***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Art therapy has been used in a variety of clinical setting s and population s , although few studies have explored its use in cancer symptom control . The specific aim of this study was to determine the effect of a 1-hour art therapy session on pain and other symptoms common to adult cancer in patients . A quasi-experimental design was used ( n=50 ) . The  Edmonton Symptom Assessment Scale ( ESAS )  and the Spielberger State-Trait Anxiety Index ( STAI-S )  were used prior to and after the art therapy to quantify symptoms , while open-ended questions evaluated the subjects ' perceptions of the experience . There were statistically significant reductions in eight of nine symptoms measured by the ESAS , including the global distress score , as well as significant differences in most of the domains measured by the STAI-S. Subjects overwhelmingly expressed comfort with the process and desire to continue with therapy . This study provides beginning evidence for the efficacy of art therapy in reducing a broad spectrum of symptoms in cancer in patients Women with breast cancer are naturally exposed to strain related to diagnosis and treatment , and this influences their experienced quality of life ( QoL ) . The present paper reports the effect , with regard to QoL aspects , of an art therapy intervention among 41 women undergoing radiotherapy treatment for breast cancer . The women were r and omized to an intervention group with individual art therapy sessions for 1 h/week ( n = 20 ) , or to a control group ( n = 21 ) . The WHOQOL-BREF and EORTC Quality of Life Question naire-BR23 , were used for QoL assessment , and administrated on three measurement occasions , before the start of radiotherapy and 2 and 6 months later . The results indicate an overall improvement in QoL aspects among women in the intervention group . A significant increase in total health , total QoL , physical health and psychological health was observed in the art therapy group . A significant positive difference within the art therapy group was also seen , concerning future perspectives , body image and systemic therapy side effects . The present study provides strong support for the use of art therapy to improve QoL for women undergoing radiotherapy treatment for breast cancer The purpose of this study was to gather data on the efficacy of a newly developed psychosocial group intervention for cancer patients , called mindfulness-based art therapy ( MBAT ) .  One hundred and eleven women with a variety of cancer diagnoses were paired by age and r and omized to either an eight-week MBAT intervention group or a wait-list control group .  Ninety-three participants ( 84 % ) completed both the pre- and post- study measurements . As compared to the control group , the MBAT group demonstrated a significant decrease in symptoms of distress ( as measured by the Symptoms Checklist-90-Revised ) and significant improvements in key aspects of health-related quality of life ( as measured by the Medical Outcomes Study Short-Form Health Survey ) . This investigation of MBAT provides initial encouraging data that support a possible future role for the intervention as a psychosocial treatment option for cancer patients 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 out patients was developed and implemented in a prospect i ve 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 OBJECTIVE Women with breast cancer suffer from considerable stress related to the diagnosis , surgery , and medical treatment . It is important to develop strategies to strengthen coping re sources among these women . Research in art therapy has shown outcomes such as an increase in self-esteem and cohesion , significant improvement in global health , and a decrease in anxiety and depression . The aim of the present article was to describe the effects of an art therapy intervention program on coping re sources in women with primary breast cancer . METHOD In this article , we report some of the results from a study including 41 women , aged 37 - 69 years old , with nonmetastatic primary breast cancer , referred to the Department of Oncology at Umeå University Hospital in Sweden for postoperative radiotherapy . The women represented various socioeconomic background s. They were r and omized to a study group ( n = 20 ) with individual art therapy for 1 h/week during postoperative radiotherapy or to a control group ( n = 21 ) . The article focuses on changes in coping re sources , as measured by the Coping Re sources Inventory ( CRI ) before and 2 and 6 months after the start of radiotherapy . The study protocol was approved by the Umeå University Ethical Committee at the Medical Faculty ( archive number 99 - 386 ) . RESULTS There was an overall increase in coping re sources among women with breast cancer after taking part in the art therapy intervention . Significant differences were seen between the study and control groups in the social domain on the second and third occasions . Significant differences were also observed in the total score on the second occasion . SIGNIFICANCE OF RESULTS This study shows that individual art