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Art Therapy Sessions For Cancer Patients: A Single-Centre Experience
Art Therapy Sessions For Cancer Patients: A Single-Centre Experience
Keywords scores of 8.0 (pre-test), 6.0 (early post-test) and 6.0 (late post-
Art therapy · Cancer · Anxiety · Quality of life · Well-being test), respectively. The depression test reported median
scores of 4.0 (pre-test), 5.0 (early post-test) and 6.0 (late post-
test), respectively. The median well-being score difference
Abstract observed between the beginning and the end of sessions is
Introduction: Cancer and anti-cancer therapies are often as- +2.13. The minimum satisfaction score observed is 3.50 out
sociated with pain, loss of self-worth, anxiety, and depres- of 10, and the maximum is 10 out of 10. The median is be-
sion. Alternative therapies such as art therapy are available tween 7.00 and 10.00. Conclusions: Art therapy sessions had
to improve patients’ quality of life, by reducing asthenia, de- an impact on patients’ welfare. We also reported a trend to-
pression, anxiety and pain. Objective: The aim of this study wards amelioration of quality of life that could probably be
was to assess the effectiveness of art therapy, namely theatre confirmed in a larger population, and potentially with a dif-
and plastic art workshops, on well-being and quality of life ferent methodology. © 2020 S. Karger AG, Basel
of participants in the Lucien Neuwirth Cancer Institute.
Methods: A prospective study was conducted at the Lucien
Neuwirth Cancer Institute (France), between April 2018 and Introduction
July 2018. Cancer patients followed at the Institute have
been asked to participate in 10 2-h sessions, once a week, Cancer and anti-cancer therapies are often associated
based on theatre and plastic art workshops. Self-report ques- with life-changing impacts for patients: pain and other
tionnaires were used to evaluate both psychological and discomfort symptoms, body image modification, loss of
quality of life domains, but also satisfaction and well-being, self-worth, familial and social isolation, anxiety, and de-
before (pre-test) and after the last session (early post-test), pression [1–7]. To help manage these issues, different
as well as 1-month post-experimentation (late post-test). Re- treatments or options can be proposed, including drug
sults: Among the 14 patients who were enroled, the QLQ- therapies, psychological support, diet measures and/or
C30 questionnaire revealed a pre-test median score of 50.0, social follow-up. Patients can also have access to comple-
an early post-test score of 51.5, and the late post-test re- mentary therapies, such as relaxation, sophrology, hyp-
vealed a score of 48.0. The anxiety test revealed median notherapy, osteopathy, or acupuncture [8–10].
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Art therapy has been used in the care of cancer patients Table 1. Baseline characteristics of the study population
for many decades and it is increasingly used in oncology
departments or palliative care units. It is based on the idea Variables Number Percentage
that creativity has a therapeutic effect, and that expression Age, years
of fear, anxiety, and pent-up emotions could enhance Median (range) 49.5 (25–71) –
well-being and quality of patients’ life. Art therapy is a Sex
real way of expression and communication for patients Female 12 85.7
Male 2 14.3
but also for their loved ones, utilizing creative modalities,
Primary cancer
including sculpture, drawing, and painting, theatre, and Breast 6 42.9
music ways. Through these methods, patients can share Lung 2 14.3
their lived experience and sensations to stand by their Ovary 2 14.3
feelings. Art therapy sessions offer a time to communi- Upper aero-digestive tract 1 7.1
Pancreas 1 7.1
cate, to be listened to, to de-stress, and to enjoy, where the Intestine 1 7.1
suffering subject feels recognized as a person and not as a Myeloma 1 7.1
patient anymore [11–13]. Professional activity
The use of art therapy in cancer care settings is increas- Sick leave 8 57.1
ingly noticeable over recent years. Interestingly, studies Retirement 3 21.4
Part-time job 2 14.3
showed an improvement of quality of life (QoL), and a No job 1 7.1
reduction of discomfort symptoms, such as asthenia, de- Patient transportation
pression, anxiety and pain [14–23]. Personal vehicle 12 85.7
From a perspective of QoL amelioration, the Lucien Taxi 1 7.1
Neuwirth Cancer Institute, in relationship with the Ligue Public transport 1 7.1
Contre le Cancer, organized art therapy sessions for can-
cer patients, who are followed at the Institute. Our aim
was to assess the effectiveness of art therapy, namely the- (early post-test), as well as at 1-month post-experimentation (late
atre and plastic art workshops, on well-being and QoL of post-test). Psychological distress was assessed using the Hospital
participants. Anxiety and Depression Scale, a 14-item inventory comprising 7
anxiety-related symptoms and 7 depression-related symptoms.
