Accumulating Evidence for Dance/Movement Therapy in Cancer Care

Effectiveness of dance movement therapy and dance movement interventions on cancer patients' health-related outcomes: a systematic review and meta-analysis

OBJECTIVES

This review examined the effectiveness of using dance movement therapy (DMT) and dance movement interventions (DMIs) with cancer and palliative care patients.

METHODS

A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six databases were searched from inception to July 9, 2022, without limits on year or age. Searching was updated on July 10, 2023. The risk of bias was assessed by the Cochrane (RoB 2) and ROBINS-I tools. Meta-analyses were conducted to pool estimates of the effects of DMT and DMI on patients' health-related outcomes. A narrative synthesis of outcomes was performed where meta-analysis was not appropriate.

RESULTS

Among a total of 16 studies included in this review, nine were randomized controlled trials and seven were non-randomized trials, with a total of 893 participants. Only six of these studies were fully or partially described as true DMTs (some with less clarity than others), whereas the majority (n = 10) were DMIs with unclear therapeutic alignment. Most studies focused on female patients with breast cancer. Cancer patients undergoing palliative care received little attention. The overall risk of bias from the evaluated studies was high. Meta-analysis of two trials revealed that DMTs had no effect on QOL in cancer patients (SMD - 0.09, 95% CI - 0.21-0.40, P = 0.54), while narrative analysis and non-randomized trials showed no overall effect of DMTs on anxiety, depression, body image, self-esteem, or sleep disturbance but significant positive effects on perceived stress, pain severity, and pain interference. DMIs had significant positive effects on cancer patients' depression (SMD - 0.53, 95% CI - 0.93 to - 0.14, P = 0.008) and fatigue (SMD - 0.42, 95% CI - 0.70 to - 0.14, P = 0.003). DMI trials synthesized narratively showed an effect on patients' body image, self-esteem, physical function, right and left handgrip strength, life satisfaction, and the mental component of QOL.

CONCLUSION

Both DMT and DMIs had promising effects on several health outcomes, but results were inconsistent, and the evidence was weak. The reviewed studies' low evidence quality and small sample sizes affected the findings' robustness and reliability. Large-scale, high-quality randomized controlled trials with sufficient sample sizes, and clear and veracious DMT and DMI protocols and data are required to provide more credible research evidence and influence practice.

Moving towards holistic rehabilitation - A qualitative study exploring how people diagnosed with cancer and cancer survivors experience a dance-like intervention

BACKGROUND

Rehabilitation that supports the individual on the journey back to their usual selves after cancer treatment becomes increasingly important. Studies have shown that a focus on the connection between body and mind might be beneficial. Consequently, Whole Person Care and initiatives that fall in line with this holistic approach to health care, such as a dance-like intervention needs further examination. The aim of this study was to explore the qualitative aspects of 5Rhythms® as experienced by people diagnosed with cancer.

METHOD

A total of 29 (17 in 2017) participants were recruited through purposeful sampling. Participants underwent one 5Rhythms® session per week for 2 months. This qualitative study with a phenomenological approach used diaries and individual interviews as its methods for data collection. Data were analysed using Giorgi's phenomenological framework and Maurice Merleau-Ponty's theoretical perspectives on phenomenological approaches to the body, perception and consciousness were applied.

RESULTS

Three main themes ('(now) I sense my entire body', 'Something liberating is happening inside my body' and 'We travel together') and five connecting sub-themes were identified through the analysis process.

CONCLUSION

Participating in 5Rhythms® contributed to reconnecting body and soul during or after battling cancer. It evoked thoughts and feelings of existential matter. Results suggest that participating in 5Rhythms® can assist in personal growth. The benefit of being among peers while on the path to recovery was also illuminated. In regard to rehabilitation, this study underlines the importance of being aware of the connection between body and mind.

Dance Movement Psychotherapy in Breast Cancer: “Throwing the Βall to Μount Olympus”

The present study is a Dance Movement Psychotherapy (DMP) pilot intervention designed to address the psychological challenges faced by Greek breast cancer patients, after surgery and around radiotherapy treatment. It was designed as a 12 weeks’ project, involving patients of diverse age and educational level, mostly living in rural areas. The personality and psychopathology inventory Symptoms’ Check List-90 (SCL-90), the therapist’s records and video self-observation were used in a mixed method approach. Thirteen subjects initiated the study, but they were gradually reduced and only four completed it. Statistical analysis was performed using SPSS-25 addressing this fact. Positive results of qualitative interpretation of the therapist’s data and SCL-90, as well as changes in movement patterns and self-perception evaluated via video self-observation, showed that the intervention was beneficial for the patients who completed it. However, the fact that not all the participants were able to finish the program, implies that although DMT intervention at an early stage can help some patients deal with strong emotions, careful evaluation of eligible individuals should precede. Besides the patients’ medical condition, demographic and personality characteristics should be considered in the design of future similar studies.

