Effectiveness of group art therapy on quality of life in paediatric patients with cancer: A randomized controlled trial

Spiritual Interventions Among Pediatric Patients With Cancer: A Systematic Review And Meta-Analysis

CONTEXT

Although spiritual intervention is crucial in the care of childhood cancer patients (CCPs), its effectiveness has not yet been systematically evaluated.

OBJECTIVES

To determine the effectiveness of existing spiritual interventions on psychological, spiritual outcomes, and quality of life (QoL) in CCPs.

METHODS

We searched eight databases to identify relevant randomized controlled trials and quasi-experimental studies. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials. Results were either synthesized in a systematic narrative synthesis or a meta-analysis using a random effects model, where appropriate. The pooled treatment effect was estimated using the standardized mean difference (SMD) and 95% confidence interval (CI).

RESULTS

Twelve studies with 576 CCPs were included. Eight studies showed a high risk of bias. The overall effect of existing spiritual interventions on QoL (Z = 1.05, SMD = 0.64, 95%CI = -0.15 to 1.83, P = 0.29), anxiety (Z = 1.11, SMD = -0.83, 95%CI = -2.30 to 0.64, P = 0.28) and depressive symptoms (Z = 1.06, SMD = -0.49, 95%CI = -1.40 to 0.42, P = 0.12) were statistically nonsignificant. The nonsignificant findings could be attributed to the high heterogeneity among the included studies (QoL: I2 = 85%; anxiety: I2 = 90%; depressive symptoms: I2 = 58%).

CONCLUSION

Evidence to support the positive effects of existing spiritual interventions on psychological and spiritual outcomes and QoL in CCPs is insufficient. Future studies should adopt a more rigorous design and unify the outcome measures to reduce the risk of bias and heterogeneity, respectively.

Unravelling the role of mind-body therapies in paediatric palliative care: A narrative review

AIM

Given the multifaceted nature of paediatric palliative care (PPC), integrative medicine and mind-body therapies, in particular, are increasingly used in this setting. However, to our knowledge, their use in PPC has never been specifically reviewed. Therefore, this work aims to provide a comprehensive overview of the application and possible beneficial effects of mind-body therapies in the PPC setting.

METHODS

Papers about the use of meditation and mindfulness, biofeedback, hypnosis, yoga, tai chi and qi gong, imagery, creative outlets, and art therapy in PPC were identified by browsing PubMed and CINHAL.

RESULTS

We found that the harmless nature of mind-body therapies has been extensively described, and available studies consistently show some benefits on the anxiety, stress, and quality of life of parents/caregivers and healthcare providers. However, well-grounded and robust evidence does not fully support the efficacy of mind-body therapies, especially in patients.

CONCLUSION

Considering the peculiarity of the PPC setting, we suggest that mind-body therapies should be further considered and properly investigated through larger controlled studies and according to the different populations of PPC children, as well as for parents, caregivers, and healthcare professionals.

Effectiveness of Occupation-Based Nursing Program on Chemotherapy-Related Symptoms and Satisfaction Among Pediatric Oncology Patients: A Randomized Controlled Trial

OBJECTIVES

This study aimed to determine the effect of an occupation-based nursing program (OBaNuP) on chemotherapy-induced symptoms and satisfaction in pediatric oncology patients.

DATA SOURCES

This study was a randomized controlled trial. The study sample consisted of 60 hospitalized children with cancer who were aged 7 to 12. Participants were randomly assigned to an OBaNuP (intervention group, n = 30) or clinical routine care only (control group, n = 30). The intervention group participated in an OBaNuP for an average of 30 minutes per day for 5 days. The Memorial Symptom Assessment Scale 7-12 and Psychosocial Symptoms in Hospitalized Children and Child Satisfaction Questionnaire were completed by participants at baseline, the first meeting immediately after intervention, and 7 days and 14 days after the intervention.

CONCLUSION

The average scores of chemotherapy-related symptoms differed over time between the intervention and control groups (P < .05). The psychosocial symptom score averages of the children in the intervention group significantly decreased at all time points compared to the control group (P < .05). The satisfaction mean scores of the children in the intervention group increased significantly at all time points compared to the control group (P < .05).

IMPLICATIONS FOR NURSING PRACTICE

The OBaNuP initiative supported the decrease of chemotherapy-related and psychosocial symptoms, while also promoting an increase in satisfaction among children undergoing cancer treatment at the hospital consistently over all observed time periods.

Nothing less than a creative triumph: a study of children admitted to hospital for serious somatic illness or injury and their experience of art therapy

Background

Hospitalization can be an extremely distressing experience for seriously ill and injured children. Art therapy has a well-established clinical history, and recent research has begun to demonstrate its effectiveness in somatic pediatric wards. Descriptive and statistical research indicates that art therapy can alleviate anxiety and fear, improve mood, and enhance communication among children, parents, and healthcare professionals. This study aims to enhance our understanding of the specific elements of art therapy that facilitate a connection with the healthier aspects of the self.

Method

A total of 12 hospitalized children, aged 4-12, participated in an art therapy session led by a certified art therapist. Verbalizations during the sessions were recorded, and subsequent observations were synchronized with verbatim transcriptions of audio recordings. A reflexive thematic analysis was conducted to identify relevant patterns of meaning.

Findings

The study identified four significant dimensions of the children's experiences during art therapy: (1) The child feels safe, (2) The child becomes a competent artist, bursting with creativity, (3) The healthy child emerges, and (4) The child achieves something beyond its limits - a triumph.

