Journal of Korean Biological Nursing Science

Korean society of Biological Nursing Science (한국기초간호학회)
권호 표지
DOI QR코드

DOI QR Code

Effects of a forest therapy camp on cancer survivors' stress, mood and natural killer cells in Korea

  • Received : 2024.04.25
  • Accepted : 2024.07.29
  • Published : 2024.08.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study investigated changes in psychological and physiological indices in cancer survivors who participated in a forest therapy camp in Korea. Methods: A total of 37 cancer survivors (19 and 18 in the experimental and control groups, respectively) participated in this study. Over a 2-night and 3-day period, the participants in the experimental group took part in a forest therapy camp that included activities such as gymnastics, walking, five-senses experiences, and meditation. Both groups completed self-report questionnaires that measured their stress levels and profile of mood states, both before and after the forest therapy camp. Blood samples were collected to measure the levels of cortisol, serotonin, and natural killer (NK) cells. Results: After the forest therapy camp, the experimental group exhibited reduced stress levels (p = .031) and a significant improvement in total mood disturbance (p = . 047) when compared with the control group. The level of serotonin also significantly increased (p < .001). However, in contrast to the prediction, a significant increase in cortisol was noted in the experimental group relative to the control group (p = .016). Moreover, no significant difference in NK cells was noted between the two groups. Conclusion: Forest therapy can be easily applied to cancer survivors. The positive psychological effects of the forest therapy camp were confirmed by improvements in stress and mood states and the increased level of serotonin in forest therapy camp participants. However, there is a need for a follow-up evaluation of cortisol and NK cells due to the absence of significant between-group differences.

Keywords

Acknowledgement

This work was supported by the National Research Foundation of Korea (NRF) grant funded (NRF-2019R1F1A1060253).