Innovative participatory evaluation methodologies to assess and sustain multilevel impacts of two community-based physical activity programs for women in Colombia

BACKGROUND

Community-based physical activity (PA) programs are appealing to women in Latin America and show potential for improving women's health. This study aimed to engage healthy middle-aged women, breast cancer survivors and local stakeholders participating in two publicly funded community-based PA programs in Bogotá, Colombia (Recreovía and My Body) to assess and visually map the perceived barriers, facilitators, and outcomes to promote programs' improvement, scaling and sustainability.

METHODS

We used two participatory action research methods, the 1) Our Voice citizen science method to capture data and drive local change in built and social environmental facilitators and barriers that influence women's engagement in community-based PA; and 2) Ripple Effects Mapping to visually map the intended and unintended outcomes of PA programs. We used thematic analysis to classify the results at the individual, social, and community levels.

RESULTS

The stakeholders engaged in the participatory evaluation included cross-sector actors from the programs (N = 6) and program users (total N = 34) from the two programs (Recreovía N = 16; My Body N = 18). Program users were women with a mean age of 55.7 years (SD = 8.03), 65% lived in low-income neighborhoods. They identified infrastructure as the main feature affecting PA, having both positive (e.g., appropriate facilities) and negative (e.g., poorly built areas for PA) effects. Regarding program improvements, stakeholders advocated for parks' cleaning, safety, and appropriate use. The most highlighted outcomes were the expansion and strengthening of social bonds and the engagement in collective wellbeing, which leveraged some participants' leadership skills for PA promotion strategies in their community. The facilitated dialogue among program users and stakeholders fostered the sustainability and expansion of the community-based PA programs, even during the COVID-19 pandemic.

CONCLUSIONS

The implementation of both participatory methodologies provided a multidimensional understanding of the programs' impacts and multisectoral dialogues that fostered efforts to sustain the community-based PA programs.

Effect of Dance Movement Therapy on Cancer-Related Fatigue in Breast Cancer Patients Undergoing Radiation Therapy: A Pre-post Intervention Study

Introduction

Dance movement therapy (DMT) is a movement-based psychosocial intervention that incorporates the therapeutic components of dance movements and group psychotherapy. DMT, also known as creative movement therapy (CMT) is a psychotherapy used as a complementary therapy in cancer care. It helps in enhancing mood, emotions, self-expression and helps to rebuild self-confidence. Besides, it allows the patients to recognise their own strengths and weaknesses as well as helps to improve physical capabilities.

Methods

By simple random sampling method, 30 breast cancer patients were recruited at Pravara Rural Hospital, Loni, Maharashtra, India. The participants were in the age range of 30-60 years based on the inclusion and exclusion criteria. Pre-intervention scores of cancer-related fatigue (CRF) were taken using the Brief Fatigue Inventory (BFI) scale and intervention was given for 45 minutes each day for 5 days a week, over a span of 2 weeks. Thereafter, post-intervention assessment was done and the scores were noted. Pre-intervention and post-intervention scores were compared using paired t-test.

Results

The mean and standard deviation (SD) of pre- and post-BFI scores derived by using paired t-test was 73.76 (8.6) and 69.33 (9.8), respectively, with a p-value of < 0.001, which is highly significant.

Conclusion

The results of the present study revealed that DMT seems to be effective in reducing some amount of CRF in breast cancer patients undergoing radiation therapy. Besides, it turned out to be an engaging, entertaining and cost-effective approach. The investigation showed that DMT appears to be beneficial in reducing the side effects of radiation therapy such as pain, stress, anxiety and fear, giving a psychotherapeutic relief but did not completely remove the persistent fatigue experienced by the breast cancer patients. Thus, further investigation with long-term follow-up is recommended.

Dance/Movement Therapy as an Intervention in Breast Cancer Patients: A Systematic Review

Aim

In this paper, we systematically review the evidence looking at the effect of dance/movement therapy (DMT) and mental health outcomes and quality of life in breast cancer patients.

Method

The literature search was done with the databases PubMed (MEDLINE), EBSCO, and Cochrane Central by using the following search words: “dancing/dance/movement therapy,” “breast cancer/neoplasms/carcinoma/tumour” or “mammary cancer,” “mental health,” and “quality of life.” Ninety-four articles were found. Only empirical interventional studies (N = 6) were selected for the review: randomised controlled trials (RCT) (n = 5) and non-RCT (n = 1). PRISMA guidelines were used.

Results

Data from 6 studies including 385 participants who had been diagnosed with breast cancer, were of an average age of 55.7 years, and had participated in DMT programmes for 3–24 weeks were analysed. In each study, the main outcomes that were measured were quality of life, physical activity, stress, and emotional and social well-being. Different questionnaires were used for the evaluation of outcomes. The mental health of the participants who received DMT intervention improved: they reported a better quality of life and decreased stress, symptoms, and fatigue.

