The Effects of Regular Exercise, Arts (Origami), and Group Psychotherapy on Quality-of-life, Anxiety, Depression, Patient Satisfaction, and Hope in Cancer Patients in Remission: A Prospective Study



How to Cite

Arslan, D., gunduz, S. ., Akkoyun, O. ., Taşkın, P. ., Lapa, T. Y. ., Ardahan, F. ., & Bozcuk, H. . (2022). The Effects of Regular Exercise, Arts (Origami), and Group Psychotherapy on Quality-of-life, Anxiety, Depression, Patient Satisfaction, and Hope in Cancer Patients in Remission: A Prospective Study. Iranian Red Crescent Medical Journal, 24(11).


Objectives: We determined the effects of a “Quality-of-Life Support Program (QOLSP)” for cancer patients in remission.

Methods: Twenty-six cancer patients, being monitored while in remission, were included. During our 8-week-long prospective study, a QOLSP was implemented weekly. The patients’ hope, anxiety, depression, and quality-of-life (QoL) were assessed using scales. Additionally, questionnaires assessed the “status of program satisfaction” and the “arm utilization angle” of the breast cancer patients (n=20).

Results: The total mean score on the hope scale was initially 25.6±3.9 and increased to 29.7±1.9 post-QOLSP (p˂0.001). Additionally, the total mean score on the EORTC QLQ-C30 scale was initially 68.9±4.9 and increased to 92.6±2.2 post-QOLSP (p˂0.001). Moreover, the total mean anxiety and depression scores on the Hospital Anxiety and Depression Scale (HADS) decreased (p<0.001 and p<0.001, respectively) post-QOLSP. The factors affecting the hope score differences, the hope pre-score and the sap score (Loss of Appetite) on the EORTC QLQ-C30 symptom scale, were significant (p<0.001 and p=0.01, respectively). The factors affecting the anxiety and depression score differences were the HADS anxiety (p=0.001) and depression (p<0.001) pre-scores, respectively. Moreover, the factor affecting the sql2 score, evaluating General Health Status on the EORTC QLQ-C30, was the sql2 pre-score (p<0.001). All 26 patients were “very satisfied” with the program, and the arm usage angle of the 20 operated breast cancer patients improved.

Conclusion: Facilities that can provide a multidisciplinary QOLSP throughout treatment and follow-up will favorably affect QoL, anxiety, depression, hope, and satisfaction among cancer patients.


“Moving cancer up the global health agenda.” Lancet 2010;375(9731):2051

Ferlay, J., H-R. Shin, F. Bray, D. Forman, C. Mathers, and D.M. Parkin. “GLOBOCAN 2008, cancer incidence and mortality worldwide: IARC CancerBase No. 10.” Lyon, France: International Agency for Research on Cancer 2010; 29.

Sabatino, S.A., R.J. Coates, R.J. Uhler, L.A. Pollack, L.G. Alley, and L.J. Zauderer. “Provider counseling about health behaviors among cancer survivors in the United States.” J Clin Oncol 2007;15: 2100-2106.

Brenner, H. “Long-term survival rates of cancer patients achieved by the end of the 20th century: a period analysis.” Lancet 2002;9340:1131-1135.

Lavigne, E., E.J. Holowaty, S.Y. Pan et al. “Breast cancer detection and survival among women with cosmetic breast implants: systematic review and meta-analysis of observational studies.” BMJ 2013;346: f2399.

Lederberg, M.S. “Psychooncology.” In Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 8th ed. Edited by B.J. Sadock and V.A. Sadock, Philadelphia, PA: Lippincott Williams & Wilkins, 2005, pp 2196-2225

Knols, R., N.K. Aaronson, D. Uebelhart, J. Fransen, and G Aufdemkampe. “Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials.” J Clin Oncol 2005;16: 3830-3842.

Sellick, S.M, and D.L. Crooks. “Depression and cancer: an appraisal of the literature for prevalence, detection, and practice guideline development for psychological interventions.” Psychooncology 1999;8: 315-333.

Öztunç. G., P. Yeşil, S. Paydaş, and S. Erdoğan. “Social support and hopelessness in patients with breast cancer.” Asian Pac J Cancer Prev 2013;14: 571-578.

Courneya, K.S., R.J. Segal, J.R. Mackey et al. “Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial.” J Clin Oncol 2007;25: 4396-4404.

Nalepa, P. “Level of anxiety in patients with lung cancer.” Pneumonol Alergol Pol 1996;64: 315-322.

Uchitomi, Y. “[Depression in cancer patients].” Nihon Rinsho. Japanese Journal of Clinical Medicine 2001;8:1583-1587.

Colyer, H. “Women's experience of living with cancer.” J Adv Nurs 1996;23:496-501.

Chen, M.L. “Pain and hope in patients with cancer: a role for cognition.” Cancer Nurs 2003;26:61-67.

