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1 Supplementary Online Content Puetz TW, Morley CA, Herring MP. Effects of creative arts therapies on psychological symptoms and quality of life in patients with cancer. JAMA Intern Med. Published online May 13, doi: /jamainternmed ereferences. Bibliography of included trials etable 1. Definitions for levels of moderators etable 2. Statistical tests of publication bias etable 3. Summary of anxiety univariate moderator analysis etable 4. Summary of depression univariate moderator analysis etable 5. Summary of fatigue univariate moderator analysis etable 6. Summary of pain univariate moderator analysis etable 7. Summary of QOL univariate moderator analysis efigure. Funnel plots This supplementary material has been provided by the authors to give readers additional information about their work.

2 ereferences. Bibliography of Included Trials 1. Bruera E, Willey J, Cohen M, Palmer JL. Expressive writing in patients receiving palliative care: a feasibility study. J Palliat Med. 2008;11(1): Bulfone T, Quattrin R, Zanotti R, Regattin L, Brusaferro S. Effectiveness of music therapy for anxiety reduction in women with breast cancer in chemotherapy treatment. Holist Nurs Pract. 2009;23(4): Burns SJ, Harbuz MS, Hucklebridge F, Bunt L. A pilot study in to the therapeutic effects of music therapy at a cancer help center. Altern Ther Health Med. 2001;7(1): Cassileth BR, Vickers AJ, Magill LA. Music therapy for mood disturbance during hospitalization for autologous stem cell transplantation: a randomized controlled trial. Cancer. 2003;98(12): Clark M, Isaacks-Downton G, Wells N, et al. Use of preferred music to reduce emotional distress and symptom activity during radiation therapy. J Music Ther. 2006;43(3): de Moor C, Sterner J, Hall M, et al. A pilot study of the effects of expressive writing on psychological and behavioral adjustment in patients enrolled in a phase II trial of vaccine therapy for metastatic renal cell carcinoma. Health Psychol. 2002;21(6): Dibbell-Hope S. The use of dance/movement therapy in psychological adaptation to breast cancer. Arts Psychother. 2000;27(1): Ferrer AJ. The effect of live music on decreasing anxiety in patients undergoing chemotherapy treatment. J Music Ther. 2007;44(3): Gellaitry G, Peters K, Bloomfield D, Home R. Narrowing the gap: the effects of an expressive writing intervention on perceptions of actual and ideal emotional support in women who have completed treatment for early stage breast cancer. Psychooncology. 2010;19(1): Hanser SB, Bauer-Wu S, Kubicek L, et al. Effects of a music therapy intervention on quality of life and distress in women with metastatic breast cancer. J Soc Integr Oncol. 2006;4(3): Hilliard RE. The effects of music therapy on the quality and length of life of people diagnosed with terminal cancer. J Music Ther. 2003;40(2): Huang S, Good M, Zauszniewski JA. The effectiveness of music in relieving pain in cancer patients: a randomized controlled trial. Int J Nurs Stud. 2010;47(11): Kwekkeboom KL. Music versus distraction for procedural pain and anxiety in patients with cancer. Oncol Nurs Forum. 2003;30(3): Li XM, Yan H, Zhou KN, Dang SN, Wang DL, Zhang YP. Effects of music therapy on pain among female breast cancer patients after radical mastectomy: results from a randomized controlled trial. Breast Cancer Res Treat. 2011;128(2):

