Effects of Laughter Therapy on Improving Negative Emotions Associated with Cancer: A Systematic Review and Meta-Analysis

Hongyu Shi; Yuejin Wu; Lu Wang; Xiuling Zhou; Feng Li

doi:10.1159/000533690

. 2023 Oct 31;102(4):343–353. doi: 10.1159/000533690

Effects of Laughter Therapy on Improving Negative Emotions Associated with Cancer: A Systematic Review and Meta-Analysis

Hongyu Shi ^a,^b, Yuejin Wu ^b, Lu Wang ^b, Xiuling Zhou ^a,^✉, Feng Li ^b,^✉

PMCID: PMC10994600 PMID: 37906984

Abstract

Introduction

With aging and growth of the population, the risk of cancer incidence and mortality is rapidly increasing. However, psychosocial treatment has been seriously neglected in many healthcare settings. Laughter therapy is a therapeutic program to improve emotional wellbeing and health which has been applied as a complementary treatment. We aim to explore effects of laughter therapy for patients with cancer on their negative emotions such as depression, anxiety, stress, pain, and fatigue.

Methods

We searched the Cochrane Library, Embase, PubMed, Scopus, Web of Science, WANFANG data, Weipu (VIP), Chinese National Knowledge Infrastructure (CNKI) and independently rated the risk of bias in every article using the Cochrane Collaboration’s Risk of Bias Assessment Tool. Review Manager and STATA software were used to pool the individually included studies.

Results

Seven studies were found eligible to be included in the present review. Overall, study quality was relatively high. Our findings suggest that laughter therapy might have a positive effect on improving emotional response in cancer patients. Arguably, laughter therapy, whether humor or laughter, has a positive effect on anxiety, stress, pain feeling, fatigue, and depression in cancer patients.

Conclusions

Laughter therapy is a convenient, multi-modality, flexible-duration therapy to improve negative emotions in cancer patients, regardless of their gender, age, and type of cancer.

Keywords: Cancer, Laughter therapy, Meta-analysis

Introduction

With aging and population growth, the risks of cancer incidence and mortality are rapidly increasing. An estimated 19.3 million new cases and 10 million cancer deaths were reported in 2020 [1]. There is a growing body of literature recognizes that for this growing group, the cancer itself, as well as medical treatments, often leads to a broad variety of psychosocial problems [2, 3]. These range from fatigue, loss of autonomous life to anxiety, depression, strain on personal relationships, even suicide risk and have a deep impact on life quality [2, 4, 5], wherein the incidence of depression or anxiety in cancer patients was 30–40% in hospital settings [6]. Simultaneously, these negative emotions may lead to cognitive dysfunction, adversely affecting various aspects of their lives [7]. However, psychosocial treatment has been seriously neglected in many healthcare settings [8], although studies have shown that psychosocial support leads to better quality of care [9].

Laughter therapy is therapeutic combination of mimicking laughter and yoga breathing exercise to improve emotional wellbeing and health which has been applied as a complementary treatment since the 1970s [10]. In this study, we define laughter therapy as a therapy with therapeutic purpose that induces or motivates the patient to laugh through a variety of methods, including laughter yoga, watching humorous movies, clown intervention [11, 12]. Ample qualitative evidence supports the value of using humor in various healthcare settings [13–16], and laughter is recognized as being a useful approach to reduce pain, stress, and anxiety, which could be explained by the suppression of epinephrine, cortisol, and 3,4-dihydrophenylacetic acid [17–19]. A growing scale of evidence also indicates that patients with cancer specifically can benefit from laughter [13, 20, 21]. Kim showed that laughter therapy reduced the anxiety, depression, and stress of breast cancer patients [22]; meanwhile, Shadi pointed out that laughter could reduce the stress of cancer patients before chemotherapy [23].

However, the overall review of the effect caused by laughter therapy on improving negative emotions associated to cancer is still unknown. Herein, we conducted this meta-analysis to explore effects of laughter therapy for patients with cancer on their negative emotions such as depression, anxiety, stress, pain, and fatigue. The results of this study will help fill a significant knowledge gap about the effects of generalized laughter therapy, which are valuable for tailoring non-pharmacologic interventions for cancer patients and informing future healthcare for them.

Method

Protocol and Registration

This systematic review of the literature was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (see online suppl. material for PRISMA Checklist; for all online suppl. material, see https://doi.org/10.1159/000533690) [24]. It was registered in the International Prospective Register for Systematic Reviews (PROSPERO) (CRD42022320330).

Literature Search and Study Selection

In this systematic review and meta-analysis, we searched the Cochrane Library, Embase, PubMed, Scopus, Web of Science, WANFANG data, Weipu (VIP), Chinese National Knowledge Infrastructure (CNKI) published between database inception and March 26, 2022. The key words and the search strategy used were “Neoplasms,” “Tumor,” “Neoplasm,” “Tumors,” “Neoplasia,” “Neoplasias,” “Cancer,” “Cancers,” “Malignant Neoplasm,” “Malignancy,” “Malignancies,” “Malignant Neoplasms,” “Neoplasm, Malignant,” “Neoplasms, Malignant,” “Benign Neoplasms,” “Benign Neoplasm,” “Neoplasms, Benign,” “Neoplasm, Benign,” “laughter therapy,” “clown,” “clown intervention,” “medical clown,” “hospital clown,” “health care clowning,” “therapy, laughter,” “clowning.” Finally, based on the above results, we performed a snowballing approach to search, screen, and examine papers, classifying them as potentially eligible studies.

Eligibility Criteria

Only those studies with randomized controlled design with the following requirements were included in the present study:

1.
Type of participants: patients diagnosed pathologically or cytologically as cancer survivors without limitations on age, stage, and type.
2.
Type of intervention: laughter therapy, including any therapeutic purpose that induces or motivates the patient to laugh through a variety of methods, including laughter yoga, watching humorous movies, clown intervention.
3.
Comparison: similar cancer treatment and usual standard of care to the intervention group.
4.
Outcome: the primary outcome measures were the extent of anxiety, stress, pain, depression, and fatigue measured by any scale.
5.
Study design: randomized controlled trials.

Data Extraction

After removing duplicates, two researchers screened 505 titles and abstracts and read in the full-text of 73 articles. Both researchers (S.H.Y. and W.Y.J.) independently reviewed the articles to identify records that met the inclusion criteria. In the title and abstract phase, disagreement on whether to include a paper meant this paper would be assessed in more detail at the abstract or full-text level. The researchers reached the consensus by discussing all the disagreements. The information from the 7 articles presents (1) author(s)’ name, (2) the publication year, (3) study period, (4) region, (5) subject characteristics (including age, cancer type, gender), (6) intervention, (7) treatment for control group, (8) F/U period, (9) the number of participants. Prevalence of laughter therapy effects on negative emotions such as fatigue, stress, depression and pain was extracted and is compiled.

