Document Type : Original Article(s)

Authors

1 Research Unit, Mangalore Institute of Oncology, Pumpwell, Mangalore, Karnataka, India

2 Radiation Oncology, Mangalore Institute of Oncology, Mangalore, Karnataka, India

3 Medical Social Worker, Mangalore Institute of Oncology, Mangalore, Karnataka, India

4 Internal Medicine, Coney Island Hospital, 2601 Ocean Pkwy, Brooklyn, New York, United States

5 Department of Community Medicine, Father Muller Medical College, Kankanady, Mangalore, India

10.30476/mejc.2024.99258.1936

Abstract

Background: Anxiety is a significant psychological challenge for patients newly diagnosed with cancer and scheduled for chemotherapy, potentially affecting their treatment adherence. This study aimed to evaluate the impact of watching the Tom and Jerry cartoon on reducing anxiety in individuals undergoing chemotherapy for the first time.
Method: This pilot study employed a prospective, non-randomized, observational, two-arm, pre-and post-test design involving literate English-speaking patients (test group) and non-literate patients (control group) who were about to receive cytotoxic chemotherapy for their cancer. The test group viewed Tom and Jerry cartoons via video systems, whereas the control group was exposed to Kannada movies. An 11-point Likert scale featuring facial expressions assessed patients' anxiety levels three times: twenty minutes before, 30 minutes after, and following the chemotherapy session. Data analysis included frequency, percentage, chi-square tests for patient and treatment data, and repeated measures ANOVA with Bonferroni correction for anxiety scores at three-time intervals. A P-value of <0.05 was considered statistically significant.
Results: The anxiety assessment outcomes indicated a significant reduction in anxiety levels among the test group patients who watched Tom and Jerry compared to the control group (P ≤ 0.001). Inter-group comparisons, analyzed using the Bonferroni test, revealed significant differences in anxiety reduction thirty minutes post-viewing (P = 0.001) and after the treatment (P = 0.04).
Conclusion: To the authors' knowledge, this is the inaugural study demonstrating the efficacy of the Tom and Jerry cartoon in alleviating anxiety among cancer patients undergoing chemotherapy, suggesting broad clinical applicability.

Highlights

Manjeshwar Shrinath Baliga (Google Scholar)

Keywords

Main Subjects

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination, and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.30476/mejc.2024.99258.1936

