The deep breathing exercises are effective in reducing the level of anxiety in patients receiving radiation therapy due to cancer.

1. EFFECTIVENESS OF DEEP BREATHING
EXERCISE TO REDUCE ANXIETY
AMONG PATIENTS RECEIVING
RADIATION THERAPY FOR CANCER
Presented by
Selvaraj.P
Professor cum HOD
Department of Psychiatric Nursing
Shanmuga College of Nursing
Salem-7

2. INTRODUCTION
• Cancer is characterized by the uncontrolled and
unregulated growth of cells. Radiation therapy is one of the
oldest methods of cancer treatment.
• Approximately 60% of the patient with cancer receive
radiation therapy at some point during treatment
( Halperin, Wazer, Perez, et al.,2013)
• Anxiety is a major issue in the cancer patient population
2/18/2022 Selvaraj.P@SCON

3. • Cancer patients undergoing radiotherapy represent an even
more fragile population that is associated with increased
levels of anxiety and depression that is often under-
detected and undertreated (Stiegelis et al., 2014)
• A review of RT studies indicated 10% to 20% of patients
showed clinically significant levels of anxiety at the
initiation of RT ( Harrison, et al.,2017)
2/18/2022 Selvaraj.P@SCON

4. • Not only pharmacological but also complementary / non-
pharmacological methods are used to prevent, reduce and
treat cancer related anxiety. Some of these methods
include exercise, acupuncture, massage, acupressure,
cognitive behavioral therapy, breathing exercises, nutrition
counseling, awareness-based stress reduction and
yoga(Balneaves, et al.,2017)
• Breathing exercises, which are carried out with slow
breathing, are effective in ensuring relaxation and relieving
stress and associated fatigue(Jerath R, Beveridge C, Barnes
V.,2019)
2/18/2022
Selvaraj.P@SCON

5. • The oncology nurse plays a key role in the assessment,
prevention, mitigation, and follow-up of cancer-related
anxiety, and in using evidence-based practice encouraging
the use, of non-pharmacological techniques that ensure
patient control and stress control.
• Well-designed clinical trials are needed to assess the
contribution of breathing exercises to the recovery process
of cancer patients.
• Therefore, this research was conducted
2/18/2022 Selvaraj.P@SCON

6. STATEMENT OF THE PROBLEM
A study to evaluate the
effectiveness of Deep Breathing
Exercise to reduce Anxiety among
patients receiving radiation therapy
for cancer in a selected hospital in
Salem.
2/18/2022 Selvaraj.P@SCON

7. MATERIALS AND METHODS
• Research approach: Quantitative experimental
• Research Design: Quasi-experimental (Experimental
group and Control group) research design
• Setting: Present study was carried out at a selected
cancer institute in Salem.
• Population: The population of the present study
comprised of patients diagnosed with cancer who
received radiotherapy in the radiation oncology unit of
a selected hospital in Salem.
2/18/2022 Selvaraj.P@SCON

8. • Sample Size: The sample size of the present study
consists of 30 patients (Experimental group-15 and
Control group-15) receiving radiation therapy
• Sampling technique: Non probability convenient
sampling technique.
• Inclusion Criteria
• The patient age group is between 30 to 60 years.
• Both male and female patients
• Ability to communicate effectively
• Patients who are willing to participate in this study.
2/18/2022 Selvaraj.P@SCON

9. • Exclusion criteria
• Patients who cannot follow activities for at least 10-
15 minutes.
• Patients who had previous exposure to deep
breathing exercises.
• A diagnosis of psychotic disease, or significant
cognitive impairment.
• Data Collection tool- Structured interview
questionnaire
• Section-I: Demographic Data
• Section-II: Structured Interview Questionnaire to
assess the level of anxiety
2/18/2022 Selvaraj.P@SCON

10. • Intervention:
Deep breathing exercises were prepared .The
investigator selected advanced inhale-hold-exhale and
4-7-8 techniques. breathing exercises were taught to
the experimental group by the investigator .The
patients were observed performing these exercises
for 10-15 minutes after each radiotherapy session
(28days), accompanied by the investigator in a quiet
room within the radiotherapy unit .
2/18/2022 Selvaraj.P@SCON