Spiegel, D., H.C. Kraemer, J.R. Bloom, and E. Gottheil. “Effect of psychosocial treatment on survival of patients with metastatic breast cancer.” Lancet 1989;2:888-891.

“World Health Organization: the constitution of the WHO.” WHO Chronicle 1947;1:29.

Aaronson, N.K., S. Ahmedzai, B. Bergman et al. “The European Organisation for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.” J Natl Cancer Inst 1993;85:365-376.

Lakoski, S.G., N.D. Eves, P.S. Douglas, and L.W. Jones. “Exercise rehabilitation in patients with cancer.” Nat Rev Clin Oncol 2012;9:288-296.

Daley, A.J., H. Crank, J.M. Saxton, N. Mutrie, R. Coleman, and A. Roalfe. “Randomized trial of exercise therapy in women treated for breast cancer.” J Clin Oncol 2007;25:1713-1721.

Mishra, S.I, R.W. Scherer, C. Snyder, P.M. Geigle, D.R. Berlanstein, and O. Topaloglu. “Exercise interventions on health-related quality of life for people with cancer during active treatment.” Clin Otolaryngol 2012;5:390-392.

Bar-Sela, G., L. Atid, S. Danos, N. Gabay, and R. Epelbaum. “Art therapy improved depression and influenced fatigue levels in cancer patients on chemotherapy.” Psychooncology 2007;16:980-984.

Wood, M.J., A. Molassiotis, and S. Payne. “What research evidence is there for the use of art therapy in the management of symptoms in adults with cancer? A systematic review.” Psychooncology 2011;20:135-145.

Oster, I., A. Svensk, E. Magnusson et al. “Art therapy improves coping resources: a randomized, controlled study among women with breast cancer.” Palliat Support Care 2006;4:57-64.

Oster, I., E. Magnusson, K.E. Thyme, J. Lindh, and S. Åström. “Art therapy for women with breast cancer: the therapeutic consequences of boundary strengthening.” The Arts in Psychotherapy 2007;34:277-288.

Reynolds, F., and S. Prior. “The role of art-making in identity maintenance: case studies of people living with cancer.” Eur J Cancer Care 2006;15:333-341.

Blake-Mortimer, J., C. Gore-Felton, R. Kimerling, J.M. Turner-Cobb, and D. Spiegel. “Improving the quality and quantity of life among patients with cancer: a review of the effectiveness of group psychotherapy.” Eur J Cancer 1999;35:1581-1586.

Classen, C., L.D. Butler, C. Koopman et al. “Supportive-expressive group therapy and distress in patients with metastatic breast cancer: a randomized clinical intervention trial.” Arch Gen Psychiatry 2001;58: 494-501.

Snyder, C.R., C. Harris, J.R. Anderson et al. “The will and the ways: development and validation of an individual-differences measure of hope.” J Pers Soc Psychol 1991;60:570-585.

Zigmond, A.S., and R.P. “The hospital anxiety and depression scale.” Acta Psychiatr Scand 1983;6:361-370.

Detmar, S.B., M.J. Muller, J.H. Schornagel, L.D. Wever, and N.K. Aaronson. “Health-related quality-of-life assessments and patient-physician communication: a randomized controlled trial.” JAMA 2002;288:3027-3034.

Galvão, D.A., and R.U. Newton RU. “Review of exercise intervention studies in cancer patients.” J Clin Oncol 2005;23:899-909.

Courneya, K.S., and C.M. Friedenreich. “Framework PEACE: an organizational model for examining physical exercise across the cancer experience.” Ann Behav Med 2001;23:263-272.

Spence, R.R., K.C. Heesch, and W.J. Brown. “Exercise and cancer rehabilitation: a systematic review.” Cancer Treat Rev 2010;36:185-194.

Oldervoll, L.M., J.H. Loge, H. Paltiel et al.“The effect of a physical exercise program in palliative care: a phase II study.” J Pain Symptom Manage 2006;31:421-430.

Lowe, S.S., and S.M. Watanabe. “Physical activity as a supportive care intervention in palliative cancer patients: a systematic review.” J Support Oncol 2009;7:27-34.

Davies, N.J., L. Batehup, and R. Thomas. “The role of diet and physical activity in breast, colorectal, and prostate cancer survivorship: a review of the literature.” Br J Cancer 2011;105:52-73.

Hayes, S.C., R.R. Spence, D.A. Galvão, and R.U. Newton. “Australian Association for Exercise and Sport Science position stand: optimising cancer outcomes through exercise.” J Sci Med Sport 2009;12: 428-434.

Eyigor, S., H. Karapolat, H. Yesil, R. Uslu, and B. Durmaz. “Effects of Pilates exercises on functional capacity, flexibility, fatigue, depression and quality of life in female breast cancer patients: a randomized controlled study.” Eur J Phys Rehabil Med 2010;46:481-487.

Radbruch, L., F. Strasser, F. Elsner et al. “Fatigue in palliative care patients—an EAPC approach.” Palliat Med 2008;22:13-32.