  1. Amjad MT, Chidharla A, Kasi A. Cancer Chemotherapy. 2023 Feb 27. In: Stat Pearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. PMID: 33232037.
  2. Grusdat NP, Stäuber A, Tolkmitt M, et al. Routine cancer treatments and their impact on physical function, symptoms of cancer-related fatigue, anxiety, and depression. Support Care Cancer. 2022; 30(5):3733-44. doi: 10.1007/s00520-021-06787-5.
  3. Wang X, Zhang Y, Fan Y, Tan XS, Lei X. Effects of music intervention on the physical and mental status of patients with breast cancer: a systematic review and meta-analysis. Breast Care (Basel). 2018;13(3):183-90. doi: 10.1159/000487073.
  4. Yangöz ŞT, Özer Z. The effect of music intervention on patients with cancer-related pain: A systematic review and meta-analysis of randomized controlled trials. J Adv Nurs. 2019; 75(12):3362-73. doi: 10.1111/jan.14184.
  5. Bradt J, Dileo C, Magill L, Teague A. Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database Syst Rev. 2016;(8):CD006911. doi: 10.1002/14651858.CD006911.pub3.
  6. Jasemi M, Aazami S, Zabihi RE. The effects of music therapy on anxiety and depression of cancer patients. Indian J Palliat Care. 2016; 22(4):455-8. doi: 10.4103/0973-1075.191823.
  7. Charalambous A, Giannakopoulou M, Bozas E, Marcou Y, Kitsios P, Paikousis L. Guided imagery and progressive muscle relaxation as a cluster of symptoms management intervention in patients receiving chemotherapy: a randomized control trial. PLoS One. 2016;11(6):e0156911. doi: 10.1371/journal.pone.0156911.
  8. Mahdizadeh MJ, Tirgari B, Abadi OSRR, Bahaadinbeigy K. Guided imagery: reducing anxiety, depression, and selected side effects associated with chemotherapy. Clin J Oncol Nurs. 2019;23(5): E87-E92. doi: 10.1188/19.CJON.E87-E92.
  9. Nishimura D, Kosugi S, Onishi Y, Ihara N, Wakaizumi K, Nagata H, et al. Psychological and endocrine factors and pain after mastectomy. Eur J Pain. 2017;21(7):1144-53. doi: 10.1002/ejp.1014.
  10. Carlson LE. Mindfulness-based interventions for coping with cancer. Ann N Y Acad Sci. 2016;1373(1):5-12. doi: 10.1111/nyas.13029.
  11. Chirico A, Maiorano P, Indovina P, Milanese C, Giordano GG, Alivernini F, et al. Virtual reality and music therapy as distraction interventions to alleviate anxiety and improve mood states in breast cancer patients during chemotherapy. J Cell Physiol. 2020;235(6):5353-62. doi: 10.1002/jcp.29422.
  12. Comparcini D, Simonetti V, Galli F, Saltarella I, Altamura C, Tomietto M, et al. Immersive and non-immersive virtual reality for pain and anxiety management in pediatric patients with hematological or solid cancer: a systematic review. Cancers (Basel). 2023;15(3):985. doi: 10.3390/cancers15030985.
  13. van Oorsouw R, Oerlemans A, van Oorsouw G, van den Boogaard M, van der Wees P, Koenders N. Patients' lived body experiences in the intensive care unit and beyond - a meta-ethnographic synthesis. Physiother Theory Pract. 2023:1-33. doi: 10.1080/09593985.2023.2239903.
  14. Sengüla S, Derelib M. Does instruction of “Integers” subject with cartoons effect students’ mathematics anxiety? Procedia Social and Behavioral Sciences. 2010;2(2):2176-80. doi:10.1016/j.sbspro.2010.03.302.
  15. Lee J, Lee J, Lim H, Son JS, Lee JR, Kim DC, et al. Cartoon distraction alleviates anxiety in children during induction of anesthesia. Anesth Analg. 2012;115(5):1168-73. doi: 10.1213/ANE.0b013e31824fb469.
  16. İnangil D, Şendir M, Büyükyılmaz F. Efficacy of cartoon viewing devices during phlebotomy in children: a randomized controlled trial. J Perianesth Nurs. 2020;35(4):407-12. doi: 10.1016/j.jopan.2020.01.008.
  17. van der Heijden MJE, Mevius H, van der Heijde N, van Rosmalen J, van As S, van Dijk M. Children listening to music or watching cartoons during ER Procedures: A RCT. J Pediatr Psychol. 2019;44(10):1151-62. doi: 10.1093/jpepsy/jsz066.
  18. Landolt MA, Marti D, Widmer J, Meuli M. Does cartoon movie distraction decrease burned children's pain behavior? J Burn Care Rehabil. 2002;23(1):61-5. doi: 10.1097/00004630-200201000-00013.
  19. Inan G, Inal S. The impact of 3 different distraction techniques on the pain and anxiety levels of children during venipuncture: a clinical trial. Clin J Pain. 2019;35(2):140-7.
  20. Guinot Jimeno F, Mercadé Bellido M, Cuadros Fernández C, Lorente Rodríguez AI, Llopis Pérez J, Boj Quesada JR. Effect of audiovisual distraction on children's behaviour, anxiety and pain in the dental setting. Eur J Paediatr Dent. 2014;15(3):297-302.
  21. Al-Khotani A, Bello LA, Christidis N. Effects of audiovisual distraction on children's behavior during dental treatment: a randomized controlled clinical trial. Acta Odontol Scand. 2016;74(6):494-501.
  22. Ghadimi S, Estaki Z, Rahbar P, Shamshiri AR. Effect of visual distraction on children's anxiety during dental treatment: a crossover randomized clinical trial. Eur Arch Paediatr Dent. 2018;19(4):239-44. doi: 10.1007/s40368-018-0352-x.
  23. Dunbar RIM, Frangou A, Grainger F, Pearce E. Laughter influences social bonding but not prosocial generosity to friends and strangers. PLoS One. 2021;16(8):e0256229. doi: 10.1371/journal.pone.0256229.
