June 2019
Toshitaka Morishima, Data curation, Formal analysis, Funding acquisition, Investigation, Resources, Visualization, Writing – original draft,1,* Isao Miyashiro, Conceptualization, Data curation, Investigation, Project administration, Resources, Validation, Writing – original draft,1 Norimitsu Inoue, Data curation, Investigation, Writing – review & editing,2,3 Mitsuko Kitasaka, Data curation, Investigation, Resources, Writing – review & editing,4 Takashi Akazawa, Investigation, Writing – review & editing,5 Akemi Higeno, Data curation, Investigation, Resources, Writing – review & editing,6 Atsushi Idota, Data curation, Investigation, Resources, Writing – review & editing,6 Akira Sato, Data curation, Validation, Writing – original draft,1 Tetsuya Ohira, Funding acquisition, Supervision, Validation, Writing – original draft,7 Masato Sakon, Conceptualization, Project administration, Supervision, Writing – review & editing,8 and Nariaki Matsuura, Project administration, Supervision, Writing – review & editing8
Maciej S. Buchowski, Editor

 

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.