Effect of Animal-Assisted Activities on Symptoms and Emotions of Children with Neoplastic Disease: A Systematic Review with Meta-Analysis

Abstract

BACKGROUND: Animal-assisted activities (AAAs) have long been present in pediatric oncology as a nonpharmacological intervention aimed at helping children cope with symptoms and negative emotions during hospitalization and antineoplastic treatment. Among the systematic reviews in the literature, there is a lack of one with meta-analysis that includes only RCTs centered on the effect of the intervention on symptoms and emotions in children with neoplastic disease. OBJECTIVE: To synthesize the effect of AAAs on symptoms and emotions of children with neoplastic disease. METHODS: Studies were searched from biomedical databases Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, Scopus, AMED, sciELO, LILACS, CNKI, J-GLOBAL, J-STAGE, main trial registries and major sources of grey literature. Searching for useful documents took place from the inception of each resource until April 18, 2024. The risk of bias of included studies was assessed with RoB 2, and the overall effect size of the intervention was calculated by creating random-effects meta-analyses graphically represented by forest plots. The summary of findings was illustrated with a table in accordance with the GRADE method. RESULTS: Three parallel-group randomized controlled trials with low risk of bias were included (N = 151, mean age: 8.5-11.2 years). AAAs are promising for anxiety reduction (N = 134; SMD = -0.07 [95% CI: -0.40, 0.27], p > 0.05) and quality of life improvement (N = 84; SMD = -0.11 [95% CI: -0.53, 0.31], p > 0.05) in children and for anxiety reduction (N = 154; SMD = -0.50 [95% CI: -1.52, 0.52], p > 0.05) in parents/caregivers. The certainty/quality of evidence is low to very low. CONCLUSIONS: The effect of animal-assisted activities to reduce anxiety and improve the quality of life of children with neoplastic disease and to reduce parent/caregiver anxiety is small to moderate; however, the quality/certainty of evidence is very low to low. Therefore, further studies on the topic that overcome the current limitations need to be conducted in order to collect more robust data in favor of implementing the intervention in pediatric oncology.