Humor in Cancer Treatment

Lillie Shockney and a patient share a laugh. As a nurse, a breast cancer survivor, and the administrator of Johns Hopkins Breast Center, Lillie offers a special kind of support to patients.
Lillie Shockney and a patient share a laugh. As a nurse, a breast cancer survivor, and the administrator of Johns Hopkins Breast Center, Lillie offers a special kind of support to patients.

Humor Definition

Humor can be broadly defined as “something that is, or is designed to be, comical or amusing,” and the area of research has been termed “gelotology” from the Greek “gelos,” or “laughter”. More specific definitions vary, but humorous communication certainly causes increased feelings of happiness and laughter in those responding to it, whether due to witty comments or amusing behavior. Humor is present in any social situation, and the nature of what is perceived as amusing varies widely among individuals, societies, and cultures. Everyone enjoys laughing, but a misjudged humorous comment can cause offense, so while laughter is almost always positive, humor itself can provoke mixed emotional responses.

Richard T. Penson, M.D. (Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA) reviewed the role of humor in medicine through an examination of physician and nurse experiences. He is sure that fostering a jovial atmosphere in the health care setting may improve the happiness and well-being of staff as well as patients. Humor may help to relax the patient, acting as a “leveling agent” among the patient, family, and oncologist, as it can often relieve the tension caused by intimate questions or exams. It seems that the most appropriate time to use humor is when there is mutual understanding of the therapeutic goals between doctor and patient. Humor may be useful for patients to ease the pain and attempt to normalize an awful situation. With respectful sensitivity, humor in medicine can be a valuable addition to the repertoire of every health care worker.

Humor and Recurrent ovarian cancer

Recurrent ovarian cancer remains a stressful diagnosis. The poor prognosis, receipt of multiple chemotherapy regimens, radiographic imaging, and physician’ visits that inundate a patient with recurrent ovarian cancer lend to increased stress in this population. Patients cope with the stress of such a serious illness in many ways. Humor is one of the oldest forms of coping with stress. To explore the feasibility of using therapeutic humor in this population, the objective of doctor Stephen L. Rose, MD (UW Carbone Cancer Center, The University of Wisconsin School of Medicine and Public Health, Wisconsin, Madison, USA) was to gain a better understanding of how patients with recurrent ovarian cancer experience humor.

Seventeen patients were accrued before reaching saturation. Overall, 14 patients (82%) reported using humor to cope with their diagnosis of recurrent ovarian cancer, and 13 patients (76%) felt that humor helped to alleviate anxiety. The use of humor by physicians and nurses was perceived as appropriate and positive by all 17 patients but was dependent on context. Most women used humor to help with coping, and many of them made humorous comments about their diagnosis. Approximately half of the patients’ families and friends made humorous comments regarding them being sick. Most of the patients enjoyed a physician’s or nurse’s use of humor during their hospitalization or treatment.

All of the patients felt that the use of humor was an appropriate and positive part of their relationship with their health care team.

Most did not feel that it trivialized their illness, although 2 patients noted that caregiver use of humor during visits when bad news was conveyed would be perceived negatively and could be hurtful. For example, one of the patients stated, “today was not a super good report from the doctor so putting humor in a not so good report is not going to make it better.” Some patients felt that inappropriate humor use by a physician could undermine the confidence they had in their physician. Many also noted that a physician would need to be able to assess verbal cues from the patient to know when humor was acceptable, with one patient noting that “it’s hard to judge because if you’re having a bad day and somebody comes in and is jovial, it could all just be topsy-turvy then.”; Most patients welcomed the use of humor once a relationship had been established with a physician but noted that humor use during the early stages of an initial visit could seem forced. All of the patients felt that humor was not necessarily a joke, but that a humorous personal anecdote was just as powerful. 

Humor and Childhood Cancer

The diagnosis of cancer in a child can be very stress provoking for both the patient and family. The child must endure painful procedures such as bone marrow aspirations and biopsies, lumbar punctures, and intravenous insertions, as well as the pain produced by the disease itself and the side effects of treatment. One strategy that nurses can use to help children cope is humor. By creating a playful environment that is conducive for humor to emerge, nurses can effectively help children to decrease their fears and anxieties. Pamela K. Frankenfield, RN, et al. (Johns Hopkins Hospital, Pediatric Oncology Clinic, Baltimore, Maryland, USA) reviewed the benefits of humor and play and provided a brief discussion of the developmental aspects of humor and play theory. Her Case Report assessed the benefits of humor and play with a 5-year-old retinoblastoma patient in an ambulatory care setting. She argued that nurses caring for children with cancer must learn to appreciate humor and play and incorporate these essential tools into their daily practice.

Despite increasing survival rates, the treatment and side effects of cancer continue to be a stressful experience in the life of a child. Some children effectively cope with cancer and maintain a normal lifestyle, whereas others have difficulty coping with cancer stressors and are unable to resume their previous lifestyle. Jacqueline S. Dowling, PhD, RN, et al. (University of Massachusetts Lowell Dept of Nursing, USA) investigated the effect of sense of humor on the relationship between cancer stressors and children’s psychosocial adjustment to cancer, immune function, and infection using Lazarus and Folkman’s theory of stress, appraisal, and coping. 

Forty-seven subjects participated in the data collection process. Major findings of the study include the moderating effect of coping humor on childhood cancer stressors relative to the incidence of infection and the direct effects of sense of humor and coping humor on children’s psychosocial adjustment to cancer stressors. 

A direct relationship was observed between sense of humor and psychosocial adjustment to cancer, such that children with a high sense of humor had greater psychological adjustment, regardless of the amount of cancer stressors.

A moderating effect was observed for incidence of infection. As childhood cancer stressors increase, children with high coping humor scores reported fewer incidences of infection than low scorers.