International Journal of

ADVANCED AND APPLIED SCIENCES

EISSN: 2313-3724, Print ISSN: 2313-626X

Frequency: 12

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 Volume 12, Issue 7 (July 2025), Pages: 100-106

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 Original Research Paper

Effectiveness of the Relax-ATM intervention in reducing anxiety and stress and improving readiness for chemotherapy

 Author(s): 

 Hilman Syarif 1, *, Jufrizal Jufrizal 2, Elka Halifah 3, Novi Afrianti 1, Dewiyuliana Dewiyuliana 1

 Affiliation(s):

  1Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Syiah Kuala, Banda Aceh, Indonesia
  2Department of Emergency Nursing, Faculty of Nursing, Universitas Syiah Kuala, Banda Aceh, Indonesia
  3Department of Maternity Nursing, Faculty of Nursing, Universitas Syiah Kuala, Banda Aceh, Indonesia

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 * Corresponding Author. 

   Corresponding author's ORCID profile:  https://orcid.org/0000-0001-5850-4816

 Digital Object Identifier (DOI)

  https://doi.org/10.21833/ijaas.2025.07.009

 Abstract

Chemotherapy is a common treatment for cancer, but it often leads to significant side effects, including psychological distress such as anxiety and stress, which may reduce patients’ readiness for treatment. Non-pharmacological interventions, including relaxation techniques, have shown promise in managing these effects. This study evaluated the effectiveness of the Relax-ATM intervention package—a combination of Benson relaxation, aromatherapy, and foot massage—in reducing anxiety and stress and enhancing chemotherapy readiness. A quasi-experimental design was used involving 60 breast cancer patients undergoing at least their second chemotherapy cycle at a referral hospital in Aceh Province, Indonesia, between September and October 2024. Participants were divided equally into intervention and control groups. The intervention group received the Relax-ATM package, while the control group received standard care. Results indicated significant reductions in anxiety (mean score: 8.83 ± 2.33 vs. 11.10 ± 3.26, p = 0.003) and stress (14.70 ± 2.17 vs. 18.67 ± 5.29, p = 0.001), as well as significant improvements in physical (8.03 ± 0.62 vs. 7.40 ± 1.01, p = 0.005) and psychological (8.00 ± 0.83 vs. 7.40 ± 1.00, p = 0.014) readiness for chemotherapy in the intervention group. These findings suggest that the Relax-ATM intervention is an effective non-pharmacological approach to improve emotional well-being and treatment preparedness in breast cancer patients undergoing chemotherapy.

 © 2025 The Authors. Published by IASE.

 This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

 Keywords

 Chemotherapy readiness, Anxiety reduction, Stress management, Breast cancer, Non-pharmacological intervention

 Article history

 Received 14 January 2025, Received in revised form 3 June 2025, Accepted 11 June 2025

 Acknowledgment

No Acknowledgment. 

 Compliance with ethical standards

 Ethical considerations

The ethical clearance for this study was approved by the Health Research Ethics Committee of Dr. Zainoel Abidin Hospital (approval letter number 179/ETIK-RSUZA/2023). All participants provided written informed consent prior to participation.

 Conflict of interest: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

 Citation:

 Syarif H, Jufrizal J, Halifah E, Afrianti N, and Dewiyuliana D (2025). Effectiveness of the Relax-ATM intervention in reducing anxiety and stress and improving readiness for chemotherapy. International Journal of Advanced and Applied Sciences, 12(7): 100-106

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 Figures

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 Tables

  Table 1  Table 2  Table 3

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 References (29)

