More than 13,000 children will be diagnosed with cancer each year. Many of these kids have to endure painful treatments that trigger stress, anxiety and depression.
Researchers are studying a drug-free and inexpensive way to help the kids feel better.
Bryce Greenwell is no stranger to tests or hospitals. He has leukemia and will undergo treatments for the next three years or more.
"I don't know how he does it, you know, he's amazing." Jenny Greenwell, Bryce's mother, told Ivanhoe.
A little pup named Swoosh is making Bryce's hospital visits much more bearable.
"It gives us something to talk about. He gets excited to come see Swoosh." Jenny said.
Bryce and Swoosh are participating in a study to determine if dogs can help pediatric cancer patients.
Mary Jo Gilmer, PhD, Director of Palliative Care Research at the Vanderbilt University School of Nursing understands the impact the disease has on lives and is excited to see how the dogs can help.
"We know that the disease takes a terrible emotional toll on families." She told Ivanhoe, "It's very obvious to me, just anecdotally, that those dogs are making a difference; that interaction is making a difference."
Studies in adult patients have shown interaction with man's best friend can lower blood pressure, reduce anxiety and improve lung function. This is the first pilot study to test animal therapy in kids with cancer.
The dogs spend about 15 minutes with patients before treatments. The kids have their pulse and blood pressure checked before and after, along with a questionnaire.
The dogs even have their saliva checked to determine if they experience stress, but Swoosh's owner Michelle Thompson says she doesn't think that's the case.
"He loves to work. He loves to get his vest on, and he's excited to go." She told Ivanhoe.
It's therapy that any kid would love!
Researchers at five sites across the country will enroll a total of 120 families for this study.
They are still collecting data and cannot report on results, but Gilmer says they have noticed children who interact with the dogs require less anti-anxiety medications than they did before the pet therapy.
TOPIC: Pet Therapy
BACKGROUND: Animal-assisted therapy or pet therapy is a treatment that uses trained dogs or other trained animals to boost recovery and comfort a patient dealing with health disorders such as heart disease and cancer. The interaction with the pet always includes the pet's handler and is believed to boost happiness and optimism for the patient. Pet therapy is mostly conducted in medical settings, but is also being tested in public universities and the community to help individuals cope with stress and anxiety. (Source: www.healthline.com)
EFFECTS: Some positive effects that pet therapy has had on patients include:
" Improved self esteem
" Increase in verbal communication
" Increase in willingness to join in activities
" Motivate willingness to exercise
NEW TECHNOLOGY: A study at Vanderbilt is investigating if therapy dogs can have a positive impact on children with cancer. Pet therapy is believed to help these children develop a more relaxed, optimistic mind set while they undergo chemotherapy. The Vanderbilt researchers will examine what effects the pet therapy plays on the anxiety of the children as well as the distress level of the therapy dogs being used. The study takes place in 5 locations across the US and will study up to 20 children suffering from acute lymphocytic leukemia and lymphoblastic lymphoma. Treatment will include one month of chemotherapy at the hospital and weekly chemotherapy sessions afterward where the therapy dogs will make their visits with the children. (Source: Kathy Rivers)
FOR MORE INFORMATION ON THIS REPORT, PLEASE CONTACT:
Ashleigh Ruehrdanz, MPH
Research and Evaluation Specialist & IRB Administrator
Humane Research and Policy
American Humane Association
Phone: (303) 630-9480
If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Marjorie Bekaert Thomas at firstname.lastname@example.org
Mary Jo Gilmer, PhD, Director of the Pediatric Palliative Care Research at Vanderbilt University School of Nursing talks about a new drug-free and inexpensive way to help pediatric cancer patients feel better.
Tell me about palliative care, what do you do here for that?
Mary Jo Gilmer: I'm Director of the Pediatric Palliative Care Research Team at Monroe Carell Jr Children's Hospital at Vanderbilt and we have found that palliative care is often misunderstood by the general public in that they may think of palliative care as end of life or hospice care. For us, palliative care really starts at the time of diagnosis. A palliative care team becomes a part of the healthcare team, the medical team, and affords the families support. It's an extra layer of support essentially. It's not that we take over any part of the care of families, but provide an extra layer and really help to walk with those families through often their most difficult journey, having a child diagnosed with a life-threatening or a life-limiting condition.
Tell me about the study. What's the name of it and where the idea came from.
Mary Jo Gilmer: The name of the study is Canines and Childhood Cancer. According to the National Cancer Institute, over 13,000 children are diagnosed every year with childhood cancer. It's the leading cause of death from disease in childhood. To put that in perspective, let's think about two classrooms of children who are diagnosed every day in the United States with cancer. Everyone in both of those classrooms is diagnosed with cancer every day in the United States. So, although we think about 13,000 children diagnosed every year, that may be a little bit hard to even grasp, but think about walking into two classrooms and every child in those classrooms is diagnosed with cancer every day in the United States.
