A Systematic Review and Meta-Analysis on the Effectiveness of Horticultural Therapy in Cancer Survivors

Abstract

Importance Common cancer treatments can produce side effects that interfere with daily functioning. In contrast, nature-based therapies such as horticultural therapy may support physical function, psychosocial well-being, and lifestyle behaviors, thereby promoting occupational engagement and quality of life. Objective To determine the effectiveness of garden-based horticultural therapy among cancer survivors. Data Sources Searches were conducted in Academic Search Complete, ProQuest, JSTOR, CINAHL Complete, PubMed, Psychology and Behavioral Sciences Collection, American Journal of Occupational Therapy , and Journal of the American Medical Association , as well as reference lists from relevant reviews and full-text articles. Study Selection and Data Collection The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and included primary intervention studies published within the past 10 years that examined soil-based garden interventions for adult cancer survivors. Findings Eight studies involving 634 participants were included in the review and three in the meta-analysis. Intervention duration ranged from 6 weeks to 1 year. Seven studies reported increased fruit and vegetable intake, whereas pain remained unchanged in five studies. Findings for psychosocial well-being and physical functioning were mixed. Three randomized controlled trials demonstrated significant pooled effects for physical health outcomes (standardized mean difference [SMD] = −0.38, 95% confidence interval [CI] = [−0.62, −0.13], Z = 3.02), physical performance (SMD = 0.19, 95% CI = [0.01 to 0.37], Z = 2.10), and lifestyle behaviors (SMD = 0.67, 95% CI = [0.27 to 1.06], Z = 3.32). No significant effect was found for psychosocial health outcomes. Conclusions and Relevance These preliminary findings suggest that garden-based horticultural therapy may support improvements in physical functioning and lifestyle behaviors among cancer survivors, though rigorous controlled trials are needed to confirm efficacy. Horticultural therapy warrants consideration as a complementary component of comprehensive occupation-based care to promote meaningful occupational engagement in this population.