Tuesday, March 20, 2012

“Art Is A Form Of Power:” Art Therapy and Cancer

Here is a lovely post about the effectiveness of art therapy with cancer patients, written by Candida Abrahamson, PhD, who generously allowed me to repost this here.  

“Art Is A Form Of Power:” Art Therapy and Cancer

Any form of art is a form of power; it has impact, it can affect change – it can not only move us, it makes us move.~Ossie Davis

In my time spent blogging about cancer, I’ve been privileged to come across a number of cancer blogs that are truly wonderful.

They’re too manifold to name here, but one I particularly like, given my affinity for research and outside sources, is written by Andrew at http://lymphomajourney.wordpress.com. Its description is apt and pithy: “Andrew blogs and tweets about his lymphoma journey, and shares articles of interest regarding cancer, healthcare, and related lifestyle issues.”

I encourage you to take a look.

It was as I was composing a post on parental responsibility to pay for a child’s college degree when the child fancies he’d like to major in, say, Horticulture, or–why not?–Bagpiping, that I came across  just such a one of the many fascinating articles and links Andrew shares.  It caught my fancy, and sent me traveling down my  mind’s own path for a day’s vacation from the vicissitudes of parenting adult children.  In his post “Using Art to Help Young Patients in Hospitals – NYTimes.com” you will find the link to the New York Times article “Hoping That Art Helps With Healing.”

And with one read-through of the article I was off the topic of whether a parent is responsible for footing the entire bill for a college degree in Agriculture for a daughter who truly wants to be a ballerina. . . .

Hmm, thought I to myself, I know the New York Times well, and they wouldn’t claim that “researchers have found that such [art therapy] programs decrease patient stress and improve quality of life,” without actually having consulted some real, not theoretical, researchers.  But–and this is something of a bone I have to pick with the outstanding paper–here, as often in its articles, the Times leaves us hanging about precisely who such researchers are, what exactly they might have found when, and how they went about finding it (and, of course, my own obsessional question: did these authors get to look at a good meta-analysis?).

So–I went ahead and filled in those blanks. I know many of you might be thinking: Who cares [I taught high school school many years ago and that's a question that crosses generational, class, gender and many other lines. I've seen the "who cares" enemy, faced it down, and emerged victorious before.]?

Can’t we just trust the Times? you think. I mean, who can you trust anymore if you can’t trust the Times? Profound questions, my friend, and I leave you to ponder them if that’s what you’d like to do.

For you of the “who cares?” club,  I also recommend skipping the rest of this post, and maybe looking for something less factually oriented and settling in for a nice skim. How about “Stupid Young-Adult Tricks” or “You Will Never Go Broke Underestimating the Intelligence of the American Public” and an ice cold beer? You will certainly not run into any random controlled trials, statistics, talk about p values, and concern about peer-reviewed journals there.

We can all reconvene tomorrow to talk about how much you owe for your child’s degree in Artisanry.

For anyone hardy enough to hang with me through this survey of the lit on art therapy and cancer. . . let’s get a move-on.

Why not start with an article published in the February 2006 issue of Journal of Pain and Symptom Management, where the authors conducted a study right here in my hometown of Chicago, at Northwestern Memorial Hospital? The study’s specific aim was to determine the effect of a 1-hour session of art therapy on pain and other symptoms common to adult cancer patients currently hospitalized. Fifty inpatients in Northwestern’s oncology unit were enrolled in the study for a 4-month period. Initially 9 symptoms were assessed (pain, tiredness, nausea, depression, anxiety, drowsiness, lack of appetite, well-being and shortness of breath). Each session was individualized, and patients had complete choice over materials and product.

Although patients could use the session to delve into psychological matters if they wished, there was no obligation to, and some merely played around with the materials, or created light products, just for enjoyment.

The results were excellent. Overall the patients reported reductions in 8 of 9 measured symptoms (nausea was the only one without improvement) after working for an hour on an art project of their choice.
The authors of the study were thrilled. Nancy Nainis, an art therapist at Northwestern Memorial Hospital and lead author on the study, was particularly intrigued by the reduction in tiredness. ”Several subjects made anecdotal comments that the art therapy had energized them,” commented Ms. Nainis. “This is the first study to document a reduction in tiredness as a result of art therapy.”

Just a year after the Nainis study, Bar-Sela et al published a paper with the type of title I love for its profound lack of creativity, and tendency to give it all away before you’ve even had to read through the method section (not that there isn’t a lot to say for that), called “Art therapy improved depression and influenced fatigue levels in cancer patients on chemotherapy” (still guessing at the outcome?).

They focused on depression and fatigue alone, cutting out the other 7 symptoms.

The group studied sixty cancer patients on chemotherapy who took part in once-weekly art session that involved painting with water-based paints. The authors designated 19 patients who took part in 4 or more sessions the “intervention group,” and the remaining who took part in 2 or fewer sessions were the “participant group.”

Once again, mean scores for both depression and fatigue dropped–significantly–in the intervention group.
I found this exciting enough that I’d be mandating art therapy coverage for all cancer patients who wanted it. But in true ”research-talk,” the authors pull their punches and conclude only, “Art therapy is worthy of further study in the treatment of cancer patients with depression or fatigue during chemotherapy treatment.” 

Sometimes research writing gives me a pain.

