Animal-Assisted Therapy

Every year, nearly 13,000 children are diagnosed with cancer, and some 40,000 are receiving treatment. It’s a scary time for both the children and their families, and anything that helps make it less frightening is a good thing. Can dogs do that?

Those of us who love dogs already know how much they improve our lives, especially by providing absolute love and comfort when we most need it. This healing human-canine bond is the basis for the ever-growing use of therapy dogs in all sorts of settings, including nursing homes, retirement homes and schools, and as part of disaster-relief teams.

Therapy dogs have become common in hospitals as well, but access varies by institution. Dogs in hospitals raise general concerns about human safety, including increased infection risks, allergies, phobias and aversions. While there is a wealth of positive, anecdotal evidence for the benefit of animal-assisted therapy (AAT) in all these settings, there’s little hard evidence to verify it. To overcome remaining barriers to AAT as part of their treatment programs, hospital staff and risk managers need proof.

Enter the American Humane Association (AHA). With financial support from Zoetis, a global animal health company, and the Pfizer Foundation, a charitable offshoot of the international pharmaceutical giant, AHA is in the final stage of a rigorous, three-year, peer-reviewed, controlled study, “Canines and Childhood Cancer: Examining the Effects of Therapy Dogs with Childhood Cancer Patients and their Families,” or CCC for short.

The study aims to document the specific medical, behavioral and mental-health benefits AAT may have for children between the ages of 3 and 12 recently diagnosed with cancer, as well as for their families. The third and final clinical stage of the study includes 100 children receiving treatment at five participating children’s hospitals across the country, including Randall Children’s Hospital at Legacy Emanuel in Portland, Ore.

Janice Olson, MD, MHA, is medical director of the Children’s Cancer and Blood Disorders Program at Randall and manages its CCC study. “We have a long tradition of pet therapy, at least since I arrived 15 years ago. So when this study opportunity came up, I said, ‘Sure, why not?’ We already had dogs visiting in in-patient, so why not out-patient as well? Staff didn’t have any concerns. Everyone was more than happy to participate.”

According to Amy McCullough, AHA’s national director of humane research and therapy, the hospitals were selected because they had existing therapy dog programs. “It was difficult to recruit hospitals for the study,” Amy said. “Doing research [has an impact on] their resources and staff. Some only allowed therapy dogs one day a week, or in one room outside of the treatment clinic. It was interesting to see the differences between hospitals across the country in terms of how therapy dogs were used. There are no standards. Some hospitals were willing to modify their policies to allow for our study—for example, in how often dogs can visit and where.”

The study requires that the dogs be registered with a therapy dog organization, be credentialed and meet the participating hospital’s criteria. Some hospitals’ criteria exceeded those AHA would have required.

To answer the question, “What can we do to improve the day-to-day health, healing, and quality of life of children suffering from cancer, and the families who suffer along with them?” the study tracks blood pressure, heart rate and psychological responses in the kids, their families, and the staff and caregivers who enjoy the benefit of working with therapy dogs. (Sadly, 50 percent of the children and families enrolled in the study will not be spending time with the therapy dogs because they are in the control group required for the study to have validity.)

Ryker Halpin was diagnosed with leukemia in April 2014, the month he turned six. He and his parents, Allison and Matt Halpin, are enrolled in the CCC study at Randall. They have an English Mastiff at home, so Allison and Matt knew Ryker would be comfortable with visits from a therapy dog. Ryker had been in the hospital a week when they were approached about participating. “Given all the dreadful news we’d just gotten, it seemed like a great opportunity, something positive to look forward to,” said Allison.

Ryker was paired with Bailey, a five-year-old female yellow Lab, and her handler Kate Dernbach. Bailey visits Ryker and his parents once a week at the hospital; each visit lasts 15 minutes (give or take five minutes). They’ll do this for four months. After each session with Bailey, Ryker is asked questions about how he’s feeling, and his blood pressure and pulse are recorded. His parents are also asked a series of questions, and a sample of Bailey’s saliva is taken to monitor her stress level.

At the time this article was written, Bailey had visited Ryker four times. “The first couple of visits were pretty low-key because Ryker had been given a lot of steroids, was just not himself, withdrawn and quiet,” Allison said. “But when he came home, he talked about Bailey. Bailey was something for him to look forward to. The last visit, Ryker was just waking up, so was in bed; he asked Bailey to get into bed with him. He enjoys brushing her. She was there during a chemo treatment; she’s one more thing to take his mind off it all.”

Dernbach and Bailey have been volunteering at Randall for close to three years, visiting once a week and making appearances on every floor to see children with all sorts of illnesses. Dernbach is a mom and a cancer survivor, so the idea of participating in the CCC study appealed to her on many levels. “It’s so rewarding to go in and help. The dogs are a huge distraction from why the kids are there, so even if the visit is only 15 minutes, it’s good for them. Bailey has calmed and relaxed people. I know what a huge impact she makes.”

Bailey’s visits with Ryker got off to a slow start. “Maybe it was just that everyone was unsure, because of the study,” Dernbach said. “He didn’t want her on the bed, didn’t want to touch her. If that happens during a visit to other kids outside the study, we quietly leave. With Ryker, we had to stay. But by the third visit, he brushed her, and on the fourth visit, he was excited to see her, asked her to get up on the bed, had his hand on her the whole time while getting chemo. Bailey slept beside him, which he thought was funny because she’s a 70-pound Lab taking up the whole bed and he couldn’t straighten out his legs.”

Bailey and the other therapy dogs are also being closely studied. Researchers videotape the visits and dog behaviorists review the videos for signs of canine stress, such as excessive yawning and other body cues. They also measure the level of the stress hormone cortisol in the dogs’ saliva before and after visits to see if and how ATT has an impact on their physical and mental health. According to Dernbach, Bailey’s not allowed to see other children during study visits with Ryker to ensure that the data collected from her saliva samples is valid.

The good news: earlier stages of the study showed that the dogs did not have increased stress from their time with the children and families. In fact, their cortisol levels, on average, were lower after spending time with the children.

McCullough and AHA hope that the study results, which are expected sometime in 2015, will bolster efforts to expand the use of ATT as an affordable adjunctive treatment option for people of all ages and walks of life, with many sorts of illnesses in a variety of settings. Some of the already-documented benefits of ATT include relaxation and lowered blood pressure; improved social skills; and decreased stress, anxiety, loneliness and depression. “We encourage therapy dog handlers to get involved in programs like this,” said McCullough. “It’s a low-cost, accessible treatment, helping families in need.”

For the Halpins, the benefits of participating in the study are immediate and real. Even the survey questions asked of Ryker after each visit with Bailey, about his stress and anxiety, are helpful. “They ask him to rate things as very satisfactory, satisfactory or unsatisfactory. He expresses his feelings in so many ways when responding to the survey. As a parent, I get better insight to his feelings. He says he’s not stressed or scared, that he’s joyful. That reminds me to not project my feelings onto him. Ryker lights up when it’s a Bailey-visit day. He’s a shy guy; seeing Bailey helps.”

Such a simple thing—a visit from a therapy dog—provides powerfully healing benefits for patients young and old, as well as for their families and the staff who treat them. Here’s hoping the study’s results open even more doors to therapy dogs and their handlers very soon. No one should have to go without.