Effects of Mandala Art Therapy (Coloring) on Nausea, Vomiting, Pain and Anxiety in Children and Youth Receiving Outpatient Chemotherapy

Abstract

Purpose: This study was designed as a randomized controlled trial (RCT) with a pretest-posttest design to investigate the effects of mandala art therapy on nausea, vomiting, pain, and anxiety in children and youth undergoing outpatient chemotherapy. Method: This study was conducted between April 15 and October 15, 2024, at the Pediatric Outpatient Chemotherapy Unit of a hospital. The study included children and youth aged 9-17 diagnosed with hematological malignancies, solid tumors, or hematological disorders accompanied by oncological conditions. The experimental group received mandala art therapy, while the control group continued with the standard protocol. The study utilized the Personal Information Form, Nausea-Vomiting Thermometer, Wong-Baker Faces Pain Rating Scale, and the State-Trait Anxiety Inventory for Children (STAIC). Data were summarized using descriptive statistics and normality was assessed using the Shapiro-Wilk test. For data that did not follow a normal distribution, the Mann-Whitney U and Wilcoxon Signed Rank tests were applied. Results: Significant differences were observed between the experimental and control groups in the of nausea, vomiting, pain, and anxiety levels post-treatment. In the experimental group, a significant reduction was observed in the nausea-vomiting and pain scores before and after the treatment (p < 0.01), while no change was noted in the control group (p > 0.05). Additionally, a significant decrease in the anxiety scores was found in the experimental group after treatment, whereas no significant difference was observed in the control group (p > 0.05). Conclusions: Mandala art therapy effectively reduces nausea, vomiting, pain, and anxiety in children undergoing outpatient chemotherapy and it appears to be a feasible and effective psychosocial intervention that could be integrated into routine supportive care in pediatric oncology. Future studies should investigate its long-term effects and in different pediatric age groups. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.