Discussion

The active ingredients contributing to effective art therapy include the stimulation of creativity, guided art-making with scaffolding support, task variation, granting children control over the artistic process, encouragement of free expression, and the display of positive regard. This study also delves into the therapeutic alliance, emphasizing its role in facilitating children's learning, self-expression, concentration, and the creation of work they take pride in. Additionally, certain psychotherapy-like interactions, such as control-mastery dynamics, were observed. Nevertheless, more extensive research with larger sample sizes is required to draw broader conclusions.

Exploring the Use of Arts-Based Interventions and Research Methods in Families of Seriously Ill Children: A Scoping Review

Family care is essential to pediatric nursing practice, as the entire family is affected by childhood illness. However, little is known about art making for therapeutic purposes and how art is used to better understand families' experiences. Our purpose was to examine the nature of arts-based interventions and research methods used with, and the experiences of families of children facing life-limiting and life-threatening illnesses, and those families who are bereaved. Academic peer-reviewed sources published between January 1999 and May 2022 were retrieved via four databases using key search terms. Twenty-five articles were analyzed, resulting in three multifaceted categories including Social, Emotional, and Family Health. Critical strengths and limitations were also identified. Art making has been incorporated into interventions and research studies due to its benefits for family well-being. Understanding the potential of art making can inspire nurses to implement such activities to enhance family nursing practice and research.

Effectiveness of spiritual interventions on psychological outcomes and quality of life among paediatric patients with cancer: a study protocol for a systematic review

INTRODUCTION

Cancer and its treatment affect children's physical, psychological and social well-being throughout the disease trajectory. Spiritual well-being is a fundamental dimension of people's overall health and is considered a source of strength to motivate patients to cope with and adapt to their disease. Appropriate spiritual interventions are important to mitigate the psychological impact of cancer on children, with an ultimate goal of improving their quality of life (QoL) throughout the treatment course. However, the overall effectiveness of spiritual interventions for paediatric patients with cancer remains unclear. This paper describes a protocol to systematically summarise the characteristics of studies related to existing spiritual interventions and synthesise their effectiveness on psychological outcomes and QoL among children with cancer.

METHODS AND ANALYSIS

Ten databases will be searched to identify appropriate literature: MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, PsycINFO, LILACS, OpenSIGLE, the Chinese Biomedical Literature Database, the Chinese Medical Current Contents and the Chinese National Knowledge Infrastructure. All randomised controlled trials that meet our inclusion criteria will be included. The primary outcome will be QoL as evaluated by self-reported measures. The secondary outcomes will be self-reported or objectively measured psychological outcomes, including anxiety and depression. Review Manager V.5.3 will be used to synthesise the data, calculate treatment effects, perform any subgroup analyses and assess the risk of bias in included studies.

ETHICAL AND DISSEMINATION

The results will be presented at international conferences and published in peer-reviewed journals. As no individual data will be involved in this review, ethical approval is not required.

Efficacy of Work-Related Support Rehabilitation for Patients with Cancer: A Meta-Analysis of Randomized Controlled Trials

Introduction The efficacy of work-related support rehabilitation for patients with cancer remains controversial. We conduct a systematic review and meta-analysis to explore the influence of work-related support rehabilitation on the quality of life in patients with cancer.

Methods We have searched Pubmed, Embase, Web of science, Ebsco, and Cochrane library databases through August 2021 for randomized controlled trials (RCTs) assessing the effect of work-related support rehabilitation on the quality of life in patients with cancer. This meta-analysis is performed using the random-effect model.

Results Four RCTs are included in the meta-analysis. Overall, compared with usual care for cancer patients, work-related support is associated with significantly improved quality of life physical score (PCS, standard mean difference [SMD]=0.22; 95% confidence interval [CI]=0.06 to 0.37; P=0.005) and reduced quality of life pain (SMD=−0.16; 95% CI=−0.31 to 0; P=0.04), but showed no obvious impact on quality of life mental score (MCS, SMD=0; 95% CI=−0.28 to 0.28; P=0.98), time of return to work (SMD=−0.78; 95% CI=−2.71 to 1.14; P=0.43), or the scores of work ability (SMD=−0.01; 95% CI=−0.16 to 9.09; P=0.13) and work limitation (SMD=0.12; 95% CI=−0.16 to 0.40; P=0.41).

Conclusions Work-related support rehabilitation may be effective to improve the quality of life of cancer patients.

The physical and psychological outcomes of art therapy in pediatric palliative care: A systematic review

Background

The integration of art therapy in health care is a growing trend in the care of cancer patients. Therefore, this study aimed to identify the physical and mental benefits of art in children with cancer.

Materials and Methods

A systematic review of English articles using Google Scholar, MEDLINE via PubMed, Scopus, the Cochrane Database of Systematic Reviews, and the Web of Science was conducted. Relevant keywords for cancer, child, art therapy and their synonyms were used accordingly. All searches were conducted to December 31, 2021.Relevant articles were included studies published in English and involving children aged 0-18 years. Studies evaluated the effects of art therapy in children with cancer.

Results

Seventeen studies had inclusion criteria, of which 12 studies were performed by clinical trial and 5 studies were performed by quasi-experimental method. Sixteen studies evaluated one type of art-therapy intervention, while one study used a combination of art-therapy approaches.The results showed that art-based interventions in the physical dimension lead to more physical activity, stability in breathing, and heart rate, and these children reported less pain. In the dimensions of psychology had less anxiety, depression, and anger but at the same time had a better quality of life and more coping-related behaviors.

Conclusion

It seems that the use of art therapy in pediatric palliative care with cancer can have good physical and psychological results for the child, but it is suggested to evaluate the effects of these interventions in children at the end of life.

