Humor and Oncology Anthony M. Joshua, Angela Cotroneo, and Stephen Clarke INTRODUCTION Most clinical oncologists face the general perception that their specialty is constantly both humorless and depressing. The truth, as many medical oncologists are aware, is that the specialty offers a great deal of emo- tional variability. Anecdotally, the use of hu- mor is widespread in the oncologist-patient relationship and in patient literature. Hu- mor serves many roles for the patient, their family, and the treating physician. Limited evidence suggests that the use of humor is becoming more widespread within patient- based literature; the profession has largely ignored this aspect of cancer care. Definition of Humor “Laughter may not always add years to your life, but it will add life to your years.” —Author unknown There is no universally accepted defini- tion of humor, and certainly not one that can reflect the subtleties in a dynamic doctor- patient relationship. In fact, the word “humor” can be used to refer to a stimulus (eg, comedy film), a mental process (eg, per- ception or creation of amusing incongruities), or a response (such as laughter or exhilara- tion). 1 In the context of oncologic care, a use- ful definition is provided by the Association for Applied and Therapeutic Humor, 2 which defines therapeutic humor as “any interven- tion that promotes health and wellness by stimulation of a playful discovery, expression, or appreciation of the absurdity or incongruity of life’s situations. This intervention may en- hance health or be used as a complementary treatment of illness to facilitate healing or cop- ing, whether physical, emotional, cognitive, or spiritual.” Classification of Humor Practically, the classification of humor in oncology falls into two broad categories. Firstly, the vast majority being the general repartee, both unplanned and spontaneous, during a conversation occurring between an oncology professional and a patient or their family. Secondly, there is a large body of “pre- pared” humor, often found in patient litera- ture that is generally designed to make patients see the lighter side of aspects of cancer care. What Is the Evidence to Date? In one of the few studies examining the issue of humor in the terminally ill, data were collected from a structured interview of 14 terminally ill adults, aged 32 to 77 years, all of whom were cognitively alert with a prognosis of 6 months, at maximum. Of these, 85% indicated that humor would be useful at this time in their illness, but only 14% described any humor in their lives. Every participant described humor in terms of its importance as a mechanism for social bonding. More than half (64%) felt that hu- mor enabled them to alter their perceptions of situations that would otherwise be over- whelming. Finally, 85% of participants de- scribed humor as empowering “hope,” which was important in enabling them to face reali- ties of everyday existence. 3 The occasional use of humor has also recently been found to be among the ten highest rated “hope-giving” be- haviors demonstrated by oncologists, 4 as ranked by 126 patients with metastatic cancer. Why Would Patients Benefit From Humor? Humor, both spontaneous and planned, is generally recognized to have three direct From the Department of Medical Oncol- ogy, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Social Work, Royal Prince Alfred Hospital, Sydney; and Central Clinical School, University of Sydney, Sydney, Australia. Submitted September 7, 2004; accepted September 17, 2004. Authors’ disclosures of potential con- flicts of interest are found at the end of this article. Address reprint requests to Anthony M. Joshua, MBBS, Department of Medical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; e-mail: anthony.joshua@doctor.com. © 2005 by American Society of Clinical Oncology 0732-183X/05/2303-645/$20.00 DOI: 10.1200/JCO.2005.09.064 JOURNAL OF CLINICAL ONCOLOGY THE ART OF ONCOLOGY: When the Tumor Is Not the Target VOLUME 23  NUMBER 3  JANUARY 20 2005 645 Downloaded from jco.ascopubs.org on December 22, 2015. For personal use only. No other uses without permission. Copyright © 2005 American Society of Clinical Oncology. All rights reserved.