Document Type : original article


1 Department of Surgical Technology, School of Midwifery Zahedan University of Medical Sciences

2 Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran

3 Master's Degree in Pediatric Nursing ,Valiasr Hospital Birjand


Background: Chemotherapy, as one of the most important treatments for cancer, may lead to complications such as anxiety and changes in children's sleeping habits. The present study aimed to evaluate the effectiveness of sand play therapy in improving anxiety and sleep habits of children with leukemia undergoing chemotherapy.
Methods: This quasi-experimental study was conducted on 80 children with leukemia undergoing chemotherapy. The participants were randomly assigned into a control group and an intervention group admitted to Abi Talib (AS) Hospital in Zahedan, southeast Iran, in 2020. Data collection tools included a demographic information questionnaire and the Revised Children's Manifest Anxiety Scale (RCMAS), and Children's Sleep Habits Questionnaire (CSHQ). The questionnaires were completed by the primary caregivers of the children, before and one week after the end of the intervention. Data analyses were performed through SPSS26 software, using independent-t, paired-t, and chi-square tests. The significance level in this study was set at (0.05).
Results: Mean age of the children was 9.35±1.44 years in the intervention group and 9.48±1.57 years in the control group. Based on the results, sandplay therapy significantly reduced anxiety and poor sleep habits in the intervention group (P<0.001).
Conclusion: The findings showed that sandplay therapy can be used as a non-pharmacological and effective treatment method to reduce the complications caused by chemotherapy in children with cancer.


  1. Marcdante K, RM K. Nelson essentials of pediatrics 7th ed. Philadelphia: Saunders Elsevier; 2015.
  2. Mirzaie M, Yazdi F, Navidi Z. Survey personal and disease characteristics of children with Cancer hospitalized in Shahrivar hospital, Rasht. 2009.
  3. Steliarova-Foucher E, Colombet M, Ries LA, Moreno F, Dolya A, Bray F, Hesseling P, Shin HY, Stiller CA; IICC-3 contributors. International incidence of childhood cancer, 2001–10: a population-based registry study. The Lancet Oncology. 2017; 18(6):719-31.
  4. Hockenberry MJ, Wilson D. Wong's nursing care of infants and children-Ebook: Elsevier Health Sciences; 2018.

5.Mehranfar M, Younesi J, Banihashem A. Effectiveness of mindfulness-based cognitive therapy on reduction of depression and anxiety symptoms in mothers of children with cancer. Iranian journal of cancer prevention. 2012; 5(1):1.

  1. Aghakhani S, Bahari F. The effectiveness of nerve planning group-languages cognitive expectancy and quality of life for children with cancer. Iranian Journal of Psychiatry and Clinical Psychology. 2018; 24(3):256-69.
  2. Partovi S, Banihashem A, Farshidi F. Prevalence of gastrointestinal side effects of chemotherapy in children with leukemia. Iranian J Pediatr. 2013; 2(14):89-124.
  3. Sabooti B H M MNS, Babai M, Haji Ali A, Atamanesh M. Teb Children Nelson: Parastaran Javan; 2019.
  4. Harris D. Putting evidence into practice®: evidence-based interventions for the management of oral mucositis. Number 1/February 2008. 1969; 12(1):141-52.
  5. Hashemi Nosratabadi T, Farshbaf Manisefat F. The effectiveness of play therapy according to levy approach in reduction of anxiety in children with diagnosed cancer. Journal of Holistic Nursing and Midwifery. 2015; 25(1):54-62.
  6. Stark DPH, House A. Anxiety in cancer patients. British journal of cancer. 2000;83(10):1261-7.
  7. Nordin K, Glimelius B. Reactions to gastrointestinal cancer—variation in mental adjustment and emotional well‐being over time in patients with different prognoses. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer. 1998;7(5):413-23.
  8. Afkham Ebrahimi A, Bandi G, Salehi M, Tafti K, Vakili Y, Farsi A. Sleep parameters and the factors affecting the quality of sleep in patients attending selected clinics of Rasoul-e-Akram hospital. Razi Journal of Medical Sciences. 2008; 15:31-8.
  9. Mattson DC, Veldorale-Brogan A. Objectifying the sand tray: An initial example of three-dimensional art image analysis for assessment. The Arts in Psychotherapy. 2010; 37(2):90-6.
  10. Zolmajd A, Borjali A, Arian K. Impact of sand play therapy on reduction of aggressive behaviors. Journal of Exceptional Children. 2007; 7(2):155-68.
  11. Ghadampour E, Shahbazirad A, Haghighi Kermanshahi M, Mohammadi F, Naseri N. The effects of sand play therapy in reduction of impulsivity and attention deficit in boys with ADHD. Quarterly Journal of Child Mental Health. 2018; 5(2):36-46.
  12. Ajorloo M, Irani Z, Aliakbari Dehkordi M. Story therapy effect on reducing anxiety and improving sleep habits in children with cancer under chemotherapy. Quarterly Journal of Health Psychology. 2016; 5(18):87-107.
  13. Sharifi Daramadi D, Fath abadi R, Bakhtiarvand M, Ahmadi A. Effectiveness of sand play therapy on challenging behaviors and anxiety in children with high-functioning autism disorder.Empowering exceptional children. 2019; 10(1):14-1.