Children with Cancer: Animal- Assisted Therapy and Coping with the Illness. Victoria Cooper. Temple University. Foundations of TR Practice / 2103

Transcription

1 Running Head: Children with Cancer Children with Cancer: Animal- Assisted Therapy and Coping with the Illness Victoria Cooper Temple University Foundations of TR Practice / 2103 April 14, 2011 Dr. Heather Porter

2 Children with Cancer 2 Abstract Although cancer is normally seen as a disability, it is a terminal illness that can affect the course of someone s life. Unfortunately, children have been shown to suffer more from cancer than adults. Most cancer patients endure long hospitalization periods and extensive treatments, but children have been reported to have the worst symptoms and long-term side effects. Animalassisted therapy (AAT) is one therapy program that has been shown to improve the attitudes of children with cancer, as well as lower their average pain during treatments. Doctors and health professionals have a complex job of not only treating the patients, but caring for them and their families. Although rates of survivors are increasing, there is no true cure for cancer, so not all patients are that fortunate. At the close of their lives, many children find themselves asking what death might be like, and what happens when they re gone.

3 Children with Cancer 3 Children with Cancer: Animal- Assisted Therapy and Coping with the Illness Articles were reviewed to study the effects of cancer in children. The first section explains the diagnosis of cancer, going into detail about the different types of cancer, the symptoms and side-effects, treatments, general statistics, and differences between ages and genders with cancer. The paper continues on with the summary of an article about the benefits of Animal-assisted therapy on children with life-threatening illnesses. The next section explains what it is like to work with children who are dying from cancer, and how to care for them in that critical period of their life. The paper concludes with a reflection piece that combines the ideas of the paper and relates it to the Therapeutic Recreation/Recreational Therapy (TR/RT) job. Cancer According to Merck (2009), cancer is the uncontrolled growth of cells, usually from a single cell. These cells lose normal control of their growth and begin to take over cells that are connected or close to them. They also metastasize, or move to other parts of the body, and then continue to grow and invade there. Cancer cells can be derived from any tissue in the body. As these cells develop and multiply, they form cancerous masses, known as tumors. Like the cancer cells, these tumors then invade other normal tissues. Tumors can either be benign (noncancerous tumors that cannot metastasize) or malignant (tumors that are cancerous and spread throughout the body). Malignant tumors can be of the blood or solid. Leukemia and lymphoma are cancers of the blood and cells of the immune system, and they cause harm by replacing normal cells with cancerous cells. Carcinomas and sarcomas are two types of solid tumors. Carcinomas are cancer of the cells that cover the surface of the body and produce hormones, called epithelial cells. Examples of carcinomas are skin, lung, colon, and breast cancers. Carcinomas occur more

4 Children with Cancer 4 in older people than younger. Sarcomas affect cells that form muscle and connective tissue, called mesodermal cells. An example of this type of cancer is osteosarcoma, or bone cancer. Sarcomas occur more in younger people than older. Cancer does not discriminate against age or gender, although more than 60% of cancers happen in adults, ages 65 and older. However, certain cancers affect more of one gender or age than another. Men are more likely to be diagnosed with prostate, lung, colon and rectum, or bladder cancer. Women are more likely to be diagnosed with breast, lung, colon and rectum, and uterine cancer. Skin cancer, specifically melanoma, equally affects men and women, but is most seen in older adults then younger individuals. Although there is no set cure for cancer, there are various treatments, such as radiation, that kill the cancer cells and try to prevent it from coming back. Risk factors for cancer are history and genetic factors, age, environmental factors (pollution), geography, diet, drugs and medical treatment, and infections. In children, cancer is very rare. Statistics show that one out of every five thousand children are diagnosed with cancer every year in the United States. The most common types of cancer in children are leukemia (33% of childhood cancer patients), brain tumors (21%), and lymphoma (8%). Wilms tumors, neuroblastoma, and retinoblastoma are other more common types of cancer in children. Treatment for children varies between or can be a combination of surgery, radiation, and chemotherapy, and is usually more effective in children then adults. Seventy five percent of children with cancer survive at least five years. However, two thousand children die each year in the United States from cancer. Since most children are still growing during treatment, side effects may occur, such as the stunted growth of whichever limb is receiving the treatment. Long term effects can be infertility, heart problems, stunted growth, or second cancers. Pediatric cancer usually requires a team of specialists to deal with not only the

