Abstract
The purpose of this study was to explore whether cancer patients, who are actively receiving cancer therapy and who sometimes have only a few months to live, have anxieties or concerns that arise as a result of not being able to care for their pets during their illness or after their demise. A survey was developed and utilized among such patients to assess whether they had pet-related concerns and anxieties and to determine whether they desired more information on available pet-related resources. Three hundred nine patients completed the survey, and 170 (55%) had a pet(s). The majority described that their pets helped them during their cancer. Only 4% of all patients and 7% of the pet owners desired more information on community resources for pet care, and 80% of pet owners had family members who were already helping them with pet care. Cancer patients appear to benefit from their pets and report few pet-related concerns. Healthcare providers at other medical centers should consider determining whether their patients have needs and anxieties related to caring for their pets and whether educational efforts should be put forth to focus on such issues.
Keywords: Cancer patients, Companion animals, Pet-related concerns and anxieties, Chemotherapy, Pet-related resources
When Leona Helmsley bequeathed $12 million to her white Maltese—and far less to some family members—the press reported the story with consternation (http://www.washingtonpost.com/wp-yn/content/article/2007/08/29/AR2007082900491.html). Nonetheless, Helmsley’s actions illustrate an important point: some people care deeply about their pet and worry about the animal’s welfare.
To our knowledge, this confluence of caring deeply about a pet, fretting about the fate of that animal, and concurrently confronting a lethal personal illness has not been examined in cancer patients. Do cancer patients who are actively receiving cancer therapy and who sometimes have only a few months to live report anxieties or concerns that arise as a result of not being able to care for their pets during their illness or after their demise?
Although this question has not been investigated, two points suggest it should be. First, 60% of all households in the United States include a pet [1]. Thus, any pet-related concerns likely affect a notable percentage of cancer patients and are, therefore, important to identify. Second, the availability of pet trusts and estate planning, coupled with a growing number of organizations that provide homes for the pets of terminally ill patients, suggest that pet owners with cancer worry about the possibility that their pets might not be adequately cared for during cancer treatment and after their demise [2]. Identifying whether such concerns do, in fact, exist represents a first step in helping patients contend with them.
To date, it remains unknown whether such pet-related concerns and anxieties really do exist. Therefore, the current study was undertaken to explore whether any such negative aspects of pet ownership exist among cancer patients who are actively receiving cancer therapy.
Methods
Overview
This study was approved by the Mayo Clinic Institutional Review Board prior to patient enrollment. All patients were told that completion and return of the questionnaire comprised informed consent for study participation. Participants were enrolled through the Chemotherapy Treatment Unit at the Mayo Clinic in Rochester, Minnesota.
All consecutive patients who were receiving therapy in the Chemotherapy Treatment Unit were eligible. In general, the nursing staff was asked to consider approaching all patients for participation, but they were also permitted to use their discretion in choosing not to approach a particular patient in the event of patient anxiety, poor reading skills, a patient not feeling well, or other factors. Whether or not patients had a pet was not a consideration, as the primary goal of this study was to determine the percentage of patients as a whole who required more information on pet-related resources.
Questionnaire Development
After an in-depth review of the published literature, the study team concluded that no previously developed questionnaire met the needs of this study. Therefore, the team utilized three methods to develop a germane tool. First, select questions from a previously validated instrument, the Lexington Attachment to Pets Survey, were incorporated into the questionnaire in development [3]. Second, the study team modified items from other tools to elicit baseline data from each patient. Third, after a series of meetings, members of the study team constructed a group of select questions that focused on the hypothesized relationships between pets and patients’ potential anxieties and concerns. The questionnaire was revised multiple times and reviewed by an investigator who was not part of the study team but was familiar with questionnaire development. Further revisions were then undertaken until a final version of the latter emerged that was acceptable to the study team (Fig. 1).
Fig. 1.
The questionnaire developed and utilized in this study
Review of the Medical Record
To supplement demographic data derived from the questionnaire, the study team undertook a review of the medical record of all patients who had not specified otherwise. This review was undertaken in >95% of surveyed patients and provided information on patient age and gender, type of cancer, and whether or not cancer treatment was being administered with curative intent.
Analyses and Sample Size
In general, this study was descriptive in nature and all demographic and survey results are provided as such with 95% confidence intervals reported. The long-term goal was to identify and ultimately provide information on available community and financial resources to help cancer patients who were worried about the care of their pets as a result of their own illness. Therefore, the primary endpoint was to report the percentage of enrolled patients who responded that they would desire further information about such resources.
