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Canines and Childhood Cancer Examining the Effects of Therapy Dogs with Childhood Cancer Patients and their Families Executive Summary
Canines and Childhood CancerExamining the Effects of Therapy Dogs with
Childhood Cancer Patients and their Families
Executive Summary
dvances in medical knowledge, treatment and technology have all butobviated the fear of numerous childhood medical diagnoses that notso long ago could have meant a potential death sentence. Yet stilltoday few words strike as much fear into the hearts of parents and
children alike as a doctor’s pronouncement, “Your child has cancer.” As is rightly thecase, billions of dollars are spent each year to prevent and more efficaciously treatpediatric cancer. While this work – some promising, some heartbreaking – wends itsway through the proper scientific channels, a question of by no means equal butnonetheless immense import has received far less attention: “What can we do toimprove the day-to-day health, healing, and quality of life of children suffering fromcancer, and the families who suffer along with them?”
Common sense and anecdotal evidence point to numerous potential answers.We know one of the worst side effects of a pediatric cancer diagnosis is fear and thestress this fear produces, and that these factors alone can hinder treatment in avariety of ways. Therefore reducing fear and stress should have a positive impact.Similarly, if there were effective means to ameliorate related conditions such asloneliness, depression, isolation and the unforgiving pain associated with both theillness itself and the course of treatment, quality of life for patients and families couldpotentially be significantly enhanced. For many medical practitioners and lay peopleboth within and outside the pediatric oncology community, there has existed astrong belief that – with the right patients and under the right circumstances – manyof these benefits could be derived through the pairing of cancer patients and theirfamilies with loving, nurturing animals. Myriad stories of the significant healingpower of animal-assisted therapy (AAT) and the human-animal bond abound.Yet little hard evidence exists as to whether these claims can be substantiated, underwhat conditions AAT is most effective, and how AAT, if proven useful, can best beincorporated into treatment.
No child…no family…should have to suffer through the trauma of a cancer diagnosisand treatment. But childhood cancer is a reality. As our pediatric oncology colleaguesrace to find ever-more effective preventative measures, treatments, and – one day –cures, our hope is that this study will help to provide meaningful, enduring,affordable, accessible and powerful healing and comfort to the children and familieswho need it now.
A
J. Michael McFarland DVM, DABVP Robin Ganzert, PhDGroup Director, Veterinary Operations President & CEO
US Operations, Zoetis American Humane Association
In 2010, American Humane Association, Zoetis, andthe Pfizer Foundation partnered to conduct a uniquestudy on the impact of animal-assisted therapy (AAT)on children with cancer and their families. The goals
of this collaboration are to promote innovation, evidence-based research, practice improvements, and knowledgeadvancement to further the field of research on human-animal interaction (HAI) and the treatment of cancer inchildren. This comprehensive review includes literature
regarding childhood cancer epidemiology andtreatment, the well-being of
patients andfamilies who areimpacted bychildhood cancer,the applications ofAAT for variouspopulations in need,the state of AATeffectivenessresearch, and theconsiderations thatneed to be madewhen incorporatingtherapy animals intoclinical settings.
Children of all ages,races, genders and socio-economic strata, and
their families, are affected by cancer every year. Medicaladvances have drastically improved the survival rates formany forms of childhood cancers; however, incidencerates have remained fairly stable for decades. At any giventime, in the United States, more than 40,000 children areundergoing cancer treatment and nearly 13,500 parentseach year are hit with the devastating news that their childhas been diagnosed with cancer. Given that medicaladvances have improved survival rates, yet so manychildren and families continue to be affected, it isimportant to understand the unique physical andpsychosocial issues that these children and families facedue to the diagnoses, treatment, mortality, andsurvivorship of childhood cancer.
Children diagnosed with cancer and their families not only cope with physical issues, but are also prone to
Canines and Childhood Cancer Executive Summarypsychosocial issues including isolation,depression, trauma, stress, and fear.Child and adolescent patients generallyundergo a decrease in their quality oflife across all stages of active cancertreatment, and may experiencedepression, emotional distress, fatigue,physical pain, post-traumatic stress,social stress, and withdrawal symptomsboth during and after their treatmentprocesses. This may affect their physicalhealth, and even when physical effectsmay improve over time, manypsychosocial and behavioral effectsremain and may impact childhoodcancer survivors for the long term.These effects on children can also varyby type of cancer; patients with certaintypes of childhood cancer experienceimprovements more than others, andchildren with other types experiencemore long-term risk for ongoingbehavioral and psychological problems.With both improvements in outcomesfor some, along with concurrent orsubsequent increases in other problemsfor others (even for the same childrenin some cases), this is truly atumultuous time for these children andtheir families in a number of respects.
