Could Art Therapy Reduce the Death Anxiety of Patients with Advanced Cancer? An Interesting Question that Deserves to be Investigated

Sir,

Cancer patients experience high levels of psychological distress and specific concerns about dying as death approaching. One of the important issues that patients with advanced stage cancer are involved with is the anxiety of confrontation with death, which is called death anxiety (DA). DA is described as the unpleasant emotion resulting from existential concerns and defined as a significant anxiety about one's death that can impair the daily life of an individual.[1] DA is a consequence of unresolved psychological and physical distress and is affected by several factors including sociodemographic variables, general health status, cultural background, previous experiences of dying, religious aspects, individual factors, family circumstances, physical suffering, and the presence of chronic disease. In addition, DA can significantly affect cancer patients’ quality of life by distorting their mental health and spiritual status.[12]

On the other hand, the central role of palliative care is to reduce patients’ psychosocial distress and concerns about death. Therefore, it is imperative for palliative care clinicians to use innovative interventions along with the current medical treatments to reduce the patients’ DA. In this regard, recently, there has been a growing interest in the application of various art-based interventions in the supportive and palliative care settings for providing end-of-life care for patients with advanced disease.[2] As described by the American Art Therapy Association, art therapy (AT) can enrich the physical, mental, and emotional well-being of individuals, families, and communities through the creative process of art production. Although the underlying mechanisms of action of AT for psychological disorders remain unclear, it has beneficial effects by the development of personal relationships, understanding the self/own illness, distraction, personal achievement, and empowerment.

The promising results of previous studies support the effectiveness of AT for reducing the anxiety of individuals. Agnese et al. showed that AT might be helpful and appropriate for reducing the anxiety of patients undergoing an allogeneic hematopoietic stem cell transplant.[3] Geue et al. found that engagement in art or music therapy could improve cancer patients’ mental health.[4] Aguilar showed that integrating AT into the care of the pediatric oncology patients undergoing treatment could improve their quality of life.[5] Potash et al. showed that AT could reduce burnout and DA among end-of-life care workers.[6]

While this intervention has been used broadly for a variety of conditions, current literature lacks evidence on the specific effects of AT on the anxiety of patients with advanced-stage cancer. Considering the importance of DA in patients with advanced cancer and potential benefits of AT in the anxiety disorders, an intriguing question emerges that warrants further investigation. Could AT reduce the DA of patients with advanced cancer? However, because of limited evidence, the efficacy of AT to reduce DA in patients with advanced or terminal cancer is not conclusive and further research is needed. It seems that AT may be beneficial in the treatment of DA in patients with advanced cancer, since this nonpharmacological intervention can be used as an effective, inexpensive, innovative, and safe intervention for reducing the DA. Therefore, further well-designed clinical trials are warranted to determine the effectiveness of AT in patients with advanced cancer.