Integrating Art-Based Approaches in Psycho-Oncology Practice: Insights From a Pilot Creative Arts Workshop Designed for Cancer Patients Receiving Psychiatric Care

Abstract

Living with cancer involves numerous challenges during illness journey, including a high rate of significant distress and an increased risk of psychiatric disorders. Addressing these complex and multidimensional needs requires innovative and patient-centered approaches. Integrative interventions, such as art-based practices, have shown evidence-based benefits in reducing symptoms of anxiety and depression in adults with cancer. However, access to such complementary interventions remains limited in routine clinical care. Our team developed and implemented a creative arts workshop specifically designed for cancer patients treated for comorbid psychiatric disorders as a complementary intervention to standard psychiatric care. This article briefly outlines the workshop, as well as some institutional and clinical challenges encountered during implementation. Actionable insights and practical recommendations for institutions interested in adopting similar initiatives are also discussed. By providing an engaging space for emotional expression, the creative arts workshop was well received by participants and contributed positively to their care experience. Future research should focus on its feasibility, acceptability, and effectiveness on psychological well-being and quality of life in this vulnerable population.

Introduction

Living with cancer can be challenging, encompassing emotional, physical, social, existential, and spiritual dimensions. ¹ While most people adapt to the illness without requiring specialized support, nearly 40% experience significant distress during their cancer journey. ² Cancer patients are also at increased risk of developing psychiatric disorders such as depression and anxiety. ³ To address these challenges, offering prompt, adapted, and standard supportive care is recommended to cancer centers. Despite these efforts, some needs of cancer patients remain underrecognized. To better align care with their preferences and expectations, innovative therapeutic approaches that address these complex and multidimensional needs are essential.

Complementary interventions to standard care are increasingly desired by cancer patients. Creative and expressive arts for example are gaining recognition for their benefits as complementary interventions in various healthcare settings, including in cancer care settings. ⁴ The art-based interventions typically provide a space for creativity and self-expression through various media, including visual arts such as drawing, painting, and more. They generally encompass 2 distinct approaches. First, art therapy is conducted by credentialed therapists with formal training in psychotherapy and grounded in the establishment of a therapeutic alliance. It typically uses of visual art media to help patients exploring and processing emotions. In contrast, creative arts are typically led by professional artists without formal psychotherapy training and emphasize artistic self-expression and creativity to enhance emotional well-being. Unlike art therapy, creative arts do not involve clinical interpretation of the artworks.

Although art-based interventions are not widely implemented in cancer care, studies have associated them with improved quality of life, increased patients’ satisfaction, reduced symptoms of anxiety and depression, and enhanced well-being.^5–8 Specifically for the management of depression and anxiety, a recent guideline by the American Society of Clinical Oncology on integrative approaches examined interventions such as mindfulness, yoga, relaxation techniques, and music therapy ⁹ and recognized their value for patients. Building on these gaps, our team developed an innovative pilot workshop as a complementary intervention to standard psychiatric treatments in psycho-oncology settings for comorbid patients. In this article, we briefly describe this initiative, share practical insights for clinicians and institutions, and outline key directions for future research.

Actionable Insights

Complementary approaches focusing on creative and visual arts generally aim to enrich patient care experiences, by fostering patient engagement, satisfaction, and emotional support. As mentioned, many cancer patients are open to integrating such complementary approaches alongside conventional treatments. Our innovative pilot project sought to enhance the care experience within a consultation-liaison psychiatry service, where psychiatric care is provided to patients referred from a tertiary cancer care center. The workshop offered creative and expressive arts sessions in addition to standard psychiatric care, which usually includes psychotropic medication and psychotherapy. It was developed in collaboration with a nonprofit organization experienced in delivering semidirected arts workshops designed for people living with mental health issues in several healthcare institutions.

Patients being treated for psychiatric disorders such as depression, anxiety, bipolar disorder, or neurocognitive impairments related to cancer treatment were invited by their treating psychiatrist to join the workshop if they showed interest in complementary interventions. Participants had to be physically able to attend 1 h virtual group sessions and express interest in the arts. When patients seemed interested, therapeutic goals were discussed with them, and the workshop facilitator (a professionally trained artist) followed up by phone or email to answer questions and provide a list of few and simple artistic materials required to participate to the workshop. All the information regarding artistic materials required was sent via email.

Between January 2020 and June 2022, 16 patients took part in the pilot workshop, with interruption for summer period. Participation ranged from 1 to 48 sessions over the 2 academic years, depending on individual availability and cancer treatment schedules. All participants were under psychiatric care and had a history of cancer, with most in remission or having recently completed treatment. Each session lasted 1 h and was held virtually once a week. The artist began each session with a brief check-in asking the participants how they were feeling and then introduced that day's art project. Participants were free to remain silent, speak, or listen to music while working. Toward the end of each session, they were invited (but not required) to share their artwork. After each session, a summary of the project was emailed to those who wanted to continue working independently.