Efficacy of a culturally tailored cognitive-behavioural intervention for Ethiopian children with haematological malignancies: study protocol for randomised controlled trial

Background

Paediatric cancer patients often experience anxiety and depression. Evidence suggests that cognitive-behavioural interventions may help reduce anxiety and depression in children undergoing cancer treatment. However, only a few studies evaluated its impact on the psychological well-being and quality of life of paediatric cancer patients globally. In Ethiopia, there has been no published study to date. Thus, this trial aims to evaluate the efficacy of a culturally tailored cognitive-behavioural intervention for Ethiopian children with haematological malignancies receiving chemotherapy.

Methods

A single-blinded, parallel-group, two-arm, repeated measure randomised controlled trial will be conducted. Eighty children aged 8 − 18 years with haematological malignancy receiving chemotherapy will be recruited and randomly assigned to experimental or control groups. The experimental group will receive five sessions of introducing cognitive-behavioural intervention, identifying and modifying maladaptive thoughts and behaviour, behavioural activation, practising deep breathing exercises, reassessing goals or treatment plans, and encouraging participants to maintain changes. Each session will be conducted face-to-face for 30–35 min a week. The control group will receive usual care. The outcomes will be measured at baseline, post-intervention, and one month after the intervention using the Revised Child Anxiety and Depression Scale and Paediatric Quality of Life Inventory Generic Core Score 4.0.

Discussion

The findings of this study will provide evidence to support the integration of culturally effective cognitive-behavioural intervention strategies into paediatric oncology practice and thus, add new knowledge to the literature and help improve the care of children with haematological malignancies receiving chemotherapy. If the cognitive-behavioural intervention is shown to be effective and culturally acceptable, it will provide evidence to include the intervention as a standard of care in paediatric haematology/oncology.

Trial registration

ClinicalTrials.gov NCT05270655. Registered on March 8, 2022.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06768-x.

The Effects of the Activity of Making Jewelry From Beads on the Anxiety Levels of Children With Cancer: A Randomised Controlled Study

Background: Children hospitalized for cancer treatment are known to experience high levels of anxiety. This study aimed to examine the effects of making jewelry from beads on the state and trait anxiety levels of children with cancer. Methods: This parallel group, randomized controlled trial was conducted on 62 children aged 7-18 who were being treated for cancer. The children were selected using the random sampling method. The jewelry-making sessions with the children in the intervention group were held twice a week for four weeks. Data were analysed using the chi-square test, the Student's t-test, the independent samples t-test and linear regression. Results: The state anxiety levels of the children in the intervention group decreased both in the first week and the fourth week after making jewelry. The difference in the average post-test scores between the two groups was found to be significant (p < .05). The fourth week average trait anxiety score of the children in the intervention group decreased (M  =  33.2) in comparison to the average score of the control group (M  =  36.5). The difference between the two groups was found to be significant (p < .001). Discussion: This study found that the activity of making jewelry from beads was effective in reducing the state and trait anxiety levels of children with cancer.

Effectiveness of psychosocial interventions on health outcomes of children with cancer: A systematic review of randomised controlled trials

INTRODUCTION

Nowadays, there is promising evidence that psychosocial interventions could be helpful in paediatric oncology. Thus, this review aimed to describe the impact of psychosocial interventions on cancer-related health outcomes in children.

METHODS

Fifteen English electronic databases were searched from October to December 2020. Only randomised controlled trials that (1) included children ≤18 years old diagnosed with cancer, (2) evaluated the effects of psychosocial interventions, and (3) reported health outcomes including quality of life, anxiety, depression, stress, distress, self-esteem, psychological adjustment, treatment adherence, pain, fatigue, and academic performance were included.

RESULTS

Ten RCTs were included in this review. Six types of psychosocial interventions (social skill training, music-based intervention, therapeutic play, cognitive therapy, wish intervention, and art therapy) were identified. The studies were assessed as having low to high risk of bias. Nine of the studies reported significant improvement in at least one outcome measure. But quantifying the pooled effect was not applicable due to the heterogeneity of interventions.

CONCLUSION

Psychosocial interventions could be beneficial in paediatric oncology. Yet, the outcomes were reported in heterogeneous types of interventions and participants. The results underscore the need to conduct further studies that include participants with specific cancer diagnoses and types of interventions.

Feasibility, acceptability, and effectiveness of school-based dance movement psychotherapy for children with emotional and behavioral difficulties

Background

Schools have been increasingly employing dance movement psychotherapists to support children cope with daily worries and stress, express and understand their emotions, develop self-awareness and self-esteem. However, evidence on the impact of dance movement psychotherapy as a tool for prevention of mental health difficulties in childhood remains limited.

Methods

Sixteen children (aged 7–9) with mild emotional and behavioral difficulties from two primary schools were randomly assigned to a Dance Movement Psychotherapy (DMP) intervention or to a waiting list, within a larger pilot cross-over randomized controlled study which aimed to (a) test whether all elements of study design can work together and run smoothly in a full-scale RCT; and (b) investigate the effectiveness of arts therapies in improving children’s health related quality of life (HRQOL; EQ-5D-Y), wellbeing and life functioning (Child Outcome Rating Scale; CORS), emotional and behavioral difficulties (Strengths and Difficulties Questionnaire; SDQ), and duration of sleep (Fitbits). The therapeutic process was also evaluated through interviews with children, participant observations, the Children’s Session Rating Scale (CSRS), and ratings of adherence to the therapeutic protocol.

Results

The findings indicated that DMP led to improvements in children’s life functioning, wellbeing, duration of sleep, emotional and behavioral difficulties, but not in quality of life. The improvements were maintained at the follow-up stages, up to 6 months post-intervention. Interviews with children also suggested positive outcomes, such as self-expression; emotional regulation; mastery and acceptance of emotions; improved self-confidence and self-esteem; reduced stress; and development of positive relationships. However, children would have preferred smaller groups and longer sessions.

