A Good Time to Dance?

A Mixed-Methods
Approach of the Effects of Dance Movement
Therapy for Breast Cancer Patients During
and After Radiotherapy
ArticleinCancer Nursing Publish Ahead of Print(1) February 2015
DOI: 10.1097/NCC.0000000000000237 Source: PubMed

1st Rainbow Tin Hung Ho

37.03 The University of Hong Kong

2nd Phyllis H Y Lo

3rd Mai Yee Luk

Abstract
Dance movement therapy (DMT) is premised on an interconnected body and mind. It has known
benefits for cancer patients' physical and psychological health and quality of life.
To offer greater insight into a previous randomized controlled trial, the present study
qualitatively explored the beneficial elements of DMT over the course of radiotherapy. To better
understand the uniqueness of DMT intervention for patients receiving radiotherapy, the study
statistically
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Rainbow T. H. Ho, PhD

Phyllis H. Y. Lo, MPhil

Mai Yee Luk, MBBS

A Good Time to Dance? A MixedMethods

Approach of the Effects of Dance
Movement
Therapy for Breast Cancer
Patients During
and After Radiotherapy
KEYWORDS

Breast cancer
Chinese
Dance movement therapy
Intervention
Radiotherapy
Background:
Dance movement therapy (DMT) is premised on an interconnected
body and mind. It has known benefits for cancer patients physical and
psychological health and quality of life.
Objective:
To offer greater insight into a
previous randomized controlled trial, the present study qualitatively explored
the
beneficial elements of DMT over the course of radiotherapy. To better
understand the
uniqueness of DMT intervention for patients receiving radiotherapy, the study
statistically compared them with patients who received DMT after treatment
completion.
Methods:
Participants were randomized into radiotherapy and
postradiotherapy control groups. The radiotherapy group received DMT
(6 sessions at 90 minutes each) as they were undergoing radiotherapy. The

postradiotherapy group was provided with the same DMT intervention at 1 to 2

months
after completing radiotherapy.
Results:
One hundred four participants identified
5 main benefit categories. Dance movement therapy helped them (1) cope
with
cancer, treatment, and physical symptoms; (2) improve mental well-being,
attention,
and appreciation for the self and body; (3) improve total functioning; (4) bridge
back
to a normal and better life; and (5) participate in shared positive experiences.
The
radiotherapy group reported categories 1 and 2 more prominently than did the
postradiotherapy group.
Conclusions:
The findings reinforced the benefits of DMT
while adding the new perspective that delivering DMT intervention throughout
cancer
Dance Movement Therapy During and After Radiotherapy
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Copyright
B
2015 Wolters Kluwer Health, Inc. All rights reserved.

Author Affiliations: Department of Social Work and Social Administration

(Dr Ho) and Centre on Behavioral Health, The University of Hong Kong (Dr Ho
and Ms Lo); and Department of Clinical On
cology, Queen Mary Hospital (Ms Luk),
Pokfulam, Hong Kong.
The authors have no conflicts of interest to disclose.
Correspondence: Rainbow T. H. Ho, PhD, Centre on Behavioral Health,
The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for
Interdisciplinary Research, 5 Sassoon Rd
, Pokfulam, Hong Kong (tinho@hku.hk).
Accepted for publication December 17, 2014.
DOI: 10.1097/NCC.0000000000000237
Copyright 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is
prohibited.

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treatment can have different and even additional benefits for patients.
Implications for Practice:
The pleasure of dancing and the psychological and

physical relief from DMT help patients cope with daily radiation treatments.
This could
decrease treatment dropout rates when administered in clinical settings.

