et al. [28]

Porter, McConnell [28] developed music therapy sessions for hospice patients in Northern Ireland with an Eastern Cooperative Oncology Group (ECOG) performance of 2 or lower. The intervention group received a total of six 45-min individual music therapy sessions, twice a week. The control group underwent usual cancer care. A trained and registered music therapist provided the program using an interactive approach. Patients could participate by singing or listening to known music, but they also got the opportunity to create something of their own, eastward.k., a tune, vocal, rhythm, or instrumental slice. The music therapist supported the patients in the creative process.

Radl et al. [24]

Self-Book art therapy was offered by Radl and Vita [24] to female cancer patients undergoing active oncological handling in a major hospital in Philadelphia, USA. Both the intervention group and the command grouping had access to all available complementary (psychological) therapies, but merely the intervention group created a Self-Book. The participants worked with an art therapist individually in half dozen sessions ("agreements") of nearly l min. The purpose of the fine art therapy was to create a self-cogitating book to limited one'southward feelings and experiences. During the first 5 sessions, the patients were instructed to make full the pages of their book with artistic artwork related to a given subject area (safe place, supports, strength and virtues, wishes for loved ones, wishes for oneself). In the concluding session, the patients were encouraged to decorate the cover of the book.

Findings: effect on event measures

Anxiety

Out of the 4 studies measuring anxiety, two found a significant improvement. De Feudis and Graziano [26] reported a significant reduction in feet scores in the intervention group, with the score decreasing from 44.3 to 37.1 (p = 0.002), while the anxiety scores in the control group did non significantly change. However, the written report did not detect a significant difference in anxiety scores between the two groups. In the study of Jang and Kang [23], feet scores were significantly improved compared to the control group (p < 0.001). Geue and Richter [27] did not find whatsoever pregnant differences, neither within the invention group nor betwixt the intervention grouping and control group. Bozcuk and Ozcan [25] compared anxiety scores among 2 intervention groups and one control group and constitute that anxiety scores did not differ significantly between the group.

Depression

Three of the seven studies compared depression scores between intervention and command groups. Jang and Kang [23] and Bozcuk and Ozcan [25] found the low scores in the intervention group to significantly improved compared to the control group (p < 0.001 and p = 0.001 respectively). Geue and Richter [27] found neither significant comeback in depression scores within the groups nor between the groups.

Quality of life

Half-dozen studies reported on QoL or QoL related scales, such as well-being, of which four institute an improvement in these outcome variables. Bozcuk and Ozcan [25] reported a significant divergence in QoL betwixt the intervention groups and the control grouping (p = 0.001). In addition, as expected through the regression to the mean principle, patients with lower QoL appeared to take the greatest advantage from painting art therapy program. All participants declared they enjoyed taking role in painting art therapy program. The intervention was too found to be feasible during chemotherapy sessions. Jang and Kang [23] besides reported comeback in quality of life, with the global health status/QoL score increasing from 26.4 to 81.three (p < 0.001). Significant beneficial effects on functional scales, concrete symptoms, and financial difficulties were also noted. None of these changes were found in the control group. Additionally, Jalambadani and Borji [22] showed statistically meaning decreases in symptoms of distress in the intervention grouping compared to the waiting list control group. The scores of physical health, psychological symptoms, social relationships, and ecology factors were improved significantly, likewise as quality of life behavior. Lastly, De Feudis and Graziano [26] reported that 89.three% of the participating patients considered the art therapy programme beneficial to their well-being.

Radl and Vita [24] documented no statistically significant differences between the Cocky-Book therapy intervention group and the control group for the principal outcome (emotional distress) or the secondary issue (psychological well-being). Withal, they did find meaning improvement in the spiritual well-beingness of the patients taking role in the Cocky-Book art therapy plan. Likewise in the study of Porter and McConnell [28] changes in McGill Quality of Life questionnaire (MQoL) scores, as well as in physical symptoms and psychological and existential well-beingness, from baseline to the first assessment (week 1) were non statistically different between the intervention grouping and the control group [28].

Summary results

In decision, of the vii studies, four identified significant results regarding anxiety, low, or QoL [22, 23, 25, 26]. Of the iv studies that studied feet, half found meaning improvements in feet scores, the other half did non [23, 26]. Regarding depression, two studies establish meaning comeback in depression scores and one did non [23, 25]. Four out of 6 studies regarding QoL showed significant comeback in QoL after the art therapy intervention [22, 23, 25]. Hence, three studies did not place any significant results regarding anxiety, depression, or QoL [24, 27, 28]. Nevertheless, all participants considered the feel valuable to their well-beingness, what came upward anecdotally equally well every bit through questionnaires afterward completion of the intervention. An overview of the results of all studies tin be plant in Table ​ 2.