  1. Agung FY, Aprina A, and Astuti T (2020). Effectiveness of foot massage on sleep quality among post-surgical patients in Dr. H Abdul Moeloek Hospital, Lampung-Indonesia. Malahayati International Journal of Nursing and Health Science, 3(2): 94-102.  https://doi.org/10.33024/minh.v3i2.3465    [Google Scholar]
  2. Aragão VM, Lima MMS, Fernandes CDS, Barros LM, Rodrigues AB, and Caetano JÁ (2023). Effects of aromatherapy on anxiety symptoms in women with breast cancer: A systematic review. Texto and Contexto-Enfermagem, 32: e20220132.  https://doi.org/10.1590/1980-265x-tce-2022-0132en    [Google Scholar]
  3. Cahyono HD, Irawaty D, and Adam M (2022). The effect of Benson relaxation application (‘Bens app’) on reducing fatigue in patients with breast cancer undergoing chemotherapy: A quasi-experimental study. Belitung Nursing Journal, 8(4): 304–310.  https://doi.org/10.33546/bnj.1843    [Google Scholar] PMid:37546495 PMCid:PMC10401370
  4. Cui J, Li M, Wei Y, Li H, He X, Yang Q, Li Z, Duan J, Wu Z, Chen Q, Chen B (2022). Inhalation aromatherapy via brain-targeted nasal delivery: Natural volatiles or essential oils on mood disorders. Frontiers in Pharmacology, 13: 860043.  https://doi.org/10.3389/fphar.2022.860043    [Google Scholar] PMid:35496310 PMCid:PMC9041268
  5. Di Nardo P, Lisanti C, Garutti M, Buriolla S, Alberti M, Mazzeo R, and Puglisi F (2022). Chemotherapy in patients with early breast cancer: Clinical overview and management of long-term side effects. Expert Opinion on Drug Safety, 21(11): 1341–1355.  https://doi.org/10.1080/14740338.2022.2151584    [Google Scholar] PMid:36469577
  6. Ebrahimi B and Adib-Hajbaghery M (2022). Effect of Benson’s relaxation technique on anxiety in family caregivers of patients with cancer: A randomized controlled trial. Nursing and Midwifery Studies, 11(1): 37–43.    [Google Scholar]
  7. Fang J, Yu C, Liu J, Mao X, Jia X, Luo J, and Liu R (2022). A systematic review and meta-analysis of the effects of muscle relaxation training vs. conventional nursing on the depression, anxiety and life quality of patients with breast cancer. Translational Cancer Research, 11(3): 548–558.  https://doi.org/10.21037/tcr-22-428    [Google Scholar] PMid:35402172 PMCid:PMC8990220
  8. Fatmawati DA and Sugianto E (2023). Penerapan terapi relaksasi Benson terhadap penurunan nyeri pada pasien kanker di Yayasan Kanker Inisiatif Zakat Indonesia Semarang. Jurnal Manajemen Asuhan Keperawatan,  7(1), 46-51.  https://doi.org/10.33655/mak.v7i1.138    [Google Scholar]
  9. Hedigan F, Sheridan H, and Sasse A (2023). Benefit of inhalation aromatherapy as a complementary treatment for stress and anxiety in a clinical setting–A systematic review. Complementary Therapies in Clinical Practice, 52: 101750.  https://doi.org/10.1016/j.ctcp.2023.101750    [Google Scholar] PMid:37031643
  10. Huddar V, Vernekar S, Tatpati N, Thali S, and D'Silva PV (2023). Comparative effect of progressive relaxation technique and Benson's technique on anxiety and fatigue in cancer survivors-an experimental study. Current Problems in Cancer, 47(1): 100933.  https://doi.org/10.1016/j.currproblcancer.2022.100933    [Google Scholar] PMid:36563484
  11. Indraswati I, Septiyan RB, Matchaya P, and Finch R (2024). Effectiveness of massage therapy on fatigue in cancer patients undergoing chemotherapy: Scoping review. Jurnal Berita Ilmu Keperawatan, 17(1): 82–91.  https://doi.org/10.23917/bik.v17i1.3817    [Google Scholar]
  12. Kamal AF and Dahlia D (2020). The effectiveness of psychoreligious intervention: Murottal Al-Quran on pain and stress level of bone cancer patient. Indonesian Journal of Global Health Research, 2(4): 375-384.  https://doi.org/10.37287/ijghr.v2i4.260    [Google Scholar]
  13. Khamis EAR, Raddaha AHA, Nafae WH, Al-Sabeely AA, Ebrahim EE, and Elhadary SM (2023). Effectiveness of aromatherapy in early palliative care for oncology patients: Blind controlled study. Asian Pacific Journal of Cancer Prevention, 24(8): 2729–2739.  https://doi.org/10.31557/APJCP.2023.24.8.2729    [Google Scholar] PMid:37642059 PMCid:PMC10685211
