Effects of laughter therapy on quality of life in patients with cancer: An open-label, randomized controlled trial

Toshitaka Morishima, Isao Miyashiro, Norimitsu Inoue, Mitsuko Kitasaka, Takashi Akazawa, Akemi Higeno, Atsushi Idota, Akira Sato, Tetsuya Ohira, Masato Sakon, Nariaki Matsuura, Toshitaka Morishima, Isao Miyashiro, Norimitsu Inoue, Mitsuko Kitasaka, Takashi Akazawa, Akemi Higeno, Atsushi Idota, Akira Sato, Tetsuya Ohira, Masato Sakon, Nariaki Matsuura

Abstract

Background: Few randomized controlled trials have assessed the effects of laughter therapy on health-related quality of life (QOL) in cancer patients. This study aimed to evaluate these effects as an exploratory endpoint in cancer patients as part of a randomized controlled trial conducted at a single institution in Japan.

Methods: The Initiative On Smile And CAncer (iOSACA) study was an open-label randomized controlled trial conducted in 2017 in which participants aged 40-64 years with cancer were randomly assigned to either an intervention group (laughter therapy) or control group (no laughter therapy). Each participant in the intervention group underwent a laughter therapy session once every two weeks for seven weeks (total of four sessions). Each session involved a laughter yoga routine followed by Rakugo or Manzai traditional Japanese verbal comedy performances. We assessed QOL as a secondary endpoint in this intention-to-treat population using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The questionnaire was completed at baseline (Week 0) and at Weeks 3 and 7. Mixed-effects models for repeated measures were developed to compare time-dependent changes in each QOL domain from baseline between the intervention and control groups.

Results: Four participants retracted consent and one participant was retrospectively excluded from analysis due to unmet inclusion criteria. The analysis was conducted using 56 participants, with 26 in the intervention group and 30 in the control group. Questionnaire completion rates were high (>90%), with similar QOL scores reported at baseline in both groups. The mixed-effects models showed that the intervention group had significantly better cognitive function and less pain than the control group for a short period.

Conclusion: Laughter therapy may represent a beneficial, noninvasive complementary intervention in the clinical setting. Further studies are needed to verify the hypotheses generated from this exploratory study.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Study participant flow diagram.
Fig 1. Study participant flow diagram.
Fig 2. Time-dependent changes in 15 quality…
Fig 2. Time-dependent changes in 15 quality of life domains.

