Non-pharmacological Interventions for Pediatric Cancer Patients: A Comparative Review and Emerging Needs in India

Effectiveness of Technology-Based Intervention in Symptom Management in Pediatric Oncology Patients: A Systematic Review and Meta-Analysis

BACKGROUND

Technology-based interventions are increasingly integrated to improve symptom management of pediatric oncology patients. However, evidence for their effectiveness remains low across various studies characterized by different methodologies and patient populations. This study aimed to synthesize and analyze the effectiveness of technology-based intervention in symptom management in pediatric oncology patients.

METHODS

Six databases (PubMed, Web of Science, Cochrane Library, Ovid MEDLINE, CINAHL, and Scopus) were searched from January 1, 2014, to January 1, 2024. The methodological quality of the included studies was assessed using the Cochrane and JBI checklists. The PRISMA guidelines for systematic reporting were followed in this study. The search protocol has been registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42024516320).

RESULTS

Thirteen studies with 624 pediatric oncology patients were analyzed. Significant differences were found between intervention and control groups in pain (Hedge's g = -0.695, 95% CI: -0.994 to -0.396, p < 0.001), fear (Hedge's g = -0.737, 95% CI: -1.01 to -0.464, p < 0.001), anxiety, and nausea and vomiting (Hedge's g = -0.573, 95% CI: -0.912 to -0.235, p < 0.001).

CONCLUSION

The findings indicate that VR, iPad, humanoid robots, and Pain Squad reduce pain in pediatric oncology. VR, biofeedback-based VR, and iPads also alleviate fear, while all three plus humanoid robots mitigate anxiety. VR, interactive mobile apps, tablet games, text reminders, and iPads effectively decrease nausea and vomiting. More research is needed to evaluate the long-term effects of these interventions.

The effectiveness of play therapy on depression and anxiety in hospitalized children with cancer: a systematic review

BACKGROUND

The presence of cancer and its treatment will induce anxiety and various effects, not only on a physical level but also on a psychological level. Play therapy can be used by children to articulate their emotions and foster proficient communication with healthcare professionals and caregivers. Play therapy emerges as a highly effective method for the management of illness in children diagnosed with cancer.

MATERIAL AND METHODS

A thorough search was conducted across multiple databases including PubMed, Web of Science, Scopus, Google Scholar, and Cochrane Library. Our review included only interventional studies published from inception to 1 March 2024 that investigated the impact of play therapy on depression and anxiety in hospitalized children with cancer. For each study, information was gathered regarding the study's objective, participant characteristics, conditions, intervention details, comparisons made, study duration, and outcome measures.

RESULTS

Following the retrieval of 2158 records, 12 studies were found to meet the eligibility criteria and were thus selected to include in the synthesis. Play therapy has been explored in several studies using interventions like cognitive-behavioral-based play therapy, family-based play therapy, group-based play therapy, virtual reality-based play therapy, and play therapy combined with other therapeutic approaches. Specifically, six studies investigated the effects of play therapy on anxiety, two studies on depression, and four studies on anxiety and depression.

CONCLUSION

Play therapy is highly recommended due to its simplicity, minimal requirement of tools and materials, ease of implementation, affordability, and suitability for hospitalized preschool and school-age children with cancer.

Impact of cognitive behavioural intervention on caregiver burden in mothers of children diagnosed with cancer

Background

Mothers of children diagnosed with cancer are found to have coping difficulties in various studies. Most of the studies were done on parents after their child has been newly diagnosed with malignancy, and very few studies were done on coping skills intervention. Hence, this study has been done to assess the impact of cognitive behavioural intervention on caregiver burden in mothers of children diagnosed with cancer.

Methods

Twenty mothers coming to the outpatient department of paediatric oncology from 01 September 2018 to 30 April 2019 were enrolled for the study. The participants were administered General Health Questionnaire, Brief Coping Operation Preference Enquiry Scale, Zung Self-Rating Anxiety Scale, and Coping Inventory for Stressful Situations-21 (CISS-21) Scale. Sixteen sessions of cognitive behavioural intervention were given over 8 weeks to all the participants. Reassessment was done after 3 months by use of the above mentioned scales.

Results

Participants' mean anxiety score was 49.40 (standard deviation [SD] ±8.89). They used adaptive (active coping and positive reframing) more than the maladaptive (denial and self-blame) coping strategies. Task- and emotion-focused coping mean score on CISS-21 revealed 19.25 (SD ±6.20) and 18.90 (SD ±5.76), respectively. Reassessment after cognitive behavioural intervention revealed statistically significant improvement in maladaptive coping styles, mean anxiety index score, avoidance, and emotion-focused coping.

Conclusion

The study has revealed mild to moderate anxiety and the use of both adaptive and maladaptive coping strategies by participants. There is statistically significant improvement in anxiety, maladaptive coping strategies with cognitive behavioural intervention.

The setting up and running of a children's activity group and learning centre for children with haematological and oncology conditions

BACKGROUND

Children diagnosed with haematological and oncology conditions spend long periods of time undergoing treatments in hospital. Treatments are intensive and may include combinations of chemotherapy, radiation, surgery and bone marrow transplants. This often means that they have prolonged hospital stays away from family, friends and familiar environments.

AIM

We aimed at starting an activity group and learning centre based in the hospital setting for children undergoing treatment for haematological and oncology conditions.

METHODS

The activity group and learning centre was set up in a tertiary care hospital under the department of Paediatric Haematology, Oncology and Bone Marrow Transplantation with the support of a local NGO called 'Samiksha Foundation' in Bangalore, India. Children who participated in the programme engaged in learning through participation in the activity groups which engaged in academic and non-academic activities. The activity group and learning centre was piloted in April and May of 2019. During the pilot sessions, 156 children participated in the group. Children of all ages were welcome to attend and were given activities based on their age and learning levels. Until March 2020, the group has seen over 600 children in attendance.

RESULTS

This methods report examines various aspects of the activity group such as setting up of the activity groups, how they are run, the activities conducted in the groups and the effects the group has had on children and their families as reported by them while undergoing treatment.

CONCLUSION

The overall response to the activity groups was positive and widely accepted among our patient community. The intervention proved to be effective, easy to implement and relatively inexpensive. We hope that by sharing data from our centre, more paediatric units may be able to implement such groups for children.

Progress in psycho-oncology with special reference to developing countries

PURPOSE OF REVIEW

Psycho-oncology has completed 25 years. There is growing recognition of the psychosocial needs of persons living with cancer and the role of sociocultural factors in addressing the needs. This review addresses the research in developing countries relating to distress associated with living with cancer and psychosocial care.

RECENT FINDINGS

There is growing recognition of the emotional needs, understanding of the sociocultural aspects of the emotional responses of persons, caregivers, role of resilience and posttraumatic growth and spirituality in cancer care. Psychosocial aspects of cancer are largely influenced by social, economic, cultural, religious and health systems. A number of innovative approaches to care like use of yoga, financial and material support and involvement of caregivers have been implemented. A positive development is the increasing professional attention to document and develop innovative care programmes.

SUMMARY

A significant proportion of the general population are living with cancer. There are significant psychosocial needs largely influenced by social, economic, cultural, religious aspects of the communities. There are a wide range of interventions from self-care to professional care to address the needs. In developing countries, there is need for longitudinal studies of psycho-social experiences, develop interventions that are culturally appropriate, along with enhanced use of information technology along with evaluation of interventions.