therapy provided by a trained art therapist in a clinical setting can give beneficial support to women with primary breast cancer undergoing radiotherapy , as it can improve their coping re sources Much of the psycho-oncology research that has been conducted to date has focused on underst and ing the negative psychological and psychosocial sequelae of cancer . However , a growing body of evidence suggests that many cancer survivors report psychological growth following a diagnosis of cancer . Further , there are few studies that examine the relationship among age , cancer , and posttraumatic growth . This study examines relationships among posttraumatic growth , generativity , age , and gender . Question naires were mailed to 400 r and omly-selected cancer survivors from a metropolitan hospital tumor registry , with a yield of 21 % . Three age cohorts were examined ( 26–41 years , 42–54 years , and 55-plus years ) . As anticipated , MANOVA showed no significant age differences in expression of generative concern among the three cohorts , but there was evidence that younger adults engage in a greater number of generative behaviors than older adults . Further , females reported more positive growth on four out of the five domains of the measure of posttraumatic growth compared to males , and the oldest cohort experienced lower levels of positive growth compared with the other two groups . Generative concern was positively correlated with the total posttraumatic growth score . Implication s for theoretical and applied research on generativity and posttraumatic growth in adult cancer survivors are discussed INTRODUCTION Cancer patients are particularly vulnerable to depression and anxiety , with fatigue as the most prevalent symptom of those undergoing treatment . The purpose of this study was to determine whether improvement in depression , anxiety or fatigue during chemotherapy following anthroposophy art therapy intervention is substantial enough to warrant a controlled trial . MATERIAL AND METHODS Sixty cancer patients on chemotherapy and willing to participate in once-weekly art therapy sessions ( painting with water-based paints ) were accrued for the study . Nineteen patients who participated in > or = 4 sessions were evaluated as the intervention group , and 41 patients who participated in < or = 2 sessions comprised the participant group .  Hospital Anxiety and Depression Scale ( HADS ) and the Brief Fatigue Inventory ( BFI ) were completed before every session , relating to the previous week . RESULTS BFI scores were higher in the participant group ( p=0.06 ) . In the intervention group , the median HADS score for depression was 9 at the beginning and 7 after the fourth appointment ( p=0.021 ) . The median BFI score changed from 5.7 to 4.1 ( p=0.24 ) . The anxiety score was in the normal range from the beginning . CONCLUSION Anthroposophical art therapy is worthy of further study in the treatment of cancer patients with depression or fatigue during chemotherapy treatment OBJECTIVE Recent research shows that almost every second woman with breast cancer is depressed or has anxiety ; the risk for younger women is even higher . Moreover , research shows that women are at risk for developing depression , also a threat for women with breast cancer . The aim of this r and omized controlled clinical trial was to study the outcome of five sessions of art therapy given at a 5-week period of postoperative radiotherapy . METHODS The participants were between 37 and 69 years old ; six participants in each group were below 50 years of age . Half of the participants ( n = 20 ) received art therapy and the other half ( n = 21 ) were assigned to a control group . At the first measurement , at least 17 % ( n = 7 ) of the participants medicated with  antidepressants .  Data were collected before and after art therapy and at a 4-month follow-up using self-rating scales that measure self-image ( the Structural Analysis of Social Behaviour ) and psychiatric symptoms ( the Symptom Check List-90 ) . RESULTS At follow-up , significant lower ratings of depression , anxiety , and somatic symptoms and less general symptoms were reported for the art therapy group compared to the control group . The regression analysis showed that art therapy relates to lower ratings of depression , anxiety , and general symptoms ; chemotherapeutic treatment predicts lower depressive symptoms ; in contrast to axillary surgery and hormonal treatment as well as being a parent predicts higher ratings of anxiety and general symptoms . SIGNIFICANCE OF RESULTS The conclusion suggests that art therapy has a long-term effect on the crisis following the breast cancer and its consequences 
    Output:
    
Narrative synthesis of the studies shows art therapy is used at all stages of the cancer trajectory , most frequently by women , the most common cancer site in participants being breast .
Art therapy is a psychotherapeutic approach that is being used by adults with cancer to manage a spectrum of treatment-related symptoms and facilitate the process of psychological readjustment to the loss , change , and uncertainty characteristic of cancer survivorship .