Assessment of Risk of Bias and Quality of Articles

S.H.Y. and W.Y.J. independently rated the risk of bias in every article, using the Cochrane Collaboration’s Risk of Bias Assessment Tool [25]. The following criteria of the Cochrane Handbook were assessed: (1) random sequence generation, (2) allocation concealment, (3) blinding of participants and researchers, (4) blinding of outcome assessment, (5) incomplete outcome data, (6) selective reporting, and (7) other bias. Differences in the assessment of bias were resolved by discussion. The overall assessment was recorded as high risk (+), low risk (−) and unclear risk(?). In addition, blinding of outcome assessment was not considered as high risk since these outcomes were self-reported measures.

Data Synthesis

Review Manager (Revman; version 5.3; Copenhagen, Denmark) and STATA (version 16.0, America) software was used to pool the individually included studies. A quantitative synthesis for the effect size of each study was calculated as the outcomes were continuous data. The mean difference (MD) was calculated as an effect method when the included studies used the same scale, and the standardized mean difference (SMD) was calculated when the included studies used different scales to evaluate intervention effects. Random effect models were used given the heterogeneity of interventions. I² statistic was used to assess the degree of heterogeneity between studies, with I² values of 0%, 25%, 50%, and 75% representing no, low, moderate, and high heterogeneity, respectively. If the evidence suggested high heterogeneity, we performed subgroup analysis or sensitivity analysis to explore possible sources of heterogeneity.

Results

Study Selection

An outline of the search process is presented in Figure 1. A total of 586 studies were discovered from the electronic databases of which finally 7 were found eligible to be included in the present review. 66 of full-text articles excluded, with reasons: review or case report (n = 10), not RCT (n = 10), study protocol (n = 7), conference abstract (n = 8), not laughter or humor intervention (n = 31).

Study Characteristics

The primary analyses included 7 reports. A summary of the key characteristics of the included studies is mentioned in Table 1. The studies included were published between 2009 and 2021. All the studies eligible were articles with full text. Four studies were published in Korea, all with English abstracts [26–29], one from Turkey [30], and one from Iran [31]. In summary, these trials randomly assigned 487 participants to either a laughter-inducing intervention or control group, with sample sizes ranging from 34 to 88 participants. 66.5 percent of the participants were female. In all studies, participants were recruited in a hospital setting. The results of the laughter induction intervention were compared with those of conventional treatment. 2 studies reported effects on pain [30, 32], 5 on anxiety [26–30], 3 on stress [26–28], 4 on depression [26–29], and 1 on fatigue [29]. Intervention duration ranged from 2 weeks to 8 weeks.

Table 1.

Characteristics of the included individual studies

Study	Study period	Region	Subject characteristics						Intervention	Treatment for control group	F/U period	Participants, n		Outcomes
			age		cancer type		gender					interventions	control
			Con	Exp	Con	Exp	Con	Exp				interventions	control
Haeng et al. [26] 2009	2018	Korea	50±9.97	45.26±9.91	Breast	Breast	Female	Female	①Duration: 60 min per session	Radiotherapy	4 times for 2 weeks	31	29	①Depression and anxiety: Hospital Anxiety and Depression (HAD)
Haeng et al. [26] 2009	2018	Korea	50±9.97	45.26±9.91	Breast	Breast	Female	Female	②Content: Relax the body, health clap, smile, blow balloons, with the rhythm of cheerful music to induce laughter, finally through peaceful music or laugh related poetry recitation to calm the mood	Radiotherapy	4 times for 2 weeks	31	29	②Stress: the Brief Encounter Psychosocial Instrument (BEPSI)
Moonkyoo et al. [32] 2014	2013.7–2014.1	Korea	49.3±8.275	59.1±5.25	Breast	Breast	Female	Female	①Duration: 60 min per session	Radiotherapy	Laughter therapy was started at the onset of RT and provided twice a week until completion of RT.	18	19	①The maximum grade of radiation dermatitis
Moonkyoo et al. [32] 2014	2013.7–2014.1	Korea	49.3±8.275	59.1±5.25	Breast	Breast	Female	Female	②Content: The laughter intervention consisted of three parts: introduction, enhancement, and wrap up	Radiotherapy		18	19	②The maximum pain score and serum growth factors level
SoHeeKim et al. [28] 2015	2008.9–2008.10	Korea	<40: 9 40–49: 123 50–59: 8 ≥60: 2	<40: 4 40–49: 11 50–59: 9 ≥60: 5	Breast	Breast	Female	Female	①Duration: 60 min per session	Radiotherapy	Four sessions	31	29	①Depression and anxiety: Hospital Anxiety and Depression (HAD)
SoHeeKim et al. [28] 2015	2008.9–2008.10	Korea	<40: 9 40–49: 123 50–59: 8 ≥60: 2	<40: 4 40–49: 11 50–59: 9 ≥60: 5	Breast	Breast	Female	Female	②Content: Participants were led to various type of laughing (e.g., laughing in rhythm with clapping, laughing for a long time, laughing with the whole body, laughing in various ways, and laughing together with dance routines)	Radiotherapy	Four sessions	31	29	②Stress: The Brief Encounter Psychosocial Instrument (BEPSI)
Mohammad et al. [31] 2019	2018	Iran	45.2±12.6	49.0±9.6	Digestive: 11	Digestive: 16	Male: 11	Male: 12 Female: 22	①Duration: Each laughter yoga session lasted 20–30 min, and the laughter lasted 30–45 s	The usual self-care training	Four sessions prior to each chemotherapy session	35	34	Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS)
					Breast: 10	Breast: 11
					Respiratory: 5	Respiratory: 3
					Reproduction: 5	Reproduction: 2
					Lymph: 2	Lymph: 0
					Bone: 2	Bone: 2	Female: 24		②Content: The exercises consisted of fifteen basic standing steps
Sarıtaş et al. [30] 2019	2016.1–2017.1	Turkey	51.86±12.98	58.72±14.26	Colon: 8 Rectum: 10	Colon: 14 Rectum: 8	Male: 20	Male: 21 Female: 23	①Duration: 10 min	Routine clinical practice	10 min before surgery	44	44	① Pain: Visual Analog Scale (VAS)
					Gastric: 5	Gastric: 11
					Pancreatic: 7	Pancreatic: 4
					Breast: 7	Breast: 0	Female: 24		②Content: Watch traditional Turkish comedy movies					② Anxiety: State-Trait Anxiety Inventory
					Gallbladder: 2	Gallbladder: 3
					Others: 5	Others: 4
Yeon et al. [29] 2019	2015.7–2016.1	Korea	57±7.3	59.52±8.51	Stomach: 21	Stomach: 14	Male: 13	Male: 7	①Duration: 60 min each	Routine clinical practice	Once weekly, eight sessions	21	31	①Depression and anxiety Hospital Anxiety and Depression Scale ②Fatigue: The Fatigue Severity Scale ③Quality of sleep: The Verran & Synder-Halpern Sleep Scale
Yeon et al. [29] 2019	2015.7–2016.1	Korea	57±7.3	59.52±8.51	Colorectum: 10	Colorectum: 7	Female: 18	Female: 14	②Contents: Facial stretching exercises and mouth corners exercises, muscle strengthening exercises, introduction of different laughter, laughter meditation, mutual greetings, handshakes, hugs, positive conversation, etc.	Routine clinical practice	Once weekly, eight sessions	21	31
Kim et al. [27] 2021	2018.9–2018.11	Korea	53.65±8.90	60.00±11.04	GI:6	GI:8	Male: 7	Male: 5	①Duration: 50 min each	Standard care	Three times a week, a total of eight times	17	17	① Anxiety: State-trait Anxiety Inventory (STAI)
					Urogenital: 2	Urogenital: 2	Female: 10	Female: 12	②Content: It consists of introduction, activity and finish					② Depression: Back Depression Inventory (BDI)
					Breast: 5	Breast: 3								② Depression: Back Depression Inventory (BDI)
					Other: 4	Other: 4								③ Stress: The Perceived Stress Scale (PSS)