Surveying a total of 300 patients would allow the report of this percentage with a one-sided 95% confidence interval of 6% by utilizing the most conservative anticipated proportion. Based on conservatively estimated rates of pet ownership in the United States and rates of previously reported noncurative chemotherapy administration within the Chemotherapy Treatment Unit at the Mayo Clinic [4], the study team decided a priori that, if 20% or more of patients stated that they desired more information on community and financial resources for taking care of their pets, there would be clinical justification for providing such information to patients in a structured fashion.
Results
Patient and Pet Demographics
A total of 309 patients completed the survey. Patients had a median age of 59 years (range=19, 91). One hundred seventy-three (56%) were women. Most (61%) were receiving chemotherapy with noncurative intent.
One hundred seventy patients (55%) were pet owners. Seven of these lived with only their pets. Dogs were the most common companion for the group as a whole (72%), followed by cats (51%); other pets lived in fewer than 10% of households and included horses, birds, and others. Approximately half of those with companion animals had more than one.
Only one cancer patient reported giving up a pet because of his cancer diagnosis. However, two commented on not acquiring another pet because of their diagnosis.
Desiring Information on Pet Resources
Only 12 patients, all of whom were pet owners, desired information on pet-related community and financial resources (Table 1). This proportion represents 4% of the whole group (95% confidence interval=2%, 6%) and 7% of the pet owners (95% confidence interval=3%, 11%). Interestingly, 11 of these patients reported receiving help from family members for pet care. Only two of these patients lived alone. These percentages were well below the 20% a priori threshold that would have prompted the study team to consider developing a structured patient educational effort on available pet resources.
Table 1.
Pet-related needs
| True | False | |
|---|---|---|
| Since my cancer, family members have helped me take care of my pet. | 135 (80) | 31 (18) |
| Since my cancer, healthcare providers have helped me come up with ways to take care of my pet. | 12 (7) | 147 (87) |
| I would like to know about community and financial resources to help me take care of my pet. | 12 (7) | 149 (88) |
Numbers in parentheses indicate percentages and may not add up to 100%, as not all respondents answered all questions
However, 136 patients (80%) had received help in taking care of their pet(s) from family members following their cancer diagnosis (Table 2). Moreover, 24% of pet owners either “strongly agreed” or “agreed” with the statement, “I worry about what would happen if I could not take care of my pet.” Twelve pet owners (7%) indicated “healthcare providers have helped me come up with ways to take care of my pet” (Table 2).
Table 2.
Benefits/challenges of pet ownership
| Strongly agree |
Agree | Neutral | Disagree | Strongly disagree |
|
|---|---|---|---|---|---|
| My pet is very important to me. | 100 (60) | 51 (30) | 17(10) | 1 (<1) | 0 |
| I am healthier because of my pet. | 76 (45) | 36 (22) | 48 (29) | 7 (4) | 1 (<1) |
| My pet helps me to deal with stress. | 80 (48) | 48 (29) | 32 (19) | 7 (4) | 1 (<1) |
| I worry about having my pet close to me while receiving cancer treatment. | 3 (2) | 6 (4) | 39 (23) | 57 (34) | 63 (37) |
| I worry about what would happen if I could not take care of my pet. | 17 (10) | 21(13) | 46 (28) | 48 (29) | 33 (20) |
Numbers in parentheses indicate percentages and may not add up to 100%, as not all respondents answered all questions
Pet Companionship
Overall, patients indicated a high level of attachment to their companion animals, and many agreed that having a pet provided health benefits (Tables 2 and 3). Although cancer patients are sometimes at higher risk for infections, most did not seem worried about contact with their pets. In response to the statement, “I worry about having my pet close to me while receiving cancer treatment,” only 6% of patients either “strongly agreed” or “agreed” with this statement.
Table 3.
Questions from the Lexington Attachment to Pets Survey
| Yes | No | Maybe | Unsure | |
|---|---|---|---|---|
| Do you consider your pet a friend? | 152 (90) | 3 (2) | 11 (7) | 2 (1) |
| Do you talk to your pet? | 164 (97) | 3 (2) | 2 (1) | 0 |
| Does owning a pet add to your happiness? | 153 (91) | 3 (2) | 11 (7) | 2 (1) |
| Do you often play with your pet? | 139 (82) | 12 (7) | 15 (9) | 3 (2) |
| Do you talk to others about your pet? | 151 (89) | 7 (4) | 11 (7) | 0 |
Numbers in parentheses indicate percentages and may not add up to 100%, as not all respondents answered all questions
Write-In Comments
Patients who completed the survey were given the opportunity to provide additional comments, and 45 did so. Ten of these patients did not have a pet. Most comments were positive, but a few expressed concerns. Positive comments included the following: “Our pets have [provided] a great deal of comfort;” “he’s a yellow 3 year old lab and very sensitive to me not feeling good;” “[it would be good to] somewhere drop the dog off for a few hours during treatment and to be able to see her right after chemo;” “I feel animals are very intuitive and very much a part of my healing process;” “pets are usually cleaner than kids and not nearly as contagious or noisy;” “my pet is just like having my own child to take care of;” and “if I still had my dog, I probably would not have cancer.”