Wow, and would that be like a classroom, nationally?
Mary Jo Gilmer: Yes, it would be two classrooms nationally, not just in Nashville, but nationally with 18 to 20 children in each room.
How did this study come about?
Mary Jo Gilmer: It really is coordinated by the American Humane Association and Vanderbilt is one of five schools across the country participating in the study. Vanderbilt currently has more children enrolled in the study than the other sites do, but I imagine they will catch up soon. We started enrolling families in January.
With the intent of what?
Mary Jo Gilmer: We know that the prognosis for childhood cancer has greatly improved. I mean, we know that more children are cured who have cancer now than even 10 years ago. With acute lymphocytic leukemia, which is the type of disease that we're studying, the cure rate is around 85% which is a very good cure rate. However, we know that the disease takes a terrible emotional toll on families for a lifetime and that's the part of the disease that we're trying very much to have an impact on. We are trying to decrease the stress and the anxiety and increase the quality of life for children and families from the time they're diagnosed with cancer throughout treatment.
Where did the idea come up with to try animals then, or a dog?
Mary Jo Gilmer: There is research of animals, dogs particularly, with adults with cancer and we have some data about how helpful it is with adults. But there's very, very little data about how it might be helpful with children. My passion is pediatrics and trying to help children, so anecdotally we think that it helps. We have stories. We can see those faces light up but we don't have the numbers to say look, this works and it's a lot less expensive than giving medications. It's a lot less expensive than long-term psychotherapy with children and their families. It's accessible. There are animal handlers who what to come and share their dogs with children with cancer and help and I really applaud the animal handlers because they're the ones that make the study possible. They get their dogs certified and they're willing to bring them in and spend time with children and their families. We need the data to show that it works and that's really where the study idea came from.
Mary Jo Gilmer: I went to meet with Bryce and his parents and told them about the project. In order to see if it makes a difference, we have to randomize children to either the usual care group or the treatment group which means that some children won't see a dog, but they still have to consent to be in the study. Bryce's parents were willing to do that and fortunately, he was randomized to the treatment, so they went home from the hospital the next day, but we received notification of when they would be back in clinic. My role is to provide an animal handler and dog which matches with the age and personality of the child, what I perceive will be a good match and I thought that Swoosh and Michelle would be a good match for Bryce. So, we set it up for them to meet when Bryce came in for his first clinic visit. Coming in for a clinic visit is extremely anxiety-producing for a child. Many of them start vomiting on the way to the hospital because they're so anxious about what's going to happen here. If there's any way to reduce that anxiety, we want to do it and we don't have the data yet, but we hope that looking forward to seeing a dog, the same dog each week, will help to reduce that anxiety. We met Bryce and both parents that first week and brought them back into a private conference room. Once in the conference room we take the child's blood pressure and pulse because we want to see if there is a trend before and after the intervention. We take their pulse and blood pressure and then Swoosh and Michelle come into the room and have about 15 minutes to interact with the child. In many different ways, it might be that the child asks the dog to do a trick, like shake hands, and then provides a treat for the dog. It might be simply brushing the dog or petting the dog or in some cases we've had a child listen to the heartbeat of the dog and it was really fun because we asked if he wanted to do that and the first thing he did when he put the stethoscope in his ears was put the bell of the stethoscope on the dog's head and I said, "Do you hear anything?" He said "No." I said, "Well where else do you think his heart might be? Where do you think you might hear it? Where do you hear your heart?" He put the stethoscope on his heart and listened to his heart and then he thought, maybe it's a similar place on the dog. So he put the stethoscope there and heard the heartbeat and that was a great way to connect because the child had his heart listened to so many times and now he could do that with the dog.
So how have you seen Bryce change or have you?
Mary Jo Gilmer: Bryce has always been a very engaging child. I loved him from the moment I first saw him, but coming back into a setting like this, he was a little bit, well maybe a lot reserved and reticent to interact. Bryce has two dogs at home and at first I thought he'd much rather be with his dogs at home than with this new dog in the hospital. That's one of the things we're interested in looking at in the study too is if it make a difference if the child has a dog or a pet at home, if they're less interested or more interested in the therapy dog. He was fairly quiet and didn't really want to pet or touch Swoosh initially. He certainly didn't want to give him a treat because Swoosh might get saliva on Bryce and Bryce didn't want that. Over time, Bryce got a little more comfortable and now Bryce is almost at the end of the study. We provide time with the dog for 16 weeks and he is at week 13, but he's very interactive with Swoosh now. His mom talks about how he looks forward to coming to see Swoosh.