References

  1. Olson ERT, Olson AA, Driscoll M, Vermeesch AL. Nature-based interventions and exposure among cancer survivors: a scoping review. International Journal of Environmental Research and Public Health. 2023;20(3):2376. https://doi.org/10.3390/ijerph20032376 
  2. Korea Central Cancer Registry, National Cancer Center. Annual report of cancer statistics in Korea in 2021 [Internet]. Goyang: Ministry of Health and Welfare; 2021 [cited 2024 Jul 5]. Available from: https://www.ncc.re.kr/cancerStatsView.ncc bbsnum= 678&searchKey= total&searchValue= &pageNum= 1
  3. 3.Kim D, Kim HL, Yang DW, Kang E, Kim J, Bae EY. Qualitative study of cancer survivors' needs related to survival stages. Health and Social Welfare Review. 2019;39(4):356-395. http://doi.org/10.15709/hswr.2019.39.4.356 
  4. den Bakker CM, Schaafsma FG, Huirne JAF, Consten ECJ, Stockmann HBAC, Rodenburg CJ, et al. Cancer survivors' needs during various treatment phases after multimodal treatment for colon cancer - is there a role for eHealth? BMC Cancer. 2018;18(1):1207. https://doi.org/10.1186/s12885-018-5105-z 
  5. Chae YJ, Park JS. A comparison of symptoms, depression, and quality of life according to stages of survivorship in lung cancer patients. Asian Oncology Nursing. 2017;17(2):79-86. https://doi.org/10.5388/aon.2017.17.2.79 
  6. Yi JC, Syrjala KL. Anxiety and depression in cancer survivors. Medical Clinics of North America. 2017;101(6):1099-1113. https://doi.org/10.1016/j.mcna.2017.06.005 
  7. Park KJ, Shin CS, Kim DS. Interpretation of the forest therapy process and effect verification through keyword analysis of literature on forest therapy. Journal of Korean Society of Forest Science. 2021;110(1):82-90. https://doi.org/10.14578/jkfs.2021.110.1.82 
  8. Park BJ. Healing forest. Society for Forests & Culture. 2021;248-264.
  9. Miyazaki Y, Lee J, Park BJ, Tsunetsugu Y, Matsunaga K. Preventive medical effects of nature therapy. Japanese Journal of Hygiene. 2011;66(4):651-656. https://doi.org/10.1265/jjh.66.651 
  10. Lee J, Li Q, Tyrvainen L, Tsunetsugu Y, Park BJ, Kagawa T, et al. Nature therapy and preventive medicine. In: Maddock J, editor. Public health: social and behavioral health. Rijeka: InTech; 2012. p. 325-350. http://doi.org/10.5772/37701
  11. Song C, Lee J, Park BJ. Physiological and psychological effects of walking around and viewing a lake in a forest environment. Journal of Korean Forest Society. 2015;104(1):140-149. https://doi.org/10.14578/jkfs.2015.104.1.140 
  12. Shin CS, Choi JH, Lee YH, Cho TH, Lee SJ, Lee IS, et al. Establishment and invigoration of the forest therapy - forest as a healthcare resource. Final report. Daejeon: Korea Forest Service; 2018 Feb. Report No.: 2012080A00-1217-AA03. https://doi.org/10.23000/TRKO201800000074
  13. Li Q, Kawada T. Effect of forest therapy on the human psycho-neuro-endocrino- immune network. Japanese Journal of Hygiene. 2011;66(4):645-650. https://doi.org/10.1265/jjh.66.645 
  14. Lee BK, Lee HH. A study on the effects of human physiology after forest phytoncide therapy. Journal of Naturopathy. 2012;1(1):14-20. 
  15. Song JH, Cha JG, Lee CY, Choi YS, Yeon PS. Effects of forest healing program on stress response and spirituality in female nursing college students and there experience. Journal of the Korean Institute of Forest Recreation. 2014;18(1):109-125. https://doi.org/10.34272/FOREST.2014.18.1.010 
  16. Kim H, Lee YW, Ju HJ, Jang BJ, Kim YI. An exploratory study on the effects of forest therapy on sleep quality in patients with gastrointestinal tract cancers. International Journal of Environmental Research and Public Health. 2019;16(14):2449. https://doi.org/10.3390/ijerph16142449 
  17. Choi YH, Ha YS. The effectiveness of a forest-experience-integration intervention for community dwelling cancer patients' depression and resilience. Journal of Korean Academy of Community Health Nursing. 2014;25(2):109-118. http://doi.org/10.12799/jkachn.2014.25.2.109 
  18. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behavior Research Methods. 2009;41(4):1149-1160. https://link.springer.com/article/10.3758/BRM.41.4.1149 
  19. Jang SJ. Standardization of health statistics data collection and measurement. Seoul: Gyechuk Munhwasa; 2000. p. 92-143.
  20. Yeun EJ, Shin-Park KKB. Verification of the profile of mood states-brief: cross-cultural analysis. Journal of Clinical Psychology. 2006;62(9):1173-1180. https://doi.org/10.1002/jclp.20269 
  21. Park CE. Effects of forest stress management program on middle aged women's physio-psychological improvement [dissertation]. Cheongju: Chungbuk National University; 2019. p. 31-81.
