Karolina Bryl, PhD, DMT/DMP, CMA, RSMT/E
Suzi Tortora, EdD, LCAT, LMHC, BC-DMT
Guest Editor’s Note: Children with cancer and their caregivers face physical and psychosocial challenges during and after treatment. Dance/movement therapy has been used to improve well-being, promote healthy coping, and mitigate the impact of illness, but limited knowledge exists regarding its use, delivery, and outcomes in pediatric oncology. In this article, Dr. Bryl and Dr. Tortora summarize findings from their recent study of patterns of use with this dance/movement therapy for pediatric patients with cancer and their caregivers.
Pediatric cancer profoundly affects the emotional and physical well-being of patients as well as their caregivers.1-4 It impacts nearly 400,000 children and adolescents globally and is the primary cause of death in this demographic.5,6 In the United States, approximately 15,780 children (1 in 285) receive a cancer diagnosis annually.7
Although advancements in pediatric oncology have enhanced survival rates for many childhood cancers, the persistent psychosocial challenges (such as anxiety, depression, interpersonal difficulties, and noncompliance with treatment) as well as physical burdens (including fatigue, sleep disturbances, and pain) remain substantial.2,8,9 Therefore, clinical guidelines advocate that comprehensive supportive care plans should incorporate interventions aimed at managing cancer-related side effects and symptoms as well as providing essential psychosocial support.10
A Supportive Intervention
Defined by the American Dance Therapy Association as “the psychotherapeutic use of movement to promote emotional, social, cognitive, and physical integration of the individual,” dance/movement therapy is a complementary, strength-based supportive intervention.11 It integrates creative, playful, physical activities to support self-expression, promote well-being. and decrease the impact of living with cancer treatment.12,13 Dance/movement therapy sessions conducted in a safe therapeutic environment encourage patients to express emotions and feelings that may be difficult to describe in words, help to develop coping skills, enhance communication, and strengthen child-caregiver relationships. This therapy also promotes body awareness, self-esteem, and socialization.12-18
Guest Editor
Jun J. Mao, MD, MSCE
Dr. Mao is the Laurance S. Rockefeller Chair in Integrative Medicine and Chief of Integrative Medicine Service at Memorial Sloan Kettering Cancer Center, New York.
The supportive care offered by pediatric dance/movement therapy aligns with the principles of integrative oncology, which focus on patient-centered methods including mind and body practices to enhance quality of life and empower patients to actively participate in their cancer journey.19 At Memorial Sloan Kettering Cancer Center, the integrative medicine service has offered dance/movement therapy since 2003 (1,000 pediatric visits annually and more than 42,500 visits to date).
Although dance/movement therapy has been offered in medical settings as early as in the 1940s, data of its use, delivery, and efficacy in pediatric patients with cancer and their caregivers are scant,14,20 with only two pilot studies21,22 and theoretical articles.13-17,23-25 To address this gap in knowledge, we conducted a retrospective chart analysis of 100 pediatric patients who received dance/movement therapy between 2011 and 2021. We systematically extracted sociodemographic characteristics, clinical variables, referral reasons, dance/movement therapy visit details, and clinician-reported outcomes noted as clinical observations of change before and after treatment. Using a qualitative thematic analysis method, we also evaluated all dance/movement therapy visit notes to identify key techniques and specific processes of intervention.
Study Findings
In our sample, the majority of patients were female (63%), White (64%), and not Hispanic or Latino (83%), with a mean age of 8.24 (± 6.26) years. Dance/movement therapy services were evenly distributed among age groups and were commonly offered to patients with neuroblastoma (45%), sarcoma (16%), leukemia (13%), and lymphoma (11%).
Psychological distress and pain were the top two reasons for referral to dance/movement therapy services regardless of the setting (inpatient = 93.3% vs outpatient = 52.9%) or visit type (new visit = 72.5% vs follow-up visit = 78.4%). Patients were also referred to dance/movement therapy for psychological and/or developmental support, end-of-life care, or fatigue, with a typical session lasting between 15 and 25 minutes. Furthermore, we learned that once patients engaged with dance/movement therapy, they often received follow-up service (new visits = 8.8% vs follow-up visits = 91.2%).
“The supportive care offered by pediatric dance/movement therapy aligns with the principles of integrative oncology....”— KAROLINA BRYL, PhD, AND SUZI TORTORA, EdD
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We found that dance/movement therapy effectively addressed psychological distress in children, improving coping with the hospital experience (58%) and enhancing self-regulation (21%). Additionally, positive outcomes were reported for improved pain management (27%) and increased physical activity (13.2%). Caregivers were present during 43.7% of visits, with 5.5% of visits dedicated to them, which resulting in reduced caregiver burden (16%) and an enhanced parent-child relationship (0.9%).
In our analysis of dance/movement therapy visit notes, we found that dance/movement therapy aided pediatric patients with cancer by enhancing coping with the hospital experience, self-efficacy, and symptom management through four main processes. Therapists use dance and movement to accomplish these goals:
1. Encourage self-expression and meaning-making (the process by which individuals construe, understand, or make sense of life events, relationships, and themselves)
2. Teach emotional self-regulation (eg, feeling identification, processing and validation, creative expression)
3. Enhance embodied coping strategies (eg, relaxation, anxiety reduction activities, distraction)
4. Engage in creative dance-play, which promotes socialization and caregiver-child interaction.26
Study Limitations
There are several limitations to our study. First, the retrospective design limits exploring additional factors related to the use of dance/movement therapy. Second, the study was conducted at a single academic cancer center, potentially limiting generalizability. Third, patients were specifically referred to dance/movement therapy, introducing possible clinician referral bias. Additionally, outcomes were reported by clinicians, as no patient-reported outcomes were available, and so could be influenced by personal biases. Finally, our dance/movement therapy program benefits from specific institutional support, which might not be available in less supportive contexts, making its implementation challenging.
Conclusions and Future Directions
Despite these limitations, this study is the first and largest exploration of pediatric dance/movement therapy to date, opening avenues for numerous research possibilities in the field. Our results provide valuable insights for intervention protocol development and an evidence-based foundation for researchers to generate hypotheses for future research investigating the effectiveness of dance/movement therapy for children living with cancer. Knowledge of the specific processes and techniques used by dance/movement therapy therapists informs intervention development, and clinician-reported outcomes guide researchers in selecting target outcomes to document the impact of dance/movement therapy on pediatric patients.
Our hope is that more well-designed and rigorous studies will follow to investigate the impact of dance/movement therapy in pediatric patients with cancer. We also hope that as a psychosocial support intervention, dance/movement therapy gains recognition and acceptance with increasing evidence of its effectiveness, ultimately becoming more integrated into the standard of care for pediatric patients and their families.
DISCLOSURE: Dr. Bryl and Dr. Tortora reported no conflicts of interest.
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Dr. Bryl is Research Associate, Integrative Medicine Department, Memorial Sloan Kettering Cancer Center, New York. Dr. Tortora is Senior Dance/Movement Therapist, Memorial Sloan Kettering Cancer Center, New York. Dr. Tortora created the Dréa’s Dream program in 2003 through the Andréa Rizzo Foundation.