5 Children with Cancer 5 illness, but the family and patient as well. This team includes the pediatric cancer specialists, the primary care doctor, a social worker, a teacher, and a psychologist. Animal Assisted Therapy and Children with Life-Threatening Illnesses Animal- assisted therapy (AAT) is a healing modality involving a patient, an animal therapist, and handler with a goal of achieving a specified therapeutic outcome (Braun, Stangler, Narveson, & Pettingell, 2009, p. 1). AAT is used to improve functioning in individuals, but is also used to comfort those in treatment. Dogs and cats are the most common animals used for AAT, but sometimes birds, guinea pigs, fish, horses, and dolphins may be used, depending on the needs of the client and the goals that need to be achieved in the therapy session (Braun et al., 2009). Animal- assisted therapy has been proved to promote calmness and lessen the amount of stresses put on a child during their treatment (Braun et al., 2009). Parents and children alike can often feel helpless and fearful during times of increased hospitalization (Braun et al., 2009). According to Kaminski, Pellino, & Wish (as cited in Braun et al., 2009, p. 1), Animal-assisted therapy has been shown to facilitate a child s coping with hospitalization. Braun et al. (2009) conducted a study about the effects of AAT on children in the hospital. Children were divided into two groups. One group of children was put into the intervention group, and they were given fifteen minutes with a dog in a therapy session. The children in the other group, the control group, had no interaction with the dog and were told to sit quietly for fifteen minutes. Blood pressure and pulse were measured before and after the session. Pain levels of both groups were also measured after the session. According to Braun et al. (2009), the results showed that the control group had a higher post test pain score than those in the intervention group. Parents also said they perceived less

6 Children with Cancer 6 pain in their child in the intervention group. There were no differences in results between age groups, genders, or those with previous experiences with pets. This study proves that AAT is successful at lessening pain (or the perception of pain) in children receiving treatment. The results, in conclusion, showed that pain was four times greater in those children who did not receive the time with the dog, than those who did receive time with the dog (Braun et al., 2009). As stated by Braun et al. (2009): The impact on pain reduction may be explained by the current understanding of the role of pets in modulating a psychoneuroendocrine response In other words, exposure to a pet of other friendly animal induces the release of endorphins, which induce a feeling of well-being, and lymphocytes, which increase the immune response. Another intriguing result that the study found was that an increased respiratory rate was discovered in children in the intervention group, and this is possibly linked to the idea that the children were excited to see a dog in the hospital (Braun et al., 2009). Children with Cancer and Their Terminal Illness This report tells about children with cancer nearing the end of their lives. It repeatedly refers back to one child, named Frank, who was diagnosed with acute lymphoblastic leukemia (ALL) at the age of ten years old (Hurwitz, Duncan, & Wolfe, 2004). After receiving chemotherapy, he was remitted. Frank relapsed twice at the age of twelve (Hurwitz et al., 2004). Studies show that twenty five percent of children with cancer don t survive (Hurwitz et al., 2004). When common treatments no longer seem like the cure, other alternatives are offered to the patient and their family. In the case of Frank, he was offered to either receive extensive chemotherapy that was painful and not necessarily affective, or a therapy that would lessen the

7 Children with Cancer 7 amount of stress put on his life by cancer (Hurwitz et al., 2004). Frank chose the second one to hopefully maximize his quality of life while in treatment (Hurwitz et al., 2004). Most children understand that the end of their normal treatments means they might be nearing the end of their life. When doctors and the team deal with patients and their families, it can be extremely difficult. They go about these discussions and decisions in a variety of ways, depending on which the parents prefer (Hurwitz et al., 2004). Dr. L, Frank s doctor, states (as cited in Hurwitz et al., 2004, p. 2): I try to be very honest with kids because I think that makes them comfortable, asking whatever is worrying them. I ask them, what do you think [dying] is like? He was worried that people would forget him, that there would be darkness and nothing left. He was concerned about pain. He was concerned about his family and how they would cope without him. Most doctors believe it is important for children to express their fears, as well as for health professionals to inform the children of their condition in a way that is appropriate to them (Hurwitz et al., 2004). Doctors also inform the parents that they will tell the children the truth about their illness, especially if they ask questions (Hurwitz et al., 2004). However, doctors feel it is very important to confront the parents as to how they want the information present to their son or daughter (Hurwitz et al., 2004). Communication is vital between all members of the child s team for treatment to be successful and for goals to be reached (Hurwitz et al., 2004). According to the American Academy of Pediatrics (as cited in Hurwitz et al., 2004, p. 5), The goal is to add life to the child s years, not simply years to the child s life. However, as much as the patient is the team s number one concern, the parents and rest of the family and community are also of major

