Animal Assisted Therapy For Cancer Supportive Care

September 14, 2009

Animal Assisted Therapy For Cancer Supportive Care
Ernest H. Rosenbaum, MD and Alexandra Andrews

Health Benefits of Pets
Exercise and Lifestyle Changes
Psychological Status and Support

Conclusion
HUD - Sample letter for Companion Animal
References

Health Benefits of Pets
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According to the Centers for Disease Control¹ Most households in the United States have at least one pet. Why do people have pets? There are many reasons.

Pets can decrease your:

- Blood pressure
- Cholesterol levels
- Triglyceride levels
- Feelings of loneliness

Pets can increase your:

- Opportunities for exercise and outdoor activities
- Opportunities for socialization

For cancer survivors animal assisted therapy (AAT) using either service animals or emotional (companion) support animals (ESA) may provide valuable support.

Service animals are individually trained to perform tasks for people with disabilities such as guiding people who are blind, alerting people who are deaf, pulling wheelchairs, alerting and protecting a person who is having a seizure, or performing other special tasks. Service animals are working animals, not pets.²

An emotional support animal is a domesticated pet which provides therapeutic benefit to its owner through companionship and affection. A pet is kept for companionship and enjoyment usually a dog, cat, bird, fish or turtle that is traditionally kept in the home for pleasure rather than commercial or any other purposes.

Both pet ownership and social support are significant predictors of survival, independent of the effects of the other psychosocial factors and physiologic status. Presence of pets has been associated with reduction of stress and blood pressure, coronary artery disease,³ and may reduce the risk of cardiovascular diseases including strokes.

Hospital animal visits have demonstrated help in pain control and stress for patients.⁴ Canine visitation therapy (CVT) improves cardiopulmonary pressures, neurohormone levels, and anxiety in patients hospitalized with heart failure.⁵

Presented at the 2008 International Stroke Conference, "A decreased risk for death due to myocardial infarction (MI and all cardiovascular diseases [including stroke] was observed among persons with cats. Acquisition of cats as domestic pets may represent a novel strategy for reducing the risk of cardiovascular diseases in high-risk individuals."⁶

Exercise and Lifestyle Changes
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A moderate amount of regular exercise is important to promote a healthy lifestyle. A recent article showed that physical exercise could help improve cognitive function, as well as decrease anxiety and depression.^7,8

Studies have shown owning and walking a dog daily promotes better physical activity in children, adults and seniors.^9,10 Increasing regular physical activity in adults at elevated risk of cardiovascular disease is an important target for preventive medicine. Research has shown that it's easier to be physically active and stick with an exercise program when there is a social support partner.¹¹

Dog ownership was associated with physical activity and walking. Dog owners had 57% to 77% higher physical activity compared to those not owning dogs.¹² The reason is that companion dogs have been shown to be excellent exercise buddies and can be counted on as loyal weight loss partners. Dog ownership is associated not only with better exercise but also with weight control. "Given the importance of social support and physical activity in weight loss, 'Do you own a dog?' or 'Have you considered buying a dog?' should be included in the medical history for overweight and obese patients."^13,14

The role of exercise and diet as preventive measures comprises hundreds of studies. They have shown a reduction of the risks of medical problems, comorbidities, toxic side effects, second cancers and increased survival and quality of life.

Psychological Status and Support
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In the Nurses' Health Study, socially isolated women had a 66% increased risk of all-cause mortality and a two-fold increased risk of breast cancer-specific mortality.¹⁵ Much of this was related to lack of access to care from family and friends. Depression is a major problem. In a study of ovarian cancer patients treated with platinum-based chemotherapy, depression was the strongest prognostic factor for survival.¹⁶ Psychosocial and family support is important, as depression does affect the outcome of older patients.¹⁷

Social isolation is a major problem for older adults in general and is a risk factor for psychological distress. "Pet ownership, or just being in the presence of a companion animal, is associated with health benefits, including improvements in mental, social, and physiologic health status."¹⁸ Emotional support animals provide social and community therapeutic support for isolation and depression among the elderly and disabled.^19,20