Palacio, A., P. Calmels, M. Genty, B. Le-Quang, and F. Beuret-Blanquart. “Oncology and physical medicine and rehabilitation.” Ann Phys Rehabil Med 2009;52:568-578.

Segal, R., W. Evans, D. Johnson et al. “Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial.” J Clin Oncol 2001;19:657-665.

McNeely, M., K. Campbell, B. Rowe, T.P. Klassen, J.R. Mackey, and K.S. Courneya. “A systematic review and meta-analysis of exercise interventions in breast cancer patients and survivors.” CMAJ 2006;1:34-41.

Conn, V., A. Hafdahl, D. Porock, R. McDaniel, and P.J. Nielsen. “A meta-analysis of exercise interventions among people treated for cancer.” Support Care Cancer 2006;14: 699-712.

Schmitz, KH., J. Holtzman, K.S. Courneya, L.C. Mâsse, S. Duval, and R. Kane. “Controlled physical activity trials in cancer survivors: a systematic review and meta-analysis.” Cancer Epidemiol Biomarkers Prev 2005;14: 1588-1595.

Eyigor, S., H. Karapolat, O.K. Korkmaz, and R. Uslu. “The level of satisfaction in cancer patients with completed treatments: a 7-year screening.” J BUON2009;14:681-687.

Dahele, M., R.J. Skipworth, L. Wall, A. Voss, T. Preston, and K.C.H Fearon. “Objective physical activity and self-reported quality of life in patients receiving palliative chemotherapy.” J Pain Symptom Manage 2007;33:676-685.

Maddocks, M., S. Mockett, and A. Wilcock. “Is exercise an acceptable and practical therapy for people with or cured of cancer? A systematic review.” Cancer Treat Rev 2009;35:383-390.

Malchiodi, C.A. “Expressive arts therapy and multimodal approaches.” In Handbook of Art Therapy, 1st ed. Edited by C.A. Malchiodi. NY: Guilford Press, New York, 2003, pp 106-117.

Bar-Sela, G., L. Atid, S. Danos, N. Gabay, and R. Epelbaum. “Art therapy improved depression and influenced fatigue levels in cancer patients on chemotherapy.” Psychooncology 2007;16:980-984.

Monti, D.A., C. Peterson, E.J. Kunkel et al. “A randomized, controlled mindfulness-based art therapy (MBAT) for women wıth cancer.” Psychooncology 2006;5:363-373.

Collie, K., J.L. Bottorff, and B.C. Long. “A narrative view of art therapy and art making by women with breast cancer.” J Health Psychol 2006;11:761-775.

Zeigler, L., P.A. Smith, and J. Fawcett. “Breast cancer: evaluation of the common journey breast cancer support group.” J Clin Nurs 2004;13:467-478.

Bulfone, T., R. Quattrin, R. Zanotti, L. Regattin, and S. Brusaferro. “Effectiveness of music therapy for anxiety reduction in women with breast cancer in chemotherapy treatment.” Holist Nurs Pract 2009;23:238-242.

Bradt, J., C. Dileo, D. Grocke, and L. Magill. “Music interventions for improving psychological and physical outcomes in cancer patients.” Cochrane Database Syst Rev 2011;8:CD006911.

Ferrer, A.J. “The effect of live music on decreasing anxiety in patients undergoing chemotherapy treatment.” J Music Ther 2007;44:242-255.

Zhou, KN, X.M. Li, H. Yan H, S.N. Dang, and D.L. Wang. “Effects of music therapy on depression and duration of hospital stay of breast cancer patients after radical mastectomy.” Chin Med J 2011;124:2321-2327.

Chuang, C.Y., W.R. Han, P.C. Li, and S.T. Young. “Effects of music therapy on subjective sensations and heart rate variability in treated cancer survivors: a pilot study.” Complement Ther Med 2010;18:224-226.

Burns, D.S. “The effect of the bonny method of guided imagery and music on the mood and life quality of cancer patients.” J Music Ther 2001;38:51-65.

Hilliard, R.E. “The effects of music therapy on the quality and length of life of people diagnosed with terminal cancer.” J Music Ther 2003;40:113-137.

Lockhart. C., and A. Anania. “Origami creations bring peace and hope to patients in transplantation unit.” Clin J Oncol Nurs 2011;15:106-107.

Kissane, D.W., B. Grabsch, D.M. Clarke et al.“Supportive-expressive group therapy for women with metastatic breast cancer: survival and psychosocial outcome from a randomized controlled trial.” Psychooncology 2007;4:277-286.

Goodwin, P.J., M. Leszcz, M. Ennis et al.“The effect of group psychosocial support on survival in metastatic breast cancer.” N Engl J Med 2001;345:1719-1726.

Faller, H., M. Schuler, M. Richard, U. Heckl, J. Weis, and R. Küffner. “Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis.” J Clin Oncol 2013;31:782-793.