  24. Bennett PN, Parsons T, Ben-Moshe R, Weinberg M, Neal M, Gilbert K, et al. Laughter and humor therapy in dialysis. Semin Dial. 2014;27(5):488-93.
  25. Brodaty H, Low LF, Liu Z, Fletcher J, Roast J, Goodenough B, et al. Successful ingredients in the SMILE study: resident, staff, and management factors influence the effects of humor therapy in residential aged care. Am J Geriatr Psychiatry. 2014;22(12):1427-37. doi: 10.1016/j.jagp.2013.08.005.
  26. Bennett PN, Parsons T, Ben-Moshe R, Neal M, Weinberg MK, Gilbert K, et al. Intradialytic Laughter Yoga therapy for haemodialysis patients: a pre-post intervention feasibility study. BMC Complement Altern Med. 2015;15:176. doi: 10.1186/s12906-015-0705-5.
  27. Savage BM, Lujan HL, Thipparthi RR, DiCarlo SE. Humor, laughter, learning, and health! A brief review. Adv Physiol Educ. 2017;41(3):341-7. doi: 10.1152/advan.00030.2017.
  28. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-7. doi: 10.1001/archinte.166.10.1092.
  29. Rao S, Prasad K, Dinesh S, Crasta A, Naik L, George A, et al. Mitigation of injection-induced pain using 10% lidocaine spray: An observational study with cancer patients. Int J Appl Res 2017; 3(6): 253-7.
  30. Yumul R, Ahdout J, Goodman A, Elvir-Lazo OL, Conte AH, Cook GA, et al. Assessment of preoperative anxiety using visual facial anxiety scale: an alternative to the verbal rating scale?. Medical Research Archives. 2015;2(2). doi: 10.18103/mra.v0i4.281.
  31. ICMR Guidelines 2017. National Ethical Guidelines For Biomedical And Health Research Involving Human Participants. Published by: Indian Council of Medical Research, New Delhi 110 029 (icmr.nic.in). ISBN: 978-81-910091-94. Available at: https://www.indiascienceandtechnology.gov.in/sites/default/files/file-uploads/guidelineregulations/1527507675_ICMR_Ethical_Guidelines_2017.pdf
  32. 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. English. doi: 10.1159/000497234.
  33. Manninen S, Tuominen L, Dunbar RI, Karjalainen T, Hirvonen J, Arponen E, et al. Social laughter triggers endogenous opioid release in humans. J Neurosci. 2017;37(25):6125-31. doi: 10.1523/JNEUROSCI.0688-16.2017.
  34. Umezawa S, Higurashi T, Uchiyama S, Sakai E, Ohkubo H, Endo H, et al. Visual distraction alone for the improvement of colonoscopy-related pain and satisfaction. World J Gastroenterol. 2015;21(15):4707-14. doi: 10.3748/wjg.v21.i15.4707.
  35. Bentsen B, Svensson P, Wenzel A. Evaluation of effect of 3D video glasses on perceived pain and unpleasantness induced by restorative dental treatment. Eur J Pain. 2001;5(4): 373-8.
  36. Elmali H, Balci Akpinar R. The effect of watching funny and unfunny videos on postsurgical pain levels. Complement Ther Clin Pract. 2017;26:36-41.
  37. Rajeswari SR, Chandrasekhar R, Vinay C, Uloopi KS, RojaRamya KS, Ramesh MV. Effectiveness of cognitive behavioral play therapy and audiovisual distraction for management of preoperative anxiety in children. Int J Clin Pediatr Dent. 2019; 12(5):419-22. doi: 10.5005/jp-journals-10005-1661.
  38. Canbulat N, Inal S, Sönmezer H. Efficacy of distraction methods on procedural pain and anxiety by applying distraction cards and kaleidoscope in children. Asian Nurs Res. 2014;8(1):23-8. doi: 10.1016/j.anr.2013.12.001.
  39. Sander Wint S, Eshelman D, Steele J, Guzzetta CE. Effects of distraction using virtual reality glasses during lumbar punctures in adolescents with cancer. Oncol Nurs Forum. 2002; 29(1):E8–15. doi: 10.1188/02.ONF.E8-E15.
  40. Kuru N, Kublay G. The effect of laughter therapy on the quality of life of nursing home residents. J Clin Nurs. 2017; 26(21-22):3354-62. doi: 10.1111/jocn.13687.
  41. Ganz FD, Jacobs JM. The effect of humor on elder mental and physical health. Geriatr Nurs. 2014;35(3):205-11. doi: 10.1016/j.gerinurse.2014.01.005.
  42. Rotton J, Shats M. Effects of state humor, expectancies, and choice on postsurgical mood and self-medication: a field experiment. J Appl Soc Psychol. 1996;26(20):1775-94. doi: 1111/j.1559-1816.1996.tb00097.x.
  43. Weisenberg M, Raz T, Hener T. The influence of film-induced mood on pain perception. 1998;76(3):365-75. doi: 10.1016/S0304-3959(98)00069-4.
  44. Lebowitz KR, Suh S, Diaz PT, Emery CF. Effects of humor and laughter on psychological functioning, quality of life, health status, and pulmonary functioning among patients with chronic obstructive pulmonary disease: a preliminary investigation. Heart Lung. 2011;40(4):310-9. doi: 10.1016/j.hrtlng.2010.07.010.
  45. You ES, Choi YH. The effects of laughter therapy on pain and anxiety among patients with postmastectomy. J East-West Nurs Res. 2012;18(1):47-52.
  46. 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. doi: 10.1007/s00520-013-2084-0.
  47. Cha MY, Hong HS. Effect and path analysis of laughter therapy on serotonin, depression and quality of life in middle-aged women. [Article in Korean] J Korean Acad Nurs. 2015;45(2):221-30. doi: 10.4040/jkan.2015.45.2.221.
  48. Akimbekov NS, Razzaque MS. Laughter therapy: A humor-induced hormonal intervention to reduce stress and anxiety. Curr Res Physiol. 2021;4:135-8. doi: 10.1016/j.crphys.2021.04.002.