The Effect of Art Therapy in Women with Gynecologic Cancer: A Systematic Review

Table 1

Study characteristics.

Author (date)	Design	Participants (N)	Intervention	Comparison	Outcomes	Results
Alcântara-Silva et al. (2018)	RCT	Radiotherapy cancer patients (116), including 27 gynecological patients	30 to 40 minutes sessions of music therapy implemented by the therapist during the first week of radiotherapy, on the week of the intermediary phase, and during the last week of radiotherapy. Twice a week in the hospital	Ordinary radiotherapy	Fatigue (FACT-F); quality of life (FACT-G); depression (BDI)	FACT-F results were significant regarding trial outcome index (), FACT-G (), and FACT-F () for the music therapy group compared with the control group
Lee et al. (2012)	RCT	Cancer patients who were about to receive chemotherapy for the first time (40), including 2 gynecological patients	25 min of monochord (MC) sounds was used as music therapy. There was a verbal introduction (4 min) before and a silent period (5 min) after each treatment, producing a total listening time of 34 min, from the second to the fifth sessions of chemotherapy. Research supported by the therapist	Progressive muscle relaxation (PMR)	Each session was investigated before and after using SAI and a questionnaire about the patient’s physical and psychological states. For the first and the last sessions, multivariate electroencephalogram (EEG) signals were recorded.	Both groups showed significantly reduced anxiety and improved physical and psychological state. EEG data demonstrated that both treatments were associated with an increase of posterior theta band activity and a decrease of midfrontal beta band activity
Wiswell et al. (2019)	Quasiexperiment study	Patients with gynecologic cancer receiving chemotherapy (16)	Five sessions of art therapy, consisting of drawing, printmaking, mandala, collage, during the chemotherapy were delivered by an art therapist. Each session was approximately 40–50 min	No	Quality of life (FACT-G)	The mean FACT-G score before chemotherapy was 82.3, and after art therapy was 78.6. The mean change in QOL was −3.7 points. A supplemental questionnaire indicated that 15 of 16 patients felt that art therapy was beneficial at each session
Lee et al. (2017)	Quasiexperiment study	Radiotherapy cancer patients (20), including cervix cancer patient (1)	The art therapy took place in two parts comprising 4 sessions of famous painting appreciation and 4 sessions of creative artwork generation; these 30 min sessions were performed by art therapist twice weekly over four weeks	No	Cancer-related distress (HADS, HDRS, ESAS)	Significant improvements in HADS anxiety and total scores were observed. HDRS scores demonstrated significant decreases. Fewer patients met the HADS or HDRS criteria for severe anxiety or depression after the intervention. No changes in ESAS mean scores were observed
Hammer et al. (2013)	Qualitative research	Newly diagnosed with gynecologic oncological patients (15)	Drawings. It was not mentioned whether a therapist was involved	No	Analyze the drawings and interview texts	Inner willpower, experiences in open nature, and closeness to loved ones contribute to hope when newly diagnosed with gynecologic cancer. Drawings and later interviews give a new understanding of the experience of hope
La cour et al. (2016)	Qualitative research	Cancer patients (10) who had received surgical treatment, including gynecological patients (8) with their relatives	Storytelling combined with dancing and crafts was a part of a rehabilitation course conducted twice by counselors	No	Cancer-related concerns. Data were generated through ethnographic fieldwork, including observations, conversations, and interviews. Participant observations and conversations were carried out during the course. Interviews were conducted one month later	It provided the patients and their relatives with strategies to manage cancer-related concerns
Ginsburgs and Goodill (2009)	Case report	Ovarian cancer patient had a hysterectomy and was currently receiving chemotherapy, being treated with radiotherapy (1)	A ten-week dance/movement therapy implemented by the therapist. Sessions were held on a weekly basis for ninety minutes, in a closed group format		The efficacy of clinical outcome variables was not researched.	Only anecdotal evidence suggested the potential benefits of the intervention. The patient was able to gain insight into parts of herself that she had suppressed during her treatments. She expressed less isolated as well as more open to the support available from others. She hoped to join the group again
Ben-Arye et al. (2015)	Case report	Recurrent ovarian cancer patient following extensive gynecological surgery, receiving chemotherapy (1)	Weekly music therapy, including Listening to individually tailored music, writing for her own poem and composing tones, conducted by the music therapist along 6 chemotherapy cycles	No	Quality of life: alleviate nausea, fatigue, and pain, relieve anxiety and depression	The patient reported significant improvement of the symptoms that impaired her QOL
Lee et al. (2015)	Case report	Ovarian cancer patient had a total hysterectomy, receiving chemotherapy (1)	Four sessions of oriental medicine music therapy based on the theories of traditional Korean medicine, twice per week for 2 weeks, for about 1 hour each time, implemented by the therapist	No	Negative and positive feelings (A self-administered questionnaire); subjective health condition (VAS)	Negative feelings decreased from a score of 17 to 7 (41% improvement); positive feelings increased from a score of 3 to 14 (more than a quadruple improvement); the VAS score increased from 40 mm to 70 mm (75% improvement)

Outcome: FACT-F: functional assessment of cancer therapy fatigue; FACT-G: functional assessment of cancer therapy-general; BDI: Beck Depression Inventory; SAI: state anxiety inventory; HADS: hospital anxiety and depression scale; HDRS: Hamilton depression rating scale; ESAS: Edmonton symptom assessment scale; VAS: visual analog scale.