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Con, control group; Exp, experimental group.

Quality Assessment

The results of Cochrane’s risk of bias assessment for all included and for each study are shown in Figure 2. In general, the risk of random sequence generation (n = 4), blinding of outcoming (n = 7), incomplete outcome data (n = 7), and selective reporting (n = 7) for most trials were low. Because treatment allocation was obvious for all the studies, blinding of participants was all assessed as high risk. Blinding for outcome assessment was considered low risk because all outcomes were self-reported measures. Overall, study quality was relatively high, except for 3 studies that lacked descriptions of random generation [27, 29, 32] and 3 studies lacked that of allocation concealment [26, 27, 32].

Effect of Laughter Therapy on Anxiety

Four studies, which included 322 participants, compared the effect of laughter therapy with the standard of care on the extent of anxiety perceived among cancer patients. As the result showed in Figure 3a, generally, laughter therapy statistically significantly improved their anxiety (SMD = −0.54, 95% CI = −0.81∼−0.28, I² = 0%, p < 0.0001) and the heterogeneity was low (p = 0.40, I² = 0%).

Fig. 3. — Meta-analyses results on anxiety, stress, pain feeling, and depression.

Effect of Laughter Therapy on Stress

There are 3 studies [26–28] of all 7 studies reporting the positive effects of laughter on stress among cancer patients. Two studies used the Korean version of the Brief Encounter Psychosocial Instrument [33], one study used the Korean version of the Perceived Stress Scale [34]. As the result showed in Figure 3b, all of them showed significant decrease in stress (SMD = −1.27, 95% CI = −1.81∼−0.73, p = 0.00001, the heterogeneity was moderate (p = 0.10, I² = 56%).

Two studies [26, 35] reported on the effects of the intervention in non-elderly adults, and another report [27] provided data on the intervention of laughter therapy in elderly cancer patients. In the older adult subgroup, significant effects were observed (SMD = −1.60, 95% CI = −2.39∼−0.82). Whereas, in the non-elderly subgroup, a statistically significant improvement in stress was also observed (SMD = −1.16, 95% CI = −1.89∼−0.43, p = 0.002). Although an ameliorative effect on stress was observed in both groups, subgroup analysis revealed that the age of the participants was a source of heterogeneity, possibly due to differences in the understanding of humor and the degree of execution of laughter between older and non-older adults.

Effect of Laughter Therapy on Pain Feeling

2 studies including 122 participants evaluated the effect of laughter therapy compared to standard of care on the extent of pain feeling [30, 32]. As shown in Figure 3c, the results indicated that laughter therapy had shown statistically significant improvements in pain feeling (SMD = −0.55 (95% CI = −0.91∼0.19, p = 0.003), and the heterogeneity was low (p = 0.55, I² = 0%).

Effect of Laughter Therapy on Depression

Four studies including 208 participants reported depression at baseline and postintervention [26, 28, 29], all of which found a significant effect of the laughter therapy on depression. Compared with the control group, laughter therapy provided a statistical improvement on depression (SMD = −0.60 95% CI = −0.89∼−0.32, p < 0.0001). There was no evidence of high heterogeneity (p = 0.65, I² = 0%), as shown in Figure 3d.

Effect of Laughter Therapy on Fatigue

One study [29] with 60 participants examined the effect of laughter therapy on fatigue among cancer patients, the results showed a significant difference in fatigue levels between the experimental and control groups after laughter therapy (p = 0.019).

Publication Bias

Regarding publication bias, funnel plots was not performed due to the small amount of literature included (less than ten articles) in this paper.

Discussion

In this systematic review and meta-analysis, we identified and critically examined evidence from randomized controlled trials on the positive effects of laughter therapy interventions on negative emotions such as anxiety, stress, pain, and depression in cancer patients compared with the standard usual care, wait-list control, and the control of doing handwork. We obtained a total of seven RCTs, and the results agree well with the findings of Jinping Zhao [36], but our participants were limited to cancer patients. To the best of our knowledge, this is the first meta-analysis and systematic review which focuses on the effect of laughter therapy on negative emotions of cancer patients. Although there has been a review of the use of humor in palliative care [37], the effect of laughter therapy on cancer patients who are not required to receive palliative is unclear.

Our findings suggest that laughter therapy might have a positive effect in improving emotional response in cancer patients. Arguably, laughter therapy, whether humor or laughter, has a positive effect on anxiety, stress, pain feeling, fatigue, and depression in cancer patients. This beneficial effect could be explained in several ways. Laughter therapy, as it includes yoga poses, can reduce the patient’s stress by enhancing parasympathetic activity and lowering blood pressure and heart rate through breathing techniques [38]. In addition, laughter decreases cortisol, a stress hormone [38]. Laughter therapy can also reduce the probability and intensity of depression by actively creating or leading to positive emotions. Particularly, we also included pain feeling as a negative emotion because emotions are integral to the assessment of persistent pain [39], especially cancer pain, which is common among cancer patients [40]. This can be explained by the fact that laughter raises the level of endorphins in the body, which helps to increase the pain threshold of cancer patients [41]. Although there is literature stating that the older adults were supposed to receive at least 4-week intervention in order to obtain obvious improvement [42], for the counterparts with cancer, laughter therapy lasting for less than 4 weeks also significantly reduced their negative emotions. Particularly, watching comedies for 10 min could help participants reduce their pain [30], though the average age of experimental group was 52.

