It may seem strange to see “humor” and “cancer” together in the title of this article, but they are meant to “fit” together during certain times in which a patient is dealing with a serious diagnosis like cancer. You may be thinking, “That’s impossible. There is nothing funny about cancer. Period.” And certainly, a diagnosis of cancer is very serious. The treatment for the disease is very daunting and not to be taken lightly. However, we also know from history, even centuries ago, that medical doctors back then recognized the value of humor when dealing with a serious illness.

There is no universally accepted definition of humor. Yet it can fill a dynamic role within a healthcare provider-patient relationship. As it relates to oncology care, perhaps a useful definition is the one created by the Association for Applied and Therapeutic Humor, which defines it as “any intervention that promotes health and wellness by stimulations of a playful discovery, expression, and appreciation of the absurdity or incongruity of life’s situation. This intervention may enhance health or be used as a complementary treatment of illness to facilitate healing or coping, whether physical, emotional, cognitive, or spiritual.”1

“Laughter is the shortest distance between two people.”  —Victor Borge

Humor and laughter are actually fundamental elements of human communication that are used across our entire lifespan. The understanding of humor, humor production (such as joking), and the actual functionality of humor (using it as a coping strategy) have evolved over the years and is essentially determined by cognitive, verbal, and social abilities.2

Even if we look at our own life experiences associated with laughter, we see something significant happening over time. It is considered to be a hard-wired response that manifests itself early—during the first four months of life—regardless of culture or native language. It truly is a universal language. At approximately eight months, infants have learned how to make others laugh.3,4

This is not new information. In the 4th century BC, Aristotle said that the first laugh marked the infant’s transition to humanness and served as primary evidence of the infant having acquired a soul. Later, in 1872, Charles Darwin hypothesized that laughter served as a social signal of mere happiness or joy. When he wrote, “The Expression of the Emotions in Man and Animals,” he meticulously described witnessing his own infant son laughing for the first time.5 Unfortunately, there was a very long gap between this research and learning more about laughter and its benefits for people today.

“The art of medicine consists of keeping the patient amused while nature heals the disease.” —Voltaire

Humor contributes to people’s health in general. It fosters muscle relaxation and results in a reduction of stress hormones. Laughter also promotes beneficial physiological changes and an overall sense of well-being. It can even have long-lasting effects that strengthen the immune system. To explain it scientifically, it decreases the number of suppressor/cytotoxic T-cells and increases the number of circulating T-help/inducer cells in peripheral blood, and enhances spontaneous lymphocyte blastogenesis as well as cytokines.6

Humor also has the power to relieve stress associated with the disease and its illness.7,8 Research published in the Journal of Clinical Oncology some years ago demonstrated that 64% of participants, all of whom were terminally ill, felt humor enabled them to alter their perceptions of situations that would otherwise be overwhelming. Additionally, 85% described humor as empowering “hope,” which was important in enabling them to face realities of everyday existence.9,10

Additionally, it serves as a psychological defense mechanism, which is beneficial in the setting of oncology care. The use of humor allows patients to psychologically distance themselves from their own death, while simultaneously enabling an acknowledgement of their terminal condition.11,12 Humor has the ability to improve pain thresholds, reduce stress, and promote general wellness.13 If we think about it, grief is the counterpart to laughter. It is unwise, however, to use excessive humor; this goes for both the oncologist as well as the patient. Insensitive joking is really offensive.14,15

Another research study demonstrated that when 97% of oncology specialists used humor in the clinical setting, 83% reported a positive effect among their patients with incurable cancer.16

There is even a Physician-Patient Humor Rating Scale that is in use to measure the impact of laughter on patient care and the improved communication between patients and their doctors.17

“Life does not cease to be funny when people die anymore than it ceases to be serious when people laugh.” —George Bernard Shaw

One of my metastatic breast cancer patients who was nearing end of life, badly wanted to go trick-or-treating with her daughter and 4-year-old grandson. She was quite ill. I called her the day after Halloween to see if she joined her family in her wheelchair. She did, and said, “I didn’t even need a costume because when I woke up yesterday I was jaundiced. So, I guess God turned me into a jack-o’-lantern. She died two days later.

On a personal note, I was a serious person since childhood, and for good reasons, associated with childhood traumas I experienced. I was witty, but never shared any of my funny thoughts. I remained serious until I was diagnosed with breast cancer myself 29 years ago. I was in my 30s. My friends, including some colleagues, avoided me once they heard of my diagnosis. My husband learned they were very distraught and afraid of upsetting me. He told them that I “needed them. NOW.”

Still the phone didn’t ring, until I sent out adoption notices that I had gotten my breast prosthesis following my mastectomy surgery and had decided to give her a name: “Betty Boob.” Then coworkers and friends called and said, “How are you and Betty doing?” One friend mailed her a gift! It was a ceramic Christmas ornament in the shape of a baby bottle that read: “Betty Boob’s 1st Christmas 1992.”

