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

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          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.

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          Most cited references38

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          Quality of life among long-term (≥5 years) colorectal cancer survivors--systematic review.

          Due to the growing number of long-term (≥5 years) colorectal cancer survivors, investigation of their quality of life (QoL) is important for an evaluation of chronic or late effects of the disease and treatment and to adjust treatment strategies to patients' needs. To summarise current research results, multiple databases including PubMed, EMBASE and CINAHL were used to identify articles about long-term QoL of colorectal cancer survivors. The content of 10 included studies was independently extracted by two reviewers. Colorectal cancer survivors indicated a good overall QoL, but may have slightly lower physical QoL than the general population. Furthermore, survivors had worse depression scores and reported to suffer from long-term symptoms such as bowel problems and distress regarding cancer. Apart from stoma and recurrence of the disease, mainly general and health-related factors such as age, social network size, income, education, BMI and number of comorbidities were associated with QoL. Studies were mainly conducted in the United States (US) (n=7) and were heterogeneous with respect to the QoL instrument used and the adjustment to covariates. QoL assessment was cross-sectional in all studies. Despite an overall good QoL, colorectal cancer survivors have specific physical and psychological problems. The reported determinants of QoL may serve to identify survivors with special needs. But further studies are needed that focus on problems like distress, depression and bowel problems of long-term colorectal cancer survivors. Copyright © 2010 Elsevier Ltd. All rights reserved.
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            Patient-reported outcomes in cancer: a review of recent research and policy initiatives.

            There is growing recognition that patient-reported outcome (PRO) measures--encompassing, for example, health-related quality of life--can complement traditional biomedical outcome measures (eg, survival, disease-free survival) in conveying important information for cancer care decision making. This paper provides an integrated review and interpretation of how PROs have been defined, measured, and used in a range of recent cancer research and policy initiatives. We focus, in turn, on the role of PRO measurement in the evaluation and approval of cancer therapies, the assessment of cancer care in the community, patient-provider decision making in clinical oncology practice, and population surveillance of cancer patients and survivors. The paper concludes with a discussion of future challenges and opportunities in PRO measure development and application, given the advancing state of the science in cancer outcomes measurement and the evolving needs of cancer decision makers at all levels.
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              Social laughter is correlated with an elevated pain threshold.

              Although laughter forms an important part of human non-verbal communication, it has received rather less attention than it deserves in both the experimental and the observational literatures. Relaxed social (Duchenne) laughter is associated with feelings of wellbeing and heightened affect, a proximate explanation for which might be the release of endorphins. We tested this hypothesis in a series of six experimental studies in both the laboratory (watching videos) and naturalistic contexts (watching stage performances), using change in pain threshold as an assay for endorphin release. The results show that pain thresholds are significantly higher after laughter than in the control condition. This pain-tolerance effect is due to laughter itself and not simply due to a change in positive affect. We suggest that laughter, through an endorphin-mediated opiate effect, may play a crucial role in social bonding.
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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: ResourcesRole: VisualizationRole: Writing – original draft
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: Project administrationRole: ResourcesRole: ValidationRole: Writing – original draft
                Role: Data curationRole: InvestigationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: ResourcesRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: ResourcesRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: ResourcesRole: Writing – review & editing
                Role: Data curationRole: ValidationRole: Writing – original draft
                Role: Funding acquisitionRole: SupervisionRole: ValidationRole: Writing – original draft
                Role: ConceptualizationRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                27 June 2019
                2019
                : 14
                : 6
                : e0219065
                Affiliations
                [1 ] Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
                [2 ] Department of Tumor Immunology, Research Center, Osaka International Cancer Institute, Osaka, Japan
                [3 ] Department of Molecular Genetics, Wakayama Medical University, Wakayama, Japan
                [4 ] Department of Nursing Services, Osaka International Cancer Institute, Osaka, Japan
                [5 ] Department of Cancer Drug Discovery and Development, Research Center, Osaka International Cancer Institute, Osaka, Japan
                [6 ] Department of Clinical Laboratory, Osaka International Cancer Institute, Osaka, Japan
                [7 ] Department of Epidemiology, Fukushima Medical University, Fukushima, Japan
                [8 ] Osaka International Cancer Institute, Osaka, Japan
                Vanderbilt University, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-0747-3287
                http://orcid.org/0000-0002-4155-9228
                http://orcid.org/0000-0003-3720-6056
                Article
                PONE-D-18-34050
                10.1371/journal.pone.0219065
                6597115
                31247017
                56ff2759-3c9d-44b1-b503-2c5c583bd7d4
                © 2019 Morishima et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 5 December 2018
                : 12 June 2019
                Page count
                Figures: 2, Tables: 4, Pages: 15
                Funding
                Funded by: Foundation for Promotion of Cancer Research in Japan
                Award ID: Grant for Cancer Survivorship Research H29
                Award Recipient :
                Funded by: Japan Society for the Promotion of Science
                Award ID: Grant-in-Aid for Scientific Research JSPS KAKENHI JP16K19291
                Award Recipient :
                TM and TO received a Grant for Cancer Survivorship Research H29 from the Foundation for Promotion of Cancer Research in Japan ( https://www.fpcr.or.jp). TM received a Grant-in-Aid for Scientific Research (JSPS KAKENHI JP16K19291) from the Japan Society for the Promotion of Science ( https://www.jsps.go.jp/english/e-grants). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
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