Changes, challenges and support in work, education and finances of adolescent and young adult (AYA) cancer survivors: A qualitative study.

PURPOSE: An increasing number of adolescents and young adults (AYA) are becoming cancer survivors and are dealing with long-term effects of the disease and its treatment. We aimed to collect detailed self-reported information about the areas of work, education, and the financial situation of AYA survivors after acute treatment. We further examined sources of support that were perceived as particular helpful. METHOD: We conducted semi-structured interviews with a sample of 11 AYA cancer survivors (on average 5 years from diagnosis; mean age at diagnosis = 25.7 years) that had been recruited for the AYA-Leipzig longitudinal study. Interviews were transcribed and data were analysed using qualitative content analysis. RESULTS: The following themes emerged as relevant: (1) career modifications and job loss, (2) career interruptions and delays, (3) uncertainty in the return-to-work process, (4) reduced work ability, (5) discrimination at the workplace, (6) changes in the personal importance of work and (7) financial burdens. Sources of considerable support included relatives as well as German social security institutions. CONCLUSIONS: Health care providers should address the specific risk of a financial burden and the somewhat complex social legal situation of young adult survivors after cancer diagnosis. AYA cancer survivors need age-specific comprehensive cancer survivorship support programs. These should accompany them in the long term and be targeted to the individual need for career modification or reorientation - even after the completion of cancer treatment and rehabilitation.

Do cancer patients with high levels of distress benefit more than less distressed patients from outpatient art therapy?

PURPOSE: Several studies have evaluated the effectiveness of art therapy for cancer patients. Our aim was to determine the effects of outpatient art therapy on the quality of life (QoL) of highly vs. less distressed cancer patients. METHODS: Participants completed the EORTC QLQ-C30 to measure QoL and the HADS to measure distress level before the intervention (t1), after completing the intervention (t2), and 6-months after t2 (t3). We performed analyses of covariance with repeated measures to test for group differences (highly vs. less distressed). We determined clinically relevant change scores and effect sizes in QoL domains (t1-t2; t1-t3) in patients with low vs. high levels of distress. RESULTS: 53 patient's participated at all three measuring points. Less (N = 22) vs. highly distressed patients (N = 31) differed at baseline and follow-up in their global QoL (mean t1:64.0 > 44.6; t2:65.5 > 55.6; t3:66.0 > 51.6; p = 0.01), emotional functioning (t1:65.2 > 37.4; t2:69.3 > 44.6; t3:57.8 > 48.5; p = 0.01), social functioning (t1:65.2 > 41.9; t2:77.3 > 52.7; t3:73.5 > 54.3; p = 0.01), cognitive functioning (t1:76.5 > 57.5; t2:74.4 > 62.4; t3:77.3 > 62.9; p = 0.02). There was no evidence of changes in physical functioning, role functioning, fatigue, pain, or insomnia. Interactions between distress, QoL, and time were not found. Effect sizes for clinical changes in QoL were medium regarding role functioning (Difft1-t3 = -14.4), fatigue (Difft1-t3 = -12.6) in the total group as well as in highly and less distressed patients. CONCLUSION: No evidence of outpatient art therapy having an effect on QoL in cancer patients over time was found, in patients with either high or low levels of distress at baseline. Consequently, it remains unclear which patients benefit the most from art therapy.

A non-randomised trial of an art therapy intervention for patients with haematological malignancies to support post-traumatic growth.

The aim of this study was to determine the effect of art therapy on post-traumatic growth in patients with haematological malignancies in a non-randomised trial (n = 36, intervention group; n = 129, control group). Art therapy was administered over a period of 22 weeks in small groups. Post-traumatic growth was measured with the Stress-Related Growth Scale. After controlling for the effect of potential confounders, no difference in post-traumatic growth was observed between the intervention and control groups after 22 weeks. There was no evidence for an effect of weekly group sessions with art therapy on post-traumatic growth in patients with haematological malignancies.

Art therapy in psycho-oncology--recruitment of participants and gender differences in usage.

PURPOSE: Over the last years, there has been increasing focus on the effect of art therapy for oncological patients. The small sample sizes of these studies show that recruiting participants is difficult and has been poorly investigated. It is also apparent that women participate in art therapy more often than men. The question remains why this difference exists and if participating men benefit from these courses more, less or in a different way than women do. METHODS: We developed and tested an outpatient art intervention for cancer patients, whereby different recruitment strategies were documented. Participants were questioned about their mental health (HADS), coping strategies (FKV), and quality of life (EORTC QLQ-C30) at the beginning and end of the intervention. RESULTS: The recruitment strategies included personal letters, referrals from the "Information Center For Cancer Patients", press releases and leaflets/posters distributed to hospitals and medical practices. About half of the participants (N=35), especially the male ones, took part in response to receiving a personal letter. All in all, 14 men and 60 women took part in the intervention whereby all 18 drop-outs were female. There were no significant gender differences regarding distress and quality of life before and after the intervention (men=14; women=41). CONCLUSIONS: A variety of approaches and intense public relations are necessary to recruit patients for art therapy. Describing recruitment strategies more in detail is suggested for upcoming art therapy studies. First gender specific differences were found in recruitment and usage. Exploring further questions in this area referring to quality of life and distress larger and uniformly distributed samples are desirable.

[The impact of an art therapy programme for cancer patients--an analysis from different points of view]. / Die Bedeutung einer kunsttherapeutischen Intervention für onkologische Patienten aus Sicht der Teilnehmer, der Kursleitung und der Supervisorin.