Conclusion

This study indicated that all outcome measures would be suitable for inclusion in a larger randomized controlled trial, though the EQ-5D-Y is not recommended as a stand-alone measure due to its lack of sensitivity and specificity for young participants. The adherence to the therapeutic protocol ratings differed between children and adults, highlighting the need to include children’s voice in future research. Strategies are also proposed of how to conduct randomization of participants in ways that do not hinder the therapeutic process.

Exploring Korean Middle- and Old-Aged Citizens’ Subjective Health and Quality of Life

The goal of this research is to investigate the determinants of subjective health and quality of life with a particular focus on middle- and old-aged citizens. Subjective health is an antecedent of quality of life. For both attributes, travel frequency, economic activity, and cultural activity frequency are the main explanatory variables. Korean middle- and old-aged citizen research panel data was used to derive the data; the study periods are 2008, 2010, 2012, 2014, and 2016. The present work used an econometric method to analyze this panel data. The results show that subjective health positively affects quality of life; meanwhile, economic activity positively affects both subjective health and quality of life. It is also found that cultural activity and travel exert inverted U-shape impacts on subjective health and quality of life. The control variables in this research were gender, body mass index, birth year, and personal assets. These results could help guide policy makers in designing more efficient welfare policies for middle- and old-aged citizens.

The effect of active visual art therapy on health outcomes: protocol of a systematic review of randomised controlled trials

BACKGROUND

Art therapy is a form of complementary therapy to treat a wide variety of health problems. Existing studies examining the effects of art therapy differ substantially regarding content and setting of the intervention, as well as their included populations, outcomes, and methodology. The aim of this review is to evaluate the overall effectiveness of active visual art therapy, used across different treatment indications and settings, on various patient outcomes.

METHODS

We will include randomised controlled studies with an active art therapy intervention, defined as any form of creative expression involving a medium (such as paint etc.) to be actively applied or shaped by the patient in an artistic or expressive form, compared to any type of control. Any treatment indication and patient group will be included. A systematic literature search of the Cochrane Library, EMBASE (via Ovid), MEDLINE (via Ovid), CINAHL, ERIC, APA PsycArticles, APA PsycInfo, and PSYNDEX (all via EBSCOHost), ClinicalTrials.gov and the WHO's International Clinical Trials Registry Platform (ICTRP) will be conducted. Psychological, cognitive, somatic and economic outcomes will be used. Based on the number, quality and outcome heterogeneity of the selected studies, a meta-analysis might be conducted, or the data synthesis will be performed narratively only. Heterogeneity will be assessed by calculating the p-value for the chi² test and the I² statistic. Subgroup analyses and meta-regressions are planned.

DISCUSSION

This systematic review will provide a concise overview of current knowledge of the effectiveness of art therapy. Results have the potential to (1) inform existing treatment guidelines and clinical practice decisions, (2) provide insights to the therapy's mechanism of change, and (3) generate hypothesis that can serve as a starting point for future randomised controlled studies.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO ID CRD42021233272.

Measuring health-related quality of life in young children with physical illness: psychometric properties of the parent-reported KIDSCREEN-27

PURPOSE

This study examined whether the KIDSCREEN-27 was reliable and valid in young children 2-7 years with chronic physical illnesses which included estimating inter-domain correlations and internal consistency; measurement invariance testing; and, discriminant and convergent validity assessments.

METHODS

Data come from the Multimorbidity in Children and Youth across the Life-course; a longitudinal study of individuals aged 2-16 years with physical illness. The parent-reported KIDSCREEN-27 was administered. Children (2-7 years; n = 106) were compared to adolescents (8-16 years; n = 157). Reliability was estimated using Cronbach α for internal consistency. Multiple group confirmatory factor analysis tested for measurement invariance. Cohen's d and Pearson coefficient were used to assess discriminant validity by sex and age. Convergent validity was tested using Pearson coefficients with the WHODAS 2.0 (child functioning/impairment). Multiple regression examined associations between multimorbidity (co-occurring physical and mental illness) and HRQL.

RESULTS

Internal consistency reliabilities were α = 0.74-0.88 (children) and α = 0.77-0.88 (adolescents). Inter-domain correlations were relatively low (children: r = 0.18-0.59; adolescents: r = 0.30-0.62) indicating that each KIDSCREEN-27 domain was measuring a unique aspect of health-related quality of life. Measurement invariance was demonstrated (scalar level). Parameter estimates of the invariant models were similar for children and adolescents. Small, non-significant correlations were found for sex and age for children and adolescents. Medium, significant correlations were found for both groups between the KIDSCREEN-27 and WHODAS 2.0. Children and adolescents with multimorbidity had significantly lower physical well-being, psychological well-being, and school environment scores compare to those without multimorbidity. Regression coefficients were similar between groups.

CONCLUSION

Findings provide evidence of adequate psychometrics for the KIDSCREEN-27 in young children with chronic physical illness.

Quality of Life Outcomes With Creative Arts Therapy in Children With Cancer

Introduction: Children with cancer experience distress and decreased quality of life (QOL). Creative arts therapy (CAT) is a therapeutic modality which may improve QOL. This study examined the relationship between CAT and QOL in children and adolescents with cancer. Secondary aims explored relationships between CAT and emotional reactions, resilience, and posture (to investigate future potential as an objective biomarker of QOL). Methods: Children aged 3-18 years undergoing cancer treatments and a parent proxy completed the PedsQL3.0 Cancer Module, Faces Scale for emotional reactions, Resilience Scale in adolescents (>12 years), and an inclinometer to measure thoracic kyphosis before and after CAT. CAT exposure (number of sessions) was recorded. Results: Ninety-eight children with cancer (mean age 7.8 years, range 3-17) and parent proxy were enrolled. Of the 83 participants included in the final analysis, 18 received no CAT, 32 received low dose, and 33 received high dose CAT. A significant improvement in QOL was seen with high dose CAT in (slope change, p  =  .015), but the overall time by group interaction was not significant. Slope change response patterns suggested that CAT led to improved posture as compared to no CAT (time by group interaction, p  =  .044). Discussion: CAT may be an effective intervention to improve QOL in this population. Because initial evidence suggests that posture also improves with CAT, further investigation of posture as a potential objective biomarker of QOL is supported. Further study with a randomized controlled trial is warranted.

