Therapy Dogs and Children With Cancer

 Therapy animals may provide emotional support for those undergoing cancer treatment.

Therapy animals may provide emotional support for those undergoing cancer treatment.

Pet therapy is frequently employed in many cancer centers, hospitals, and nursing homes. Although staff and patients report that such interactions provide benefit in these settings, there is little rigorous scientific evidence to substantiate that effect. Small studies have assessed interactions between therapy dogs and adult patients, but no studies have been conducted with large sample sizes, validated instruments, and control groups to evaluate the impact that therapy dogs have on children with cancer, according to Amy McCullough, PhD, National Director of Humane Research and Therapy for the American Humane Association.

Dr McCullough hopes new research will correct that. In a recent presentation at the American Academy of Pediatrics (AAP) National Conference & Exhibition, she described how the American Humane Association with the sponsorship of Zoetis, the animal health company, undertook an ambitious study to look at the science behind the therapy dog modality.1 She emphasized that while survivorship of childhood cancer has increased over the past 40 years, quality of life for patients and their families is still concerning. The nationwide multi-institutional project was designed to measure the psychosocial effects of such animal-assisted interventions (AAIs). The investigators wanted to know specifically if therapy dogs have positive effects on the stress and anxiety experienced by children with cancer. They also wondered whether interactions with dogs could alleviate the anxiety that parents experienced from having an ill child. The researchers also wanted to determine how dogs react to the intense visits, including any distress they may experience.

TREATMENT AND CONTROL GROUPS

Since the project began in 2014, 70 patients and their families and more than 30 therapy dog-handler teams have enrolled across the 5 study sites. Patients are selected at random to receive either standard-of-care treatment required by each child's diagnosis or standard-of-care plus regular 15- to 20-minute visits from a registered therapy dog and handler in the outpatient clinic or inpatient unit. Children enroll in the study just after they receive a diagnosis, which is usually the time when they and their parents are the most anxious and confused. Typically a nurse or a child life specialist is the data-collection point person, as he or she gets to know the families and discuss their participation in the study. If the patient and parents agree, they then enroll in the program. Children and parents who do not enroll become the control group. They can enjoy visits with regularly scheduled therapy dogs along with other patients in the hospital, but they do not participate in a set weekly appointment and a guaranteed “dose” of interacting with the same dog. Dr McCullough reports that nearly all patients who have been approached have participated in the study.

RATING SCALES

Both patient groups participate for 4 months. At designated intervals they complete behavioral and psychosocial rating scales, such as the PedsQL™: Measurement Model for the Pediatric Quality of Life Inventory and the State-Trait Anxiety Inventory (STAI).2,3 Children have their blood pressure and pulse measured at the beginning and end of each session. 

EVALUATING THE DOG

Evaluations are also conducted of the dogs participating in the program. As part of each session a staff member videotapes the canine therapists so that their behavior can be rated weekly on handler self-reports and on AAI behavior-specific ethograms. Samples of canine saliva are obtained to assess cortisol as a gauge of the dogs' stress levels during each session, and the sample is compared to each dog's average baseline cortisol measurement. The dogs' behavior in the session and temperament are also assessed by each handler.

Since they have visits with the same dog each week, the patients bond to the dogs and act as though they own them. The handlers play an important role also, becoming a source of support for the parents as well as the children. They discuss the dog's activities during the week since their last visit. A handler might even buy the dog a collar in the color of the child's favorite sports team as a show of support. All team members are dedicated to supporting the family.

MANY POSITIVE REACTIONS

Dr McCullough reported that the investigators see positive reactions from the staff during each session. Video demonstrates nurses and physicians interacting with the dogs, in addition to the children and their parents. The children talk about the dogs instead of their procedures. If children are upset in the clinic, the dogs help calm them. The dogs also help to distract patients from procedures that may be unpleasant or painful. Some hospitals keep a jar of dog treats at the nurses' station, indicating that dogs are welcome and reinforcing that the therapy dog intervention has a positive impact on nursing staff as well.

The researchers are looking forward to analyzing final data by early 2017. They are hopeful that the outcome will continue to show with scientific rigor that young cancer patients experience positive results from interacting with therapy dogs.

References

  1. McCullough A, Jenkins M, Ruehrdanz A. The effects of animal-assisted interventions (AAIs) for pediatric oncology patients, their parents, and therapy dogs at five hospital sites. Presentation at: American Academy of Pediatrics National Conference & Exhibition; October 24-27, 2015; Washington, DC; Abstract 30412.
  2. PedsQL™ Pediatric Quality of Life Inventory™. Available at: http://www.pedsql.org/index.html. Accessed November 17, 2015.
  3. Spielberger CD, Gorsuch RL, Lushene PR, Vagg PR, Jacobs GA. Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press; 1983.