Art therapy in the course of chemotherapy can be considered as one of the complementary psycho-oncological interventions to reduce distress and support the psychological adjustment of patients, because in addition to its antitumor effects, chemotherapy may be associated with a series of physical and psychological consequences such as nausea, fatigue, pain, sleep disturbance, changes in appetite, hair loss, decreased functional ability, worry about the future, and feelings of loss of control, and the sum of these factors can increase the level of distress of the patient. Cancer-related distress is a multidimensional concept that encompasses anxiety, depression, worry, fear, communication problems, family difficulties, and pressures caused by physical symptoms and treatment, and for this reason, its management requires an approach beyond mere control of physical symptoms. Art therapy is based on the purposeful use of creative processes such as painting, drawing, collage, music, illustration, and other artistic activities, and in the oncology setting, it can allow the patient to represent and process the complex experience of treatment in a non-verbal way. The theoretical basis of this approach is based on the interconnection of emotion, cognition, attention, behavior, and physiological processes, which means that reducing stress and creating a sense of control can affect the way the patient perceives symptoms and adapts to treatment. During chemotherapy, the patient may have a recurring experience of waiting, receiving medication, observing complications, and worrying about the next course of treatment, which in some people leads to an increase in predictive anxiety. This change in role can enhance feelings of agency and self-efficacy and reduce the intensity of feelings of helplessness. Psychologically, one of the important pathways in which art therapy is effective is to facilitate the expression of emotions that the patient may not be able or unwilling to talk about directly. Fear of progressing the disease, fear of death, anger, grief, worry about changing appearance, and the pressure of attachment to family can be expressed symbolically through images or creative activity. This nonverbal expression does not in itself mean a definitive treatment of emotion, but it can provide a suitable raw material for therapeutic dialogue and psychological processing. In this process, the art therapist plays a facilitative role, encouraging the patient to explain their personal experience of the image, color, shape, music, or creation process, rather than imposing the meaning of the work. Such an approach avoids undocumented interpretations and diagnoses based on artwork, and brings the intervention closer to the patient's actual experience. Research evidence in the field of art and cancer interventions has shown that some creative interventions can be associated with reduced anxiety and psychological distress, improved mood, and increased feelings of relaxation, although effect size and consistency of results vary from study to study, and the results of not all studies can be generalized to all patients undergoing chemotherapy. Some studies have also reported improvements in some dimensions of quality of life and increased patient participation in meaningful activities after art interventions, but determining the extent of the independent effect of art therapy from factors such as social support, therapist communication, attention received, and positive patient expectation remains an important methodological issue. From a clinical perspective, art therapy can be implemented individually or in groups in oncology wards, chemotherapy centers, hospitals, and supportive care programs. The choice of the type of activity should be made based on the patient's physical condition, energy level, personal preference, age, motor ability, and stage of treatment; for the patient with severe fatigue, short and low activities requiring movement, and for the person who is more capable, more complex and collaborative activities can be designed. In patients with nausea or severe sensitivity to odor, the use of pungent odor-smelling substances may not be appropriate, and the environment of the intervention should be adapted to the patient's medical conditions. Therefore, art therapy in chemotherapy should be part of a complementary care program and should never replace antiemetic drugs, pain management, treatment of sleep disorders, medical care, or specialized psychological interventions. One of the important uses of creative interventions is to reduce anxiety before receiving chemotherapy; art activity can focus the patient's attention on a meaningful activity while waiting or receiving treatment, reducing the constant focus on the threat and possible symptoms. In the interval between therapy sessions, art activity can also be a tool to record the daily experience, identify emotional changes, and increase a sense of continuity and control. In group interventions, in addition to artistic activity, the patient can share his experience with people with similar conditions and benefit from social support. A sense of belonging and observing that others are facing similar fears and difficulties may reduce feelings of isolation. However, art group therapy is not suitable for all patients, and some people prefer individual intervention due to fatigue, social anxiety, or the need for privacy. From a clinical point of view, it is important to assess distress before initiating the intervention, and the severity of anxiety, depression, sleep disturbance, pain, fatigue, and quality of life can be assessed with standard tools to tailor the intervention to the individual's needs. In cases where distress is severe or there are signs of significant psychological disorders, art therapy should be placed alongside specialized psychological or psychiatric evaluation and treatment. Another area of interest is the impact of chemotherapy on body image and individual identity; physical changes such as hair loss, weight changes, and skin changes can affect a person's sense of body and self-concept, and art therapy can provide an opportunity to represent and process these changes. On the other hand, artistic activity may help to reconstruct meaning during the course of treatment, as the patient can organize the experience of the disease into a personal and creative narrative. This process does not mean creating a compulsive positive attitude toward cancer, but rather allows the individual to express and make meaning about their experience in its true complexities, including fear, anger, hope, loss, and adaptation. The important limitation in this area is the heterogeneity of art therapy interventions, the differences in the type of art, the number of sessions, the duration, the training of the therapist, and the method of evaluation have made the results of the studies not easily comparable. The small sample size, lack of an active control group, short-term follow-up, and differences in the type of cancer and chemotherapy regimen are other research limitations. Also, determining whether the reduction in distress is due to the artistic process itself or the result of supportive interaction with the therapist and the treatment environment requires more rigorous research designs. Future studies could use controlled trials with larger samples, longer follow-up, and standardized protocols to simultaneously examine outcomes such as distress, anxiety, depression, quality of life, fatigue, sleep, and adherence to treatment. Combining psychological measures with physiological indicators can also help to better understand possible mechanisms, although interpretation of biomarkers should be done with caution and in conjunction with the patient's clinical status. Overall, art therapy in the course of chemotherapy can play a role in the management of distress as a complementary intervention, by facilitating the expression of emotion, increasing agency, reducing the focus on threat, strengthening social connection, and creating opportunities for meaning-making. The main importance of this approach lies in that it considers the patient not merely as the recipient of the drug, but as a human being with emotional, identity, and social experience, allowing part of the process of adaptation to cancer to be pursued through creativity and active participation. However, its effectiveness should be evaluated based on valid evidence and appropriate to the characteristics of each patient, and the place of art therapy in the care of patients undergoing chemotherapy should be defined in the form of a comprehensive psycho-oncological model and in cooperation with the medical team