Tabular array two

Written report results

Reference	Study blueprint	Participants				Intervention			Outcome measures	Main findings
		Diagnosis	N 1	F:Mii	IG:CGiii	Methods	Elapsing	Teacher
Bozcuk et al. [25]	iii-group comparative study	Adult cancer patients receiving chemotherapy	97	54:43	65:32	Painting art therapy program (PATP): introduction about technique and materials, making watercolor paintings, elaborating well-nigh the meaning and field of study of the paintings	six weeks	Professional painting artist	EORTC-QLQ-C30 questionnaire; Hospital Feet and Depression Scale (HADS)	- Pregnant improved QoL and decreased depression in cancer patients who received PATP - All participants enjoyed the intervention to some extent - PATP may be of more do good to patients who are relatively in more demand of assistance - PATP is viable during chemotherapy sessions
De Feudis et al. [26]	Non-randomized pre-post report blueprint	Adult cancer patients	115	88:27	59:56	The production of spontaneous artwork; provoking individual self-reflections connected to the art work; shared meaning—making inside the group	4 months; each participant took role in one session (90 min)	Therapist with expertise in fine art therapy	Country-Trait Anxiety Inventory-Class (STAI-Y); Edmonton Symptom Cess Scale-Revised (ESAS-R); 2 open-concluded questions virtually satisfaction with the intervention	- Meaning reduction in anxiety and psychosomatic distress symptoms (drowsiness and fatigue) were establish in the IG compared to the CG - Most participants perceived fine art therapy as having a positive influence on their well-being - Intervention format was considered appropriate past other staff members
Geue et al. [27]	Prospective intervention study	Adult cancer patients who had just finished acute treatment	183	94:89	54:129	Structuring materials and practicing experimental cartoon; introducing watercolors; creating an individual book	22 weekly sessions of 90 min	Artist with psycho-oncological preparation	Infirmary Feet and Depression Calibration (HADS); Questionnaire on Coping with Illness (FKV); Perceived Adjustment to Chronic Illness Scale (PACIS)	- No changes in low scores were found for the IG - Anxiety scores decreased in a pre-mail service comparison, just there were no meaning differences with the CG -Subjective experiences were positive throughout
Jalambadani et al. [22]	Semi-experimental written report	Women with breast cancer, whatever stage	124	124:0	Unclear	The viii-week MBAT plan of Monti et al. (2006)	12 weeks; once a week; 90 min	Artist with psycho-oncological training	WHO Quality-of-Life (WHOQOL)-BREF questionnaire	- Patients in the IG showed meaning decreases in symptoms of distress compared to the CG - Back up for the hypothesis that MBAT intervention tin can assist decrease distress levels and better QoL
Jang et al. [23]	Randomized controlled trial	Women with chest cancer phase 0-III	24	24:0	12:12	Korean mindfulness-based stress reduction'south (K-MBSR) psychological intervention combined with the 8-week MBAT program of Monti et al. (2006)	12 sessions; 45 min	Qualified art therapist	Personality Assessment Inventory (PAI); EORTC-QLQ-C30 questionnaire	- Compared to the CG, patients in the IG reported significantly decreased depressive symptoms later treatment - Compared to the CG, patients in the IG reported significantly decreased feet after treatment - Global wellness status in the IG was increased later the treatment period
Porter et al. [28]	Randomized controlled trial	Oncology hospice inpatients	51	36:15	25:26	Singing, playing, listening to known music; creating a melody, rhythm, song, or instrumental slice	Upwards to 6 individual sessions over 3 weeks	Trained and registered music therapist	McGill Quality of Life Questionnaire	- As expected, the change from baseline 1 was non significantly unlike between IG and CG - Notable improvement in existential well-existence in IG compared to IG - Notable disimprovement in physical well-being in CG compared to IG
Radl et al. [24]	Randomized controlled trial	Female cancer patients	60	threescore:0	30:xxx	Creation of a journal-mode, self-reflective visual volume	half dozen sessions; l min	Art therapist	Distress Thermometer (DT); FACIT-Sp; Patient-Reported Outcomes Measurement System Brief Psychological Well-being examination (PROMIS)	- No statistically meaning differences between Self-Book art therapy in IG and CG for the principal event (emotional distress) or the secondary outcome (psychological well-being) - Statistically significant increase in participant'south spiritual well-being compared to the CG - Greater effects in younger participants

^1-iv N number of patients; F:M female to male ratio; IG:CG intervention grouping to control group ratio; NA not applicable

Discussion

Master findings

In this systematic review, nosotros found some positive furnishings of art making on feet, depression, and QoL in adults with cancer. Four out of seven included studies described these beneficial furnishings. All studies reported that participants considered the experience valuable to their well-being.