And then, what does any discussion of research need, to really get those scientists excited? A random controlled study, of course. So let’s look at one of those, with yet another title that blows the ending before we can really get going: “Art therapy improves experienced quality of life among women undergoing treatment for breast cancer: a randomized controlled study.”

This study came out of Umea, Sweden, and looked at art therapy as an intervention for 41 women undergoing radiation for treatment for breast cancer. 20 women were randomly assigned to individualized art therapy sessions once a week. Both this group and the control group had their quality of life assessed before radiation start started, 2 months, and then 6 months after the onset of treatment. (Quality of life was assessed utilizing the WHOQOL-BREF and EORTC Quality of Life Questionnaire-BR23, the one for breast cancer specifically.)

Conclude the authors, “A significant increase in total health, total QoL [quality of life], physical health and psychological health was observed in the art therapy group.” Seems like they got even more than they bargained for. 

Art Therapy at the Cedars Cancer Institute

And let’s not leave a very vulnerable group of cancer patients unaccounted for: children.  In a study of children with leukemia, the authors highlighted the painfulness of certain procedures these children must undergo, such as lumbar puncture or bone marrow aspiration.  This research team, headed by Favara-Scacco, noted that children scheduled for for painful procedures demonstrated resistance and anxiety during and after these procedures.

So they began providing the children, between 2 and 14 years of age, with art therapy in September 1997, with the aim of preventing anxiety and fear during these most painful treatments, and of avoiding completely ongoing emotional distress in the long-term. Therapy was continued up until within a few months of the October, 2001, publication of the paper, “Art therapy as support for children with leukemia during painful procedures.”

The change was profound. When painful treatments were necessary, children who had been provided with art therapy demonstrated more collaborative and less resistant behavior than those in the control group, and a significant number of patients or parents requested art therapy again when the treatment had to be repeated.

The researchers were impressed. Once again, in that oh-so-understated way of writing, they asserted that art therapy was”shown to be a useful  intervention that can prevent permanent trauma and support children and parents during intrusive interventions.” Compared with general anesthetic’s side effects, it’s a home run, at least in my book.

And I’d like to end in a place where so many patients fear they will find themselves–in hospice care.  

Blessedly, there is much we can do to ease the physical suffering of the terminally ill cancer patient. But that does little, sometimes, to quiet the mind, with its fear of death, its attachment to this world, its anxieties about further suffering–and then, perhaps, fear of suffering even after the end.

Art therapy has been used in hospice care units since the early 1990s, to help ease the emotional strain on bereaved family members. But this was the first study to explore the effectiveness of art therapy for terminally ill cancer patients themselves.
Art at Treetops Hospice
Published just this month, the study took place at the Hospice Palliative Care Unit in Taipei Veteran General Hospital from April 2001 to December 2004 (see Lin citation).

In order to assess the impact of the therapy, researchers evaluated patients’: 1. Feelings (of concentration during the art appreciation component of the therapy; of fun while painting, and feelings toward the artworks themselves); 2. Cognition (including thoughts on the meaning of life and sharing thoughts on life and death); 3. Behavior (meaning patients developed an approach to art appreciation and creation without focusing on progress); and 4. Impact on illness (feeling of relief of emotional stress and improvement of medical symptoms during therapy).

The researchers were quite pleased with their results. In a rather more creatively written paper than the standard, “Art therapy for terminal cancer patients in a hospice palliative care unit in Taiwan,” they assert, ”[i]n the process of the art therapy, we found that patients went from inactivity to actively creating artworks. .  .These patients were able to overcome physical distress such as pain, and transformed the pain into creative artwork (McIntyre, 1992; Hawkins, 1993; Mayo, 1996; Kaye, 1997; Kennett, 2000; Michele, 2004). From the description of the artwork they created, we could easily sense the spirit of the patients.”

Ever the cynic, I’m not at all sure how they could “sense the spirit” in a way that “counts” in a research paper, but despite snide asides, I found the paper’s ending even more uplifting:

“. . .[T]hrough art appreciation and hands-on painting, terminal cancer patients who were in deteriorating health conditions and facing death could have a chance to manage their emotional crisis. They were able to experience a sensation of nonverbal communication, and soothe the pressure and discomfort from illness (Kuo et al., 2002).”

If art therapy offers symptom relief, a feeling of a modicum of control for young cancer patients, and the potential to “manage emotional crises,” then, really folks, where are the watercolors?


Bar-Sela G, et al. Art therapy improved depression and influenced fatigue levels in cancer patients on chemotherapy. Psycho-Oncology 2007; 16(11):980-4.

Bidgood Jess. Hoping that art helps with healing. New York Times March 14, 2012.
Favara-Scacco C, et al. Art therapy as support for children with leukemia during painful procedures. Medical & Pediatric Oncology 2001; 36(4):474-80.

Lin MH, et al. Art therapy for terminal cancer patients in a hospice palliative care unit in Taiwan. Palliative and Supportive Care 2012; 10(1):51-7.

Nainis N, et al. Relieving symptoms in cancer: innovative use of art therapy. Journal of Pain and Symptom Management 2006; 31(2):162-9.

Svensk AC, et al. Art therapy improves experienced quality of life among women undergoing treatment for breast cancer: a randomized controlled study. European Journal of Cancer Care (Engl.) 2009; 18(1):69-77.

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