BACKGROUND: Art therapy is used in the whole field of psycho-oncological maintenance to support coping mechanisms with creative techniques. Previous studies stated effects of art therapy just by referring to the participants' ratings. This study wants to extend the perspective by including the views of all involved parties--participating patients, dropouts, art therapist and supervisor. PATIENTS AND METHODS: We developed and tested an art therapy programme for cancer patients. The participants' and dropouts' ratings were documented by using a questionnaire with open and closed questions upon completion of the intervention. The art therapist and the supervisor described their personal point of view. RESULTS: 74 patients took part in the intervention whereof 18 dropped out. Of these, 8 could be interviewed regarding the reasons for not participating further in the study. The dropouts evaluated the intervention positively(4/8) or could not make a final statement (3/8). 55 questionnaires were available from the 56 participants. They described the importance of the programme in several ways. Most of all, they reported of: stimulation of imagination (50/55), emotional stabilisation(48/55), enlargement of means of expression (45/55) and contact with other patients (42/55). The dropouts named several reasons for their decision to cancel: too intense focus on the disease(N = 3), modern drawing (N = 1), too much talks (N = 1) and too much sketching (N = 1) were some points of criticism. The art therapist as well as the supervisor emphasized activation as a main outcome for the participants. CONCLUSIONS: Positive effects of the intervention programme highlight the importance of establishing an art therapy in ambulant care. It enlarges the range of psychosocial maintenance and enables oncological patients to cope with the disease and its consequences with artistic means.

[An art education programme for groups in the psycho-oncological after-care]. / Eine kunstpädagogische Gruppenintervention in der ambulanten psychoonkologischen Versorgung.

In this paper the formal and contentual structure of the outpatient art education programme for oncological patients is presented. The group intervention was comprised of 22 separate sessions. The course consisted of 3 phases. The first unit helped to foster mutual understanding and to learn various experimental drawing techniques using a given topic. The second unit merged into the shaping of personal thoughts and feelings with the aim of encouraging self-perception and reflection. The aim in the third phase is to create a personal book. The effects of the intervention for the participants were examined in studies. The art therapist as well as the supervisor sees development of better coping strategies, contact with other patients and enhancement of scope of action through the regular activities as main effects. Participants reported the enlargement of means of expression, emotional stabilization, coping with illness, personal growth and contacts with other patients as meanings. This art education course enlarges the field of psycho-oncological interventions in outpatient care with a low-treshhold and resource-oriented creative programme.

An overview of art therapy interventions for cancer patients and the results of research.

OBJECTIVES: Over the last few years several offers in- and outpatient creative therapy interventions for cancer patients have been developed, implemented and researched. This article describes the content, concept and structure of art therapy interventions based on painting or drawing as well as some further methodical procedures and research results of art therapy in the field of psycho-oncology. METHODS: We searched electronic databases for papers published between 1987 and March 2009 on painting or drawing based art therapy interventions in oncology. The papers were selected using the inclusion criteria detailed below. RESULTS: Of 56 retrieved manuscripts, 17 papers reporting 12 research projects were included. The art therapy interventions differ from each other considerably in their content and structure. The variance in the study design of the papers was also high. More females than males participated in the interventions. The papers dealt with a variety of questions. A total of seven quantitative papers focused on mental health. A decrease in anxiety and depression was noted in six of these. Three papers documented an increase in quality of life. Moreover, four qualitative papers indicated positive effects on personal growth, coping, the development of new form of self-expression, and social interaction. Three papers with qualitative methods investigated participants' mechanisms for coping with their disease. CONCLUSION: Published papers show that art therapy benefits cancer patients in various ways including improving their mental health. Nevertheless, more studies with an evidence-based design are necessary for reaching further conclusions on efficacy of art therapy. This research should include a focus on gender differences, and controlling possible influencing factors.

[Art therapy for cancer patients in outpatient care. Psychological distress and coping of the participants]. / Gestaltungskurs fur Krebspatienten in der ambulanten Nachsorge. Psychische Belastung und Krankheitsverarbeitung der Teilnehmer.

BACKGROUND: Various types of art therapy increasingly gain importance in psycho-oncology. The aim of this article is to determine whether art therapy may help decrease psychological distress and increase coping skills in cancer patients. PATIENTS AND METHODS: An art therapy course for use in psycho-oncological care for outpatients was developed and implemented in a prospective observation study of the Department of Social Medicine,Leipzig University. Participants' levels of psychological distress (HADS) as well as their coping skills (TSK) were quantitatively evaluated before (t1) and after (t2) the intervention. RESULTS: After completion of the course mean anxiety of the participants(n = 18) had significantly decreased from 11.06 to 9.33 (p < 0.04). On average, however, participants reported more anxiety both before and after the intervention than a representative comparison group of n = 48 cancer patients (anxiety: mean= 5.51). Regarding depression no significant change could be observed after completion of the intervention (t1 = 6.94, t2 =6.22; p < 0.32). Also in relation to the comparison group (mean= 5.24) no significant difference in depression could be detected (t1: p < 0.066, t2: p < 0.519). No significant change in participants' coping skills could be observed. CONCLUSIONS: The level of psychological distress among cancer patients in outpatient care is above average. This underlines the need for psycho-oncological aftercare services. Art therapy interventions can make an important contribution to the psychological well-being of cancer patients.