When comparing the effectiveness of different laughter therapy on anxiety and depression, the results of this review showed that both the depression and anxiety of patients who received laughter were reduced. This finding agreed well with Jinping Zhao’s study [36], while his study stated that no significant effect on anxiety was discovered in the humor subgroup but a significantly ameliorated on anxiety was found in the cancer patients’ subgroup. This may be due to the differences in the study population. The participants in our study were all cancer patients, so the baseline levels may be lower. Therefore, we believe that our findings have reference significance for the clinical selection of laughter for cancer patients.

Generally, all results in the article were highly heterogeneous, with only moderate heterogeneity shown in the results for stress. Sources of heterogeneity in similar articles include the following: (1) diversity of cancer types; (2) the stage of cancer in participants differs; (3) the introduction of laughter may have influence on heterogeneity [36]; (4) the wide range of age [35]; (5) the differences in competence and experience of laughter therapy; and (6) the intrinsic characteristics of the outcome measurement tools. After heterogeneity analysis of the individual results, we consider the age factor as a source of heterogeneity in the effect of laughter therapy on stress in cancer patients.

Additionally, the participants were from three countries: Iran, Turkey, and Korea. The way and attitudes towards humor may differ in Asia and the West. The laughter therapy originated from the West, with Norman Cousins often referred to as the “father of laughter therapy” [43]. However, as stated by Schwartz and Saunders [44], there are downsides to laughter therapy. The interventions used in laughter therapy, such as comedy movies and music, vary depending on the cultural background and condition of the patients. Otherwise, it may distract the patients’ attention or offend them [44]. The different ways of thinking and cultural backgrounds between the East and the West have influenced their comedic strategies in films. The developed agrarian civilization in the East has shaped the people’s reserved and well-mannered characteristics, resulting in humor that is often intellectual in nature and rarely involves absurd or nonsensical elements. On the other hand, the developed commercial culture in the West has fostered the open-mindedness of Westerners, leading to a variety of comedic forms. Even during the era of silent films, humor could be achieved through exaggerated facial expressions and actions without the need for language [45]. Due to cultural differences between the East and the West, the comedic design of some Western silent films and pantomimes is not suitable for application in clinical practice in China. In the future, when designing laughter therapy programs in China, it is important to consider our own cultural environment and incorporate more Chinese cultural elements [46]. In addition to assessing patients’ physiological and psychological states, cultural assessment of patients should also be conducted to understand their cultural and historical backgrounds. This includes selecting appropriate movements, films, music, etc., that can trigger laughter [44].

Limitations

To some extent, only 7 studies were included in the meta-analysis, which reflected the scarcity of RCTs in this field. Moreover, all the studies had high risk of bias in blinding of participants and personnel. There is a similar study focusing on patients without cancer achieving blinding [47], which can be used as reference in recent research studies. In addition, the studies did not include the effect of laughter therapy on child cancer patients. During the search stage, we found a Chinese document, but we excluded that one for not being an RCT [48]. And also, we excluded a Persian document for linguistic reasons. Furthermore, complexity of concepts such as sense of humor may make it difficult to warrant the rigor of the research [49, 50].

Conclusion

Laughter therapy is a convenient, multi-modality, flexible-duration therapy to improve negative emotions in cancer patients regardless of their gender, age, and type of cancer. The other thing to notice is that our results come from relatively small sample size. In that case, we believe more randomized controlled studies with large samples are in need to verify the effectiveness of laughter therapy on a wide variety of populations, including studies among adults and children in future.

Clinical Implications

Although pain and suffering can be managed with medication, cancer as a disease causes numerous impairments associated with the disease itself or with the treatment of the disease, and increasingly, cancer patients are looking to use an integrative medicine approach, combining pharmacological and non-pharmacological treatments, to support and improve the quality of life associated with their health [51].

Laughter therapy can be used as a complementary approach to mitigate the negative effects associated with cancer. For cancer patients, subgroups such as gender, duration of action, laughing style, and age, which are common in other literature, had a low impact on the heterogeneity of the results in this study [36, 48], suggesting that laughter therapy in the broad sense is acceptable as a valuable non-pharmacological treatment for cancer patients, regardless of duration of action. In particular, for people with limited mobility such as patients undergoing surgery, watching humorous films also has a significant mood-improving effect [52].

Nurses and other clinical workers need to actively translate this therapy into clinical practice to alleviate negative emotions such as using methods such as laughter yoga, watching humorous films, and clown interventions during hospital stays, and teaching these simple methods to patients and their relatives as part of health education to enhance treatment outcomes.

Statement of Ethics

An ethics statement is not applicable because this study is based exclusively on published literature.

Conflict of Interest Statement

The authors have no conflicts of interest to declare.

Funding Sources

The authors received no funding for the study.

Author Contributions

Hongyu Shi: conception and design of the work and drafting the work. Yuejin Wu: analysis and interpretation of data for the work. Lu Wang: revise critically for important intellectual content. Xiuling Zhou: revise critically for important intellectual content and agreement to be accountable for all aspects of the work. Feng Li: final approval of the version to be published.

Funding Statement

The authors received no funding for the study.

Data Availability Statement

All data generated or analyzed during this study are included in this article and its online supplementary material. Further inquiries can be directed to the corresponding author.