Our young daughter was the catalyst for my husband and I to find our sense of humor and use it daily. When first diagnosed, she asked me two questions I expected to hear, based on feedback I had gotten from cancer patients I cared for over the decades: “Mommy, are you going to die?” And, “Mommy did you get cancer because you had me?” Then she asked me questions I had no pre-rehearsed answer for: “Will the doctor let you bring your breast home to keep? After all, it isn’t his, it’s yours. You can put it on the mantle in one of daddy’s big pickle jars and when you are sad you can go and look at it.”

When I told my husband, he said he didn’t have a pickle jar big enough to hold my 44DD. Then she asked, “Will the doctor take your right breast and move it to the middle, because if he doesn’t, you will lean to the right when you walk.” I showed her in a catalog what a breast prosthesis looked like and that I would be wearing a mastectomy bra that had pockets in it to hold the prosthesis in place. She responded, “A bra with a pocket! What a clever thing! Whenever you go to the ATM machine to take out money you always worry that someone will steal it from you. So, you can put it in one of those mastectomy pockets, then no one can get to it!”

What she unknowingly did for us, because to her these questions were all serious, was help us to find our sense of humor. And when I needed a second mastectomy two years later, I contacted friends and colleagues and said, “We learned today that Betty Boob will be getting a roommate and we need your help in selecting the best name for her.”18 For the past 29 years, I have found something funny to laugh about related to my cancer every day, and plan to continue this approach to my survivorship care for the rest of my life. My humor and wit are “out there” now, in books, articles, and even in stand-up comic speaking engagements across the country.

When in the clinic or speaking to a patient on the phone, if I can’t get my breast cancer patient, including those with metastatic disease, to laugh, I feel that I have failed her.

References:

1. Joshua AM, Cotroneo A, Clarke S. “Humor and Oncology.” Journal of Clinical Oncology. Vol 23. Issue 3. 2005.

2. Falkenberg. “Development of Laughter and Humour Throughout the Lifespan.” Z Gerontol Geriatrics. 43(1):25-30. Feb 2010.

3. Mileault G. “Laughter Matters.” Science Am Mind. May-June; 28(3):33-37. 2017.

4. Mileault G, Sparrow J, Poutre M, Perdue B, Macke L. “Infant Humor Perception from 3 to 6 Months and Attachment at One Year.” Infant Behavior Development. Dec;35(4):797-802. 2012.

5. Mileault G. “Laughter Matters.” Science Am Mind. May-June;28(3):33-37. 2017.

6. Mayr B. “Interactions Between the Immune System and the Pyche.” Tierarzztl Prax Ausg K Kleintiere. July;26(4):230-235. 1998.

7. Seawood BL. “Humor’s Healing Potential.” Health Prog. April;73(3):66-70. 1992.

8. Savage BM, Lujan HL, Thipparthi RR, DiCarol SE. “Humor, Laughter, Learning, and Health! A Brief Review.” Adv Physiol Educ. Sept 1;41(3):341-34. 2017.

9. Herth K. “Contributions of Humor as Perceived by the Terminally Ill.” Am J Hosp Care 7:36,1990-40.

10. Joshua AM, Cotroneo A, Clarke S. “Humor and Oncology.” Journal of Clinical Oncology. Vol 23. Issue 3. 2005.

11. Langley-Evans A, Payne S. “Light-hearted Death Talk in a Palliative Day Care Context.” J Adv Nurs 26:1091,1997-1097.

12. Joshua AM, Cotroneo A, Clarke S. “Humor and Oncology.” Journal of Clinical Oncology. Vol 23. Issue 3. 2005.

13. Chritie W, Moore C. “The Impact of Humor on Patients with Cancer.” Clin J Oncol Nurs. April;9(2):211-218. 2005.

14. Joshua AM, Cotroneo A, Clarke S. “Humor and Oncology.” Journal of Clinical Oncology. Vol 23. Issue 3. 2005.

15. Penson RT, Partridge RA, Rudd P, Seiden MV, Nelson JE, Chabner BA, Lynch Jr TJ. “Laughter: The Best Medicine?” Oncologist. Sept:10(8):651-660. 2005.

16. Buiting HM, de Bree R, Brom L, Mack JW, can den Brekel MWM. “Humour and Laughing in Patients with Prolonged Incurable Cancer: an Ethnographic Study in a Comprehensive Cancer Centre.” Ual Life Res. Sept;29(9):2425-2434. 2020.

17. Zoinierek KBH, DiMatteo MR, Mondala MM, Zhang Z, Martin LR, Messiha AH. “Development and Validation of the Physician-Patient Humor Rating Scale.” J Health Physchol. Nov;14(8):1163-1173. 2009.

18. Shockney L. “Stealing Second Base.” Jones & Bartlett Learning. MA. 2007.

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