Not surprisingly, families of childrenwith cancer also tend to struggle whilecoping with the considerable challengesof childhood cancer and its aftermath.Upon learning that their child hascancer, parents tend to experienceanger, anxiety, denial or avoidance oftheir child’s illness, distress, grief, post-traumatic stress, sleeping problems,weight gain, and decreased physicalactivity, all of which can greatlyendanger their health and well-being.Parental distress tends to vary as afunction of time from diagnosis, withparents of more recently diagnosedpatients presenting higher levels ofdistress than parents of children whohave been living with cancer for sometime. The relationship between parents
is also commonly impacted – both negatively and positively – by their child’s cancerdiagnosis and treatment, and family roles and responsibilities often change whenone child in the family has cancer. Thus, siblings of cancer patients also experiencepsychosocial effects, including acting out, feeling left out or less important,loneliness, maturation (as a result of increased expectations andresponsibilities), sorrow, and anxiety. Overall, distressexperienced by one family member cannegatively affect the physical and emotionalwellbeing of the ill and vulnerable childwith cancer.
Given that a diagnosis of childhood cancer cannegatively impact both children and families on amultitude of levels, it is important for healthcareprofessionals to not only attend to the physicaland medical needs of the child, but also to theemotional, psychological, and social needs of theentire family. One very exciting possibility is that afocus on improving children’s ability to cope withstress could prove to be comprehensively beneficialto their entire family. Additionally, due to the high and
stressful costs of cancer treatment,services or adjunctive interventionsaimed at addressing the family’spsychological needs should be bothaccessible and affordable. AAT is one ofseveral adjunctive, low-cost treatmentoptions that could potentially addressthe immediate and ongoingpsychosocial needs of many familiescoping with childhood cancer.
For many families, animals and petstake center stage in their daily lives,offering companionship, solace, joy,and for some, even kinship.Increasingly, greater attention has beengiven to the roles that animals can playin supporting the health and emotionalwell-being of people in need. Manyresearch studies have providedpromising evidence that involvinganimals in therapeutic interventionsprovides benefits for manypopulations, such as exercise oropportunities for positive play;relaxation and reduced anxiety;unconditional support and acceptance;improved skills that lead to healthyrelationships with others; enhancedsocial interactions; increased learning,
growth, and development; and improvedsenses of self-esteem and confidence. Forcritically or terminally ill populations, suchas children with cancer and their families,therapy animals also have the potential ofnormalizing the hospital experience,motivating active participation in thehealing process, offering helpfuldistraction from pain or worry, decreasingblood pressure and heart rate; alleviatingdistress; increasing opportunities forsensory stimulation and physical touch;and decreasing depressive symptoms byoffering joy, company, and something tolook forward to.
Notably, the incorporation of therapyanimals into healthcare treatment is acomplex undertaking which requires aspecial consideration of myriad topics inorder to ensure safe and beneficialinteractions. Such topics includeinfectious disease control and zoonoses,human allergies, phobias and physicalharm, animal well-being, therapy animalselection, handler role, participantinclusion, and service delivery protocol.
The majority of findings documenting thebenefits of AAT and pet ownership havelargely been anecdotal and the field hasconsistently struggled with developingand conducting rigorous research. Whilethe field of HAI research has expandedenormously, it is not yet clear that theincorporation of animals in clinicalsettings is effective from a scientificstandpoint. The Canines and ChildhoodCancer (CCC) project intends to add tothis knowledge base by examining theexperiences of children and familiescoping with childhood cancer, and byunderstanding how best to integrate AATinto pediatric cancer treatment. Theliterature documented in this review isintended to serve as a resource to thefields of HAI and pediatric oncology, aswell as a foundation for the current studyexamining the efficacy and impact of AATin the context of childhood cancertreatment.
Research StudyOverview –Next StepsWith the completion of this comprehensiveliterature review, as well as focus groupsand interviews with hospital staff, familycaregivers and animal-assisted therapyhandlers, American Humane Associationand Zoetis conclude the first phase of theCanines and Childhood Cancer study. The information gathered during this initial phase will serve to inform a scientificstudy design in order to conduct a pilot trial with 3-5 pediatric oncology sites acrossthe country.
Upon the conclusion of the pilot trial, weanticipate the launch of a full clinical trialacross multiple sites for a period of 12-18months. During this time, certified therapydogs and their handlers will conductregular animal-assisted therapy sessionswith pediatric oncology patients and theirfamilies, which will be measured by a range of instruments including biological,psychological and social measures.
Results from the study will be widelydisseminated through professionalconferences and peer-reviewed journals in a diverse range of disciplines, includingveterinary medicine, pediatric oncology,social work, and animal-assisted therapy.Our hope is that this important researchwill help facilitate the healing process forpediatric oncology patients and theirfamilies so that they thrive while copingwith the considerable challenges ofchildhood cancer and its aftermath.
For more information, please contact:
To download the entire review, go to www.CaninesAndChildhoodCancer.org
Vanessa MarianiDirector, Academic & Professional Affairs, US
Amy McCullough, M.A.National Director, Animal Assisted Therapy
American Humane [email protected]
