After Cancer Surgery, This Simple Art Activity Cuts Anxiety in Half—But Pain Relief Is More Complex

A simple art therapy technique called mandala coloring can dramatically reduce anxiety levels in gynecologic cancer patients after surgery, cutting anxiety scores nearly in half according to new research. However, while the mental health benefits were substantial, the impact on physical pain was more modest, suggesting that different aspects of recovery may require different approaches.

How Much Did Mandala Art Actually Help?

Researchers at a training hospital in Istanbul studied 42 women who underwent open abdominal hysterectomy for gynecologic cancers between February and August 2023. The results showed striking differences between patients who used mandala coloring books and those who received standard care alone.

For anxiety relief, the numbers were impressive. Patients in the control group saw their State-Trait Anxiety Inventory scores drop from 63.48 to 47.43 after surgery. But those who used mandala coloring experienced a much more dramatic decrease, with scores plummeting from 56.33 to just 31.52—representing nearly a 44% reduction in anxiety levels.

What Makes Mandala Art Therapy Different?

Mandala art therapy draws from psychologist Carl Jung's work, who described mandalas as symbols representing the inner self and argued they could serve as therapeutic tools. The circular, symmetrical patterns are designed to promote focus and emotional balance, making them particularly suitable for patients dealing with the stress of cancer treatment.

The World Health Organization recommends non-pharmacological methods alongside traditional medical treatments for managing pain and anxiety in cancer patients. These complementary approaches include:

• Art Therapy: Activities like mandala coloring that engage creative expression while promoting relaxation and emotional processing
• Mind-Body Techniques: Breathing exercises, meditation, and hypnosis that help patients develop coping mechanisms
• Physical Therapies: Massage, acupressure, and aromatherapy that address both physical and emotional comfort
• Music and Prayer: Spiritual and auditory interventions that provide emotional support and distraction from discomfort

Why Was Pain Relief More Limited?

While anxiety showed dramatic improvement, pain relief was more modest. Control group patients saw their Visual Analog Scale pain scores decrease from 7.17 to 0.82 after surgery, while the mandala group went from 6.68 to 1.77. Though statistically significant, this represents a smaller practical difference compared to the anxiety results.

This finding aligns with the complex relationship between physical pain and emotional distress. The research notes that "pain can directly affect the emotional state of patients and increase their anxiety levels, which can negatively affect the healing process." The stronger impact on anxiety suggests that mandala therapy may work primarily through psychological pathways rather than direct pain mechanisms.

The study's focus on gynecologic oncology patients is particularly relevant, as this field falls within the extended scope of midwifery care according to the International Confederation of Midwives. Midwives play essential roles in providing holistic care to women with gynecological cancers, addressing both physical and psychological needs during treatment and recovery.

What Does This Mean for Cancer Care Moving Forward?

As World Cancer Day 2026 approaches with its theme "United by Unique," this research supports the growing emphasis on patient-centered cancer care that recognizes individual needs beyond just treating the tumor. The global theme acknowledges that no two cancer journeys are the same, and each person's experience is shaped by their emotional resilience, family support, and access to comprehensive care.

The mandala study represents exactly this kind of personalized approach—a simple, low-cost intervention that can be easily integrated into standard post-surgical care. For cancer centers and healthcare institutions, this means strengthening not just medical treatments but also "emotional and psychological support" as part of comprehensive care pathways.

People-centered cancer care focuses on understanding each patient's medical condition within the context of their life, values, and priorities. It involves integrating psychological support, pain management, and rehabilitation alongside traditional medical interventions, with clear communication and shared decision-making throughout the treatment journey.