The QoL was rated with the EORTC-QLQ-C30 that encompasses
6 domains (i.e., physical function, role function, emotional func-
Methods tion, pain, fatigue, global health/QoL). All patients were also asked
to express their expectations regarding these art therapy sessions
Study Design and Study Population and to indicate their concomitant treatments, in particular antalgic
We conducted a prospective study at the Lucien Neuwirth Can- and anxiolytic treatments. Patient and study details were obtained
cer Institute between April 2018 and July 2018. Cancer patients from the medical records and interviews with the subjects. After
receiving or having received chemotherapy and/or radiotherapy the study period (14 weeks), no further follow-up was planned.
were eligible to participate: diagnosed with cancer, independently Finally, we surveyed patients’ satisfaction before and after each ses-
of the stage, aged ≥18 years, good performance status, could com- sion with a visual well-being scale, graduated from 0 (not satisfied
municate and understand the questionnaires, could attend the at all) to 10 (fully satisfied), as a proxy to evaluate art therapy im-
planned workshop sessions. plementation at the Lucien Neuwirth Cancer Institute.
2 Oncology Gras/Daguenet/Brosse/Beneton/Morisson
DOI: 10.1159/000504448
Université de Paris
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(86%). Their median age was 49.5 years (range, 25–71 Table 2. Concomitant treatments at the 3 assessment points
years). The main primary tumour location was the breast
(n = 6, 42.9%), followed by the lung (n = 2, 14.3%) and Pre-test, Early post-test, Late post-test,
n (%) n (%) n (%)
ovary (n = 2, 14.3%). Most patients were on sick leave
during art therapy session (n = 8, 57.14%), other ones Anti-cancer 11 (73.4) 12 (66.6) 14 (82.3)
were on retirement (n = 3, 21.4%), 2 participants were in Analgesic 2 (13.3) 4 (22.2) 2 (11.8)
part-time job (14.3%), and 1 participant had no job dur- Antidepressant 2 (13.3) 1 (5.6) 1 (5.9)
Anxiolytic 0 (0.0) 1 (5.6) 0 (0.0)
ing the sessions (7.1%). Three different means of trans-
portation were used by patients: personal vehicle (n = 12, Total 15 (100.0) 18 (100.0) 17 (100.0)
85.7%), taxi (n = 1, 7.1%) and public transport (n = 1,
7.1%). The detailed baseline characteristics are shown in
Table 1.
Table 3. Median questionnaires scores and standard ratios at the 3
Before, during, and 1 month after sessions, patients’ assessment points
concomitant treatments were reported. They were main-
ly anti-cancerous treatments whatever the observed pe- Pre-test Early Late
riod (n = 11, 73.4% in pre-test; n = 12, 66.6% in early post- post-test post-test
test; n = 14, 82.3% in late post-test). The second mostly
QLQ-C30
used treatment was analgesics (n = 2, 13.3% in pre-test; Total scores 50.0±9.2 51.5±11.5 48.0±8.9
n = 4, 22.2% in early post-test; n = 2, 11.8% in late post- HADS
test). Finally, antidepressants and anxiolytics were less Anxiety scores 8.0±4.9 6.0±4.2 6.0±4.4
used (between 5.6 and 13.3% for antidepressants, and 0.0 Depression scores 4.0±3.7 5.0±3.0 6.0±3.6
and 5.6% for anxiolytics). Concomitant analgesic, anxio- Total scores 11.5±7.6 12.0±5.7 14.0±5.1
lytic, antidepressant, and anti-cancerous treatments are HADS, Hospital Anxiety and Depression Scale.
reported in Table 2.
4.50
4
3.00 3.00
2
0
Before After Before After Before After Before After Before After Before After Before After Before After Before After Before After
Session 1 Session 2 Session 3 Session 4 Session 5 Session 6 Session 7 Session 8 Session 9 Session 10
10 10.00
9.75
9.00 9.00 9.00 9.13
8.50
8 7.88
7.05 7.00
6
4
Q1
min
2 median
max
Q3
0
Session 1 Session 2 Session 3 Session 4 Session 5 Session 6 Session 7 Session 8 Session 9 Session 10
Well-Being Discussion
Well-being before and after each session is reported in
Figure 1. Differences were calculated: the minimal differ- This study revealed a trend towards QoL amelioration
ence observed is −8.5, meaning that the patient was in a and a real satisfaction for participants, despite a small and
worse mood than before the session. Maximum differ- heterogeneous population, and recruitment difficulties.
ence observed is +8.0, and the median is +2.1. Indeed, group constitution was time-consuming and has
taken approximately 3 months.
Satisfaction The first difficulty was the homogeneity of the popula-
Figure 2 represents global satisfaction for participants tion. Different pathologies were represented (breast or
at each session. The minimum observed is 3.5 out of 10, lung), in accordance with data that we can find in the lit-
and the maximum is 10 out of 10. The median is between erature [15, 16]. There were 12 women and only 2 men in
7.0 and 10.0. art therapy sessions. Many studies showed that mostly
women participate in art therapy sessions [16], explain-
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4 Oncology Gras/Daguenet/Brosse/Beneton/Morisson
DOI: 10.1159/000504448
Université de Paris
Downloaded by:
ing the few prostate or lung cancers, frequently treated at Well-being score amelioration was associated with an
our Institute [10]. However, the initial idea was to recruit important global satisfaction, with medians between 7
only patients with cerebral tumours, because they often and 10, and results always equal to or higher than 5, sug-
present communication difficulties, and art therapy could gesting that patients were quite satisfied. Forzoni et al.
