The impact of different types of play interventions on anxiety and depressive symptoms in children with cancer: A systematic review and meta-analysis.

Background

Childhood cancer is the second leading cause of pediatric death. Diagnosis and treatment frequently trigger anxiety and depressive symptoms. Play interventions match children's developmental needs to relieve distress but vary in efficacy. This meta-analysis quantified such interventions' effects on symptom improvement in children with cancer.

Objective

To characterize play intervention designs and quantify their effects on anxiety and depressive symptoms among children with cancer.

Methods

Systematic searches covered 12 databases from inception to April 27, 2026. Independent screening, data extraction, and quality appraisal were completed by two researchers, and meta-analyses were performed via RevMan 5.4 and Stata 18.0.

Results

Overall, 23 studies involving 1541 children with cancer were included. Pooled analyses showed that play interventions significantly alleviated anxiety (SMD = -1.84, 95%CI: -2.35 to -1.32, P < 0.001) and depressive symptoms (SMD = -1.62, 95%CI: -2.14 to -1.11, P < 0.001) in pediatric cancer patients. Subgroup analyses indicated medical play yielded the greatest improvement in anxiety (SMD = -1.87, 95%CI: -2.56 to -1.18, P < 0.001), while group play exerted the optimal effect on depressive symptoms (SMD = -2.09, 95%CI: -2.49 to -1.70, P < 0.001, I2 = 0%).

Conclusion

As practical non-pharmacological mental health interventions for pediatric oncology, play interventions ease anxiety and depressive symptoms in children with cancer. IMPLICATIONS TO PRACTICE Tailored play interventions are recommended for children with cancer. Thrice-weekly offline medical or group play suits children with severe anxiety symptoms, while online group or video play fits those with prominent depressive symptoms.