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

ImportanceCommon 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.ObjectiveTo determine the effectiveness of garden-based horticultural therapy among cancer survivors.Data SourcesSearches 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 CollectionThe 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.FindingsEight 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 RelevanceThese 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.