Interpretations

These results partially support the findings of previous non-controlled studies on the effectiveness of art therapy on psychological outcomes in cancer care [30–33]. This is somewhat encouraging, considering novel, evidence-based interventions to meliorate psychological outcomes for cancer patients are urgently needed, especially in view of the increased life expectancy of this patient population [34], which prolongs the menstruum of being ill. Whereas QoL is considered of chief importance past cancer patients [35], psychological needs are still unrecognized and undertreated [36].

In our review, we only considered interventions involving active art making by the patients. Clearly, many other forms of art therapy interventions for cancer patients exist, from purely passive appreciation of art to more interactive forms such every bit co-creation, in which an artist creates art while making use of the patient'due south narrative [37]. Active artistic work is likely to differ in its mental bear upon from passive art consumption and is therefore best investigated separately.

Strengths and limitations

Strengths

For this review, we did not merely search the ordinarily used database PubMed/MEDLINE but also EMBASE and PsycINFO, providing an overview of the literature that is as complete as possible. Side by side, we used a stringent definition of fine art therapy, focusing on art making in the presence of an creative person or art therapist only. In this manner, the studies were highly comparable. We excluded all studies that did not use a command group, which increased the validity of our results. Finally, the included studies were from countries across the earth, enhancing the generalizability of the results.

Limitations

Despite the strengths of this review, our findings need to be interpreted with caution. The included articles showed several methodological shortcomings. First, three out of seven studies were non randomized, which may have led to selection bias [25–27]. Randomization of the participants was but attempted in the RCTs, because others were afraid that randomization might decrease the willingness of patients to participate. Second, it is not entirely certain that all the effects found in the non-RCTs are due to the art therapy interventions, considering the included studies did not address controlling for confounders. For instance, it was ofttimes not clear what the cancer characteristics, such equally metastasized or non- metastasized, of the patients were. Third, in that location was a remarkable imbalance in participation betwixt men and women, as three out of seven studies did not include male person patients at all. Tavani already addresses the depression number of male art therapists [38], but only few studies take elaborated why men are less likely to participate in art-making programs. This should be investigated further in lodge to brand fine art therapy suitable for a general population. Finally, the widely varying cultural settings of the included studies are likely to have contributed to the heterogeneity of the studies.

Clinical implications and future research

Our findings are supportive for farther development of art-making approaches in cancer care. To improve the clinical evaluation of these approaches, the methodological shortcomings, e.grand., the lack of randomization, demand to be addressed. Outcomes of this review propose that more randomized controlled trials with larger sample sizes are needed to establish the evidence of art therapy's effectiveness for adults with cancer. We also recommend developing a protocol to standardize fine art therapy interventions that are also feasible for clinical practice and for continuation at home.

Conclusion

In conclusion, fine art therapy involving a professional person art therapist or artist and agile art-making of the patients tin possibly take a positive consequence on anxiety, low, and QoL in adults with cancer. Still, further research with stringent definitions of art therapy as an intervention and advisable randomized designs are urgently needed.

Supplementary Information

Acknowledgements

This report is part of a larger study on an art intervention for cancer patients. In search of stories, which is funded past the Dutch Cancer Society, grant number 11507.

Availability of data and materials

Not applicable.

Code availability

Non applicable.

Authors' contributions

JTB, ZMB, and HWML designed the written report. JTB and ZMB collected and analyzed the data. JTB, ZMB, and HWML wrote the manuscript and all authors participated in manuscript review. All authors approved the final manuscript.

Funding

This study was funded by The Young Academy, Regal Dutch University of Sciences, and the Dutch Cancer Society (grant number 11507).

Compliance with ethical standards

Conflict of involvement

The authors declare that they take no conflict of interest.

Footnotes

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

J. T. Bosman and Z. Yard. Bood contributed equally to this piece of work.

Contributor Information

Z. M. Bood, Email: ln.cmumadretsma@doob.1000.z.

H. W. 1000. van Laarhoven, Email: ln.cmumadretsma@nevohraalnav.h.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981299/

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