Complementary therapies for children undergoing stem cell transplantation: report of a multisite trial

BACKGROUND

Children undergoing stem cell transplant (SCT) experience high levels of somatic distress and mood disturbance. This trial evaluated the efficacy of complementary therapies (massage, humor therapy, relaxation/imagery) for reducing distress associated with pediatric SCT.

METHODS

Across 4 sites, 178 pediatric patients scheduled to undergo SCT were randomized to a child-targeted intervention involving massage and humor therapy, the identical child intervention plus a parent intervention involving massage and relaxation/imagery, or standard care. Randomization was stratified by site, age, and type of transplant. The interventions began at admission and continued through SCT Week +3. Primary outcomes included patient and parent reports of somatic distress and mood disturbance obtained weekly from admission through Week +6 using the Behavioral, Affective, and Somatic Experiences Scales. Secondary outcomes included length of hospitalization, time to engraftment, and usage of narcotic analgesic and antiemetic medications.

RESULTS

A mixed model approach was used to assess longitudinal trends of patient and parent report outcomes and to test differences between groups on these measures. Significant changes across time were observed on all patient and parent report outcomes. However, no significant differences between treatment arms were found on the primary outcomes. Similarly, no significant between-group differences were noted on any of the medical variables as secondary outcomes.

CONCLUSIONS

Results of this multisite trial failed to document significant benefits of complementary interventions in the pediatric SCT setting.

Evidence-Based Interventions for Survivors of Childhood Cancer and Their Families

OBJECTIVE

To summarize existing empirical reports of psychological interventions for children with cancer and their families and to outline directions for future work.

METHODS

Research accomplishments related to four areas were summarized: understanding and reducing procedural pain; realizing long-term consequences; appreciating distress at diagnosis and over time; and knowing the importance of social relationships. Recommendations for future research in this field were discussed in three domains: balancing competence and psychopathology; integrating research-based interventions into clinical care; future directions).

RESULTS AND CONCLUSIONS

Interventions related to procedural pain and distress have strong empirical support. Although most survivors of childhood cancer and their families adjust quite well as they complete treatment, evidence-based interventions during and after treatment that address cancer-specific sequelae represent important growing areas of work. In the future, the development of interventions to address emerging survivorship issues will be vital, and theoretically grounded, evidence-based pragmatic interventions will be necessary.

Pharmacologic and psychologic interventions for procedural pain

OBJECTIVE

This study evaluated a combined pharmacologic and psychologic intervention (combined intervention, CI) relative to a pharmacologic-only (PO) intervention in reducing child distress during invasive procedures in childhood leukemia. Predictors of child distress included age, group (CI, PO), and procedural variables (medications and doses, technical difficulty, number of needles required).

METHODOLOGY

This was a randomized, controlled prospective study that compared the PO (n = 45) and CI arms (n = 47), at 1, 6, and >12 months after diagnosis. A cross-sectional control group consisted of parents of 70 patients in first remission before the prospective study. Parent questionnaires, staff and parent ratings, and data on medications administered, technical difficulty of the procedure, and needle insertions were obtained for each procedure. This article reports on the final data point for the project (>12 months).

RESULTS

Mothers and nurses reported lower levels of child distress in the CI than the PO group. The CI and PO groups showed lower levels of child and parent distress than the cross-sectional control group. Distress decreased throughout the time, and child age was inversely related to distress (younger children had more distress) regardless of group. Child distress was associated with staff perceptions of the technical difficulty of the procedure and with child age, but not with medications administered.

CONCLUSIONS

The data showed that pharmacologic and psychologic interventions for procedural distress were effective in reducing child and parent distress and support integration of the two approaches. Younger children experienced more distress and warranted additional consideration. Staff perceptions of the technical difficulty of procedures were complex and potentially helpful in designing intervention protocols.