  22. Svenningsson P, Chergui K, Rachleff I, Flajolet M, Zhang X, El Yacoubi M, et al. Alterations in 5-HT1B receptor function by p11 in depression-like states. Science. 2006;311(5757):77-80. https://doi.org/10.1126/science.1117571 
  23. Park BJ, Shin CS, Shin WS, Chung CY, Lee SH, Kim DJ, et al. Effects of forest therapy on health promotion among middle-aged women: focusing on physiological indicators. International Journal of Environmental Research and Public Health. 2020;17(12):4348. http://doi.org/10.3390/ijerph17124348 
  24. Han MA. Stress and depressive symptoms in cancer survivors and their family members: Korea community health survey, 2012. International Journal of Environmental Research and Public Health. 2017;14(9):999. https://doi.org/10.3390/ijerph14090999 
  25. Kim JS, Kim MJ, Min J, Hwang S, Yu J, Jeon Y. Effect of forest therapy program on stress and physical health promotion of forest fire victims. Journal of Environmental Science International. 2020;29(9):915-924.  https://doi.org/10.5322/JESI.2020.29.9.915
  26. Lee SJ, Jin DL, Kim YA, Seo HJ, Yoon SJ. How should the healthcare system support cancer survivors? Survivors' and health professionals' expectations and perception on comprehensive cancer survivorship care in Korea: a qualitative study. BMC Cancer. 2023;23:1255. https://doi.org/10.1186/s12885-023-11736-y 
  27. Crowder SL, Rozen E, Stern M, Carson TL. Lifestyle interventions with mind-body or stress-management practices for cancer survivors: a rapid review. International Journal of Environmental Research and Public Health. 2023;20(4):3355. https://doi.org/10.3390/ijerph20043355 
  28. Ochiai H, Ikei H, Song C, Kobayashi M, Miura T, Kagawa T, et al. Physiological and psychological effects of a forest therapy program on middle-aged females. International Journal of Environmental Research and Public Health. 2015;12(12):15222-15232. https://doi.org/10.3390/ijerph121214984 
  29. Park CE, Kim DJ, Park KS, Shin CS, Kim YH. Effects of yoga and meditation-focused forest healing programs on profile of mood states (POMS) and stress response of adults. Korean Journal of Environment and Ecology. 2018;32(6):658-666. https://doi.org/10.13047/kjee.2018.32.6.658 
  30. Ahn J, Schatzkin A, Lacey JV, Albanes D, Ballard-Barbash R, Adams KF, et al. Adiposity, adult weight change, and postmenopausal breast cancer risk. Archives of Internal Medicine. 2007;167(19):2091-2102. https://doi.org/10.1001/archinte.167.19.2091 
  31. Nielsen NR, Gronbaek M. Stress and breast cancer: a systematic update on the current knowledge. Nature Clinical Practice Oncology. 2006;3(11):612-620. https://doi.org/10.1038/ncponc0652 
  32. Archer JA, Hutchison IL, Dorudi S, Stansfeld SA, Korszun A. Interrelationship of depression, stress and inflammation in cancer patients: a preliminary study. Journal of Affective Disorders. 2012;143(1-3):39-46. https://doi.org/10.1016/j.jad.2012.05.023 
  33. Kim JS. Return-to-work experience of breast cancer survivors: a qualitative study based on grounded theory approach [dissertation]. Seoul: Yonsei University; 2016. p. 100-108.
  34. Hansen MM, Jones R, Tocchini K. Shinrin-yoku (forest bathing) and nature therapy: a state-of-the-art review. International Journal of Environmental Research and Public Health. 2017;14(8):851. https://doi.org/10.3390/ijerph14080851 
  35. Lee J, Park BJ, Tsunetsugu Y, Kagawa T, Miyazaki Y. The restorative effects of viewing real forest landscapes, based on a comparison with urban landscapes. Scandinavian Journal of Forest Research. 2009;24(3):227-234. https://doi.org/10.1080/02827580902903341 
  36. Park SN. A study on anti-stress effect of phytoncides [dissertation]. Daejeon: Daejeon University; 2016. p. 27-91.
  37. Oh B, Lee KJ, Zaslawski C, Yeung A, Rosenthal D, Larkey L. Health and well-being benefits of spending time in forests: systematic review. Environmental Health and Preventive Medicine. 2017;22(1):71. https://doi.org/10.1186/s12199-017-0677-9 
  38. Cooper MA, Fehniger TA, Caligiuri MA. The biology of human natural killer-cell subsets. Trends in Immunoly. 2001;22(11):633-640. https://doi.org/10.1016/s1471-4906(01)02060-9 
  39. Park JY. Relationship between stress and quality of life of family caregivers of patient with lung cancer. Asian Oncology Nursing. 2010;10(2):129-136. https://doi.org/10.5388/jkon.2010.10.2.129 
  40. Lee SJ. The effect of resilience of middle-aged women on social support, self-esteem and depression [dissertation]. Seoul: Seoul Venture University; 2018. p. 154-160.