1 Impact of creative art therapy on fatigue and quality of life in patients treated for localized breast cancer: A randomized study

BACKGROUND

Art therapy (AT) as supportive care may help patients cope with cancer treatments. This non-blinded randomized trial assessed the impact of creative AT on severe fatigue and quality of life (QoL) in localized breast cancer patients undergoing irradiation.

MATERIAL AND METHODS

320 patients were randomized to an AT group (ATG) (8 weekly sessions starting during irradiation) or to a standard group (SG). The primary endpoint was severe global fatigue (FACIT-F score <37) at 1 month post-irradiation. QoL (Fact-B), anxiety/depression (HADS) and different dimensions of fatigue (MFI-20) were assessed at 1, 6 and 12 months post-irradiation. The secondary endpoints, fatigue among patients treated with chemotherapy, QoL (Fact-B), anxiety/depression (HADS) and different dimensions of fatigue (MFI-20) at 1, 6 and 12 months post-irradiation (with post hoc analysis in patients with treated with chemotherapy) were also assessed.

RESULTS

82% of patients completed ≥8 sessions. Severe initial global fatigue was observed in 43% of patients in each group, and among in 64% of patients whose treatment protocol contained chemotherapy. At 1 month post-irradiation, 45% in the ATG and 57% of patients in the SG reported severe global fatigue (p=0.37); among patients with initial severe mental fatigue (MFF), 79% and 44% had improved MFF (p=0.007) respectively; similarly 79% and 44% with initial poor motivation had better mental motivation (p=0.03). At 6 and 12 months, social well-being scores in the ATG were higher (21.3 and 21.4 vs. 19.8 and 19.2, p=0.05 and p<0.01) with a significant improvement for patients who had chemotherapy (41% vs. 18%, p=0.017). A positive association was observed between the number of AT sessions, fatigue and QoL (p<0.01).

CONCLUSION

AT did not significantly improve global severe fatigue among all cancer participants one month after radiation therapy, however it had a positive impact on social well-being and may improve mental fatigue and motivation. This article is protected by copyright. All rights reserved.

Complementary and alternative medicine modalities used to treat adverse effects of anti-cancer treatment among children and young adults: a systematic review and meta-analysis of randomized controlled trials

Background

Dealing with the symptom burden of cancer diagnosis and treatment has led parents to seek different self-management strategies including Alternative and Complementary Medicine (CAM). The aim of this study was to perform a systematic review and meta-analysis about the use and effect of CAM modalities to treat adverse effects of conventional cancer treatment among children and young adults.

Methods

Six scientific research databases were used to identify randomized controlled trials (RCTs) from 1990 to September 2020. Included studies investigated the use of CAM to treat cancer treatment related adverse effects in children and young adults compared to controls.

Results

Twenty RCTs comprising 1,069 participants were included in this review. The included studies investigated acupuncture, mind–body therapies, supplements, and vitamins for chemotherapy-induced nausea and vomiting (CINV), oral mucositis, and anxiety among children and young adults who underwent conventional cancer treatment. Seven studies (315 participants) were included in the meta-analysis. The overall effect of CAM (including acupuncture and hypnosis only) on chemotherapy-induced nausea and/or vomiting and controls was statistically significant with a standard mean difference of -0.54, 95% CI [-0.77, -0.31] I² = 0% (p < 0.00001). There was a significant difference between acupuncture and controls (n = 5) for intensity and/or episodes of CINV with an SMD -0.59, 95% CI [-0.85, -0.33] (p < 0.00001). No significant difference was found between hypnosis and controls (n = 2) for severity or episodes of CINV with an SMD -0.41, 95% CI [-1.09, 0.27] I² = 41% (p = 0.19).

Conclusion

Current evidence from this meta-analysis of randomized controlled trials shows that CAM, including acupuncture and hypnosis only, is effective in reducing chemotherapy-induced nausea and vomiting in children and young adults. More rigorous trials and long-term effects should be investigated if acupuncture and hypnosis are to be recommended for clinical use.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-022-03537-w.

Does Creative Arts Therapy Improve Distressing Symptoms in Children with Cancer? A Synthesis of Extant Literature

Introduction: Children with cancer experience symptom distress which has been correlated with decreased quality of life (QOL). Creative arts therapy (CAT) encompasses the therapeutic use of creative arts which may improve QOL among children with cancer by affecting symptoms. Therefore, the research question was asked: Does CAT affect symptoms of pain, nausea, fatigue, anxiety, and mood in children with cancer? Methods: Based on the study question, a comprehensive literature search of PubMed, CINAHL, PsycINFO, and Embase was completed. Inclusion criteria limited articles to specific symptom outcomes in two-group intervention studies in the English language. Selected articles were confirmed for inclusion by the study team, followed by group discussion to develop matrices with levels of evidence based on the Grading of Recommendations Assessment, Development, and Evaluation (Grade) guidelines. Results: Initial searches revealed 1,391 articles, screened to 44 for systematic review. Based on the inclusion criteria, 11 articles remained. Four studies had evidence levels graded as low, three were low to moderate, and four were moderate. Outcomes of mood and anxiety were measured in five studies, pain in four, fatigue in two, and nausea in one study. Discussion: Psychological outcomes were measured more commonly than physical outcomes. Evidence reached a moderate grade in four studies. Summary: Through this synthesis of intervention studies with CAT in children with cancer, improvement in distressing symptoms has potential, but the state of the science for symptom management with CAT could be strengthened for nurses to promote CAT to improve QOL among children with cancer.

