This article originally appeared on medpagetoday.com

Cancer patients who participated in creative arts therapy derived significant clinical, psychological, and quality-of-life benefits, a meta-analysis of more than two dozen studies showed.

The analysis showed moderate-to-large improvements in pain and quality-of-life scores, and the effect on pain increased with follow-up. Creative arts therapy had modest effects on anxiety and depression, according to Matthew Herring, PhD, of the University of Alabama at Birmingham, and co-authors.


For most outcomes, the effect size decreased over time, they reported online in JAMA Internal Medicine.

“The cumulative evidence indicates that creative arts therapy can decrease symptoms of anxiety, depression, and pain and increase quality of life among cancer patients after treatment,” the authors concluded. “The effects are greatly diminished during follow-up. Future well-designed, randomized controlled trials are needed to address the methodological heterogeneity found within this field of research.”

Though a large proportion of adults report use of alternative medicine, creative arts therapy has received limited attention in the medical literature as compared with interventions such as supplements and mind-body therapies. Qualitative outcomes have predominated in studies of creative arts therapy, but recently research into the therapy’s effects has expanded to include disciplines such as neuropsychiatry, the authors noted.

Several literature reviews have suggested that creative arts therapy can improve cancer- and treatment-related symptoms both during and after cancer therapy. However, prior systematic reviews have neglected the potential psychological benefits of creative arts therapy. To address the gap in data and knowledge, Herring and colleagues reviewed randomized, controlled trials to assess the effects of creative arts therapy on psychological symptoms and quality of life in cancer patients.


Herring and colleagues extracted data on effect size, moderators, and study quality and calculated Hedges d (delta) effect sizes by comparing results of pre- and post-intervention assessments.

The final analysis comprised 27 clinical trials and 1,576 patients, two-thirds of whom had either breast cancer (44.2%) or hematologic malignancies (21.9%).

Creative arts therapy had the greatest impact on pain and quality of life. Collectively, the studies produced an effect size of 0.54 (P<0.001) for improvement in pain and 0.50 (P<0.001) for improvement in quality of life, each reflecting moderate to large effects by the statistical methods used.

Creative arts interventions led to relatively small, but statistically significant improvements in anxiety (delta=0.28, P=0.001) and depression (delta=0.23, P=0.01).

Fatigue did not change significantly in response to creative arts therapy (delta=0.16, P=0.12).


During follow-up after the interventions ended, pain was the only outcome that maintained a significant treatment effect (delta=0.59, P<0.001).

Analysis of factors that moderated effect size showed that the effect on anxiety was greatest when interventions were administered by nontherapists and when a waiting-list or usual-care comparison was used. The largest effects on pain occurred with inpatient treatment and among homogeneous outpatient groups. Investigators did not analyze moderators for depression or quality of life because effect size varied substantially across studies.

The authors acknowledged several limitations of the analysis, including lack of validated symptom assessments as well as lack of information about the interventions, appropriateness of comparisons, adherence, and medication use.

Creative arts therapy led to small or moderate overall effects on outcomes, authors of an editorial noted. The major contribution of the analysis was the investigation of potential moderators of treatment effect. However, the report lacked clarity that made the results difficult to interpret, said Joke Bradt, PhD, and Sheryl Goodill, PhD, of the College of Nursing and Health Professions at Drexel University in Philadelphia.

“Relying on the distinction of therapist present versus no therapist remains problematic when no definition of therapist is provided,” said Bradt and Goodill. “Furthermore, the authors did not provide information on which of the included studies were categorized as ‘therapist present’ or ‘no therapist present.’ This lack of transparency, in combination with the apparent definitional contradictions within the review, renders the findings based on that categorization potentially meaningless.”


“We recommend that future research teams conducting systematic reviews of creative arts therapies include a creative arts specialist to improve construct validity and ensure that included studies have proper adherence to professional standards for the provision of creative arts therapy services,” they added.

Buffalo, N.Y., creative arts therapist Katherine Trapanovski found more merit in the analysis.

“What the study showed me is that you are able to see across various art forms and treatments that the arts really do make a difference in terms of the quality of life patients have while they are receiving treatment and through recovery,” said Trapanovski, of the University at Buffalo and Roswell Park Cancer Institute, both in Buffalo, N.Y.

Herring and co-authors reported no conflicts of interest.

Bradt and Goodill reported no conflicts of interest.