PILOT STUDY TO EXAMINE THE EFFECTS OF ART THERAPY DURING CHEMOTHERAPY ON STRESS AND QUALITY OF LIFE IN PATIENTS WITH STAGE 3 COLON CANCER For Presentation at The Culture Health and Wellness International Conference Arts in Heath Southwest, Bristol, United Kingdom June 24, 2013

THE RESEARCH TEAM  Deborah Elkis-Abuhoff, Ph.D., LCAT, ATR-BC, ATCS, BCPC Hofstra University, New York, USA  Robert Goldblatt, Ph.D. N. Y. Inst. of Technology College of Osteopathic Medicine, New York, USA  Morgan Gaydos, MA, ATR, LCAT Nassau University Medical Center, New York, USA  Caitlin Convery, BA Hofstra University, New York, USA

ADDITIONAL TEAM MEMBERS AT MONTER CANCER CENTER, NORTH SHORE/LONG ISLAND JEWISH HEALTH SYSTEM, NEW YORK, USA  Karen Gleason, RN, BSN, OCN is the nurse overseeing the chemotherapy scheduling and recruitment of patients  James D’Olomipio, MD, is the physician on the team responsible for helping to identify appropriate participants, those that meet our criteria, and informs Karen of their possible inclusion.

ART THERAPY IN MEDICINE  There has always been a natural collaboration between Art Therapy and Medicine - Art has the ability to synthesize, integrate, and communicate a patient’s pain and loss - Healing is to become whole physically and psychologically - Art Therapy can bring about insights related to the experience of critical illness and its treatment

ART THERAPY IN MEDICINE  Malchiodi (1993) was the first to use the phase “Medical Art Therapy” in publication.  Wadeson (2003): Creating art distracts from thoughts of the disease and/or symptoms, bringing about more relaxed and peaceful feelings.  Tingey-Hall (1997): Patients expressed their emotions through the use of paint.  This was shown to relieve stress, calm the nervous system, and lift depression.  The process absorbed the participant, stimulating imagination that lead to a relaxed meditative state.

PURPOSE OF OUR STUDY  The purpose of this study is to follow patients diagnosed with colon cancer, through their chemotherapy protocol, to assess for emotional well-being. By incorporating technology based art therapy, those who are receiving chemotherapy for Stage III or Stage IV colon cancer will have a decrease in stress and an enhancement of quality of life.

ART THERAPY IN CHEMOTHERAPY  Challenges of initiating Art Therapy within the Chemotherapy setting:  Organization of supplies and the mess related with art materials  Restricted mobility of the patient while receiving chemotherapy  The importance to maintain a clean environment within the clinical health setting

RESEARCH DESIGN  Participants include a total of 50 males and females, above the age of 18, diagnosed with colon cancer stage III or IV and are going through a standard protocol of chemotherapy (either FOLFOX or XELOX)  Patients who are randomized into the experimental group will be given the information and opportunity to be included in the art therapy component of the project, which includes the iPad experience along with the chemotherapy treatment.  Those in the control group will receive their prescribed chemotherapy treatment with the inclusion of only the self report assessments

MATERIALS  iPads  Demographic form  The Perceived Stress Scale (PSS-4)  Functional Assessment of Cancer Therapy (FACT-C), which has been standardized for use with cancer patients.  Post questionnaire (one for experimental group, one for control group)  Printer  Stylus brushes

PROCEDURES  After informed consent, all participants were asked to complete a demographic questionnaire, the Perceived Stress Scale-4 (PSS-4), and the Functional Assessment of Cancer Therapy-Colorectal (FACT-C)  The PSS-4 consists of four self report questions assessing level of stress that the patient perceives they are experiencing.  In the past week, how often have you felt that you were unable to control the important things in your life?  The FACT-C is a 5-point Likert scale that has an ability to distinguish between groups based on functional status and extent of disease. The FACT-C was also found to be sensitive to changes in functional status. Colorectal cancer-specific items form the Colorectal Cancer Subscale (CCS):  I lack energy; I get support from my friends; I feel sad; I am sleeping well; I am losing weight

PROCEDURES  Participants in the experimental group received an iPad at each chemotherapy session to create artwork with any or all the art applications. At the end of each session, they returned the iPad with at least one piece of artwork saved for data collection. If the participant wanted to receive a copy of any of their created artwork they were able to receive printed copies upon request.  For all participants in the 12 week cycle a pre- and post- assessment of the PSS-4 and the FACT-C were collected on weeks 1,4, 8, and 12  For all participants in the 8 week cycle a pre- and post- assessment of the PSS-4 and the FACT-C were collected on weeks 1,4, and 8.

THE IPAD SET UP:  Homepage with assessments and art applications

IPAD APPLICATIONS ZEN BRUSH ART RAGE 123D SCULPT

SAMPLE ART WORK FROM IPAD ZEN BRUSH

SAMPLE ART WORK FROM IPAD ART RAGE

SAMPLE ART WORK FROM IPAD 123D SCULPT

GROWTH AND DISSEMINATION  As this initial pilot phase is completed, the research will be disseminated to additional populations within the cancer treatment facility. We have already had several other oncologist express interest in included their patients.  The next phase will explore the connection between the real time data and the medical team to immediately be able to address the needs of the patient receiving chemotherapy.  The medical director of the children’s hospital within the health system has invited us to develop a project geared directly to their young patients.  It is anticipated that this project will reach its potential over the next 3 – 5 years. We continue to invite others to collaborate and further disseminate this research project to additional health care facilities.

CONTACT INFORMATION  Deborah Elkis-Abuhoff, Ph.D., LCAT, ATR, BC, ATCS, BCPC Hofstra University, Hempstead, New York, USA  Robert Goldblatt, Ph.D New York Institute College of Osteopathic Medicine, Old Westbury, New York USA