While anecdotal evidence underscores the positive impact of therapy dogs for children with cancer and their families, rigorous studies of efficacy are currently lacking, even as animal-assisted interventions (AAIs) occur daily in many of today’s pediatric oncology settings. Likewise, both the level and nature of stress that therapy dogs may experience during AAI sessions with pediatric patients is currently not well understood. The Canines and Childhood Cancer (CCC) Study – a groundbreaking research effort from American Humane Association with support from Zoetis and the Morris Animal Foundation through a partnership with the Human Animal Bond Research Initiative (HABRI) – is the first of its kind to rigorously measure the effects of AAIs at multiple pediatric oncology sites across the U.S.
CCC researchers are interested in whether or not complementary AAIs have positive effects on patient stress, anxiety, and health-related quality of life; on parent stress and anxiety; and on therapy dog stress. The overall goals of this study are to advance evidence-based and innovative research, while enhancing pediatric cancer treatment and informing best practices for therapy dogs and handlers who volunteer in clinical settings. Researchers also hope that study findings, if merited, will support the expansion of credible AAI programming, so that more patients may have the opportunity to interact with therapy animals while undergoing medical treatment. Researchers hypothesize that children and parents who visit with a therapy dog during treatment will experience less stress and anxiety, as well as improvements in their health-related quality of life when compared to those who do not receive AAI visits. Additionally, researchers anticipate findings will show that therapy dogs experience minimal distress during AAI sessions with this population.
Since 2010, American Humane Association has provided research oversight across three project phases: 1) a comprehensive needs assessment, 2) a 6-month pilot study, and 3) the current full clinical trial with the following five sites:
- Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, TN
- Randall Children’s Hospital at Legacy Emanuel in Portland, OR
- St. Joseph’s Children’s Hospital in Tampa, FL
- UC Davis Children’s Hospital in Sacramento, CA
- UMass Memorial Children’s Medical Center (in partnership with Cummings School of Veterinary Medicine at Tufts University) in Worcester, MA
Patients, aged 3-17 years and recently diagnosed with cancer, and their parents are randomly selected to receive either standard of care treatment for their diagnosis only or their standard of care plus regular (ideally weekly), 15-minute visits from a registered therapy dog and handler in the outpatient clinic or inpatient ward. Both study group subjects participate for four months and complete validated psychosocial and behavioral instruments, including the State Trait Anxiety Inventory (both patients and parents), the Pediatric Quality of Life Inventory™ (both patients and parents), and the Pediatric Inventory for Parents (parents only), at designated intervals. Children also have their blood pressure and pulse measured at the beginning and end of each study session.
During each session, therapy dogs have their behavior videotaped and rated via an AAI behavior ethogram, which is designed to allow for the capture of both stress-related (e.g., excessive panting and restlessness) and affiliative-related (e.g., tail wagging and seeking patient/parent interaction) canine behaviors. Additionally, handlers are asked to record their dog’s behavior and their activities with the patient, so that researchers can compare sessions and develop an accurate list of typical AAI activities that occur in pediatric healthcare settings. Finally, canine salivary cortisol is used to examine the dogs’ stress levels during each AAI session, and is compared to their average baseline cortisol measurement, session behavior, and handler-rated temperament (via the online Canine Behavioral Assessment and Research Questionnaire).
To date, 64 children have been enrolled in the clinical trial:
- Treatment group n = 35; control group n = 29
- 53% male; 47% female
- Mean age = 7.5 years
- 78% Caucasian/White; 16% Hispanic/Latino; 6% other
- 62% diagnosed with Acute Lymphoblastic Leukemia or ALL
- 76% with pets in the home
During the needs assessment and pilot stages of the CCC project, researchers learned that AAI research in hospital settings must include careful consideration and management of various logistics, such as site-specific policies and procedures regarding the timing of AAI visits. In addition, early anecdotal findings regarding perceived therapy dog benefits underlined what researchers reported in their 2012 literature review, including:
- Normalization and enjoyment of the hospital environment
- Distraction from pain or worry
- Unconditional support and affection
- Calm and relaxation
- Mood elevation
- Future orientation and motivation to participate in treatment
- Increased social interaction
Over the course of the study, researchers have also received testimonials from parents, hospital staff, handlers, and the patients themselves regarding the positive impact of AAIs in the hospital. Here is a small sampling of what researchers have heard so far:
- “Knowing she’d see Angus [the therapy dog] helped [my daughter] calm down and be less afraid before we went into the clinic.” – parent of clinical trial patient
- “[Interacting with the therapy dog] just made me happier for, like, the rest of the day. For once in the hospital, I didn’t feel like I was at the hospital. I just felt like I was at home, playing with a dog.” – pilot patient
- “The [AAI] brought the family around one thing instead of the kid watching TV, the brother playing a video game, and mom reading a book. It involved everyone together as a family, which I thought was very powerful.” – hospital staff member who participated in a focus group
- At the end of the session, a 4-year girl said, “Well…..I’m ready to go have my spinal tap now.” – hospital staff member reporting on a clinical trial patient
The CCC Study is anticipated to be a milestone in our understanding of the vital bond shared between people and animals. Data collection for the clinical trial is currently underway, and will conclude in 2016. For more information about the CCC Study, please visit www.caninesandchildhoodcancer.org, or contact Dr. Amy McCullough at firstname.lastname@example.org.
Zoetis (zō-EH-tis) is the leading animal health company, dedicated to supporting its customers and their businesses. Building on a 60-year history as the animal health business of Pfizer, Zoetis discovers, develops, manufactures and markets veterinary vaccines and medicines, with a focus on both farm and companion animals. The company generated annual revenues of $4.3 billion in 2012. It has more than 9,300 employees worldwide and a local presence in approximately 70 countries, including 29 manufacturing facilities in 11 countries. Its products serve veterinarians, livestock producers and people who raise and care for farm and companion animals in 120 countries.
About American Humane Association
American Humane Association is the country’s first national humane organization and the only one dedicated to protecting both children and animals. Since 1877, American Humane Association has been at the forefront of virtually every major advance in protecting our most vulnerable from cruelty, abuse and neglect. Today we’re also leading the way in understanding the human-animal bond and its role in therapy, medicine and society.