References

1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. 10.3322/caac.21660. [DOI] [PubMed] [Google Scholar]
2. Lang-Rollin I, Berberich G. Psycho-oncology. Dialogues Clin Neurosci. 2018;20(1):13–22. 10.31887/DCNS.2018.20.1/ilangrollin. [DOI] [PMC free article] [PubMed] [Google Scholar]
3. Klaassen Z, Arora K, Wilson SN, King SA, Madi R, Neal DE Jr, et al. Decreasing suicide risk among patients with prostate cancer: implications for depression, erectile dysfunction, and suicidal ideation screening. Urol Oncol. 2018;36(2):60–6. 10.1016/j.urolonc.2017.09.007. [DOI] [PubMed] [Google Scholar]
4. Fernández-Sola C, Martínez-Bordajandi Á, Puga-Mendoza AP, Hernández-Padilla JM, Jobim-Fischer V, López-Rodríguez MDM, et al. Social support in patients with sexual dysfunction after non-nerve-sparing radical prostatectomy: a qualitative study. Am J Mens Health. 2020;14(2):1557988320906977. 10.1177/1557988320906977. [DOI] [PMC free article] [PubMed] [Google Scholar]
5. Lewandowska A, Rudzki G, Lewandowski T, Próchnicki M, Rudzki S, Laskowska B, et al. Quality of life of cancer patients treated with chemotherapy. Int J Environ Res Public Health. 2020;17(19):6938. 10.3390/ijerph17196938. [DOI] [PMC free article] [PubMed] [Google Scholar]
6. Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011;12(2):160–74. 10.1016/S1470-2045(11)70002-X. [DOI] [PubMed] [Google Scholar]
7. Lange M, Joly F, Vardy J, Ahles T, Dubois M, Tron L, et al. Cancer-related cognitive impairment: an update on state of the art, detection, and management strategies in cancer survivors. Ann Oncol. 2019;30(12):1925–40. 10.1093/annonc/mdz410. [DOI] [PMC free article] [PubMed] [Google Scholar]
8. Fernando A. Mental health and cancer: why it is time to innovate and integrate-A call to action. Eur Urol Focus. 2020;6(6):1165–7. 10.1016/j.euf.2020.06.025. [DOI] [PMC free article] [PubMed] [Google Scholar]
9. Reid J. Psychosocial, educational and communicative interventions for patients with cachexia and their family carers. Curr Opin Support Palliat Care. 2014;8(4):334–8. 10.1097/SPC.0000000000000087. [DOI] [PMC free article] [PubMed] [Google Scholar]
10. 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(1):31–8. [PMC free article] [PubMed] [Google Scholar]
11. Ripoll RM, Casado IQ. Laughter and positive therapies: modern approach and practical use in medicine. Rev Psiquiatr Salud Ment. 2010;3(1):27–34. 10.1016/S1888-9891(10)70006-9. [DOI] [PubMed] [Google Scholar]
12. Catapan Sd C, Oliveira WF, Rotta TM. Palhaçoterapia em ambiente hospitalar: uma revisão de literatura. Cien Saude Colet. 2019;24(9):3417–29. 10.1590/1413-81232018249.22832017. [DOI] [PubMed] [Google Scholar]
13. Samant R, Balchin K, Cisa-Paré E, Renaud J, Bunch L, McNeil A, et al. The importance of humour in oncology: a survey of patients undergoing radiotherapy. Curr Oncol. 2020;27(4):e350–3. 10.3747/co.27.5875. [DOI] [PMC free article] [PubMed] [Google Scholar]
14. Dean RA, Major JE. From critical care to comfort care: the sustaining value of humour. J Clin Nurs. 2008;17(8):1088–95. 10.1111/j.1365-2702.2007.02090.x. [DOI] [PubMed] [Google Scholar]
15. Granek-Catarivas M, Goldstein-Ferber S, Azuri Y, Vinker S, Kahan E. Use of humour in primary care: different perceptions among patients and physicians. Postgrad Med J. 2005;81(952):126–30. 10.1136/pgmj.2004.019406. [DOI] [PMC free article] [PubMed] [Google Scholar]
16. Johnson P. The use of humor and its influences on spirituality and coping in breast cancer survivors. Oncol Nurs Forum. 2002;29(4):691–5. 10.1188/02.ONF.691-695. [DOI] [PubMed] [Google Scholar]
17. Akimbekov NS, Razzaque MS. Laughter therapy: a humor-induced hormonal intervention to reduce stress and anxiety. Curr Res Physiol. 2021;4:135–8. 10.1016/j.crphys.2021.04.002. [DOI] [PMC free article] [PubMed] [Google Scholar]
18. Christie W, Moore C. The impact of humor on patients with cancer. Clin J Oncol Nurs. 2005;9(2):211–8. 10.1188/05.CJON.211-218. [DOI] [PubMed] [Google Scholar]
19. Penson RT, Partridge RA, Rudd P, Seiden MV, Nelson JE, Chabner BA, et al. Laughter: the best medicine? Oncologist. 2005;10(8):651–60. 10.1634/theoncologist.10-8-651. [DOI] [PubMed] [Google Scholar]
20. Buiting HM, de Bree R, Brom L, Mack JW, van den Brekel MWM. Humour and laughing in patients with prolonged incurable cancer: an ethnographic study in a comprehensive cancer centre. Qual Life Res. 2020;29(9):2425–34. 10.1007/s11136-020-02490-w. [DOI] [PubMed] [Google Scholar]
21. Tanay MA, Wiseman T, Roberts J, Ream E. A time to weep and a time to laugh: humour in the nurse-patient relationship in an adult cancer setting. Support Care Cancer. 2014;22(5):1295–301. 10.1007/s00520-013-2084-0. [DOI] [PubMed] [Google Scholar]
22. Kim SH, Kim YH, Kim HJ. Laughter and stress relief in cancer patients: a pilot study. eCAM. 2015;2015:864739. 10.1155/2015/864739. [DOI] [PMC free article] [PubMed] [Google Scholar]
23. 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(4):179–83. [PMC free article] [PubMed] [Google Scholar]
24. Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015;162(11):777–84. 10.7326/M14-2385. [DOI] [PubMed] [Google Scholar]
25. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. 2019;10:Ed000142. 10.1002/14651858.ED000142. [DOI] [PMC free article] [PubMed] [Google Scholar]
26. Haeng LS. The effect of laughter therapy on depression, anxiety, and stress in patients with breast cancer undergoing radiotherapy. Asian Oncol Nurs. 2009;9(2):155–62. [Google Scholar]
27. Kim D, Kim S, Na AY, Sohn CH, Lee S, Lee HS. Identification of decrease in TRiC proteins as novel targets of alpha-amanitin-derived hepatotoxicity by comparative proteomic analysis in vitro. Toxins. 2021;13(3):197–204. 10.3390/toxins13030197. [DOI] [PMC free article] [PubMed] [Google Scholar]
28. 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. [DOI] [PMC free article] [PubMed] [Google Scholar]
29. Park S, Lee Y, Chung HH, Choi-Kwon S. Effects of a laughter therapy on depression, anxiety, fatigue and quality of sleep in gastrointestinal cancer patients post-treatment: a randomized controlled trial. jkbns. 2019;21(3):188–98. 10.7586/jkbns.2019.21.3.188. [DOI] [Google Scholar]
30. Sarıtaş S, Genç H, Okutan Ş, İnci R, Özdemir A, Kizilkaya G. The effect of comedy films on postoperative pain and anxiety in surgical oncology patients. Complement Med Res. 2019;26(4):231–9. 10.1159/000497234. [DOI] [PubMed] [Google Scholar]
31. Nia MN. Effect of laughter yoga on mental well-being of cancer mohammad namazi NiaPatients undergoing chemotherapy. Evid Based Care J. 2019;9(3):7–14. [Google Scholar]
32. 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;7:2053–9. 10.2147/OTT.S72973. [DOI] [PMC free article] [PubMed] [Google Scholar]
33. Frank SH, Zyzanski SJ. Stress in the clinical setting: the Brief encounter psychosocial instrument. J Fam Pract. 1988;26(5):533–9. [PubMed] [Google Scholar]
34. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96. 10.2307/2136404. [DOI] [PubMed] [Google Scholar]
35. 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(4):217–22. 10.1089/acm.2014.0152. [DOI] [PubMed] [Google Scholar]
36. Zhao J, Yin H, Zhang G, Li G, Shang B, Wang C, et al. A meta-analysis of randomized controlled trials of laughter and humour interventions on depression, anxiety and sleep quality in adults. J Adv Nurs. 2019;75(11):2435–48. 10.1111/jan.14000. [DOI] [PubMed] [Google Scholar]
37. Pinna MÁC, Mahtani-Chugani V, Sánchez Correas M, Sanz Rubiales A. The use of humor in palliative care: a systematic literature review. Am J Hosp Palliat Care. 2018;35(10):1342–54. 10.1177/1049909118764414. [DOI] [PubMed] [Google Scholar]
38. Funakubo N, Eguchi E, Hayashi R, Hirosaki M, Shirai K, Okazaki K, et al. Effects of a laughter program on body weight and mental health among Japanese people with metabolic syndrome risk factors: a randomized controlled trial. BMC Geriatr. 2022;22(1):361. 10.1186/s12877-022-03038-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
39. Lumley MA, Cohen JL, Borszcz GS, Cano A, Radcliffe AM, Porter LS, et al. Pain and emotion: a biopsychosocial review of recent research. J Clin Psychol. 2011;67(9):942–68. 10.1002/jclp.20816. [DOI] [PMC free article] [PubMed] [Google Scholar]
40. Santoni A, Santoni M, Arcuri E. Chronic cancer pain: opioids within tumor microenvironment affect neuroinflammation, tumor and pain evolution. Cancers. 2022;14(9):2253. 10.3390/cancers14092253. [DOI] [PMC free article] [PubMed] [Google Scholar]
41. 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(1731):1161–7. 10.1098/rspb.2011.1373. [DOI] [PMC free article] [PubMed] [Google Scholar]
42. Kuru Alici N, Arikan Dönmez A. A systematic review of the effect of laughter yoga on physical function and psychosocial outcomes in older adults. Complement Ther Clin Pract. 2020;41:101252. 10.1016/j.ctcp.2020.101252. [DOI] [PubMed] [Google Scholar]
43. Yim J. Therapeutic benefits of laughter in mental health: a theoretical review. Tohoku J Exp Med. 2016;239(3):243–9. 10.1620/tjem.239.243. [DOI] [PubMed] [Google Scholar]
44. Schwartz KD, Saunders JC. Laughter, Leininger, and home healthcare. Home Healthc Nurse. 2010;28(9):552–7. 10.1097/NHH.0b013e3181f2f312. [DOI] [PubMed] [Google Scholar]
45. Tse M. Humour differences between Chinese and western films in the perspective of intercultural communication--the grand Budapest hotel as an example. Film Rev. 2016(11):50–2. [Google Scholar]
46. Yan Z, Yuanmei Q, Xiaoyan Z, Yuan Z, Zan C, Xiaojing R. Progress of clown care application at home and abroad. Clin Nurs China. 2023;15(03):191–5. [Google Scholar]
47. Wolyniez I, Rimon A, Scolnik D, Gruber A, Tavor O, Haviv E, et al. The effect of a medical clown on pain during intravenous access in the pediatric emergency department: a randomized prospective pilot study. Clin Pediatr. 2013;52(12):1168–72. 10.1177/0009922813502257. [DOI] [PubMed] [Google Scholar]
48. Rong L, Weibo C, Ranran W, Na L, Juntao B. Family participatory clown care in PICC placement and maintenance in children with oncology. Chin Nurs Education. 2022;19(01):75–80. [Google Scholar]
49. Kurudirek F, Arikan D, Sarialioğlu A. Effects of therapeutic clowning on pain and anxiety during venous blood sampling in Turkey: randomised controlled trial. J Spec Pediatr Nurs. 2021;26(4):e12352. 10.1111/jspn.12352. [DOI] [PubMed] [Google Scholar]
50. Fusetti V, Re L, Pigni A, Tallarita A, Cilluffo S, Caraceni AT, et al. Clown therapy for procedural pain in children: a systematic review and meta-analysis. Eur J Pediatr. 2022;181(6):2215–25. 10.1007/s00431-022-04440-9. [DOI] [PubMed] [Google Scholar]
51. Oei SL, Thronicke A, Matthes H, Schad F. Evaluation of the effects of integrative non-pharmacological interventions on the internal coherence and resilience of breast cancer patients. Support Care Cancer. 2021;29(3):1413–21. 10.1007/s00520-020-05617-4. [DOI] [PubMed] [Google Scholar]
52. Ding Y, Yin H, Wang S, Meng Q, Yan M, Zhang Y, et al. Effectiveness of clown intervention for pain relief in children: a systematic review and meta-analysis. J Clin Nurs. 2022;31(21–22):3000–10. 10.1111/jocn.16195. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

