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.

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.
Lang-Rollin I, Berberich G. Psycho-oncology. Dialogues Clin Neurosci. 2018;20(1):13–22.
Klaassen Z, Arora K, Wilson SN, King SA, Madi R, Neal DEJr, 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.
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.
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.
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.
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.
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.
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.
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.
Ripoll RM, Casado IQ. Laughter and positive therapies: modern approach and practical use in medicine. Rev Psiquiatr Salud Ment. 2010;3(1):27–34.
Catapan Sd C, Oliveira WF, Rotta TM. Palhaçoterapia em ambiente hospitalar: uma revisão de literatura. Cien Saude Colet. 2019;24(9):3417–29.
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.
Dean RA, Major JE. From critical care to comfort care: the sustaining value of humour. J Clin Nurs. 2008;17(8):1088–95.
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.
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.
Akimbekov NS, Razzaque MS. Laughter therapy: a humor-induced hormonal intervention to reduce stress and anxiety. Curr Res Physiol. 2021;4:135–8.
Christie W, Moore C. The impact of humor on patients with cancer. Clin J Oncol Nurs. 2005;9(2):211–8.
Penson RT, Partridge RA, Rudd P, Seiden MV, Nelson JE, Chabner BA, et al. Laughter: the best medicine?Oncologist. 2005;10(8):651–60.
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.
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.
Kim SH, Kim YH, Kim HJ. Laughter and stress relief in cancer patients: a pilot study. eCAM. 2015;2015:864739.
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.
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.
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.
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.
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.
Kim SH, Kim YH, Kim HJ. Laughter and stress relief in cancer patients: a pilot study. Evid Based Complement Alternat Med. 2015;2015:864739.
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.
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.
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.
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.
Frank SH, Zyzanski SJ. Stress in the clinical setting: the Brief encounter psychosocial instrument. J Fam Pract. 1988;26(5):533–9.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96.
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.
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.
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.
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.
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.
Santoni A, Santoni M, Arcuri E. Chronic cancer pain: opioids within tumor microenvironment affect neuroinflammation, tumor and pain evolution. Cancers. 2022;14(9):2253.
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.
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.
Yim J. Therapeutic benefits of laughter in mental health: a theoretical review. Tohoku J Exp Med. 2016;239(3):243–9.
Schwartz KD, Saunders JC. Laughter, Leininger, and home healthcare. Home Healthc Nurse. 2010;28(9):552–7.
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.
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.
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.
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.
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.
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.
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.
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.
You do not currently have access to this content.