Clown Intervention on Psychological Stress and Fatigue in Pediatric Patients With Cancer Undergoing Chemotherapy

Abstract

Background Clown intervention has been shown to enhance emotional and behavioral processes, but few studies have comprehensively examined the effectiveness of this practice using biomarkers. Objective The aim of this study was to evaluate the effect of a clown intervention on the levels of psychological stress and cancer-related fatigue in pediatric patients with cancer undergoing chemotherapy. Methods Sixteen patients who met all criteria from a pediatric oncology inpatient unit in a Brazilian comprehensive cancer care hospital participated in this quasi-experimental study. Eight saliva samples were collected, comprising 4 at baseline and 4 after clown intervention (+1, +4, +9, and +13 hours after awakening). Salivary cortisol and α-amylase levels were determined using high-sensitivity enzyme-linked immunosorbent assay kits. Stress and fatigue were measured by the Child Stress Scale-ESI and the PedsQL Multidimensional Fatigue Scale, respectively. Relationships among stress, fatigue, and biomarker levels were investigated using nonparametric statistics. Results In comparison with baseline measurements, the total psychological stress and fatigue levels improved after the clown intervention at the collection time point +4 hours (P = .003 and P = .04, respectively). Salivary cortisol showed a significant decrease after clown intervention at the collection time points +1, +9, and +13 hours (P < .05); however, α-amylase levels remained unchanged. Conclusion These findings provide preliminary evidence that clown intervention merits further study as a way to reduce stress and fatigue in pediatric cancer inpatients, and that self-report and biomarker measures are feasible to collect in this patient group. Implications for Practice Clown intervention as a nonpharmacological intervention may improve stress and fatigue levels in pediatric inpatients with cancer undergoing chemotherapy.

Effectiveness of hospital clowns for symptom management in paediatrics: systematic review of randomised and non-randomised controlled trials

“…Most studies were randomised controlled trials (n=13), and the remaining were non-randomised controlled trials (n=11). Web table 1 summarises the main characteristics of the 24 studies included in the analysis 464748495051525354555657585960616263646566676869. Studies were undertaken in nine different countries, including Italy (n=6),464852576164 Israel (n=7),47555658606267 Brazil (n=3),636669 Portugal (n=2),5068 and one study each from Canada,54 Colombia,65 Denmark,51 Germany,53 South Korea,59 and Spain 49.…”

“…Web table 1 summarises the main characteristics of the 24 studies included in the analysis 464748495051525354555657585960616263646566676869. Studies were undertaken in nine different countries, including Italy (n=6),464852576164 Israel (n=7),47555658606267 Brazil (n=3),636669 Portugal (n=2),5068 and one study each from Canada,54 Colombia,65 Denmark,51 Germany,53 South Korea,59 and Spain 49. All the studies were single centre trials, and most included male and female patients (n=23) 4647484950515253545556575859606163646566676869.…”

“…Studies were undertaken in nine different countries, including Italy (n=6),464852576164 Israel (n=7),47555658606267 Brazil (n=3),636669 Portugal (n=2),5068 and one study each from Canada,54 Colombia,65 Denmark,51 Germany,53 South Korea,59 and Spain 49. All the studies were single centre trials, and most included male and female patients (n=23) 4647484950515253545556575859606163646566676869. Only one study exclusively included male patients62 because the study population included children undergoing outpatient penile surgery.…”

Efficacy of the complementary therapies in the management of cancer pain in palliative care: A systematic review

“…The clinical use and assessment of the potential benefits of the complementary therapies in the treatment of cancer patients has recently increased in both pediatric (18)(19)(20)(21)(22) and adult patients (23)(24)(25)(26) . Among the manipulation practices based on the body, the therapeutic massage stands out as the most commonly used complementary therapy modality (41)(42) .…”

“…The NCCAM categorizes them mainly as: use of natural products; body and mind practices; and body-based manipulation practices (17) . Over the past three decades, the use of CTs has increased considerably both in pediatric patients (18)(19)(20)(21)(22) and in the adult population (23)(24)(25)(26) . However, the efficacy of the CTs for cancer pain management in adults with cancer in palliative care is still a gap in the scientific literature (11) .…”