8 Children with Cancer 8 importance. Frank s mother was quoted (as cited in Hurwitz et al., 2004, p.7) saying, I feel like I don t want to leave the hospital. When we walk out the door, it s really going to hit. Here you have all the doctors and nurses and people that are there for you. According to Hurwitz et al. (2004), parents are under as much stress as the child is due to the constant hospitalization and the possibility of losing their son or daughter. Doctors must always remind the family that they are not alone. The whole team cares for their needs as well. Cancer unfortunately takes a toll on these children s bodies, and this increases as they near the end of their lives. Fatigue affects 81% of adults with cancer, and a majority of children, although no exact number has ever been recorded (Hurwitz et al., 2004). Eighty percent of children reported feeling a great deal of pain (Hurwitz et al., 2004). The third most common symptom of cancer in children is dyspnea, or shortness of breath (Hurwitz et al., 2004). Despite all these symptoms, the children remain strong. Dr L. states (as cited in Hurwitz et al., 2004, p. 7-8): One of the things that s truly amazing about taking care of these kids is that they truly are unique and special human beings. They teach you so much. I think it s a privilege to have the opportunity to know them, and I try not to forget that You can much such a difference in the time that they have, and it s such a privilege to have that opportunity. Reflection After studying cancer, specifically cancer in children, TR/RT could play a large component in their recovery and treatment process. Being hospitalized for large portions of time causes quality of life to decrease because these children aren t getting the normal lives they deserve. Instead of being in school running around on the playground with their friends, they are confined to a hospital room, where they most likely have minimal social interactions, unless it is

9 Children with Cancer 9 their family or other children in the cancer ward, and minimal physical interactions. If TR/RT was promoted in a cancer ward with children, they could still have the fun they deserve, within safety boundaries. Also, a healthy leisure lifestyle would help the children return to doing the things they loved, in a hospital or not, which would maximize their quality of life. It is said that when a person feels better emotionally and mentally, they often get better physically much quicker. If this is true, which I believe it is, then including TR/RT and/or animal-assisted therapy into hospital program would better the patients there. Conclusion Article one showed the benefits of animal-assisted therapy. If more hospitals saw these results, many children would be less distressed by the treatments they must undergo. Article two describes in detail more of the stresses in parents and children hospitalized from cancer, and I think that if the results from article one were incorporated with the statistics in article two, less pain would be reported from children, and possibly even less stress from the parents. Recreation and leisure are very important in people s lives and so they should be incorporated in the treatments and therapies that children with cancer receive. Hospitals need to recognize the immense mental and physical health benefits of TR/RT on those with cancer, not just on those with physical or developmental disabilities. Although cancer is not considered a typical disability, it is a life-threatening illness that can completely change life as they know it. Quality of life, not just amount of life, should also be the concern of doctors working with children with cancer, and so more TR/RT programs should be implemented that enhance the well-beings of their patients.

10 Children with Cancer 10 References Braun C., Stangler T., Narveson J., & Pettingell S. (2009). Animal-assisted therapy as a pain relief intervention for children. Complementary Therapies in Clinical Practice, 15, Retrieved from Temple University s Library database Hurwitz C., Duncan J., & Wolfe J. (2004). Caring for the child with cancer at the close of life. American Medical Association, 292, Retrieved from jama.ama-assn.org on April 5, 2011 Merck (2009). Cancer. Accessed via website on 4/5/2011 Merck (2009). Childhood Cancers. Accessed via website on 4/5/2011