3 15. Lin MF, Hsieh YJ, Hsu YY, Fetzer S, Hsu MC. A randomized controlled trial of the effect of music therapy and verbal relaxation on chemotherapy-induced anxiety. J Clin Nurs. 2011;20(7-8): Monti DA, Peterson C, Kunkel EJS, et al. A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer. Psychooncology. 2006;15(5): Nguyen TN, Nilsson S, Hellstrom AL, Bengtson A. Music therapy to reduce pain and anxiety in children with cancer undergoing lumbar puncture: a randomized clinical trial. J Pediatr Oncol Nurs. 2010;27(3): Puig A, Lee SM, Goodwin L, Sherrard PAD. The efficacy of creative arts therapies to enhance emotional expression, spirituality, and psychological well-being of newly diagnosed stage I and stage II breast cancer patients: a preliminary study. Arts Psychother. 2006;33(3): Rosenberg HJ, Rosenberg SD, Ernstoff MS, et al. Expressive disclosure and health outcomes in a prostate cancer population. Int J Psychiatry Med. 2002;32(1): Sabo CE, Michael SR. The influence of personal message with music on anxiety and side effects associated with chemotherapy. Cancer Nurs. 1996;19(4): Sandel SL, Judge JO, Landry N, Faria L, Ouellette R, Majczak M. Dance and movement program improves quality of life measures in breast cancer survivors. Cancer Nurs. 2005;28(4): Shabanloei R, Golchin M, Esfahani A, Dolatkhah R, Rasoulian M. Effects of music therapy on pain and anxiety in patients undergoing bone marrow biopsy and aspiration. AORN J. 2010;91(6): Smith M, Casey L, Johnson D, Gwede C, Riggin OZ. Music as a therapeutic intervention for anxiety in patients receiving radiation therapy. Oncol Nurs Forum. 2001;28(5): Stordahl JJ. The influence of music on depression, affect, and benefit finding among women at the completion of treatment for breast cancer [dissertation]. Coral Gables, Florida: University of Miami; Svensk AC, Oster I, Thyme KE, et al. Art therapy improves experienced quality of life among women undergoing treatment for breast cancer: a randomized controlled study. Eur J Cancer Care. 2009;18(1): Thyme KE, Sundin EC, Wiberg B, Oster I, Astrom S, Lindh J. Individual brief art therapy can be helpful for women with breast cancer: a randomized controlled clinical study. Palliat Support Care. 2009;7(1): Zimmerman L, Pozehl B, Duncan K, Schmitz R. Effects of music in patients who had chronic cancer pain. West J Nurs Res. 1989;11(3):

4 etable 1. Definitions for levels of moderators Effect Moderator Levels Participant Characteristics Nationality Sex Age Baseline symptom score United States: data from participants from the United States only Other: data from participants from countries other than the United States Male: data from male patients only Female: data from female patients only Mixed: data from samples that combined male and female patients Continuous variable: years Continuous variable: T scores Intervention Characteristics Intervention mode Therapeutic monitoring Intervention type Session type Session duration Program duration Art: the intervention used a 2-dimensional (eg, drawing) and/or 3-dimensional (eg, sculpting) modality Dance: the intervention used a dance or movement modality Music: the intervention used a music-listening and/or participation modality Writing: the intervention used an expressive writing modality Creative arts therapist: the intervention sessions were directly led and monitored by a therapist No creative arts therapist: the intervention was developed by a therapist, but sessions were not directly led or monitored by a therapist Individual: the intervention was conducted one on one between the patient and a therapist Group: the intervention was conducted with 2 or more patients and a therapist Single session: the intervention consisted of a single CAT session Multisession: the intervention consisted of two or more CAT sessions Continuous variable: minutes Continuous variable: weeks

5 Study Design Characteristics Intervention period Intervention setting Intervention confound Homogeneity of cancer group Type of comparison During treatment: the intervention included individuals diagnosed with cancer currently undergoing active treatment (eg, chemotherapy) Posttreatment: the intervention included individuals diagnosed with cancer following the completion of active treatment (eg, chemotherapy) Inpatient: the intervention included any health care service setting in which the patient is admitted to a facility (eg, hospital, nursing home) Outpatient: the intervention included any health care service setting in which the patient is not admitted to a facility (eg, physician's office, clinic, patient s home) Other: the intervention used a setting not categorized above (eg, community center) Confounded: the intervention consisted of both CAT treatment and 1 or more additional intervention components (eg, education, counseling, pharmacotherapy) Not confounded: the intervention consisted of only CAT treatment without the addition of other intervention components (eg, education, counseling, pharmacotherapy) Homogeneous: the study included only a defined sample of cancer patients (eg, breast cancer) Heterogeneous: the study included a mixed sample of cancer patients (eg, breast, prostate, and lung cancer) No treatment: the study used a no-treatment control comparison condition Waitlist: the study used a waiting-list control comparison condition Usual care: the study used a usual-care control comparison condition Placebo: the study used a placebo control comparison condition