Recognizing the importance of supportive animal assisted therapy, The Fair Housing Amendments Act of 1988, Section 504 of the Rehabilitation Act of 1973, and Title II of the Americans with Disabilities Act permit either a person with disabilities or an elderly/senior to keep a pet for emotional support.²¹ Effective November 26, 2008, the Department of Housing and Urban Development issued Pet Ownership for the Elderly and Persons With Disabilities.²² Landlords, condominium associations, trailer parks, etc, must make accommodation for the pet and not charge extra fees or deposits. A letter or prescription from a medical professional regarding the need for the companion animal may be required.

Conclusion
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Animal assisted therapy preventive healthcare creates opportunities for better lifestyle choices, and social networks. An emotional support animal may relieve depression, anxiety, stress, and improve coping skills. Cancer supportive care pet ownership may be a novel approach to promote better health and quality of life.

HUD - Sample letter for Companion Animal
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Sample letter for Companion Animal²³

DATE
NAME OF PROFESSIONAL (therapist, physician, psychiatrist, rehabilitation counselor)
ADDRESS

Dear [HOUSING AUTHORITY/LANDLORD]:
[NAME OF TENANT] is my patient, and has been under my care since [DATE]. I am intimately familiar with his/her history and with the functional limitations imposed by his/her disability. He/She meets the definition of disability under the Americans with Disabilities Act, the Fair Housing Act, and the Rehabilitation Act of 1973.

Due to [REASON], [FIRST NAME] has certain limitations regarding [SOCIAL INTERACTION/COPING WITH STRESS/ANXIETY, ETC]. In order to help alleviate these difficulties, and to enhance his/her ability to live independently and to fully use and enjoy the dwelling unit you own and/or administer, I am prescribing an emotional support animal that will assist [FIRST NAME] in coping with his/her disability.

I am familiar with the voluminous professional literature concerning the therapeutic benefits of assistance animals for people with disabilities such as that experienced by [FIRST NAME]. Upon request, I will share citations to relevant studies, and would be happy to answer other questions you may have concerning my recommendation that [FULL NAME OF TENANT] have an emotional support animal. Should you have additional question, please do not hesitate to contact me.

Sincerely,
Signature

[NAME OF PROFESSIONAL]

References
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1.

Health Benefits of Pets | CDC Healthy Pets Healthy People (http://www.cdc.gov/healthypets/health_benefits.html)

2.
U.S. Department of Justice, Civil Rights Division, Disability Rights Section, Americans with Disabilities Act, ADA Business BRIEF: Service Animals, (http://www.ada.gov/svcabrpt.pdf), April 2002.

3.
Friedmann E., Thomas S.A., Pet ownership, social support, and one-year survival after acute myocardial infarction in the Cardiac Arrhythmia Suppression Trial (CAST), Am J Cardiol. 1995; Dec. 15;76(17):1213-7

4.

Sobo E.J., Eng B., Kassity-Krich N., Canine Visitation (Pet) Therapy: pilot data on decreases in child pain perception, J Holist Nurs 2006; Mar;24(1):58-9.

5.

Kathie M. Cole, RN, MN, CCRN, Anna Gawlinski, RN, DNSc, Neil Steers, PhD and Jenny Kotlerman, MS., Animal-Assisted Therapy in Patients Hospitalized With Heart Failure, American Journal of Critical Care 2007;16: 575-585 CE Article.