References

    1. Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Nikšić M, et al. Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018;391:1023–1075. 10.1016/S0140-6736(17)33326-3
    1. Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66:271–289. 10.3322/caac.21349
    1. Stark D, Kiely M, Smith A, Velikova G, House A, Selby P. Anxiety disorders in cancer patients: their nature, associations, and relation to quality of life. J Clin Oncol. 2002;20:3137–3148. 10.1200/JCO.2002.08.549
    1. Tannock IF, Ahles TA, Ganz PA, Van Dam FS. Cognitive impairment associated with chemotherapy for cancer: report of a workshop. J Clin Oncol. 2004;22:2233–2239. 10.1200/JCO.2004.08.094
    1. Loge JH, Abrahamsen AF, Ekeberg, Kaasa S. Fatigue and psychiatric morbidity among Hodgkin’s disease survivors. J Pain Symptom Manage. 2000;19:91–99.
    1. Findley PA, Sambamoorthi U. Preventive health services and lifestyle practices in cancer survivors: a population health investigation. J Cancer Surviv. 2009;3:43–58. 10.1007/s11764-008-0074-x
    1. Jansen L, Koch L, Brenner H, Arndt V. Quality of life among long-term (≥5 years) colorectal cancer survivors—systematic review. Eur J Cancer. 2010;46:2879–2888. 10.1016/j.ejca.2010.06.010
    1. Ernst E. The role of complementary and alternative medicine in cancer. Lancet Oncol. 2000;1:176–180.
    1. Cousins N. Anatomy of an illness (as perceived by the patient). N Engl J Med. 1976;295:1458–1463. 10.1056/NEJM197612232952605
    1. Goldstein JH. A laugh a day: Can mirth keep disease at bay? Sciences (New York). 1982;22:21–25.
    1. Shahidi M, Mojtahed A, Modabbernia A, Mojtahed M, Shafiabady A, Delavar A, et al. Laughter yoga versus group exercise program in elderly depressed women: a randomized controlled trial. Int J Geriatr Psychiatry. 2011;26:322–327. 10.1002/gps.2545
    1. Walter M, Hänni B, Haug M, Amrhein I, Krebs-Roubicek E, Müller-Spahn F, et al. Humour therapy in patients with late-life depression or Alzheimer’s disease: a pilot study. Int J Geriatr Psychiatry. 2007;22:77–83. 10.1002/gps.1658
    1. Ghodsbin F, Sharif Ahmadi Z, Jahanbin I, Sharif F. The effects of laughter therapy on general health of elderly people referring to jahandidegan community center in shiraz, iran, 2014: a randomized controlled trial. Int J Community Based Nurs Midwifery. 2015;3:31–38.
    1. Dolgoff-Kaspar R, Baldwin A, Johnson MS, Edling N, Sethi GK. Effect of laughter yoga on mood and heart rate variability in patients awaiting organ transplantation: a pilot study. Altern Ther Health Med. 2012;18:61–66.
    1. Bukutu C, Le C, Vohra S. Asthma: a review of complementary and alternative therapies. Pediatr Rev. 2008;29:e44–e49. 10.1542/pir.29-8-e44
    1. Bennett MP, Zeller JM, Rosenberg L, McCann J. The effect of mirthful laughter on stress and natural killer cell activity. Altern Ther Health Med. 2003;9:38–45.
    1. Takeda M, Hashimoto R, Kudo T, Okochi M, Tagami S, Morihara T, et al. Laughter and humor as complementary and alternative medicines for dementia patients. BMC Complement Altern Med. 2010;10:28 10.1186/1472-6882-10-28
    1. Berk LS, Tan SA, Fry WF, Napier BJ, Lee JW, Hubbard RW, et al. Neuroendocrine and stress hormone changes during mirthful laughter. Am J Med Sci. 1989;298:390–396.
    1. Hirosaki M, Ohira T, Kajiura M, Kiyama M, Kitamura A, Sato S, et al. Effects of a laughter and exercise program on physiological and psychological health among community-dwelling elderly in Japan: randomized controlled trial. Geriatr Gerontol Int. 2013;13:152–160. 10.1111/j.1447-0594.2012.00877.x
    1. Weisenberg M, Raz T, Hener T. The influence of film-induced mood on pain perception. Pain. 1998;76:365–375.
    1. Weisenberg M, Tepper I, Schwarzwald J. Humor as a cognitive technique for increasing pain tolerance. Pain. 1995;63:207–212.
    1. Zweyer K, Velker B, Ruch W. Do cheerfulness, exhilaration, and humor production moderate pain tolerance? A FACS study. Humor. 2004;17:85–119.
    1. Yoshino S, Fujimori J, Kohda M. Effects of mirthful laughter on neuroendocrine and immune systems in patients with rheumatoid arthritis. J Rheumatol. 1996;23:793–794.
    1. Dunbar RI, Baron R, Frangou A, Pearce E, van Leeuwen EJ, Stow J, et al. Social laughter is correlated with an elevated pain threshold. Proc Biol Sci. 2012;279:1161–1167. 10.1098/rspb.2011.1373
    1. Christie W, Moore C. The impact of humor on patients with cancer. Clin J Oncol Nurs. 2005;9:211–218. 10.1188/05.CJON.211-218
    1. Penson RT, Partridge RA, Rudd P, Seiden MV, Nelson JE, Chabner BA, et al. Laughter: the best medicine? Oncologist. 2005;10:651–660. 10.1634/theoncologist.10-8-651
