The Effect of Story Therapy on Reducing Anxiety in Children with Cancer Undergoing Chemotherapy

Abstract

Background: Childhood cancer, a major cause of mortality, causes significant psychological stress in young patients, negatively impacting their quality of life and potentially interfering with treatment. Objectives: This study aimed to evaluate the effectiveness of storytelling as an intervention to reduce anxiety in children undergoing chemotherapy for cancer. Patients and Methods: This randomized clinical trial, conducted from January to November 2023 at Ali Asghar Children's Hospital in Tehran, involved forty children undergoing chemotherapy. Forty children were randomly allocated to either the intervention group (n = 20) or the control group (n = 20) using block randomization. The intervention group participated in ten weekly 1.5-hour storytelling sessions, while the control group received standard care without additional intervention. Anxiety levels were assessed using the Revised Children's Manifest Anxiety Scale (RCMAS) alongside a researcher-developed checklist. Assessments were conducted at baseline and after the completion of the ten storytelling sessions to measure outcomes. Data were analyzed using the Kolmogorov-Smirnov test to assess normality and the independent t-test to compare group differences. Results: Independent t-test results showed that before the intervention, the story therapy group had significantly higher total anxiety scores (17.12 ± 2.06) compared to the control group (12.20 ± 5.27; P = 0.002). After the intervention, the story therapy group exhibited significantly lower total anxiety scores (9.76 ± 3.73) than the control group (15.97 ± 4.14; P < 0.001). Post-intervention analysis revealed significant reductions in physiological anxiety (2.41 vs. 5.50, P < 0.001), concentration anxiety (3.53 vs. 6.00, P = 0.001), and total anxiety (9.76 vs. 15.95, P < 0.001) in the story therapy group compared to the control group, while worry scores did not show a significant difference (3.82 vs. 4.45, P = 0.301). Gender comparisons indicated significant decreases in physiological and total anxiety for both men and women following story therapy, although concentration anxiety improved significantly only in men. Age-based analyses revealed that younger children (≤ 7 years) had higher initial physiological, concentration, and total anxiety scores but experienced more significant reductions after intervention than older children, with worry scores remaining unchanged across ages. Conclusions: The findings suggest that storytelling can be used as a valuable and non-invasive treatment method to reduce anxiety in children with cancer.