6 Outcome Measure Anxiety STAI: study used the State-Trait Anxiety Inventory POMS Tension: study used the Profile of Mood States Tension Scale SCL-90 Anxiety: study used the Symptom Checklist-90 Anxiety Scale HADS Anxiety: study used the Hospital Anxiety Depression Scale VAS Anxiety: study used a visual analog scale for anxiety Depression POMS Depression: study used the Profile of Mood States Depression Scale SCL-90 Depression: study used the Symptom Checklist- 90 Depression Scale HADS Depression: study used the Hospital Anxiety Depression Scale CES-D: study used the Center for Epidemiologic Studies Depression Scale Pain VAS Pain: study used a visual analog scale for pain MPQ: study used the McGill Pain Questionnaire Other: study used a pain measure not categorized above Fatigue POMS Fatigue: study used the Profile of Mood States Fatigue Scale VAS Fatigue: study used a visual analog scale for fatigue Quality of Life FACT: study used the Functional Assessment of Cancer Therapy scale Other: study used a fatigue measure not categorized above Abbreviation: CAT, creative arts therapies.

7 etable 2. Statistical tests for publication bias Begg Rank Correlation Model Kendall s τ df P Value Anxiety Depression Pain Fatigue Quality of Life Egger Regression Test Model β t Test df P Value Anxiety Depression Pain Fatigue Quality of Life

8 etable 3. Summary of anxiety univariate moderator analysis Effect Moderator Effects (k) Δ or β 95% CI P Value I 2 Demographics Nationality United States to % Other to % Sex Male to % Female to % Mixed to % Age (years) to % Baseline score (T score) to % Intervention Characteristics Intervention mode Art to % Dance to NA Music to % Writing to NA Therapeutic monitoring Creative arts therapist to % No creative arts therapists to % Intervention type Individual to % Group to % Session type Single session to % Multisession to % Session duration (minutes) to % Program duration (weeks) to % Study Characteristics Intervention period During treatment to % Posttreatment to % Intervention setting Inpatient to NA Outpatient to % Other to NA

9 Intervention confound Confounded to % Not confounded to % Homogeneity of group - Homogeneous to % Heterogeneous to % Type of comparison No treatment 0 NA NA NA NA Waiting list to % Usual care to % Placebo to % Outcome measure STAI to % POMS Tension to % SCL-90 Anxiety to % HADS Anxiety to % VAS Anxiety to % Abbreviations: HADS, Hospital Anxiety Depression Checklist; NA, not applicable; POMS, Profile of Mood States; SCL-90, Symptom Checklist-90; STAI, State-Trait Anxiety Inventory; VAS, visual analog scale.

10 etable 4. Summary of depression univariate moderator analysis Effect Moderator Effects (k) Δ or β 95% CI P Value I 2 Demographics Nationality United States to % Other to NA Sex Male 0 -NA NA NA NA Female to % Mixed to % Age (years) to % Baseline score (T score) to % Intervention Characteristics Intervention mode Art to % Dance to NA Music to % Writing to NA Therapeutic monitoring Creative arts therapist to % No creative arts therapists to % Intervention type Individual to % Group to % Session type Single session 0 -NA -NA NA NA Multisession to % Session duration (minutes) to % Program duration (weeks) to % Study Characteristics Intervention period During treatment to % Posttreatment to NA Intervention setting Inpatient to NA Outpatient to % Other to NA

11 Intervention confound Confounded to % Not confounded to % Homogeneity of group - Homogeneous to % Heterogeneous to % Type of Comparison No treatment 0 NA NA NA NA Waiting list to % Usual care to % Placebo to NA Outcome measure POMS Depression to % SCL-90 Depression to % HADS Depression to % CES-D to NA Abbreviations: CES-D, CES-D Center for Epidemiological Studies Depression; HADS, Hospital Anxiety Depression Scale; NA, not applicable; POMS, Profile of Mood States; SCL-90, Symptom Checklist-90.

