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Physical Impairments and Service Dogs

Cancer occurs at the cellular level, the “building blocks”
of the body [1]. It is a mistake in the copying of cells. Cells will grow where they are not
needed and not die when they are supposed to. Groupings of these cells are
called tumors. Tumors come in two types, benign and malignant. Benign tumors
are not considered cancer [1]. Malignant tumors can spread to other parts of the body and invade other tissues. Common treatments for cancer are chemotherapy and radiation therapy.

Children can get cancer like adults can, but with some differences. Cancer in children can occur without warning or symptoms, but have a high rate of cure [2].
Common cancers are leukemia, brain tumors, lymphoma, and soft tissue sarcoma [2]. Children with cancer face possible isolation, loss of control of their lives in hospitals, and biopsychosocial conditions related to their illness [3].

Therapy animals are being investigated regarding their
efficacy in improving the quality of life (QOL) for children with cancer [4]. Even for adults, undergoing chemotherapy, hospital visits,
and treatment can be daunting and stressful. Animals provide a source of
comfort and stability for children (similar to other areas of research,
Depression and Cardiovascular Health). Studies have found that the presence of
animals can help the child be more social, more comfortable, feel less
isolated, and comply with their treatment guidelines [3].

== State of Current Research ==

Pet ownership, animal assisted activities, and animal
assisted therapy fit the National Institute of Health’s criteria as a complementary
and alternative medicinal (CAM) treatment. Reasons for using CAMs in the face of cancer often have been
found to be psychological in nature and related to the side effects of the
disease and conventional treatment, including fear, anxiety, hopelessness, body
image changes, and stress [5]. CAMs are also a way by which patients can regain some control of their environment, an environment in which they are subject to hospital schedules, tests, and their disease. A 2003 study investigates the extent to which a trained therapy dog and handler can help a patient maintain a positive outlook and use their social networks. While this study does not directly relate to childhood cancer, it addresses the same issues that children in hospital settings face. A population of 30 people with cancer was exposed to visits from a dog and handler, a friendly human visit, or a quiet reading session to see which had the greatest effect on anxiety [5]. Dog visits were rated the highest for making a person feel comfortable and safe. Patients reported that the presence of a dog was comforting and made them feel more at ease[5].

A 2004 study by Johanne Gagnon, France Bouchard, Marie Landry, Marthe Belles-Isles, Martine Fortier, and Lise Fillion describes the implementation of a hospital based animal therapy program for children with cancer. The authors note that the physical damage done by cancer can lead to adverse biopsychosocial issues such as anxiety, depression, loss of appetite, and withdrawal[6]. The study also investigates the extent to which therapy dogs may decrease the distress felt by children with in hospitals. Data was collected from two groups, children on the one hand, parents and nurses on the other. Questionnaires were issued to gather data on the effectiveness of the
canine interventions.

The study concluded that after the intervention benefits for
children included being more independent, eats more, and is more comfortable in
the hospital [6]. The parents report that hospitalization is “a happier event, that it is a day of happiness and that it helps with morale” [6]. Nurses report feeling more cheerful, motivated, and
positive in their facilities [6]. The authors believe that implementing therapy dog programs
in hospitals is beneficial to the children, parents, and staff, though more
research needs to be done to determine the extent to which AAT is effective as
well as how far into chemotherapy or other treatments can therapy dogs have an
impact [6].

The authors of “Canines and Childhood Cancer” note that
“children diagnosed with cancer and their families not only cope with physical
issues, but are also prone to psychosocial issues including isolation,
depression, trauma, stress, and fear” [3]. The article is a literature review aimed at examining
and describing the benefits of therapy dog interaction with hospitalized
children and their families. Children with cancer report a lower QOL, often
feeling isolated, depressed, anxious, and a loss of control over their lives.
CAM approaches try to treat these symptoms. The literature review found several
benefits of therapy dog interaction reported by patients and parents:

1. The dog provided distraction from pain/situation

2. The dog brought pleasure/happiness

3. The dog is fun/entertaining

4. The dog reminds the child of home

5. The child enjoys snuggling/contact with the dog

6. The dog provides company

7. The dog is calming

8. The dog eases pain [3].

The literature review also outlines research conducted
concerning AAT and depression. The findings are similar and cross disciplinary.
AAT can help make children in therapy sessions more compliant and willing to
open up to the therapist. Similarly, the review found that children in hospital
settings were more compliant with their treatment regimens when animals were
present [3].

