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Effects of an urban forest healing program on cancer-related fatigue in cancer survivors

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Abstract

Purpose

This study aimed to examine the effects of an eight-session structured urban forest healing program for cancer survivors with fatigue.

Background

Cancer-related fatigue (CRF) is a complex and multifactorial common symptom among cancer survivors that limits quality of life (QoL). Although health benefits of forest healing on physiological, physical, and psychological aspect as well as on the immune system have been reported in many studies, there is limited evidence on the efficacy of specialized forest program for cancer survivors.

Method

A single-blinded, pre-test and post-test control group clinical trial was conducted with -75 cancer survivors assigned to either the forest healing group or the control group. The intervention was an eight-session structured urban forest program provided at two urban forests with easy accessibility. Each session consists of three or four major activities based on six forest healing elements such as landscape, phytoncides, anions, sounds, sunlight, and oxygen. Complete data of the treatment-adherent sample (≥ 6 sessions) was used to examine whether sociodemographic, clinical, physiological (respiratory function, muscle strength, balance, 6-min walking test) and psychological (distress, mood state, sleep quality, QoL) characteristics at baseline moderated the intervention effect on fatigue severity at 9 weeks.

Results

Significant time-group interactions were observed muscle strength, balance, 6-min walking test, distress, fatigue, moods, and QoL. The mean difference in fatigue between pre- and post-forest healing program was 9.1 (95% CI 6.2 to 11.9), 11.9 (95% CI 7.6 to 16.1) in moods, and -93.9 (95% CI -123.9 to -64.0) in QoL, showing significant improvements in forest healing group, but no significant improvements in the control group.

Conclusion

This study suggests that a forest healing program positively impacts the lives of cancer survivors, by addressing both physical and psychological challenges associated with CRF.

Trial registration number

KCT0008447 (Date of registration: May 19, 2023)

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Data Availability

The datasets generated during this study are available from the corresponding author upon reasonable request.

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Funding

This research was supported by the ‘R&D’ program for Forest Science Technology (Project No. 2021393A00-2123-0103) provided by Korea Forest Service (Korea Forestry Promotion Institute) and the Gachon University research fund of 2021 (GCU- 202206020001).

Author information

Authors and Affiliations

  1. Department of Nursing, College of Nursing, Gachon University, Hambangmoe-ro 191, Yeonsu-gu, Incheon, Korea

    Kwang-Hi Park, Eun Young Park & Esther Bang

  2. Graduate School, Department of Nursing, College of Nursing, Gachon University, Incheon, Korea

    Kwang-Hi Park, Eun Young Park, Sang Yi Baek & Sieun Lee

  3. Department of Physical Therapy, College of Health Science, Gachon University, Incheon, Korea

    Haneul Lee

  4. Graduate School, Department of Physical Therapy, College of Health Science, Gachon University, Incheon, Korea

    Haneul Lee, Yerim Do & Youngeun Lim

  5. College of Nursing, Kosin University, Busan, Korea

    Ji Hyun Sung

  6. Department of Nursing, College of Medicine, University of Ulsan, Ulsan, Korea

    Min Kyung Song

  7. Department of Nursing, Yeoju Institute of Technology, Yeoju, Korea

    Miyoung An

Authors
  1. Kwang-Hi Park
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  2. Haneul Lee
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Contributions

Kwang-Hi Park, Haneul Lee, Eun Young Park contributed to the purpose of the study and the study design. Haneul Lee, Esther Bang, SangYi Baek, Yerim Do, Sieun Lee, and Youngeun Lim investigated and analyzed data. The first draft of the manuscript was written by Kwaing-Hi Park, Haneul Lee, and JiHyun Sung, and all authors critically reviewed the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kwang-Hi Park.

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Ethics approval

The study protocol was approved by the Institutional Review Board of Gachon University (approval no. 1044396-202103-HR-055-03) and was conducted in accordance with the Declaration of Helsinki.

Informed consent for research involving human participants

Written informed consent was obtained from all the participants.

Conflict of interest

The authors declare no competing interests.

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Park, KH., Lee, H., Park, E.Y. et al. Effects of an urban forest healing program on cancer-related fatigue in cancer survivors. Support Care Cancer 32, 4 (2024). https://doi.org/10.1007/s00520-023-08214-3

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