Animal-Assisted Therapy in Pediatric Cancer Patients

The biophilia hypothesis explains humans’ innate tendency to bond closely with other natural life forms, particularly animals. This human-animal interaction is complex and depends on such factors as evolution and cognitive similarities. Interestingly, human interactions with companion animals often mirror the mother-baby relationship.

In 2014, the International Association of Animal-Interaction Organizations (IAHAIO) developed guidelines for interventional therapies incorporating the human-animal bond. One such therapy is animal-assisted therapy (AAT), which, according to the IAHAIO, “focuses on enhancing physical, cognitive, behavioral and/or socio-emotional functioning of the particular human recipient.”

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AAT, which has been largely accepted by the medical community, has numerous reported benefits, including reducing anxiety and depressive symptoms. To date, however, AAT methods (eg, session duration and frequency) have not been standardized and there have been no quantitative studies evaluating its effectiveness in children.

To address this knowledge gap, a research team performed a quantitative study of AAT in children with cancer and their caregivers. Pediatric cancer, the study investigators noted, causes immense suffering for children and increases their risk of developing psychological disorders, highlighting the importance of evaluating AAT in children with cancer. Study results, recently published in PLoS ONE, demonstrated AAT’s effectiveness in the pediatric oncology setting.

Assessment

Twenty-four children aged 6 to 12 receiving outpatient care for a solid tumor or acute lymphoid leukemia were evaluated. The children had to meet specific inclusion and exclusion criteria to ensure development of a systematic protocol for AAT usage. Exclusion criteria included fear of animals and neutropenia.

For the 2 therapy dogs in the study, a strict protocol was developed outlining guidelines for animal entry and handling within the hospital, including restricted access and hand-washing before and after animal contact.

The AAT program consisted of thrice weekly 30-minute sessions for up to 4 weeks. The children participated in preplanned activities, such as training and recreation, with the therapy dogs. Before and after the program, the children and their caregivers completed self-assessments evaluating such outcomes as quality of life, mood, and anxiety. Their heart rate and blood pressure were also measured.

Results

Approximately 60% of the children were female, with Ewing’s sarcoma and rhabdomyosarcoma being the most common cancer types. The children experienced significant reductions in pain, irritation, and stress, yet no significant changes in heart rate or blood pressure. In addition, by study’s end the caregivers had significantly less anxiety, stress, and mental confusion (eg, muddled thoughts).

The investigators observed a trend toward decreased depressive symptoms in the children and caregivers; this may not have been statistically significant due to small sample size or insufficient follow-up.

Neither the children nor the dogs experienced complications during the AAT program. In addition, there was no association between AAT and worsening of a child’s clinical status. Also, the therapy dogs were not visibly stressed.

Concluding Thoughts

The improvements observed in this study were similar to those reported in previous studies of AAT in adults. Such improvements may have been related directly to the benefits of the human-animal bond, which releases “feel good” hormones like oxytocin and reduces cortisol release. Alternatively, the improvements may be explained by mutualism, which can foster enjoyable and close emotional bonding with animals.

Overall, the investigators concluded that AAT was effective for children receiving outpatient oncologic care. However, given the study’s limitations, such as small sample size, additional research will be needed to “prove the effectiveness of AAT in promoting the physical, mental, and emotional well-being of children undergoing oncological treatment and the humanization of the hospital environment.”

Dr. JoAnna Pendergrass received her doctor of veterinary medicine degree from the Virginia-Maryland College of Veterinary Medicine. She completed a postdoctoral fellowship at Emory University’s Yerkes National Primate Research Center. Dr. Pendergrass is the founder and owner of JPen Communications, a medical communications company.