Safety of Complementary and Alternative Medicine (CAM) treatment among children and young adults who suffer from adverse effects of conventional cancer treatment: A systematic review

Background:

Complementary and Alternative Medicine (CAM) is widely used around the world to treat adverse effects derived from cancer treatment among children and young adults. Parents often seek CAM to restore and maintain the child’s physical and emotional condition during and after cancer treatment.

Objectives:

The objectives of this review were (i) to identify literature that investigates CAM use for treating adverse effects of conventional cancer treatment, (ii) to investigate the safety of the included CAM modalities, and (iii) to evaluate the quality of included studies.

Methods:

Five scientific research databases were used to identify observational, quasi-experimental, and qualitative studies from January 1990 to May 2021. Included studies investigated the use of CAM to treat adverse effects of cancer treatment in childhood cancer.

Results:

Fifteen studies were included in this review. Ten quasi-experimental, 3 observational studies (longitudinal/prospective), 2 qualitative studies, and 1 study with a quasi-experimental and qualitative arm were identified. Less than half (n = 6; 40%) of the studies included reported adverse effects for the CAM modality being studied. Among the studies that reported adverse effects, they were mostly considered as direct risk, as 13% reported mainly bleeding and bruising upon acupuncture treatment, and dizziness with yoga treatment. All adverse effects were assessed as minor and transient. CAM modalities identified for treating adverse effects of cancer treatment were alternative medical systems, manipulative and body-based therapies, biologically-based therapies, and mind-body therapies. CAM modalities were used to alleviate anxiety, pain, toxicity, prevent trauma, and improve health-related quality of life, functional mobility, and physical activity levels. All studies assessed scored 70% or above according to the Joanna Briggs Institute critical appraisal for study quality checklists.

Conclusion:

Most of the studies (58.3%) included in this review did not report adverse effects from CAM modalities used to treat adverse effects of cancer treatment in children and young adults. This lack of safety information is of concern because parents need to know whether the modality represents an extra burden or harm to the child. To improve awareness about safety in the field, a universal and uniform reporting system for adverse effects in CAM research is needed.

An Investigation into Art Therapy Aided Health and Well-Being Research: A 75-Year Bibliometric Analysis

Considering the physical, and psychological impacts and challenges brought about the coronavirus disease 2019 (COVID-19), art therapy (AT) provides opportunities to promote human health and well-being. There are few systematic analysis studies in the fields of AT, which can provide content and direction for the potential value and impact of AT. Therefore, this paper aims to critically analyze the published work in the field of AT from the perspective of promoting health and well-being, and provides insights into current research status, hotspots, limitations, and future development trends of AT. This paper adopts a mixed method of quantitative and qualitative analysis including bibliometric analysis and keyword co-occurrence analysis. The results indicate that: (1) the current studies on AT are mostly related to research and therapeutic methods, types of AT, research populations and diseases, and evaluation of therapeutic effect of AT. The research method of AT mainly adopts qualitative research, among which creative arts therapy and group AT are common types of AT, and its main research populations are children, veterans, and adolescents. AT-aided diseases are trauma, depression, psychosis, dementia, and cancer. In addition, the therapeutic methods are mainly related to psychotherapy, drama, music, and dance/movement. Further, computer systems are an important evaluation tool in the research of AT; (2) the future development trend of AT-aided health and well-being based on research hotspots, could be focused on children, schizophrenia, well-being, mental health, palliative care, veterans, and the elderly within the context of addressing COVID-19 challenges; and (3) future AT-aided health and well-being could pay more attention to innovate and integrate the therapeutic methods of behavior, movement, and technology, such as virtual reality and remote supervision.

Utilization of Parallel Resources and Sociodemographic Factors in Treating Children with Complex Chronic Diseases: A Cross-Sectional Study

Background: Children with complex chronic conditions have a high need for health and social care resources. Many parents explore parallel resources such as alternative therapies, associations, psychological support, private medical consultations, and other out-of-pocket expenses for healthcare. The use of these alternative health resources is sometimes unclear and may lead to health inequalities. To characterize the use made of alternative healthcare resources for children with complex chronic conditions. Additionally, we evaluate the influence of sociodemographic factors on the distribution of this utilization of resources; (2) Methods: Cross-sectional study. Children with complex chronic diseases were treated at a tertiary hospital in Granada, Spain in 2016. We analyzed their use of healthcare resources and socioeconomic variables. This research complies with STROBE guidelines for observational studies; (3) Results: In total, 265 children were analyzed (mean age 7.3 years, SD 4.63). A total of 105 children (39.6%) attended private consultations with specialists, and 12.1% (n = 32) of the children had additional private health insurance. One out three parents belonged to a mutual support association (n = 78), and 26% (n = 69) of the children used alternative therapies. Furthermore, 75.4% (n = 199) of the children received no psychological support. Children whose parents had a higher educational level and occupations status made greater use of parallel healthcare resources.; (4) Conclusions: A significant proportion of children used multiple health resources in addition to the public healthcare system depending on sociodemographic determinants. Studies are needed to determine whether the use of these alternative services achieves better levels of health.

