Discussion
rheumatoid arthritis, sleep disturbance, fatigue, breast cancer, cancer, pain, increases pain
RHEUMATOID ARTHRITIS, CANCER, INFLAMMATION, BREAST CANCER
Our study shed light the effect of laughter yoga on HRQOL in cancer patients undergoing chemotherapy. The findings revealed that the implementation of the laughter yoga has improved the cancer patients HRQOL in terms of emotional functioning, role functioning, physical functioning, and overall HRQOL status. Laughter yoga had also reduced the symptoms of fatigue, pain, sleep disturbance, as well as nausea/vomiting. Implementing laughter yoga to the cancer patients undergoing chemotherapy in clinical settings by trained personnel thus might be helpful to alleviate their difficulties and enhance HRQOL.In a study in Japan, the findings had demonstrated that laughter accompanied by exercises had boosted emotional functioning in older adults. In the present study, laughter yoga had further augmented emotional functioning among the cancer patients thanks to their positive feelings and emotions, which could in turn have a positive effect on emotional functioning [Likewise, a four-session fun-laughter program in another study had been able to lower pain in patients with rheumatoid arthritis [In a study done in Turkey, six sessions of breathing exercises had reduced the incidence rate and severity of nausea/vomiting in breast cancer patients receiving chemotherapy [The possible mechanism of beneficial effect of laughter yoga seen in the interventional group could be due to the effect of laughter yoga on neurological, endocrine, and immune systems of human body. Laughter has shown to cause release of endorphins and dopamine, decrease of cortisol (stress hormone), and affects production of cytokines in the human body. These effect in turn enhances positive mood and sleep, modulates inflammation, and increases pain tolerance. The real or fake laughter is described to exert similar effect in the body [The present study had some limitations. Firstly, the positive effects observed could partly be due to different factors such as the social circumstances created for the laughter yoga intervention, the competency of the laughter yoga instructor, or due to the environment of hospital, or other patients related factors like the level of self-care, and the type of diet they used. Secondly, in the study, the intervention was administered in a moderate group of 8 to 14 participants, for about 20–30 min, and final outcome was assessed after four sessions. Likewise, the intervention was delivered to the patients undergoing chemotherapy and meeting all eligible criteria that consisted of the patients who could walk to do the laughter yoga in standing posture, further study may be needed to see the effects of laughter among the patients who are currently in wheel chair or in bed but still can laugh and do some physical movement and deep breathing, and on those patients who are using other treatment modalities. Finally, since the outcome measure is based on patient reported outcome as measured by structured tool, EORTC QLQ-C30, there can be chances of recall bias [