All data generated or analyzed during this study are included in this article and its online supplementary material. Further inquiries can be directed to the corresponding author.

[B1] 1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. 10.3322/caac.21660. [DOI] [PubMed] [Google Scholar]

[B2] 2. Lang-Rollin I, Berberich G. Psycho-oncology. Dialogues Clin Neurosci. 2018;20(1):13–22. 10.31887/DCNS.2018.20.1/ilangrollin. [DOI] [PMC free article] [PubMed] [Google Scholar]

[B3] 3. Klaassen Z, Arora K, Wilson SN, King SA, Madi R, Neal DE Jr, et al. Decreasing suicide risk among patients with prostate cancer: implications for depression, erectile dysfunction, and suicidal ideation screening. Urol Oncol. 2018;36(2):60–6. 10.1016/j.urolonc.2017.09.007. [DOI] [PubMed] [Google Scholar]

[B4] 4. Fernández-Sola C, Martínez-Bordajandi Á, Puga-Mendoza AP, Hernández-Padilla JM, Jobim-Fischer V, López-Rodríguez MDM, et al. Social support in patients with sexual dysfunction after non-nerve-sparing radical prostatectomy: a qualitative study. Am J Mens Health. 2020;14(2):1557988320906977. 10.1177/1557988320906977. [DOI] [PMC free article] [PubMed] [Google Scholar]

[B5] 5. Lewandowska A, Rudzki G, Lewandowski T, Próchnicki M, Rudzki S, Laskowska B, et al. Quality of life of cancer patients treated with chemotherapy. Int J Environ Res Public Health. 2020;17(19):6938. 10.3390/ijerph17196938. [DOI] [PMC free article] [PubMed] [Google Scholar]