12 etable 5. Summary of Fatigue Univariate Moderator Analysis Effect Moderator Effects (k) Δ or β 95% CI P Value I 2 Demographics Nationality United States to % Other 0 -NA NA NA NA Sex Male 0 -NA NA NA NA Female to NA Mixed to % Age (years) to % Baseline score (T score) to % Intervention Characteristics Intervention mode Art to NA Dance to NA Music to % Writing to NA Therapeutic monitoring Creative arts therapist to % No creative arts therapists to % Intervention type Individual to % Group to NA Session type Single session to NA Multisession to % Session duration (minutes) to % Program duration (weeks) to % Study Characteristics Intervention period During treatment to % Posttreatment to NA Intervention setting Inpatient to NA Outpatient to % Other to NA Intervention confound Confounded to %

13 Not confounded to % Homogeneity of group - Homogeneous to % Heterogeneous to % Type of comparison No treatment 0 NA NA NA NA Waiting list to NA Usual care to % Placebo to NA Outcome measure POMS Fatigue to % VAS Fatigue to NA Abbreviations: NA, not applicable; POMS, Profile of Mood States; VAS, visual analog scale.

14 etable 6. Summary of pain univariate moderator analysis Effect Moderator Effects (k) Δ or β 95% CI P Value I 2 Demographics Nationality United States to % Other to % Sex Male to NA Female to % Mixed to % Age (years) to % Baseline score (T score) to % Intervention Characteristics Intervention mode Art to % Dance 0 -NA NA NA NA Music to % Writing to NA Therapeutic monitoring Creative arts therapist to % No creative arts therapists to % Intervention type Individual to % Group to % Session type Single session to % Multisession to % Session duration (minutes) to % Program duration (weeks) to % Study Characteristics Intervention period During treatment to % Posttreatment to %

15 Intervention setting Inpatient to % Outpatient to % Other 0 -NA -NA NA NA Intervention confound Confounded to % Not confounded to % Homogeneity of group - Homogeneous to % Heterogeneous to % Type of comparison No treatment to % Waiting list to NA Usual care to % Placebo to % Outcome measure VAS Pain to % MPQ to % Other to % Abbreviations: MPQ, McGill Pain Questionnaire; NA, not applicable; VAS, visual analog scale.

16 etable 7. Summary of QOL univariate moderator analysis Effect Moderator Effects (k) Δ or β 95% CI P Value I 2 Demographics Nationality United States to % Other to NA Sex Male 0 -NA NA NA NA Female to NA Mixed to % Age (years) to % Baseline score (T score) to % Intervention Characteristics Intervention mode Art to NA Dance to NA Music to % Writing 0 NA NA NA NA Therapeutic monitoring Creative arts therapist to % No creative arts therapists 0 NA -NA NA NA Intervention type Individual to % Group to NA Session type Single session 0 -NA -NA NA NA Multisession to % Session duration (minutes) to % Program duration (weeks) to % Study Characteristics Intervention period During treatment to % Posttreatment to % Intervention setting Inpatient 0 -NA NA NA NA Outpatient to % Other to NA Intervention confound Confounded to NA

17 Not confounded to % Homogeneity of group - Homogeneous to % Heterogeneous to % Type of comparison No treatment 0 NA NA NA NA Waiting list to % Usual care to % Placebo 0 NA NA NA NA Outcome Measure FACT to % Other to % Abbrevations: FACT, Functional Assessment of Cancer Therapy; NA, not applicable; QOL, quality of life. efigure. Funnel plots (following pages)

18 Standard Error 0.0 Anxiety Effects Mean Δ 95% Confidence Interval Mean Δ

19 Standard Error 0.0 Depression Effects Mean Δ 95% Confidence Interval Mean Δ

20 Standard Error 0.0 Pain Effects Mean Δ 95% Confidence Interval Mean Δ

21 Standard Error 0.0 Fatigue Effects Mean Δ 95% Confidence Interval Mean Δ

22 Standard Error 0.0 Quality of Life Effects Mean Δ % Confidence Interval Mean Δ