Mental health in adults with cancer: an umbrella review and evidence map of creative arts interventions

Abstract Background. Creative arts interventions, including music, visual art, dance, drama and expressive writing, are increasingly offered as supportive care during cancer treatment. Several systematic reviews have examined their mental health effects, however the review level evidence has not been synthesised. An umbrella review of these reviews, covering anxiety, depression, stress/distress and quality of life in adults with cancer, was therefore conducted. Methods. Ten systematic reviews, together reporting 20{,}810 participants, were eligible. Confidence in each review was appraised with A MeaSurement Tool to Assess systematic Reviews 2, certainty was extracted as graded by the reviews, trial overlap was quantified with the corrected covered area, and non-overlapping evidence was re-analysed on a standardised scale with credibility classes, robustness scenarios and an exploratory random-forest heterogeneity analysis. Results. Here we show that, in reviews drawing on 145 unique trials, creative arts interventions are associated with lowered anxiety (standardised mean differences 0.28 to 1.59), depression (0.23 to 0.91) and stress/distress (1.19), and with improved quality of life (0.42 to 1.42), positive values denoting benefit. After de-duplication, anxiety is supported as a short-term association for receptive music listening (Hedges \textit{g}\,=\,0.67, 32 trials), and depression is weakly supported, by one small visual-art subset only. Findings should be interpreted in view of overlap, as the corrected covered area is 7.6\% and 12 of 45 review pairs exceed 15%. Conclusions. Receptive music listening is a low-burden option that may be offered around procedural anxiety. Agreement across reviews is weaker evidence than it appears, and trials with active comparators are needed before creative arts interventions can be recommended as established care.