The Creative Arts Therapy (CAT) Project: A Pilot Study
from Caring For Our Future, Summer 2005
By Jenny Madden, MSN, RN, CPNP, Assistant Professor, Pediatrics Neuro-Oncology
Children in the Hematology/Oncology/BMT clinic at The Children’s Hospital spend between 150 to 200 hours a year in the infusion room receiving chemotherapy infusions or blood products. But until recently, these children were entertained by television, video games or a part-time Child Life Therapist.
The Creative Arts Therapy (CAT) Project was initiated in the fall of 2001 to provide and evaluate therapeutic interventions for children in the Infusion Center . The idea was founded in research on dance/movement therapy for adolescents with cancer. The project is a study with both a randomized and a non-randomized arm. The randomized arm focuses on brain-tumor patients specifically to narrow the eligible patients. The non-randomized arm welcomes any child in the Infusion Center for CAT.
Art therapist Pat Rutter, MA, passes a ball
with children in the BMT/Hematology/
Oncology Clinic as part of the Clinic's
Creative Arts Therapy Project.
The concern is that psychological trauma during chemotherapy may adversely affect the quality of life of the pediatric patient, both during the infusions and after. Creative Arts Therapy may improve the quality of life of all patients receiving infusions in the outpatient Hematology/Oncology clinic at TCH. The specific subset of brain tumors is being studied to narrow the complicating factors.
Children with brain tumors are at increased risk for permanent neurological damage due to their growing and developing brains and bodies (Stewart & Cohen, 1998). Many authors have studied the late-effects of the treatment of brain tumors in pediatrics on quality of life (Jenkin, Danjoux, & Greenberg, 1998; Kosch et al., 1998). However, brain-tumor patients also are known to have significant morbidity during treatment as a result of surgery, radiation and chemotherapy. Little is published on the day-to-day effects of treatment on the quality of life of pediatric brain-tumor patients, but it has been acknowledged that even the act of coming to the clinic weekly for chemotherapy infusions impacts the patient’s life.
Creative Arts Therapy (CAT) is a broad term encompassing the modalities of dance/movement, music, art, drama and poetry therapies. Creative expression has been linked with an increased ability to cope with hospitalization for children. In addition, the processes of creative expression as therapy are known to increase quality of life in adult and pediatric cancer patients. However, no rigorous studies have been done to show direct improvement from CAT on quality of life for children while receiving chemotherapy infusions.
New brain-tumor patients admitted to the Neuro-Oncology service at TCH are randomized to either the experimental group (six one-hour CAT sessions in the infusion room) or the control group (six one-hour visits from a hospital volunteer). Twenty-four patients aged 2 to 18 who meet study criteria will be recruited. CAT is provided by a master’s-prepared, licensed dance/movement therapist who also is experienced in music and art therapies and has extensive experience with chronically ill children. Volunteers are members of the TCH Volunteer Department and are trained in working with oncology patients. Nurses caring for the children in the infusion room, as well the nurse Principal Investigator, oversee the project.
The Creative Arts Therapy Project
encompasses dance/movement, music, art,
drama, and poetry therapies.
Children in the experimental group receive two sessions of each modality of CAT (dance/movement, art and music), for a total of six sessions. Children in the control group receive six visits from a volunteer who sits at the patient’s bedside in the infusion room, providing attention through conversation, reading or watching TV.
The primary dependent variable is the quality of life of the pediatric brain-tumor patient as measured by the Pediatric Oncology Quality of Life Inventory (PedsQL). The PedsQL consists of developmentally appropriate forms for children 5 to 18 years old. A parent-proxy report also is available for children unable to complete the self-report. Data are collected after the third and sixth infusions. A brief interview with the child is conducted at the final evaluation.
The non-randomized arm of the CAT study invites any patient in the infusion room to participate in a group session of CAT. The patient and parent are approached, a consent form is signed, and the patient completes an emotional reactions questionnaire before and after the group. The group is offered weekly, but patients only complete the questionnaire at their first CAT group. Focus groups also will be held with infusion-room staff to gain the caregiver perspective. Demographic data on the sample are collected.
The CAT Project has been funded by the Luke Fernie Nursing Research Grant from the TCH Nursing Research Committee. In addition, the Rossetti family has provided a generous gift to continue the project. Finally, Nicholas Foreman, MD, has pledged Neuro-Oncology funding to keep the project alive. Further grants currently are being pursued.
With an increasing interest in supportive care and complementary therapy for children with cancer, we expect this pilot study to show an improvement in quality of life for the children who receive Creative Art Therapy during their chemotherapy infusions. The significance to oncology nursing includes increasing awareness and accessibility to complementary therapies for pediatric oncology patients, while supporting evidence-based practice through nursing research.
Anecdotally, it is a joy to hear laughter coming from the Infusion Center . We now hear music and singing emanating from the room where children receive long days of medications. Kids are moving their bodies, playing parachute, kicking balls and jumping up and down, all while attached to their IV pumps. Hopefully, the CAT Project will show that art can improve the quality of life of these patients.
