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

PLoS One. 2019 Jun 27;14(6):e0219065. doi: 10.1371/journal.pone.0219065. eCollection 2019.


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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cognition
  • Cross-Over Studies
  • Female
  • Humans
  • Laughter Therapy*
  • Male
  • Middle Aged
  • Neoplasms / physiopathology
  • Neoplasms / psychology
  • Neoplasms / therapy*
  • Pain Measurement
  • Prospective Studies
  • Quality of Life
  • Surveys and Questionnaires

Grant support

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.