R
adiotherapy is administered as an adjuvant treatment
to most women diagnosed with
breast cancer after breastconserving surgery or some cases of mastectomy. For most
patients, radiation treatment is t
ypically administered 3 to 4 weeks
following surgery or chemotherapy
and is also the last of the adjuvant therapies that must be administered regularly at a hospital.
Although many patients are relieved that the adverse effects of
radiotherapy are much milder than those of chemotherapy, many
patients must nevertheless deal wi
th blistering of th
eskin,fatigue,
depression, sleep disturbance, and pain.
1
Y
5

Consequently, it has
been reported that 70% of patients receiving radiotherapy are in
need of psychosocial support, pred
icated on their quality of life.
6

Having to deal with a multitude of

uncertainties related to possible adverse effects, patients often like to hear about the experiences
of others undergoing similar treatment.
7

In a randomized study of
breast cancer patients receiving radiotherapy, the provision of concrete cognitive information about the treatment experience and
possible adverse effects effectivel
y improved their ability to cope.
8

Other interventions made use of cognitive behavioral therapy

and hypnosis,

which lessened negative emotions and increased

the positive affect for patients undergoing radiotherapy compared with control patients. Still
others adopted eclectic approaches
involving psychoeducation, cognit
ive-behavioral therapy, and supportive expressive therapy for patients receiving radiotherapy.
10

Depression, anxiety, and health-related quality of life improved

in the experimental groups, particularly for female patients receiving a high dose of radiotherapy and who had previously received
adjuvant chemotherapy. Althoug
h they have exhibited no proven
effect on survivorship, the few int
erventions for patients undergoing radiotherapy epitomize the psy
chosocial needs of this cohort.
Meanwhile, much of what underlies a compromised quality
of life and psychological well-be
ing may have physical underpinnings. For instance, the quality of life of patients undergoing radiotherapy is substantially affected by illness or treatment-related
fatigue.
6

Patients also tend to be relati

vely sedentary during their
radiation treatment periods, sp
ending more time
sitting or lying
down and less time standing and walking.
11

Karvinen et al
12

noted
that patients were concerned about not having enough time for
physical activity or the fear of feeling worse or more tired or
causing pain, stiffness or injury. At the same time, early survivors or those still in treatment were more likely to identify the
health benefits of exercising than their counterparts. In view of
such findings, carefully designed
exercise regimens appear to have
clear benefits for patients undergoing radiotherapy. Although

empirical studies are scarce, a 12-week resistance training exercise

appears to have promising effect
s in warding off cancer-related
fatigue during radiotherapy compa
redwithpsychosocialinterventions involving muscle relaxation.
13

Significance of Study
Dance movement therapy (DMT) is known for its positive
physical and psychological effects and for improving the quality
of life of breast cancer patients.
14
Y
16

Studies of stress-related hormones provide convincing evidence of the benefits of DMT.

17

Dance movement therapy adopts both verbal and nonverbal

communication and endorses creative processes and aesthetic
perspectives in viewing life and interpersonal relations. These
elements can greatly enhance the healing power of the approach
for ill populations in need of social support, care, alternative
ways to cope, motivation to grow, and a way to find happiness
despite their circumstances. As forms of moderate physical activity,
DMT activities such as traditional Greek dances can strengthen
physical function, handgrip strength, and life satisfaction and
lessen depressive symptoms for breast cancer survivors who have
completed cancer therapies for 3 months or longer.
18

Aim of Study
Although DMT has been well received by Chinese breast cancer
patients,
19,20

this was one of the first studies to explore how the

intervention can be rendered suitable even for patients under
treatment. The aim of the study was to offer greater insight into
the finding of a previous randomized controlled trial, which was
that significant improvements to p
atients fatigue and pain symptoms occurred for those who received DMT during the period of
radiotherapy treatment.

Given such promising findings, the current objective was to

attain implementation-level understanding on how and when
DMT can be more effectively administered for cancer patients.
More specifically, the current study qualitatively explored the beneficial elements of DMT and how the intervention was able or not
able to meet the needs of patients over the course of radiotherapy.
To better understand the interven
tion and needs unique to patients
receiving radiotherapy, the stu
dy also drew comparisons with patients who received DMT after com
pleting radiation treatments.
n

Materials and Methods

Study Design and Recruitment
SUBJECTS AND SETTING

The participants involved in this study were breast cancer patients

recruited from an oncology and radi
otherapy department at 2 local
2
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hospitals and 3 cancer patient service centers across Hong Kong.