Conclusion

We found only six studies for review, and some had a small number of participants. However, our findings indicate that DMT could be successfully used as a complimentary therapy in addition to standard cancer treatment for improving the quality of life and mental health of women who have been diagnosed with breast cancer. More research is needed to evaluate the complexity of the impact of complimentary therapies. It is possible that DMT could be more effective if used with other therapies.

Evidence of disease severity, cognitive and physical outcomes of dance interventions for persons with Parkinson's Disease: a systematic review and meta-analysis

BACKGROUND

Patients with Parkinson's Disease (PD) usually experience worsening of both motor and non-motor symptoms. Dancing has been postulated to help patients with Parkinson's via several mechanisms that lead to improved physical, cognitive and social functions.

METHODS

This systematic review was conducted following Cochrane methodology and reported following the PRISMA guideline. Four databases (up to June 2021) were searched for RCTs comparing dance to standard or other physical therapy for improvements in disease severity, quality of life, cognitive and physical outcomes as well as adverse events in patients with PD. We synthesised data using RevMan and included certainty-of-evidence rating (GRADE) for major outcomes.

RESULTS

A total of 20 RCTs (N = 723) articles that evaluated Tango, Ballroom, Irish, Waltz-Foxtrot, Folk, Turo, mixed dances and a PD-tailored dance were included. Dancers (versus non-dancers) had better motor experience (MDS-UPDRS 3) (MD -6.01, 95 % CI -9.97 to -3.84; n = 148; 5 RCTs) and improved balance (MiniBest Test) (MD 4.47, 95 % CI 2.29 to 6.66; n = 95; 3 RCTs), with no consistent differences on gait, agility and cognitive outcomes. Small samples and methodological limitations resulted in low-certainty-evidence across outcomes.

CONCLUSIONS

Apart from a suggestion that dance intervention modestly reduced motor disease severity and improved certain aspects of balance, there is insufficient evidence on all other outcomes, such as agility and motor function, cognitive, mood and social outcomes, quality of life as well as adverse events including the risk of fall. As evidence is insufficient to inform practice, evidence of benefits on motor disease severity and balance needs to be considered in the context of user-perception of benefit versus harm and acceptability in the development of practice guideline recommendations.

Dance promotes positive benefits for negative symptoms in autism spectrum disorder (ASD): A systematic review

BACKGROUND

Autism spectrum disorder (ASD) is characterized as a neurodevelopmental disorder with stereotyped and repetitive behaviors. Dance practice can elicit esthesia to stimulate the communication process through the notion of the phenomenal body that is recognized in an expressive and symbolic space.

OBJECTIVE

To conduct a systematic review to identify how dance promotes positive benefits for the negative symptoms in ASD.

METHOD

We formulated the research question based on PICO: "What is the influence of dance on negative symptoms in individuals with autism spectrum disorder?". Databases were searched in March 2019 and included PubMed, Science Direct, Scopus, PsycInfo and Web of Science.

RESULTS

We identified 9,350 studies of which five were selected for our review (a total of 266 individuals). All included studies showed an influence of dance on negative symptoms, including empathy, emotional expression, body awareness, behavior, and psychological wellbeing that impact on social reciprocity, and consequently the communication process, in ASD.

CONCLUSIONS

Dance practice may contribute to body awareness and social involvement using techniques that provide mirroring, synchronization, rhythm, and reciprocity in adults with normal to high-functioning ASD.

Children Are Born to Dance! Pediatric Medical Dance/Movement Therapy: The View from Integrative Pediatric Oncology

Children freely expressing themselves through spontaneous dance is a natural part of childhood. The healing powers of dance are universal in all cultures across history. Dance/movement therapy (DMT) in pediatric oncology is little known and underutilized. This article discusses DMT, specifically focusing on pediatric oncology. It defines and clarifies the difference between medical DMT as a psychotherapeutic modality aimed at addressing the patient’s psychosocial needs, and dance and therapeutic dance used recreationally to engage patients during their hospital visits. A literature review of DMT with medically ill children in the United States and worldwide is provided. It culminates with a focus on advancements in the field, discussing the future of pediatric medical DMT. Grounded in a biopsychosocial perspective, the intrinsically nonverbal and embodied nature of pediatric medical DMT is uniquely positioned to be a strong component of integrative oncology services. The use of DMT to synthesize potentially traumatic aspects of the medical experience is proposed. It ends with a call for research posing the question: Can pediatric medical DMT support the patient to express feelings while in cancer treatment within the context of a psychotherapeutic milieu, enabling the patient to create an embodied coherent narrative that fosters expressivity and empowerment?