Hayama, Y., & Inoue, T. (2012). The effects of deep breathing on 'tension-anxiety' and fatigue in cancer patients undergoing adjuvant chemotherapy. Complementary Therapies in Clinical Practice, 18, 94–98.

To investigate the effect of a deep breathing intervention, incorporated within conventional nursing care, on tension-anxiety and fatigue experienced by Japanese women with gynecologic cancer undergoing adjuvant chemotherapy for the first time.

To reduce tension-anxiety and fatigue through deep breathing that incorporated elements of exercise.

The deep breathing intervention was initiated for patients in the intervention group. Each patient received 15 minutes of guidance from the researcher using a DVD and pamphlets. The intervention was performed with nursing assistance pre- and postchemotherapy, with the latter given on the second, fourth, and sixth days. The control group received treatment with the usual chemotherapy and nursing care.

• The study was comprised of 23 women.
• Mean age was 53.6 years (standard deviation [SD] = 9.4 years) in the intervention group and 61.7 years (SD = 9.8 years) in the control group.
• All patients were diagnosed with gynecologic cancers, including uterine (54.5%), ovarian, cervical, and peritoneal carcinomatosis. Cancer stage ranged from I (54.5%) to III.
• Patients were included in the study if they had a recent diagnosis, were postoperative and receiving their first administration of adjuvant chemotherapy, were literate in Japanese, and were willing to participate.
• Patients were excluded if they were younger than 20 years and had received recent psychological treatment (including medication and psychotherapy) and/or recent asthma treatment.

• Single site
• Inpatient
• Osaka, Japan

• Patients were undergoing the active treatment phase of care.
• The study has clinical applicability for late effects and survivorship.

The study used a randomized, controlled trial design.

• Profile of Mood States (POMS)–Short Form (Japanese version):  tension-anxiety and fatigue subscales assessed pre- and posttherapy
• Cancer Fatigue Scale (CFS), subscales of subjective fatigue:  physical, affective, and cognitive assessed pre- and posttherapy

There were no statistically significant differences between groups in terms of age, diagnosis, or cancer clinical stage or treatment type (p > 0.05). Prechemotherapy data showed no significant differences between the intervention and control groups in the previously mentioned measurement tools. The postchemotherapy tension-anxiety scores were lower in the intervention group (p = 0.01). Both groups showed significant reductions in tension-anxiety scores (both p = 0.00). The postchemotherapy physical and total fatigue scores of the intervention group were significantly lower than those of the control group (physical, p = 0.04; total, p = 0.04).

The study demonstrated that the tension-anxiety and fatigue scores of patients undergoing chemotherapy for gynecologic cancers were lowered when the nurses assisted them with deep breathing for a short period in addition to providing conventional nursing care provided pre- and postchemotherapy. The prominent features of the study were that it used a program that combined three deep breathing techniques and was of short duration (10 minutes).

• The study had a small sample size, with less than 30 patients.
• The nurse-to-patient ratio for teaching was 1:1.
• The study was limited to patients with gynecologic cancer and had a limited time period evaluated for fatigue (fatigue can worsen as chemotherapy continues). 
• The study needs to be reproducible in different facilities and with a larger sample size. 
• The study lacked an attentional control.

These are very simple exercises that can be taught to patients and be performed even while they are receiving chemotherapy. In addition to usual nursing care, nurses can contribute to reducing patients’ tension-anxiety and fatigue by assisting them in performing deep breathing.