The effects of group art therapy on adolescents' self-concept and peer relationship: A mixed-method study

This study examined the effects of group art therapy on self-concept and peer relationships among adolescents using a mixed-method approach. Twelve recruited adolescents from a high school in Northern Taiwan attended weekly 2-h group art therapy sessions for 8 weeks. Through a discovery-oriented approach incorporating focus group interviews and individual interviews, qualitative results revealed that the participants started getting to know themselves better and were able to explore their inner selves while noticing their own emotions. Their self-concept also became more positive along with reduced negative self-concept, increased positive self-concept, and clearer visions towards future goals. Furthermore, the therapy modified adolescents' negative peer relationships by reducing their social anxiety and adjusting their complicated experiences. Participants were found to experience trustable, allied, and compassionate positive peer relationships while having reduced loneliness and improved social skills at the same time. Besides, the participants answered self-concept and peer relationship scales at pre- and post-interventions as well as a 12-month follow-up thereafter. Friedman test on the longitudinal data showed participants reporting consistently higher self-concept and peer relationship at post-intervention and 12-month follow-up than at the pre-intervention stage. Taken together, the findings duly support art therapy in boosting adolescents' self-concept and peer relationships.

Art Heals: Randomized Controlled Study Investigating the Effect of a Dedicated In-house Art Gallery on the Recovery of Patients After Major Oncologic Surgery

INTRODUCTION

We sought to investigate the effect of exposure to a dedicated art gallery during the perioperative period on the recovery of patients undergoing major oncologic procedures.

METHODS

Eighty patients were randomized into 2 arms; standard of care versus exposure to art. All patients completed a survey assessing their baseline art knowledge, and 4 poststudy validated questionnaires assessing their pain (Pain Rating Scale), hope (Herth Hope Index), anxiety (State-Trait Anxiety Inventory for Adults), and mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale). A linear model adjusted for baseline scores was run comparing the scores among the 2 study arms. Stepwise multivariate regression analyses were used to identify predictors of improved pain, hope, anxiety, and wellbeing.

RESULTS

Both groups were comparable in terms of demographics, passion, and knowledge about art. There was no statistically significant difference in pain scores between the 2 groups. The exposure to art group experienced higher hope (2.4 points higher vs 0.05, P = 0.004), lower anxiety (8 points lower vs -0.9, P < 0.0001), and higher mental well-being scores (5.23 points higher vs -0.05, P < 0.0001) in comparison to the standard of care group. On multivariate analyses, exposure to art was significantly associated with improved hope, anxiety, and mental well-being after adjusting for patient and disease characteristics.

CONCLUSIONS

Dedicated exposure to art was associated with improved hope, anxiety, and mental well-being of patients after major oncologic surgery.

Art Therapy: A Complementary Treatment for Mental Disorders

Art therapy, as a non-pharmacological medical complementary and alternative therapy, has been used as one of medical interventions with good clinical effects on mental disorders. However, systematically reviewed in detail in clinical situations is lacking. Here, we searched on PubMed for art therapy in an attempt to explore its theoretical basis, clinical applications, and future perspectives to summary its global pictures. Since drawings and paintings have been historically recognized as a useful part of therapeutic processes in art therapy, we focused on studies of art therapy which mainly includes painting and drawing as media. As a result, a total of 413 literature were identified. After carefully reading full articles, we found that art therapy has been gradually and successfully used for patients with mental disorders with positive outcomes, mainly reducing suffering from mental symptoms. These disorders mainly include depression disorders and anxiety, cognitive impairment and dementias, Alzheimer's disease, schizophrenia, and autism. These findings suggest that art therapy can not only be served as an useful therapeutic method to assist patients to open up and share their feelings, views, and experiences, but also as an auxiliary treatment for diagnosing diseases to help medical specialists obtain complementary information different from conventional tests. We humbly believe that art therapy has great potential in clinical applications on mental disorders to be further explored.

The effectiveness of mandala drawing in reducing psychological symptoms, anxiety and depression in hospitalised adolescents with cancer: A randomised controlled trial

OBJECTIVE

This study aimed to evaluate the effectiveness of individual mandala drawing methods on psychological symptoms, anxiety and depression in hospitalised adolescents with cancer.

METHODS

A randomised controlled trial design with repeated measures was conducted. The study was carried out in a paediatric haematology and oncology clinic in Turkey. The study protocol is registered at ClinicalTrials.gov NCT04297982. The study sample consisted of 60 hospitalised adolescents aged between 12 and 17. Participants were randomly assigned to receive two 1- to 2-h mandala drawing sessions (intervention group, n = 30) or routine care only (control group, n = 30). Each adolescent was assessed using the Hospital Anxiety and Depression Scale and the Memorial Symptom Assessment Scale (Psychological subscale) questionnaires and was evaluated at baseline and after 5 days.

RESULTS

The anxiety and depression scores significantly decreased in the intervention group, compared with the control group, after 5 days of intervention, F(1, 57) = 28.9, p < 0.01, η²  = 0.337. Similarly, the psychological symptoms scores significantly decreased in the intervention group, compared with the control group, F(1, 57) = 69.7, p < 0.001, η²  = 0.550).

CONCLUSION

The individual mandala activity intervention was effective in reducing on psychological symptoms, anxiety and depressive symptoms in adolescents with cancer.

Effects of Drawing Therapy on Pediatric Oncology Patients: A Systematic Review

BACKGROUND

A small but significant number of children and adolescents with cancer experience severe physical and psychological distress. Previous studies have shown that drawing therapy positively affects relieving psychological problems. However, the effect of drawing therapy on pediatric oncology patients has not been established by systematic review.

OBJECTIVE

The aim of this study was to determine the effect of drawing therapy on the pediatric oncology population.