    1. Borod M. SMILES—toward a better laughter life: a model for introducing humor in the palliative care setting. J Cancer Educ. 2006;21:30–34. 10.1207/s15430154jce2101_11
    1. Lengacher CA, Bennett MP, Kip KE, Keller R, LaVance MS, Smith LS, et al. Frequency of use of complementary and alternative medicine in women with breast cancer. Oncol Nurs Forum. 2002;29:1445–1452. 10.1188/02.ONF.1445-1452
    1. Kong M, Shin SH, Lee E, Yun EK. The effect of laughter therapy on radiation dermatitis in patients with breast cancer: a single-blind prospective pilot study. Onco Targets Ther. 2014;7:2053–2059. 10.2147/OTT.S72973
    1. Kim SH, Kim YH, Kim HJ. Laughter and stress relief in cancer patients: a pilot study. Evid Based Complement Alternat Med. 2015;2015:864739 10.1155/2015/864739
    1. Kim SH, Kook JR, Kwon M, Son MH, Ahn SD, Kim YH. The effects of laughter therapy on mood state and self-esteem in cancer patients undergoing radiation therapy: a randomized controlled trial. J Altern Complement Med. 2015;21:217–222. 10.1089/acm.2014.0152
    1. Farifteh S, Mohammadi-Aria A, Kiamanesh A, Mofid B. The impact of laughter yoga on the stress of cancer patients before chemotherapy. Iran J Cancer Prev. 2014;7:179–183.
    1. Phipps S, Barrera M, Vannatta K, Xiong X, Doyle JJ, Alderfer MA. Complementary therapies for children undergoing stem cell transplantation: report of a multisite trial. Cancer. 2010;116:3924–3933. 10.1002/cncr.25415
    1. Phipps S, Peasant C, Barrera M, Alderfer MA, Huang Q, Vannatta K. Resilience in children undergoing stem cell transplantation: results of a complementary intervention trial. Pediatrics. 2012;129:e762–e770. 10.1542/peds.2011-1816
    1. Peppercorn JM, Smith TJ, Helft PR, Debono DJ, Berry SR, Wollins DS, et al. American society of clinical oncology statement: toward individualized care for patients with advanced cancer. J Clin Oncol. 2011;29:755–760. 10.1200/JCO.2010.33.1744
    1. Lipscomb J, Gotay CC, Snyder CF. Patient-reported outcomes in cancer: a review of recent research and policy initiatives. CA Cancer J Clin. 2007;57:278–300. 10.3322/CA.57.5.278
    1. Physician Data Query. Levels of evidence for human studies of integrative, alternative, and complementary therapies. Apr 15, 2016 [cited Apr 12, 2019]. In: PDQ Cancer Information Summaries. Bethesda (MD): National Cancer Institute. .
    1. Altman DG, Bland JM. Treatment allocation by minimisation. BMJ. 2005;330:843 10.1136/bmj.330.7495.843
    1. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–376. 10.1093/jnci/85.5.365
    1. Kobayashi K, Takeda F, Teramukai S, Gotoh I, Sakai H, Yoneda S, et al. A cross-validation of the European Organization for Research and Treatment of Cancer QLQ-C30 (EORTC QLQ-C30) for Japanese with lung cancer. Eur J Cancer. 1998;34:810–815.
    1. Fayers PM, Bjordal K, Groenvold M, Curran D, Bottomley A, on behalf of the EORTC Quality of Life Group. The EORTC QLQ-C30 Scoring Manual (3rd Edition). 2001 [cited Apr 12, 2019]. In: EORTC Quality of Life. Brussels (Belgium): European Organisation for Research and Treatment of Cancer. .
    1. Scott NW, McPherson GC, Ramsay CR, Campbell MK. The method of minimization for allocation to clinical trials. a review. Control Clin Trials. 2002;23:662–674.
    1. Senn SS, Senn S. Cross-over trials in clinical research. 2nd ed West Sussex, UK: John Wiley & Sons; 2002.
    1. Grob JJ, Amonkar MM, Martin-Algarra S, Demidov LV, Goodman V, Grotzinger K, et al. Patient perception of the benefit of a BRAF inhibitor in metastatic melanoma: quality-of-life analyses of the BREAK-3 study comparing dabrafenib with dacarbazine. Ann Oncol. 2014;25:1428–1436. 10.1093/annonc/mdu154
    1. Reijneveld JC, Taphoorn MJ, Coens C, Bromberg JE, Mason WP, Hoang-Xuan K, et al. Health-related quality of life in patients with high-risk low-grade glioma (EORTC 22033–26033): a randomised, open-label, phase 3 intergroup study. Lancet Oncol. 2016;17:1533–1542. 10.1016/S1470-2045(16)30305-9
    1. Linge-Dahl LM, Heintz S, Ruch W, Radbruch L. Humor Assessment and Interventions in Palliative Care: A Systematic Review. Front Psychol. 2018;9:890 10.3389/fpsyg.2018.00890
    1. Gotay CC, Muraoka MY. Quality of life in long-term survivors of adult-onset cancers. J Natl Cancer Inst. 1998;90:656–667. 10.1093/jnci/90.9.656
    1. McPhail S, Haines T. Response shift, recall bias and their effect on measuring change in health-related quality of life amongst older hospital patients. Health Qual Life Outcomes. 2010;8:65 10.1186/1477-7525-8-65
    1. Ellis L. Gender differences in smiling: An evolutionary neuroandrogenic theory. Physiol Behav. 2006;88:303–308. 10.1016/j.physbeh.2006.03.034

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