[B6] 6. Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011;12(2):160–74. 10.1016/S1470-2045(11)70002-X. [DOI] [PubMed] [Google Scholar]

[B7] 7. Lange M, Joly F, Vardy J, Ahles T, Dubois M, Tron L, et al. Cancer-related cognitive impairment: an update on state of the art, detection, and management strategies in cancer survivors. Ann Oncol. 2019;30(12):1925–40. 10.1093/annonc/mdz410. [DOI] [PMC free article] [PubMed] [Google Scholar]

[B8] 8. Fernando A. Mental health and cancer: why it is time to innovate and integrate-A call to action. Eur Urol Focus. 2020;6(6):1165–7. 10.1016/j.euf.2020.06.025. [DOI] [PMC free article] [PubMed] [Google Scholar]

[B9] 9. Reid J. Psychosocial, educational and communicative interventions for patients with cachexia and their family carers. Curr Opin Support Palliat Care. 2014;8(4):334–8. 10.1097/SPC.0000000000000087. [DOI] [PMC free article] [PubMed] [Google Scholar]

[B10] 10. 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(1):31–8. [PMC free article] [PubMed] [Google Scholar]

[B11] 11. Ripoll RM, Casado IQ. Laughter and positive therapies: modern approach and practical use in medicine. Rev Psiquiatr Salud Ment. 2010;3(1):27–34. 10.1016/S1888-9891(10)70006-9. [DOI] [PubMed] [Google Scholar]

[B12] 12. Catapan Sd C, Oliveira WF, Rotta TM. Palhaçoterapia em ambiente hospitalar: uma revisão de literatura. Cien Saude Colet. 2019;24(9):3417–29. 10.1590/1413-81232018249.22832017. [DOI] [PubMed] [Google Scholar]

[B13] 13. Samant R, Balchin K, Cisa-Paré E, Renaud J, Bunch L, McNeil A, et al. The importance of humour in oncology: a survey of patients undergoing radiotherapy. Curr Oncol. 2020;27(4):e350–3. 10.3747/co.27.5875. [DOI] [PMC free article] [PubMed] [Google Scholar]

[B14] 14. Dean RA, Major JE. From critical care to comfort care: the sustaining value of humour. J Clin Nurs. 2008;17(8):1088–95. 10.1111/j.1365-2702.2007.02090.x. [DOI] [PubMed] [Google Scholar]

[B15] 15. Granek-Catarivas M, Goldstein-Ferber S, Azuri Y, Vinker S, Kahan E. Use of humour in primary care: different perceptions among patients and physicians. Postgrad Med J. 2005;81(952):126–30. 10.1136/pgmj.2004.019406. [DOI] [PMC free article] [PubMed] [Google Scholar]

[B16] 16. Johnson P. The use of humor and its influences on spirituality and coping in breast cancer survivors. Oncol Nurs Forum. 2002;29(4):691–5. 10.1188/02.ONF.691-695. [DOI] [PubMed] [Google Scholar]

[B17] 17. Akimbekov NS, Razzaque MS. Laughter therapy: a humor-induced hormonal intervention to reduce stress and anxiety. Curr Res Physiol. 2021;4:135–8. 10.1016/j.crphys.2021.04.002. [DOI] [PMC free article] [PubMed] [Google Scholar]

[B18] 18. Christie W, Moore C. The impact of humor on patients with cancer. Clin J Oncol Nurs. 2005;9(2):211–8. 10.1188/05.CJON.211-218. [DOI] [PubMed] [Google Scholar]

[B19] 19. Penson RT, Partridge RA, Rudd P, Seiden MV, Nelson JE, Chabner BA, et al. Laughter: the best medicine? Oncologist. 2005;10(8):651–60. 10.1634/theoncologist.10-8-651. [DOI] [PubMed] [Google Scholar]

[B20] 20. Buiting HM, de Bree R, Brom L, Mack JW, van den Brekel MWM. Humour and laughing in patients with prolonged incurable cancer: an ethnographic study in a comprehensive cancer centre. Qual Life Res. 2020;29(9):2425–34. 10.1007/s11136-020-02490-w. [DOI] [PubMed] [Google Scholar]

[B21] 21. Tanay MA, Wiseman T, Roberts J, Ream E. A time to weep and a time to laugh: humour in the nurse-patient relationship in an adult cancer setting. Support Care Cancer. 2014;22(5):1295–301. 10.1007/s00520-013-2084-0. [DOI] [PubMed] [Google Scholar]

[B22] 22. Kim SH, Kim YH, Kim HJ. Laughter and stress relief in cancer patients: a pilot study. eCAM. 2015;2015:864739. 10.1155/2015/864739. [DOI] [PMC free article] [PubMed] [Google Scholar]

[B23] 23. 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(4):179–83. [PMC free article] [PubMed] [Google Scholar]

[B24] 24. Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015;162(11):777–84. 10.7326/M14-2385. [DOI] [PubMed] [Google Scholar]

[B25] 25. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. 2019;10:Ed000142. 10.1002/14651858.ED000142. [DOI] [PMC free article] [PubMed] [Google Scholar]

[B26] 26. Haeng LS. The effect of laughter therapy on depression, anxiety, and stress in patients with breast cancer undergoing radiotherapy. Asian Oncol Nurs. 2009;9(2):155–62. [Google Scholar]

[B27] 27. Kim D, Kim S, Na AY, Sohn CH, Lee S, Lee HS. Identification of decrease in TRiC proteins as novel targets of alpha-amanitin-derived hepatotoxicity by comparative proteomic analysis in vitro. Toxins. 2021;13(3):197–204. 10.3390/toxins13030197. [DOI] [PMC free article] [PubMed] [Google Scholar]

[B28] 28. 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. [DOI] [PMC free article] [PubMed] [Google Scholar]

[B29] 29. Park S, Lee Y, Chung HH, Choi-Kwon S. Effects of a laughter therapy on depression, anxiety, fatigue and quality of sleep in gastrointestinal cancer patients post-treatment: a randomized controlled trial. jkbns. 2019;21(3):188–98. 10.7586/jkbns.2019.21.3.188. [DOI] [Google Scholar]

[B30] 30. Sarıtaş S, Genç H, Okutan Ş, İnci R, Özdemir A, Kizilkaya G. The effect of comedy films on postoperative pain and anxiety in surgical oncology patients. Complement Med Res. 2019;26(4):231–9. 10.1159/000497234. [DOI] [PubMed] [Google Scholar]

[B31] 31. Nia MN. Effect of laughter yoga on mental well-being of cancer mohammad namazi NiaPatients undergoing chemotherapy. Evid Based Care J. 2019;9(3):7–14. [Google Scholar]