== Areas for Investigation ==

Gagnon et al. note that while the efficacy and potential
benefits of dog-assisted therapy are demonstrated in their study, the
mechanisms by which those benefits are realized are still unknown. They call
for further studies to better understand the action process and for more
empirical evidence to support the implementation and use of animal assisted
therapy in hospital settings [6].

Jenkins et al. note that from here, one challenge is to
define and calrify precisely what an effective AAT intervention is. How do we
measure this, and what are the metrics? [3].

The 2012 literature review concludes with the hypothesis
that “it is also possible that AAT/AAA interventions may create conditions that
trigger endocrinological or neurological functions which in trn may affect the
course of human disease or human behavior” [3]. The authors suggest further research to explore possible benefits.

== Key Resources ==

Gagnon, J., Bouchard, F., Landry, M., Belles-Isles, M., Fortier, M., Fillion, L. (2004). Implementing a hospital-based animal therapy program for children with cancer: A descriptive study. Canadian Oncology Nursing Journal. 14(4). 217-222.

This study details the implementation of an animal therapy
program in a hospital setting for young children. Selection criteria specified
children over the age of two with a diagnosis of cancer and the ability to
speak, write, and converse in French to give consent. The study investigated
the ability of animal therapy to ease the distress of children undergoing
treatment in a hospital setting. Data was obtained using surveys and
questionnaires of both nursing staff and parents. The study found the “simple
fact of being in the company of a dog encourage the child” to leave their
rooms, participate in activities, and socialize with others.

Jenkins, M., Ruchrdanz, A., McCullogh, A., Casillas, K., Fluke, J. D., USA, American Humane Association. (2012). Canines and childhood cancer: Examining the effects of therapy dogs with childhood cancer patients and their families. 1-34.

This literature review shows evidence for implementing AAT
for children with cancer in hospital settings. The report describes studies
generally and reports the impact AAT with canines had on children, parents, and
hospital staff. The review also covers other territory, such as the effect of
AAT/AAA on depression, and how to implement animal therapy into a hospital
setting.

Johnson, R., Meadows, R., Haubner, J., Sevedge, K. (2003). American Behavioral Scientist. 47(55).

This article classifies AAT as complimentary and alternative
medicine (CAM) in the realm of cancer treatment. CAM aims to treat either the
disease itself or to mitigate side effects.
CAM treatments are also a way by which patients can regain some control
of their environment, an environment in which they are subject to hospital
schedules, tests, and their disease. People can become depressed, anxious, or
less compliant with treatment. Treating these psychosocial conditions can help
to improve overall health, aiding recovery, improving mood, and morale.

  1. ^ a b Cancer. In !MedlinePlus. Retrieved from http://www.nlm.nih.gov/medlineplus/cancer.html

  2. ^ a b Cancer in Children. In !MedlinePlus. Retrieved from http://www.nlm.nih.gov/medlineplus/cancerinchildren.html

  3. ^ a b c d e f g Jenkins, M., Ruchrdanz, A., McCullogh, A., Casillas, K., Fluke, J. D., USA, American Humane Association. (2012). Canines and childhood cancer: Examining the effects of therapy dogs with childhood cancer patients and their families. 1-34.

  4. ^ Urbanski, BL., Lazenby, M. (2012). Distress among hospitalized pediatric cancer patients modified by pet-therapy intervention to improve quality of life. Journal of Pediatric Oncology Nursing. 29(5). 272-82.

  5. ^ a b c Johnson, R., Meadows, R., Haubner, J., Sevedge, K. (2003). American Behavioral Scientist. 47(55).

  6. ^ a b c d e f Gagnon, J., Bouchard, F., Landry, M., Belles-Isles, M., Fortier, M., Fillion, L. (2004). Implementing a hospital based animal therapy program for children with cancer: A descriptive study. Canadian Oncology Nursing Journal. 14(4). 217-222.

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