METHODS

PubMed, EMBASE, MEDLINE, Cochrane, PsycINFO, CINAHL, and Chinese databases including CNKI, Wanfang, VIP, and CBM were searched. Studies published in the English and Chinese languages up to December 2019 were screened, and randomized controlled trials and nonrandomized experimental studies of drawing therapy interventions for pediatric oncology patients were reviewed. Screening was undertaken independently by 2 reviewers. The review protocol was registered with PROSPERO (registration number: CRD42020178365).

RESULTS

Eight studies were included. Three studies were randomized controlled trials, and 5 studies were nonrandomized experimental studies. Seven studies showed that drawing therapy had positive effects on reducing depression and anxiety and improving quality of life. However, 1 study showed a contradictory result, that is, participants had an increased anxiety level after intervention.

CONCLUSIONS

Drawing therapy is effective in improving negative emotions, relieving somatic symptoms, and increasing social communication for pediatric oncology patients.

IMPLICATIONS FOR PRACTICE

Drawing therapy may be considered an adjuvant psychological intervention strategy for pediatric oncology patients. Meanwhile, more rigorous studies are needed to address the deficiencies of small number size and methodological weakness.

An Investigation of the Effectiveness of Arts Therapies Interventions on Measures of Quality of Life and Wellbeing: A Pilot Randomized Controlled Study in Primary Schools

BACKGROUND

Over the last decades there has been a change in the way schooling is perceived recognizing that children's learning is closely linked to children's health. Children spend most of their time at school, which is often the place where problems are identified and interventions are offered, not only for treatment but also prevention. Embedding arts therapies into the educational system may help address children's emerging needs and have a positive impact on their wellbeing.

METHODS

A pilot cross-over randomized controlled design was employed to investigate the effectiveness of an arts therapies intervention on a series of child- and teacher-reported outcome measures, specifically, health related quality of life (assessed using a HRQOL scale; EQ-5D-Y), wellbeing and life functioning (assessed using the child outcome rating scale; CORS), emotional and behavioral difficulties (assessed using the strengths and difficulties questionnaire; SDQ), as well as duration of sleep (assessed using Fitbits). Sample size calculations for future large-scale studies were also performed, and the sustained impact of the intervention was evaluated at 3, 6, and 12 months follow-up. The pluralistic theoretical and therapeutic framework of this intervention was informed by a systematic review on school-based arts therapies interventions and is presented in detail in the study protocol. Participants were 62 children with mild emotional and behavioral difficulties.

RESULTS

Improvements in HRQOL and CORS were greater in those engaged in the arts therapies intervention than the control groups and were maintained at the follow-up stages. Significant improvements were only found for duration of sleep (P = 0.002) and SDQ (P = 0.008). Minimal clinically important differences (MCIDs) as defined in the published protocol were found for CORS, SDQ and duration of sleep, but not HRQOL.

DISCUSSION

Findings indicate that the arts therapies interventions were having a clinically significant effect on life functioning, duration of sleep, emotional and behavioral difficulties. Findings also indicate a small effect size for health related quality of life, suggesting the intervention was having a small positive effect on this outcome measure. The study indicates that all outcome measures assessed here would be suitable for inclusion in a larger randomized controlled study utilizing these arts therapies interventions, and that a sample size of 225 participants would be required if these outcome measures were used.

Using Arts-Based Therapies to Improve Mental Health for Children and Young People With Physical Health Long-Term Conditions: A Systematic Review of Effectiveness

Background: Children with physical health long-term conditions (LTCs) have increased risk of mental health difficulties relative to healthy peers. However, availability of psychological support integrated into pediatric physical health settings is limited, and there are long waiting times for access to child mental health services. Arts-based therapies involve using creative media to develop a therapeutic relationship, and offer a potential alternative to talking-based therapies. The aim of this systematic review is to establish the effectiveness of arts-based therapies for improving the mental health of children with physical health LTCs.

Methods: The review protocol was published on PROSPERO. Four electronic databases were searched (Medline, Embase, Cinahl, and PsycINFO), plus hand searches of two key journals and relevant reviews, and forward/back citations searches of selected articles were conducted. The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess bias in selected articles. Second reviewers completed 10% of article screening and 20% of bias assessments. The findings were synthesized narratively.

Results: Sixteen studies met inclusion criteria and demonstrated some improvements on indicators of mental health and well-being including quality of life, coping behaviors, anxiety, self-concept, and mood. However, replication across interventions and outcomes was absent. Overall, the quality of evidence of effectiveness in the studies reviewed was moderate/weak. This was due to bias in study design; other limitations included a lack of detail on intervention components, e.g., use of a manual, and single recruitment sites.

Conclusions: The heterogeneity of existing research evaluating arts-based therapies for children with physical health LTCs limits conclusions about effectiveness. Suggestions are made to inform the design of future research studies to help build a robust evidence base.

Psycho-art-drama: development and testing a new integrated complementary method of psychiatric treatments for hospitalised children with cancer (a case study)

Objective: Art therapy as a psychotherapy method using art, and psychodrama as a therapeutic method using role play, have different roots, principles, techniques and different effect mechanisms and advantages. Integrated psychotherapies are aimed to maximise each of the component advantages, as well as minimising disadvantages. Therefore, the main objective of this study was to develop a new integrated psychotherapy method, named psycho-art-drama (PAD) for hospitalised children with cancer and testing its effectiveness.Methods: After designing the PAD protocol, five hospitalised children with cancer accompanied with their mothers selected based on inclusion and exclusion criteria to participate in this single-subject study.Results: The results showed that PAD was significantly effective in reducing the bio-psycho-social expressions of incompatibility in the hospital (BPSEIH) in all of the five children.Conclusions: Findings of this study give preliminary support using the PAD model in similar conditions.