Group painting therapy for children and adolescents with bone tumors: a quasi-experimental trial evaluating anxiety, depression, post-traumatic growth, and health-related quality of life.
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BACKGROUND: Children and adolescents undergoing treatment for malignant bone tumors frequently experience heightened psychological distress, including anxiety, depression, and reduced health-related quality of life (HRQoL). Group painting therapy has been proposed as a supportive non-pharmacological strategy, yet empirical evidence in pediatric oncology remains limited. This study aimed to evaluate the impact of an eight-week structured group painting therapy program on anxiety, depression, post-traumatic growth (PTG), and HRQoL in this population. METHODS: A quasi-experimental pretest-posttest study was conducted among children and adolescents (aged 8-18 years) with primary malignant bone tumors at Henan Cancer Hospital from December 2023 to December 2024. A total of 76 participants were consecutively enrolled and allocated to an intervention group receiving group painting therapy (n=39) or a control group receiving standard nursing care (n=37) using a nonrandomized ward-based approach. Anxiety, depressive symptoms, PTG, and HRQoL were assessed at baseline and post-intervention using validated instruments, including SCARED, DSRSC, PTGI, and PedsQL™ 3.0 Cancer Module. RESULTS: Compared with the control group, the intervention group demonstrated greater reductions in anxiety and depressive symptoms, along with significant improvements in PTG and selected HRQoL domains. Notable improvements were observed in emotional functioning, social communication, generalized anxiety, somatic symptoms, personal strength, and appreciation of life. No significant between-group differences were observed in physical symptom domains such as pain and nausea. CONCLUSIONS: Group painting therapy was associated with improvements in emotional well-being, PTG, and selected HRQoL domains in children and adolescents with primary bone tumors. These findings suggest that painting therapy may be a promising adjunct to routine pediatric oncology care for promoting resilience and psychological recovery.