  14. Li D, Li Y, Bai X, Wang M, Yan J, and Cao Y (2022). The effects of aromatherapy on anxiety and depression in people with cancer: A systematic review and meta-analysis. Frontiers in Public Health, 10: 853056.  https://doi.org/10.3389/fpubh.2022.853056    [Google Scholar] PMid:35757624 PMCid:PMC9215260
  15. Lovibond SH and Lovibond PF (1995). Manual for the depression anxiety stress scales. 2nd Edition, Psychology Foundation, Sydney, Australia.  https://doi.org/10.1037/t01004-000    [Google Scholar]
  16. Marsidi SR (2021). Identification of stress, anxiety, and depression levels of students in preparation for the exit exam competency test. Journal of Vocational Health Studies, 5(2): 87-93.  https://doi.org/10.20473/jvhs.V5.I2.2021.87-93    [Google Scholar]
  17. Moradi Y, Jafarizadeh H, Asghari R, Mirzamohammadi O, and Alinejad V (2023). Single and combined use of Benson relaxation technique and oxygen therapy on chemotherapy-induced nausea and vomiting in gastric cancer patients. Explore, 19(4): 587-593.  https://doi.org/10.1016/j.explore.2022.11.006    [Google Scholar] PMid:36535861
  18. Nazari AM, Zare-Kaseb A, Arbabi Z, Gholampour MH, Emami Zeydi A, and Ghazanfari MJ (2023). The effect of Benson relaxation technique on cancer patients: A systematic review. Supportive Care in Cancer, 31(12): 681.  https://doi.org/10.1007/s00520-023-08142-2    [Google Scholar] PMid:37938356
  19. Nurrohmah A, Aprianti A, and Hartutik S (2022). Risk factors of breast cancer. Gaster, 20(1): 1-10.  https://doi.org/10.30787/gaster.v20i1.777    [Google Scholar]
  20. Oshvandi K, Mirzajani Letomi F, Soltanian AR, and Shamsizadeh M (2021). The effects of foot massage on hemodialysis patients’ sleep quality and restless leg syndrome: A comparison of lavender and sweet orange essential oil topical application. Journal of Complementary and Integrative Medicine, 18(4): 843-850.  https://doi.org/10.1515/jcim-2020-0121    [Google Scholar] PMid:33838094
  21. Pereira M, Moreira CS, Izdebski P, Dias AC, Nogueira-Silva C, and Pereira MG (2022). How does hedonic aroma impact long-term anxiety, depression, and quality of life in women with breast cancer? A cross-lagged panel model analysis. International Journal of Environmental Research and Public Health, 19(15): 9260.  https://doi.org/10.3390/ijerph19159260    [Google Scholar] PMid:35954612 PMCid:PMC9368225
  22. Purnamayanti NKD, Putra MG, and Haryani H (2021). Complementary and alternative therapy to reduce fatigue among oncology patient under chemotherapy: A nursing perspective. Indonesian Contemporary Nursing Journal (ICON Journal), 6(1): 38-46.    [Google Scholar]
  23. Siregar AN, Syaputri MH, Putri MA, Azizah N, and Jannah TDR (2024). Studi literatur: Murottal Al-Quran sebagai penurun kecemasan pada pasien pengidap kanker. Catha: Journal of Creative and Innovative Research, 1(3): 211-219.    [Google Scholar]
  24. Sriningsih N and Pratiwi A (2022). Pengaruh terapi relaksasi Benson terhadap kecemasan pasien pre operasi di RSUD Kab Tangerang. Jurnal Ilmu Kedokteran Dan Kesehatan Indonesia, 2(3): 50-61.  https://doi.org/10.55606/jikki.v2i3.697    [Google Scholar]
  25. Wahyuni S, Rahma A, Aminanto S, and Triyanto A (2023). Penggunaan terapi komplementer dalam meningkatkan outcome perawatan pasien dengan kanker payudara: Scoping review. Jurnal Keperawatan Klinis dan Komunitas (Clinical and Community Nursing Journal), 7(1): 1-10.  https://doi.org/10.22146/jkkk.79810    [Google Scholar]
  26. WHO (2022). Breast cancer statistics. World Health Organization, Geneva, Switzerland.  
  27. WHO (2024). Breast cancer. World Health Organization, Geneva, Switzerland. 
  28. Winasis A and Djuwita R (2023). Obesitas dan kanker payudara: Literature review. Media Publikasi Promosi Kesehatan Indonesia (MPPKI), 6(8): 1501-1508.  https://doi.org/10.56338/mppki.v6i8.3501    [Google Scholar]
  29. Yükseltürk Şimşek N, Nacir B, and Demir A (2022). Determining the effect of reflexology on nausea, vomiting and anxiety in patients with breast cancer receiving chemotherapy: A randomized controlled study. Complementary Medicine Research, 29(5): 382-392.  https://doi.org/10.1159/000525034    [Google Scholar] PMid:35609525