[B32] 32. 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;7:2053–9. 10.2147/OTT.S72973. [DOI] [PMC free article] [PubMed] [Google Scholar]

[B33] 33. Frank SH, Zyzanski SJ. Stress in the clinical setting: the Brief encounter psychosocial instrument. J Fam Pract. 1988;26(5):533–9. [PubMed] [Google Scholar]

[B34] 34. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96. 10.2307/2136404. [DOI] [PubMed] [Google Scholar]

[B35] 35. 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(4):217–22. 10.1089/acm.2014.0152. [DOI] [PubMed] [Google Scholar]

[B36] 36. Zhao J, Yin H, Zhang G, Li G, Shang B, Wang C, et al. A meta-analysis of randomized controlled trials of laughter and humour interventions on depression, anxiety and sleep quality in adults. J Adv Nurs. 2019;75(11):2435–48. 10.1111/jan.14000. [DOI] [PubMed] [Google Scholar]

[B37] 37. Pinna MÁC, Mahtani-Chugani V, Sánchez Correas M, Sanz Rubiales A. The use of humor in palliative care: a systematic literature review. Am J Hosp Palliat Care. 2018;35(10):1342–54. 10.1177/1049909118764414. [DOI] [PubMed] [Google Scholar]

[B38] 38. Funakubo N, Eguchi E, Hayashi R, Hirosaki M, Shirai K, Okazaki K, et al. Effects of a laughter program on body weight and mental health among Japanese people with metabolic syndrome risk factors: a randomized controlled trial. BMC Geriatr. 2022;22(1):361. 10.1186/s12877-022-03038-y. [DOI] [PMC free article] [PubMed] [Google Scholar]

[B39] 39. Lumley MA, Cohen JL, Borszcz GS, Cano A, Radcliffe AM, Porter LS, et al. Pain and emotion: a biopsychosocial review of recent research. J Clin Psychol. 2011;67(9):942–68. 10.1002/jclp.20816. [DOI] [PMC free article] [PubMed] [Google Scholar]

[B40] 40. Santoni A, Santoni M, Arcuri E. Chronic cancer pain: opioids within tumor microenvironment affect neuroinflammation, tumor and pain evolution. Cancers. 2022;14(9):2253. 10.3390/cancers14092253. [DOI] [PMC free article] [PubMed] [Google Scholar]

[B41] 41. 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(1731):1161–7. 10.1098/rspb.2011.1373. [DOI] [PMC free article] [PubMed] [Google Scholar]

[B42] 42. Kuru Alici N, Arikan Dönmez A. A systematic review of the effect of laughter yoga on physical function and psychosocial outcomes in older adults. Complement Ther Clin Pract. 2020;41:101252. 10.1016/j.ctcp.2020.101252. [DOI] [PubMed] [Google Scholar]

[B43] 43. Yim J. Therapeutic benefits of laughter in mental health: a theoretical review. Tohoku J Exp Med. 2016;239(3):243–9. 10.1620/tjem.239.243. [DOI] [PubMed] [Google Scholar]

[B44] 44. Schwartz KD, Saunders JC. Laughter, Leininger, and home healthcare. Home Healthc Nurse. 2010;28(9):552–7. 10.1097/NHH.0b013e3181f2f312. [DOI] [PubMed] [Google Scholar]

[B45] 45. Tse M. Humour differences between Chinese and western films in the perspective of intercultural communication--the grand Budapest hotel as an example. Film Rev. 2016(11):50–2. [Google Scholar]

[B46] 46. Yan Z, Yuanmei Q, Xiaoyan Z, Yuan Z, Zan C, Xiaojing R. Progress of clown care application at home and abroad. Clin Nurs China. 2023;15(03):191–5. [Google Scholar]

[B47] 47. Wolyniez I, Rimon A, Scolnik D, Gruber A, Tavor O, Haviv E, et al. The effect of a medical clown on pain during intravenous access in the pediatric emergency department: a randomized prospective pilot study. Clin Pediatr. 2013;52(12):1168–72. 10.1177/0009922813502257. [DOI] [PubMed] [Google Scholar]

[B48] 48. Rong L, Weibo C, Ranran W, Na L, Juntao B. Family participatory clown care in PICC placement and maintenance in children with oncology. Chin Nurs Education. 2022;19(01):75–80. [Google Scholar]

[B49] 49. Kurudirek F, Arikan D, Sarialioğlu A. Effects of therapeutic clowning on pain and anxiety during venous blood sampling in Turkey: randomised controlled trial. J Spec Pediatr Nurs. 2021;26(4):e12352. 10.1111/jspn.12352. [DOI] [PubMed] [Google Scholar]

[B50] 50. Fusetti V, Re L, Pigni A, Tallarita A, Cilluffo S, Caraceni AT, et al. Clown therapy for procedural pain in children: a systematic review and meta-analysis. Eur J Pediatr. 2022;181(6):2215–25. 10.1007/s00431-022-04440-9. [DOI] [PubMed] [Google Scholar]

[B51] 51. Oei SL, Thronicke A, Matthes H, Schad F. Evaluation of the effects of integrative non-pharmacological interventions on the internal coherence and resilience of breast cancer patients. Support Care Cancer. 2021;29(3):1413–21. 10.1007/s00520-020-05617-4. [DOI] [PubMed] [Google Scholar]

[B52] 52. Ding Y, Yin H, Wang S, Meng Q, Yan M, Zhang Y, et al. Effectiveness of clown intervention for pain relief in children: a systematic review and meta-analysis. J Clin Nurs. 2022;31(21–22):3000–10. 10.1111/jocn.16195. [DOI] [PubMed] [Google Scholar]

PERMALINK

Effects of Laughter Therapy on Improving Negative Emotions Associated with Cancer: A Systematic Review and Meta-Analysis

Hongyu Shi

Yuejin Wu

Lu Wang

Xiuling Zhou

Feng Li

Abstract

Introduction

Methods

Results

Conclusions

Introduction

Method

Protocol and Registration

Literature Search and Study Selection

Eligibility Criteria

Data Extraction

Assessment of Risk of Bias and Quality of Articles

Data Synthesis

Results

Study Selection

Fig. 1.

Study Characteristics

Table 1.

Quality Assessment

Fig. 2.

Effect of Laughter Therapy on Anxiety

Fig. 3.

Effect of Laughter Therapy on Stress

Effect of Laughter Therapy on Pain Feeling

Effect of Laughter Therapy on Depression

Effect of Laughter Therapy on Fatigue

Publication Bias

Discussion

Limitations

Conclusion

Clinical Implications

Statement of Ethics

Conflict of Interest Statement

Funding Sources

Author Contributions

Funding Statement

Data Availability Statement

References

Associated Data

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

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