be a solution to enhance this point. Sharing the same pa- [11] reported in their article that 94% of participants de-
thology could also facilitate communication within the scribed their art therapy experience as “helpful.” Indeed,
group. But the health state of this kind of patients worsens these data have clinical implications, as they showed that
quickly and we were unable to form a group. Therefore, art therapy may be useful to support patients during the
sessions were opened to all pathologies. stressful time of chemotherapy treatment. Different pa-
The second difficulty was the way of transport, because tients used it to fulfil their own different needs, either be-
patients had to be able to come to sessions with their own cause there is a need to relax (improved mood) or to talk
transportation. Almost all patients took their personal ve- (self-narrative) or to visually express and elaborate emo-
hicles to come. Patients should be in good health to drive tions (discovering new meanings).
and this could be a bias for recruitment: too weak people are Regarding pain, Lefèvre et al. [21] reported a signifi-
not able to come to sessions, even if they would want to. cant pain reduction. This reduction was not reported in
Three months were necessary to recruit enough partici- our study, because among the selected population, no
pants. During this time, many patients’ health state wors- participant presented pain: only 3 patients out of 14 used
ened, and they either cancelled their participation or came analgesics at baseline. One month after the sessions, only
to sessions all the same, but impaired. Health state could 1 patient still took analgesics. So, few patients were in
explain important absenteeism. Indeed, it was difficult to pain, or with uncontrolled pain. Only one absence was
obtain a full group for each session: this is the disadvantage due to pain.
of having a fixed day, because Thursday is probably not the Sessions proposed by the professionals included paint-
day where most people are available. Furthermore, partici- ing and theatre. Other art therapy session types might be
pants were patients, so they had a lot of medical appoint- more suitable to enhance QoL, and to decrease stress and
ments. One patient was regularly absent, because he felt anxiety, such as music therapy [25]. By diversifying the
younger than the other ones in the group: maybe the popu- offer, workshops could also become more attractive for
lation was not enough heterogeneous concerning partici- patients.
pants’ ages. Interestingly, Koom et al. [17] and Bar-Sela et Despite the beneficial impact on QoL (QLQ-C30 score
al. [18] also reported high absenteeism. Furthermore, pa- amelioration) in the present study, further investigations
tients were mostly on sick leave during art therapy session on a larger population might be necessary to confirm that,
(n = 8, 57.1%), and other ones were on retirement (n = 3, as observed in other studies such as those by Koom et al.
21.4%), or in part-time jobs (n = 2, 14.3%). [17] on 50 patients, Svensk et al. [20] on 41 patients, or
Anxiety and depression scores were globally quite sta- Bozcuk et al. [22] on 48 patients. Our population of 14
ble, whereas in the literature, a depression score ameliora- patients might have been too small to observe a signifi-
tion [18, 22], or an amelioration on both scores is often cant difference.
observed [14, 16, 19, 21, 23]. More sessions might be nec-
essary to observe this amelioration.
Concerning well-being, we can also report a good im- Conclusion
pact. Indeed, median and maximum scores were globally
improved after each session. Last but not least, maximum Art therapy sessions have been appreciated by pa-
scores of well-being increased after each session, and min- tients, who reported high satisfaction and high well-being
imum scores enhanced for all sessions, excepted for ses- scores. We can conclude that art therapy sessions have a
sions 4, 5, 6, and 7. It was neither the same patient at each positive impact on patients’ welfare. We also reported a
session who chose the minimum score, nor the same pa- trend towards QoL amelioration. Yet, this has to be con-
tient at one session who put the minimum before and after firmed in a study with a larger population, and poten-
the session. This could mean that some sessions were tially with different workshops, such as music therapy.
more liked than other ones, and patients did not prefer the Pain investigation is another endpoint to follow. Collec-
same sessions. It could come from different expectations, tive efforts have to be put to permit access to these work-
as previously mentioned: “change one’s mind, meet peo- shops for all patients, in order to promote art therapy as
ple, discover art therapy, and express one’s feelings.” a novel and efficient supportive care in routine praxis.
193.51.85.197 - 2/12/2020 4:40:55 PM
We would like to thank the Ligue Contre le Cancer Loire that The authors have no conflicts of interest to declare.
allows us to set up art therapy sessions. Many thanks to the Marche
Bleue association that recruited two art therapists, Anne Jalard and
Camille Chaslot, who performed art therapy sessions. These pro-
fessionals took time to constitute groups, and to answer partici- Funding Sources
pants’ questions. They were really appreciated by the patients.
The “Ligue Contre le Cancer Loire” offered to “Marche Bleue”
the financial support to hire art therapists for leading art therapy
sessions in the Lucien Neuwirth Cancer Institute.
Statement of Ethics
References
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6 Oncology Gras/Daguenet/Brosse/Beneton/Morisson
DOI: 10.1159/000504448
Université de Paris
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