11. • Data collection procedure:
• A formal prior written permission was obtained from the
authorities., the investigator identified the eligible samples.
Among them, 30 samples were (among which 15 samples
were experimental group, 15 samples were control group)
selected by using the non-probability convenient sampling
technique.
• Informed written consent was obtained from each sample.
Then the data was collected from control group samples and
then from experimental group samples using structured
interview questioners.
• The maximum time taken by the samples to complete the
tool was 15-20 minutes. Then breathing exercises were taught
to the experimental group by the investigator
• Control Group samples did not receive any intervention.
Then, after 28 days, the post-test was done.
2/18/2022 Selvaraj.P@SCON

12. RESULTS
• SECTION-I: Distribution of Sample Based On Demographic
Variables
• In an experimental group, out of 15 samples,
• 7(46.7%) were 30-40 years old,
• 7(46.7%) of the sample were male and
• 8(53.7%) of the sample were female,
• 7(46.7%) of the sample were Hindu.
• Occupation, 4(26.7%) of the sample were agricultural
workers.
• Education status, 5(33.3%) were primary education.
• Diet, 4(26.7%) of the sample were vegetarian.
• Family history of cancer, 8(53.3%) of the sample were absent.
• Duration of illness, 7(66.7%) of the sample were 1-2 years.
• Regularity of treatment, 13(86.7%) of the sample were
regular
2/18/2022 Selvaraj.P@SCON

13. • In the control group, it shows that out of 15 samples,
• 6(40%) of the samples were 41-50 years old.
• 7(46.7%) of the samples were males,
• 8(53.7%) of the samples were females,
• (73.3%) of the samples were Hindu.
• Occupation, 4(26.7%) of the sample were businesses.
• Education status, 3(20%) were higher secondary.
• Diet, 12(80%) of the sample were non-vegetarian.
• Family history of cancer, 9(60%) of the sample were
absent.
• Duration of illness, 9(60%) of the sample were 1 – 2
years.
• Regularity of treatment, 14(93.3%) of the sample were
regular.
2/18/2022 Selvaraj.P@SCON

14. SECTION-II : Analysis of pre-test and post-test level of anxiety score among
the sample
0
10
20
30
40
50
60
70
80
90
100
Pre-test Post-test Pre-test Post-test
Experimental group Control group
0
3(20%)
0
0
4(26.67%)
7(46.67%)
0
0
5(33.33%)
5(33.33%)
10(66.67%)
10(66.67%)
6(40%)
0
5(33.33%) 5(33.33%)
Percentage
of
samples
LEVEL OF ANXIETY AMONG PATIENT RECEIVING RADIATION THERAPY FOR CANCER
Normal
Mild
Moderate
Severe
2/18/2022
Selvaraj.P@SCON

15. SECTION-III: Compare the mean pre-test and mean post- test anxiety
scores among the sample within experimental and control group.
Group
Pre-test Post test Mean
differe
nce
df
Paired
‘t’ test
Mean SD mean SD
Experimental
group
65.4 13.4 48.6 15.2 16.8 14 12.9*
Control group
71 10 70.3 9.7 0.73 14 1.4NS
Table -1: Mean, SD, mean difference and paired t value of scores on the anxiety among
samples within experimental group and control group.
n1= 15, n2=15
*Significance at p< 0.05 level; NS- Not Significant; t14= 2.15

16. HYPOTHESIS
• Alternate hypothesis H1: The mean post-test anxiety
score is less than the mean pre-test anxiety score
among patients receiving radiation therapy for
cancer
• Statistical hypothesis H01: There is no significant
difference between mean pre-test and mean post-
test anxiety score among patients receiving
radiation therapy for cancer.
2/18/2022 Selvaraj.P@SCON

17. SECTION-IV: Compare the mean pre-test and mean post test scores on
level of anxiety among the sample between experimental and control
Level of
Anxiety
Experimental
group
Control group
df
Unpaire
d ‘t’ test
Mean SD Mean SD
Pre test 65.4 13.4 71 10 28 1.3NS
Post test 48.6 15.2 70.3 9.7 28 4.67*
Table-2: Mean, SD, unpaired t value of pre-test and post-test anxiety
scores among the sample between experimental group and control
group. n1 = 15, n2=1 5
*-Significant at p<0.05 level; NS-not significant; t28 = 2.05