All of the participants had previously taken part in a randomized
controlled trial to study the effectiveness of dance movement
Y
based
psychotherapeutic intervention during radiotherapy treatment.
One hundred four participants completed that trial, including
60 in a group who were receiving radiotherapy at the time of
receiving DMT and 44 in another group who had completed
radiotherapy when they received DMT.
INCLUSION CRITERIA

All of the participants were Chinese-speaking women in stages

0 to 4 of primary breast cancer. Patients with secondary cancers,
other severe concomitant diseases or major psychiatric illnesses
were excluded.

SAMPLE SIZE

One hundred fifty-nine participants were recruited for the clinical

trial. The sample size was determined by multiple regression
modeling to ensure a medium effect size (f
2

)of0.15,atapower
of 0.8 and a significance level of .05. Participants undergoing
radiotherapy were randomized into 2 groups. Whereas participants in 1 group received DMT as they were receiving radiotherapy, those in the other group were provided with the same
DMT intervention about 1 to 2 months after completing radiotherapy. Hence, the data reflected the views of 2 cohorts of DMT
participants: (1) those who were undergoing radiotherapy (concurrent radiotherapy group) and (2) others who had already
completed radiotherapy (postradi
otherapy group). The 55 participants who failed to complete thi
s study accounted for those who
opted not to take part in the DMT intervention after they had
completed radiotherapy or simply did not provide a response in
the questionnaire.
Qualitative data were collected immediately after DMT for
the concurrent radiotherapy group and immediately after the
postradiotherapy group completed their DMT treatment by
means of a written open-ended questionnaire developed by the
research team (Figure). The participants responded in writing
to declare whether they found DMT helpful and how (Did
you find the DMT class helpful to you or not? If so, in what
aspects?). Those in the concurrent radiotherapy group were
also asked whether they found DMT helpful during the
radiotherapy treatment period and how (Was the DMT class
helpful during your radiotherapy treatment? If so, in what
aspects?). Participants were provided with lined paper and were
free to write as much or as little in response to the 2 questions.
n

Ethical Considerations
This study was approved by the institutional review board of the
University of Hong Kong/Hospital Authority Hong Kong West
Cluster. Written consent was solicited from all of the participants, who were also informed of their rights.
n

Intervention Program
Dance movement therapy intervention was developed based
on its demonstrable benefits for Chinese cancer patients.
19,20

Acknowledging the need for culturally sensitive practice, the intervention adopted the Westernoriginated DMT by incorporating Chinese health philosophies
and movement exercises. This
movement-based psychotherapy program included gentle upper
arm movements to address possible edema, group dance and
movement games to improve mood and vitality, improvisational
movements to encourage personal
expression, movement interaction among group members to facilitate communication, and
sharing of movement experience among group members as a
means of building mutual support. Articulations of the movement process reflecting psychosocial issues and daily concerns
were addressed to explore alternatives in coping with cancer and
treatment.
Table 1 lists the details of the program. Six sessions were
conducted twice a week, with each session lasting 90 minutes.
The structure and schedule of each s
ession were similar throughout,
and the content was adjusted to address the immediate needs
and concerns of the group.
n

Data Analysis
All of the data were collected in written Chinese, and content analysis was adopted to enable quantitative comparisons between the
2 participant groups. The writte
n data collected had their original
language retained, but codes and categories emerging from the analyses were done in English. Codes were formulated directly based
on the manifest content.
21

Therefore, each participant might have

yielded multiple codes. The codes were identified inductively, quantified, and further clustered exclusively into respective categories according to their meaning or functional purpose in relation to the
cancer or treatment experience. Each category was provided with an

English label. The reliability of the codes and categories formulated

was enhanced by a process of deliberation and consensus among
3 researchers on the team. A coding frame was constructed by
Figure
n

Time line of recruitment, intervention and data collection.

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Mark as interesting Comment
A Good Time to Dance? A Mixed-Methods Approach of the Effects of Dance Movement Therapy
for Breast Cancer Patients During and After Radiotherapy. Available from:
https://www.researchgate.net/publication/273064954_A_Good_Time_to_Dance_A_MixedMethods_Approach_of_the_Effects_of_Dance_Movement_Therapy_for_Breast_Cancer_Patient
s_During_and_After_Radiotherapy [accessed Oct 5, 2016].