Effects of Creative Arts Therapy on Psychological Outcomes and Stress‐Related Physiological Markers in Children With Cancer: A Systematic Review
Kristiawati Kristiawati, Nursalam Nursalam, Arina Qona'ah, Idyatul Hasanah, Diah Priyantini, Domingos Soares, Asroful Hulam ZamroniABSTRACT
Children with cancer frequently experience psychological distress and symptom‐related challenges during diagnosis, treatment, and hospitalization. Creative arts therapy (CAT) has been used as a complementary approach to support emotional expression, coping, and stress regulation; however, its effects on psychological outcomes and stress‐related physiological markers remain unclear. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). The CINAHL, Cochrane, Embase, PubMed, Scopus, and Web of Sciences databases were searched for quantitative studies published between 2014 and 2025. Eligible studies included children and adolescents with cancer who received CAT. A total of 4860 records were identified, of which 26 studies met the inclusion criteria and were synthesized narratively. CAT was generally associated with reductions in anxiety, depression, stress, distress, fear, procedural pain, and emotional discomfort, and with improvements in coping, emotional regulation, sleep quality, relaxation, happiness, and quality of life. A smaller subset of studies reported potential benefits for physiological markers, including heart rate, respiratory rate, blood pressure, cortisol levels, hemodynamic status, and hematologic indicators. CAT may support psychological well‐being, symptom relief, and stress regulation among children with cancer and may be a useful complement to supportive care in pediatric oncology, although further rigorous trials using standardized outcomes are needed.