Effects of relaxation breathing exercise on fatigue and cortisol level among Indonesian gynecological cancer patients undergoing chemotherapy: a pilot study

Objective: This study aimed to determine the effect of the relaxation breathing exercise (RBE) on fatigue and cortisol levels among Indonesian women with gynecological cancer undergoing chemotherapy. Methods: This pilot study consecutively recruited 44 gynecological cancer patients to receive RBE (22) or usual care (22). Cortisol level was measured before and after completion of the intervention (day 8). Fatigue was measured using the Piper Fatigue Scale (PFS). Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) at the baseline days of the study for days 1, 4, and 8. The obtained data were analyzed using Fisher’s exact test, the independent t-test, and the Mann–Whitney U test. Results: There were significant increases in cortisol levels within the groups, either the intervention or control groups, respectively (P-value = 0.0003 and 0.001). Despite there being no statistical significance between the intervention and control groups, there were noticeable differences in the cortisol levels, indicating the extreme increase in cortisol levels in the control group (Median [IQR1– IQR3]: 2.30 [0.99–9.09]; Min–Max: 0.43–23.38) compared with the intervention group (Median [IQR1–IQR3] = 2.97 [1.26–5.18]; Min–Max = 0.39–6.91). Conclusions: RBE helps prevent a significant increase in cortisol levels that can alleviate fatigue for women with gynecological cancer. Further research was recommended to compare several intervention modalities for fatigue and cancer-related symptom management based on cortisol level changes.