6.
Adnan I. Qureshi, M. Fareed, K. Suri, Mustapha A. Ezzeddine, Afshin A. Divani; Zeenat Qureshi, Cats as Domestic Pets Reduce the Risk of Cardiovascular Diseases. Results from the Second National Health and Nutrition Examination Study, Mortality Follow-up Study. Abstracts From the 2008 International Stroke Conference, Stroke 2008; 39;527-729, published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 72514, P293

7.
Nicola T. Lautenschlager, MD; Kay L. Cox, PhD; Leon Flicker, MBBS, PhD; Jonathan K. Foster, DPhil; Frank M. van Bockxmeer, PhD; Jianguo Xiao, MD, PhD; Kathryn R. Greenop, PhD; Osvaldo P. Almeida, MD, PhD Effect of Physical Activity on Cognitive Function in Older Adults at Risk for Alzheimer Disease, A Randomized Trial, JAMA 2008; 300(9): 1027-1037.

8.
Kristine Yaffe, MD; Deborah Barnes, MPH; Michael Nevitt, PhD; Li-Yung Lui, MA, MS; Kenneth Covinsky, MD, A Prospective Study of Physical Activity and Cognitive Decline in Elderly Women Women Who Walk. Arch Intern Med 2001; 161:1703-1708.

9.
Timperio A., Salmon J., Chu B, Andrianopoulos N., Is dog ownership or dog walking associated with weight status in children and their parents? N.Health Promot J Austr 2008; Apr;19(1):60-3.

10.

Hayley E. Cutt Matthew W. Knuiman and Billie Giles-Corti, Does getting a dog increase recreational walking? International Journal of Behavioral Nutrition and Physical Activity 2008; 5:17

11.

Steptoe A., Rink E., Kerry S., Psychosocial predictors of changes in physical activity in overweight sedentary adults following counseling in primary care, Prev Med 2000; Aug 31(2 Pt 1):183-94.

12.

Hayley Cutt, BSc, Billie Giles-Corti, PhD, Matthew Knuiman, PhD, Anna Timperio, PhD and Fiona Bull, PhD, Understanding Dog Owners' Increased Levels of Physical Activity: Results From RESIDE, January 2008, Vol 98, No. 1 | American Journal of Public Health 66-69.

13.
Robert F. Kushner, MD, Obesity Management Companion Dogs as Weight Loss Partners Obesity Management October 2008; 4(5): 232-235.

14.

Robert F. Kushner, Dawn Jackson Blatner, Dennis E. Jewell and Kimberly Rudloff, The PPET Study: People and Pets Exercising Together Obesity 2006; 14, 1762-1770.

15.
Candyce H. Kroenke, Laura D. Kubzansky, Eva S. Schernhammer, Michelle D. Holmes, Ichiro Kawachi, Social Networks, Social Support, and Survival After Breast Cancer Diagnosis Journal of Clinical Oncology, March 1, 2006, Vol 24, No 7: pp. 1105-1111.

16.
Extermann, M. and Hurria, A., Comprehensive Geriatric Assessment for Older Patients With Cancer J Clin Oncol 2007; 25: 1824-1831.

17.

David Spiegel and Janine Giese-Davis, Depression and cancer: mechanisms and disease progression, Biological Psychiatry August 2003 Volume 54, Issue 3, 1, Pages 269-282.

18.

Erika Friedmann PhD and Heesook Son MPH, RN, The Human-Companion Animal Bond: How Humans Benefit Veterinary Clinics of North America Small Animal Practice, March 2009 Volume 39, Issue 2 Pages 293-326.

19.
Brodie S.J., Biley F.C.,An exploration of the potential benefits of pet-facilitated therapy J Clin Nurs 1999; Jul 8(4):329-37.

20.
Knight S., Edwards V.,.In the company of wolves: the physical, social, and psychological benefits of dog ownership, J Aging Health 2008; Jun;20(4):437-55

21.
Department of Housing and Urban Development and the Department of Justice Reasonable Accommodations under the Fair Housing Act, (http://www.usdoj.gov/crt/housing/jointstatement_ra.php)

22.
Department of Housing and Urban Development, Pet Ownership for the Elderly and Persons With Disabilities, (http://edocket.access.gpo.gov/2008/E8-25474.htm), 24 CFR Part 5, [Docket No. FR-5127-F-02]RIN 2501-AD31

23.
Department of Housing and Urban Development, Sample letter for Companion Animal

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