Exposure to creative arts therapies can improve anxiety, depression, and pain symptoms, as well as quality of life in patients with cancer, but the effect is reduced during follow-up. That is the conclusion of a review of randomized clinical trials published earlier this year in JAMA Internal Medicine (2013;173:960-969). Previous studies have suggested that such therapies were effective to improve cancer- and treatment-related symptoms during and after treatment in patients, but this is the first systematic review of randomized clinical trials to examine the effects of creative arts therapies on the psychological symptoms of cancer patients.

"People have broadened their perspectives on what health is and have moved beyond just the physical," the corresponding author, Timothy Puetz, PhD, MPH, Presidential Management Fellow at the NIH, noted via email. "It is important to conduct more research on creative arts therapies and the potential beneficial effects they may have on this patient population."

The researchers reviewed 27 studies involving 1,576 patients from the Educational Resource Information Center, Google Scholar, MEDLINE, PsychInfo, PubMed, and Web of Science. Creative arts therapy interventions included art, dance, drama, music, writing, and combined creative arts modalities (studies that explicitly evaluated mind-body techniques, such as yoga, meditation, and qigong were not included). The results showed that:

* Anxiety was significantly reduced during exposure to the interventions, but was not significantly reduced during the period after exposure to the interventions in follow-up;

* Depression was significantly reduced during exposure to the interventions, but not significantly reduced during the period after exposure to the interventions in follow-up;

* Pain was significantly reduced during exposure to the interventions, and was also significantly reduced during the period after exposure to the interventions in follow-up;

* Fatigue was not significantly reduced after exposure to the interventions; and

* Quality of life was significantly increased after exposure to the interventions, but not significantly increased in the period after the interventions in follow-up.

Although the magnitude of the effects of creative arts therapies was generally reduced in follow-up, the researchers concluded that better-designed randomized clinical trials are needed: "Future well-designed RCTs are needed to address the methodological heterogeneity found within this field of research."

Specifically, such trials should: determine the most effective therapies-i.e., modality, frequency, and length of session; examine the relationship between neurobiological and psychological measures of cancer symptoms; and compare creative arts therapies with psychosocial and pharmacological interventions.