During the workshop, the artist encouraged participants to take a nonjudgmental, present-focused attitude, inspired from the mindfulness approach. ¹⁰ Participants could freely adapt each project. While emotional expression was welcomed, the sessions were designed as expressive outlets. If any participant experienced distress, the artist notified the treating psychiatrist to ensure proper follow-up. A variety of themes and techniques were explored, including the use of color and shape inspired by Aboriginal art and abstract drawings based on biological patterns. Figure 1 presents selected examples of the artwork produced during such creative arts workshops offered in community. The diversity in the visual content reflects each participant's unique artistic experience. These samples also illustrate how artistic expression can support emotional expression, reinforce a sense of agency, or even enhancing self-esteem. For some participants, the possibility of sharing their artwork might have contributed to a sense of recognition and empowerment. Informal feedback obtained from participants in our pilot workshop suggested that they appreciated their experience.

Figure 1.

Examples of artworks produced during such creative art workshops. The participants have authorized the distribution of these images anonymously.

While we observed that the workshop gradually fostered a warm, supportive atmosphere marked by trust, humor, and peer connection, certain challenges emerged. Implementing this patient-centered innovation within our institution has taught us valuable lessons. The main institutional challenge faced by our team was participant recruitment. Some eligible patients declined participation due to lack of interest in the arts, while others found it difficult to attend to the weekly sessions. Maintaining scheduling flexibility was necessary since patients often juggle numerous medical appointments. A few participants stopped attending, which might have reflected either a lack of motivation or potential difficulties in maintaining regular participation due to the burden of their medical care. The virtual platform seemed to be user-friendly for most. Any technical issues were promptly resolved by the help of the artist. This delivery format was chosen based on perceived patients’ needs and was particularly advantageous in the context of the COVID-19 pandemic, allowing remote participation. Some patients mentioned however that in-person sessions would have enhance interpersonal connection, though it would require a dedicated space within our institution and greater staff availability.

Art materials used during the workshop were simple (color pencils, papers, markers, scissors, etc) and affordable, with free kits offered to those in need. As the result, the program remained low-cost, with the most significant expenses being the artist's salary. Institutions considering implementing a similar workshop should expect to encounter some financial challenges. Securing funding may be initially difficult, as arts-based interventions are not always recognized by stakeholders as legitimate components of healthcare, especially in a resources-limited context. Additionally, clinicians preconceived notions or skepticism about the value of these workshops as complementary intervention for psychiatric disorders could also limit patients’ referrals.

Practical Recommendations

While our first experience of the creative arts workshop was successful, further research appears essential before any broader implementation of this group intervention. Qualitative studies could for example provide insights into participants lived experiences and satisfaction with such complementary intervention to standard psychiatric care. Identifying context-specific key barriers and facilitators within hospital settings would also be valuable for sustainable clinical integration and insure both feasibility and acceptability. Though virtual delivery offers flexibility and accessibility, it presents its own challenges (lack of device or internet access, low digital literacy, technical difficulties, etc). Perceived reduced interpersonal connection during workshop could be potential drawbacks. A thorough investigation of virtual versus in-person formats for such creative arts intervention would identify their respective advantages and limitations. If the intervention is shown to be both feasible and acceptable, further studies could examine its effectiveness using validated psychometric tools and its cost-effectiveness, particularly for resource-constrained health systems. Ultimately, these findings could inform the development of more holistic, patient-centered interventions for individuals living with cancer and comorbid psychiatric conditions.

If future research efforts provide sufficient insights, some healthcare institutions may wish to start implementing it starting with obtaining strategic engagement across multiple levels to support buy-in from healthcare professionals and facilitate its integration in existing services. Based on our pilot single-site experience, engaging stakeholders by presenting a clear rationale, supported by relevant evidence, and expected benefits to patient care seemed for us facilitating. Address from the start skepticism about art-based intervention sharing research-based evidence and patients’ testimonials might help to earn credibility. Involving various healthcare professionals, psychiatrists, professional artists, information technology support staff (for the virtual delivery), and patient partners would be relevant. Piloting the program on a small scale and use iterative feedback to refine session content could help adjust the delivery format. It appears also important to develop clear referral pathways to ensure consistent and continuing recruitment. Technical barriers to the virtual format should be anticipated. Institutions could, if possible, consider providing tech support if needed. Finally, building in metrics pre- and postintervention could help give feedback to the institution and further reinforce the perception of the value of the program.

Conclusion

An art-based group workshop was developed by our team as a complementary intervention to standard psychiatric treatment and aimed at promoting well-being of cancer patients receiving psychiatric care. This pilot initiative offered a creative, nonclinical space for self-expression and was successfully implement. A pilot study is now underway to formally assess its feasibility and acceptability. As we strive toward more holistic cancer care, integrating artistic self-expression could be a promising complementary approach to enhance quality of life, patients’ experience, and promote posttraumatic growth for cancer patients living with psychiatric comorbidities.