Office of the Director, National Institutes of Health, Bethesda, MD, USA.
JAMA Intern Med. 2013 Jun 10;173(11):960-9. doi: 10.1001/jamainternmed.2013.836.
Creative arts therapies (CATs) can reduce anxiety, depression, pain, and fatigue and increase quality of life (QOL) in patients with cancer. However, no systematic review of randomized clinical trials (RCTs) examining the effects of CAT on psychological symptoms among cancer patients has been conducted.
To estimate the effect of CAT on psychological symptoms and QOL in cancer patients during treatment and follow-up and to determine whether the effect varied according to patient, intervention, and design characteristics.
We searched ERIC, Google Scholar, MEDLINE, PsycInfo, PubMed, and Web of Science from database inception to January 2012. Studies included RCTs in which cancer patients were randomized to a CAT or control condition and anxiety, depression, pain, fatigue and/or QOL were measured pre- and post-intervention. Twenty-seven studies involving 1576 patients were included. We extracted data on effect sizes, moderators, and study quality. Hedges d effect sizes were computed, and random-effects models were used to estimate sampling error and population variance.
During treatment, CAT significantly reduced anxiety (Δ = 0.28 [95% CI, 0.11-0.44]), depression (Δ = 0.23 [0.05-0.40]), and pain (Δ = 0.54 [0.33-0.75]) and increased QOL (Δ = 0.50 [0.25-0.74]). Pain was significantly reduced during follow-up (Δ = 0.59 [95% CI, 0.42-0.77]). Anxiety reductions were strongest for studies in which (1) a non-CAT therapist administered the intervention compared with studies that used a creative arts therapist and (2) a waiting-list or usual-care comparison was used. Pain reductions were largest during inpatient treatment and for homogeneous cancer groups in outpatient settings; significantly smaller reductions occurred in heterogeneous groups in outpatient settings.
Exposure to CAT can improve anxiety, depression, and pain symptoms and QOL among cancer patients, but this effect is reduced during follow-up.
创意艺术疗法（CAT）可以减轻癌症患者的焦虑、抑郁、疼痛和疲劳，并提高生活质量（QOL）。然而，目前尚未有系统评价随机临床试验（RCT）来检查 CAT 对癌症患者心理症状的影响。
评估 CAT 对癌症患者治疗和随访期间心理症状和生活质量的影响，并确定其效果是否因患者、干预措施和设计特征而异。
我们从数据库建立之初到 2012 年 1 月，在 ERIC、Google Scholar、MEDLINE、PsycInfo、PubMed 和 Web of Science 中进行了搜索。这些研究纳入了将癌症患者随机分配到 CAT 或对照组的 RCT，并在干预前后测量了焦虑、抑郁、疼痛、疲劳和/或生活质量。共纳入了 27 项研究，涉及 1576 名患者。我们提取了效应大小、调节因素和研究质量的数据。计算了 Hedges d 效应大小，并使用随机效应模型估计抽样误差和总体方差。
在治疗期间，CAT 显著降低了焦虑（Δ=0.28 [95%CI，0.11-0.44]）、抑郁（Δ=0.23 [0.05-0.40]）和疼痛（Δ=0.54 [0.33-0.75]），并提高了生活质量（Δ=0.50 [0.25-0.74]）。在随访期间，疼痛也显著减轻（Δ=0.59 [95%CI，0.42-0.77]）。与使用创意艺术治疗师的研究相比，非 CAT 治疗师实施干预的研究中，焦虑的缓解作用最强；而使用等待名单或常规护理作为对照组的研究中，焦虑的缓解作用最强。在住院治疗期间，疼痛的减轻程度最大，而在门诊环境中，同质性癌症组的疼痛减轻程度最大；在门诊环境中，异质性癌症组的疼痛减轻程度明显较小。
接触 CAT 可以改善癌症患者的焦虑、抑郁和疼痛症状以及生活质量，但这种效果在随访期间会降低。