18. SECTION-III: ASSOCIATION OF SELECTED DEMOGRAPHIC VARIABLES WITH MEAN
PRE-TEST ANXIETY SCORE AMONG THE SAMPLE OF EXPERMENTAL GROUP
Demographic
variable
Degree of
freedom
Chi-square value Table value
Age
Gender
Occupation
6
3
15
1.61NS
7.52NS
7.23NS
12.59
7.82
24.99
Table-3: Chi-square value for selected demographic
variables and pre-test level of anxiety score.
n-15
Level of significance = p< 0.05; NS- not significant

19. DISCUSSION
• In this study, an experimental group mean pre-test anxiety
score was 65.4; mean post- test anxiety score was 48.6.
• The mean post- test anxiety score was less than the mean
pre- test score.
• In the control group, the mean pre- test anxiety score was 71
and the mean post -test anxiety score was 70.3.
• The mean post- test anxiety score was lower than the mean
pre- test anxiety score.
• This indicated that deep breathing exercises were effective in
reducing the level of anxiety among the samples.
2/18/2022 Selvaraj.P@SCON

20. • The results of the present study were supported by the
following study
• Dhruva et al. (2012) reported in their studies that
pranayama reduces cancer-related fatigue, increases
sleep quality and reduces anxiety.
• Rajita Devi, Hiranya Kumar Saharia (2016) conducted
the study, The study concludes that deep breathing
exercises are an effective intervention in reducing
fatigue among cancer patients and can be effectively
utilized by oncology nurses to improve quality of life
2/18/2022 Selvaraj.P@SCON

21. • Halkett, G.K.B., O’Connor, M., Aranda, S. et al(2013)
conducted a pilot randomised controlled trial to
determine whether a radiation therapist led psycho-
educational intervention for breast cancer patients
prior to radiotherapy is likely to be effective in reducing
radiotherapy-related concerns, patient anxiety and
depression
• This intervention is likely to be effective in reducing
patient anxiety and concerns and increasing
knowledge.
2/18/2022 Selvaraj.P@SCON

22. CONCLUSION
• The study concludes that deep breathing exercises are
an effective intervention in reducing anxiety among
patients undergoing radiation therapy for cancer and
can be effectively utilized by oncology nurses to
improve the psychological state of the patients.
Continuous research is needed to define the role of
breathing exercises intervention in improving the
patient’s experience by reducing anxiety.
2/18/2022 Selvaraj.P@SCON

23. REFERENCE
1. Halperin, E. C., Brady, L. W., Wazer, D. E., & Perez, C. A.
(2013). Perez & Brady's principles and practice of
radiation oncology. Lippincott Williams & Wilkins.
2. Harrison, H., Birks, M., Franklin, R., & Mills, J. (2017,
January). Case study research: Foundations and
methodological orientations. In Forum qualitative
Sozialforschung/Forum: qualitative social
research (Vol. 18, No. 1, pp. 1-17).
3. Dhruva A, Miaskowski C, Abrams D et al (2012) Yoga
Breathing for Cancer Chemotherapy– Associated
Symptoms and Quality of Life: Results of a Pilot
Randomized Controlled Trial. The Journal Of
Alternatıve And Complementary Medıcıne 18(5):473–
479 doi: 10.1089/acm.2011.0555.
2/18/2022 Selvaraj.P@SCON

24. 3. Rajita Devi1, Hiranya Kumar Saharia.( 2016)
Effectiveness of Programmed Deep Breathing
Exercises On Reducing The Level Of Fatigue During
External Radiation Therapy. J. Evolution Med. Dent.
Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 05/
Issue 38/ May 12,
4. Halkett, G.K.B., O’Connor, M., Aranda, S. et al. Pilot
randomised controlled trial of a radiation therapist-
led educational intervention for breast cancer
patients prior to commencing radiotherapy. Support
Care Cancer 21, 1725–1733 (2013).
https://doi.org/10.1007/s00520-013-1719-5
2/18/2022 Selvaraj.P@SCON

25. 2/18/2022 Selvaraj.P@SCON