Laughter Yoga Effect on Cancer Patients' Physiopsychological Symptoms

Effects of Laughter Yoga on Symptom Severity, Hope, and Life Engagement in Patients Undergoing Chemotherapy; A Randomized Controlled Study

Non-pharmacological interventions that promote positive emotional states and coping may play a critical role in care of cancer patients undergoing chemotherapy. .This study aimed to evaluate the effects of laughter yoga on symptoms, hope, and life engagement levels in cancer patients undergoing chemotherapy. Conducted between January and June 2025 at the chemotherapy unit of Atatürk University Research Hospital in Türkiye, this randomized controlled trial included 55 chemotherapy patients who were randomly assigned to an intervention group (n = 27) receiving 40-minute weekly laughter yoga sessions for four weeks or to a control group (n = 28) receiving routine care. Symptom severity, hope, and life engagement were measured at baseline and after four weeks using the Edmonton Symptom Assessment Scale (ESAS), Herth Hope Scale (HHS), and Life Engagement Scale (LES). Post-intervention analyses revealed statistically significant improvements in the intervention group compared to the control group. Patients who received laughter yoga reported significantly lower symptom severity on the ESAS (p < 0.05), along with significantly higher levels of hope and life engagement as measured by the HHS and LES, respectively (p < 0.05).

Study Overview

• Status: Completed
• Conditions: Quality of Life; Cancer; Nurse's Role
• Intervention / Treatment: Behavioral: lauhgter yoga

Detailed Description

Sample Size Calculation:

The sample size was calculated using G*Power (version 3.1.9.7). Based on ANCOVA test (fixed effects, main effects and interactions), a large effect size (Cohen's f=0.40) was assumed based on previous laughter yoga literature in oncology patients (Moon et al., 2024; Mayers 2013; Faul et al, 2007). With an alpha level of 0.05 and a power of 0.80 (for two groups and one covariate), the minimum required sample size was determined to be 48 participants. To compensate for a potential attrition rate, 60 patients were initially recruited for the study. Inclusion criteria: (1) age ≥18, (2) pathologically confirmed cancer diagnosis, (3) be able to communicate, and (4) voluntary participation. Exclusion criteria: (1) psychiatric disorder, (2) treatments other than chemotherapy, (3) severe psychiatric illness, (4) hearing or vision loss, (5) prior laughter therapy experience, or (6) unstable clinical condition. Discontinuation Criteria: (1) withdrawal request, (2) worsening of clinical condition, (3) change in treatment protocol.Due to the nature of the laughter yoga intervention, participants and the first author (who performed the sessions) could not be blinded. After baseline assessments, 60 eligible patients were randomized into intervention (n=30) and control (n=30) groups with a 1:1 allocation ratio using a computer-generated random number list (randomizer.org). Allocation concealment was ensured by an independent external researcher who held the randomization list and was not involved in patient recruitment or intervention thus ensuring that the researchers remained blinded to the group assignments during the initial evaluation. However, to minimize bias, data analysis was conducted by an independent statistician who remained blinded to the group assignments throughout the study. Of the initial 60 participants, five patients (three from the intervention group and two from the control group) were excluded after randomization due to changes in their medical treatment protocols. The study was completed with 55 patients (27 intervention, 28 control). A per-protocol analysis was performed, including only those participants who completed the designated intervention sessions and follow-up assessments.

• Study Type: Interventional
• Enrollment (Actual): 55
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Yakutiye
    • Erzurum, Yakutiye, Turkey (Türkiye), 25080
      • Atatürk Üniversitesi

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion criteria: (1) age ≥18, (2) pathologically confirmed cancer diagnosis, (3) be able to communicate, and (4) voluntary participation.

Exclusion criteria: (1) psychiatric disorder, (2) treatments other than chemotherapy, (3) severe psychiatric illness, (4) hearing or vision loss, (5) prior laughter therapy experience, or (6) unstable clinical condition.

Discontinuation Criteria: (1) withdrawal request, (2) worsening of clinical condition, (3) change in treatment protocol.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Arm 2
Experimental: Arm 1; laughter yoga	Behavioral: lauhgter yoga; include laughter yoga effects on cancer patients' symptom management

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Edmonton Symptom Assesment Scale (ESAS)	Bruera et al. (1991) to evaluate nine symptoms commonly seen in cancer patients. These symptoms are pain, fatigue, nausea, sadness, anxiety, insomnia, loss of appetite, feeling good, shortness of breath and other problems. In the other problems section of the scale, 2 additional symptoms seen in patients by researchers (feeling of thirst and discomfort due to catheters and catheters) were added in accordance with literature information. The severity of each symptom is evaluated with numerical numbers from 0 to 10. A score of 0 indicates that there is no symptom, a score of 10 indicates that the symptom is felt very severely, and the severity of the symptom increases from 0 to 10.	4 weeks
Life Engagement Scale	The Life Engagement scale, developed by Scheier et al. (2006) to assess individuals' life goals and whose Turkish validity and reliability were determined by Akın et al., is a measurement tool consisting of 6 items and a single dimension (life engagement). The scale has a 5-point scale ("1" I completely disagree, "5" I completely agree). Items 1, 3 and 5 are reverse coded in the scale. Increasing scores indicate a high level of life engagement.	4 weeks
Herth Hope Scale	The Herth Hope Scale was developed by Kaye Herth. The scale consists of 30 items. Each item has four options: "Never " "Rarely appropriate," "Sometimes" and "Always " . The corresponding scores are 0, 1, 2, and 3, respectively. The respondent is asked to mark a single option for each item. The scale consists of 3 sub-dimensions. These are "Future," "Positive Readiness and Expectation," and "Relationships Between Oneself and Those Around Oneself." The "Future" sub-dimension measures the cognitive-temporal dimension of hope, the "Positive Readiness and Expectation" sub-dimension measures the emotional-behavioral dimension of hope, and the "Relationships Between Oneself and Those Around Oneself" sub-dimension measures the dimension of hope related to relationships and the conditions in which it exists. The total hope score varies between 0-90, and the total score of each subscale varies between 0-30. High scores, It shows that hope is high.	4 weeks

Collaborators and Investigators

• Sponsor: Ataturk University

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2024
• Primary Completion (Actual): June 30, 2025
• Study Completion (Actual): August 15, 2025

Study Registration Dates

• First Submitted: September 26, 2024
• First Submitted That Met QC Criteria: October 21, 2024
• First Posted (Actual): October 23, 2024

Study Record Updates

• Last Update Posted (Actual): May 18, 2026
• Last Update Submitted That Met QC Criteria: May 15, 2026
• Last Verified: October 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neoplasms
• Other Study ID Numbers: ATATURKU-NRS-YCY-02

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No