The fact that you're taking blood pressure, does that make a difference in their lives if they don't have that stress? Is it a physical thing or is it just emotional like we're talking about, psychosocial?
Mary Jo Gilmer: In this study, it's more the emotional outcome, the psychological outcome that we are looking at. The physiologic changes are one indicator and there are also surveys that we give to the child and to the parents which ask them about how they're feeling. Are they feeling stressed? Are they feeling anxious or sad? Are they feeling cheerful or relaxed? We ask them those questions, but taking the blood pressure and pulse is just one other way of assessing their body's response to the situation. We know that there certainly is a physical component to how we feel emotionally, but that's a much more difficult thing to document.
For their psychological emotional comfort at coping or at adjusting to their illness, or long range, maybe how they respond to the medication differently,, how would that be?
Mary Jo Gilmer: That's a great study, looking at the relationship between their response to medications and their emotional status. We do know that in some situations, some children in this study are receiving fewer anti-anxiety medications than they were before seeing the dog. It may certainly have an effect on their response to medications, their responses to the illness, both short-term and long-term.
Coming in, I'm sure it's very frightening for an adult, much less a child to have to come in to face some of this stuff.
Mary Jo Gilmer: Yes. Just the smells, the sounds and the sights in a clinic like this. You might hear a child crying down the hall and think, "Oh, what's going on." So it is very anxiety-producing for kids.
When you see the various children in your study, what goes through your mind and your heart when you see them responding to the dog?
Mary Jo Gilmer: When we first started the study and there wasn't a lot of interaction in week one and week two, I was just feeling sad. We want to make a difference. We want to reduce the anxiety, but now we're in week 14 of the study and I can see those children's reactions and the dogs responding to the children. I can see that bond developing which is very exciting and heartwarming.
You've just started getting in some results. Tell me where we go from here at this point.
Mary Jo Gilmer: We will collect the data from all five sites, there are four besides Vanderbilt. We need larger numbers and our goal here at Vanderbilt is to enroll 20 families. We've enrolled six at this point and we're just about on target because we're a third of the way through the year. Once we are about halfway through, we'll begin to analyze the data that we have and at that point can look at trends. This is still pretty much a pilot even though with all five sites, we will have a maximum of 120 families. It's not enough to make a definitive cause and effect or a correlation, but it is enough to tell us that it's beginning to make a difference and let's see with more families involved if we can extend the study and show even more dramatic effects.
So at this point, what do you think?
Mary Jo Gilmer: It's very obvious to me, just anecdotally, that the dogs are making a difference. That interaction is making a difference with not only the child, but with the parents as well. The parents seem to look forward to it and the nurses seem to look forward to having the dogs here. The nurses ask us, is Swoosh, Orla or Kevlar coming today? They really light up when they know that the dog is coming because they too have seen what a difference a dog can make with children.
And you have three dogs that are working in this study?
Mary Jo Gilmer: We have five actually that have been approved and we have baseline samples on all five, but we only have three that are working on the project right now.
You're also checking the saliva of the dog. What is that all about?
Mary Jo Gilmer: By checking saliva, and we can do this in humans too, we're looking at cortisol levels in the saliva which is an indication of the stress level. We certainly don't want to stress the dogs and we need to know is this causing them undue stress by bringing them into the clinic and having them see children with cancer, children who may be very sick. Does that stress the dog? Once again, anecdotally, we don't think it does because the owners tell us they're so excited and that the dogs want to come. We'll look at the cortisol level in the saliva over time and see what the results are.
What is your hope that comes out of this study?
Mary Jo Gilmer: In this study, we're trying to find ways to decrease stress and anxiety in children who have been diagnosed with cancer and their parents as well. Animal-assisted therapy has been shown to have an effect with some populations, particularly the elderly and adults and we want to see if it can make a difference in children.
And if you find out it does, what will your thought be?
Mary Jo Gilmer: If we determine that it has an effect on reducing anxiety and stress, we hope that it will enable us to get more animal handlers and dogs into facilities to help children in many ways. There have been some dogs that have been used with children with autism, bereaved children and children with diabetes. We know with some adults that the dogs can be helpful in a myriad of ways and I think we need to try to make healthcare more accessible and more affordable and this is one way we hope that will happen.
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If you would like more information, please contact:
Ashleigh Ruehrdanz, MPH
Research and Evaluation Specialist & IRB Administrator
Humane Research and Policy
American Humane Association
Phone: (303) 630-9480
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