Other comments that expressed concerns include the following: “My pets’… health problems cause me additional stress;” “I am not planning on exposing myself to our farm animals completely while taking chemo;” and “because I am at risk for a hip fracture, I can’t lift more than 10 pounds and my cat weighs 12.”
Discussion
To our knowledge, this study is the first to survey cancer patients about their pets in an effort to probe into related anxieties and concerns. Surprisingly, although 55% of patients identified themselves as having a pet and although the majority was dealing with an incurable illness, only 4% of all patients desired information on community and financial resources for pet care. Within this group of 170 pet owners, family members and friends were already helping 80% of cancer patients take care of their pets and further resources were not requested. From the standpoint of this study’s primary endpoint, the vast majority of cancer patients do not seem to require a structured tool to enable them to learn about community and financial resources for pet care.
This study observed other important findings. First, not only was having a pet not a source of stress for most cancer patients, but the majority described their pets as beneficial in helping them cope with the stress associated with their diagnosis. One patient went so far as to describe that pets were involved in the “healing process.” Such information might be important for healthcare providers as they discuss end-of-life issues with cancer patients.
Secondly, most cancer patients were not concerned about acquiring an infection from a pet. Only 6% were worried about being around their pet during cancer therapy, a finding that suggests that patients view the risk of infection from their pets as low. This low rate of concern is in agreement with a previously published literature that pet exposure is relatively safe for patients [3–6]. Although only 6% of patients expressed such worry, there is perhaps a role for counseling certain patients on the safety of pet exposure.
Finally, the results of this study should not necessarily be generalized to all other cancer patients. Patients in the current study were undergoing treatment at a tertiary care cancer center; and it is plausible that these patients have stronger social support and other resources that enabled them to travel to and receive therapy at such a center, as suggested by the fact that only seven patients lived alone with their pets and only two of these requested more information on financial and community resources for pet care. Patients who completed this survey appear to have had pet-related resources that may not be as readily available to other cancer patients. Moreover, it is possible that patients might have unrecognized needs and that acquiring a list of pet-related resources might be of benefit to a large group of pet owners, as suggested by the finding that 11 patients in this study were receiving help from family but nonetheless requested information on pet-related resources. Thus, despite the findings of this survey, some patients might benefit from learning about resources, which might include contact information for local pet shelters, local legal resources for establishing posthumous pet care, and a sampling of other, web-based information of potential value to pet owners with cancer across the country (Table 4).
Table 4.
Select resources on pet care for cancer patients
In conclusion, other healthcare providers at other medical centers might consider exploring whether their patients might have needs and anxieties related to caring for their pets.
Contributor Information
Brenda R. Larson, Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
Sherry Looker, Department of Nursing, Mayo Clinic, Rochester, MN, USA.
Dianne M. Herrera, Department of Nursing, Mayo Clinic, Rochester, MN, USA
Edward T. Creagan, Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
Suzanne R. Hayman, Division of Hematology, Mayo Clinic, Rochester, MN, USA
Judith S. Kaur, Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
Aminah Jatoi, Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
References
- 1.Market research statistics. [Accessed 22 June 2009];U.S. pet ownership—2007. Available at http://www.avma.org/reference/marketstats/ownership.asp.
- 2.Willing R. [Accessed 22 June 2009];Animal owners set up trust funds for their pets. Available at http://www.usatoday.com/news/nation/2002-08-15-pettrust_x.htm.
- 3.Raina P, Waltner-Toews D, Bonnett B, Woodward C, Abernathy T. Influence of companion animals on the physical and psychological health of older people: an analysis of a one-year longitudinal study. J Am Geriatr Soc. 1999;47:323–329. doi: 10.1111/j.1532-5415.1999.tb02996.x. [DOI] [PubMed] [Google Scholar]
- 4.Brodie SJ, Riley FC, Shewring M. An exploration of the potential risks associated with using pet therapy in healthcare settings. J Clin Nurs. 2002;11:444–456. doi: 10.1046/j.1365-2702.2002.00628.x. [DOI] [PubMed] [Google Scholar]
- 5. [Accessed 22 June 2009];Fever and neutropenia: treatment guidelines for patients with cancer, version II. 2006 Mar; Available at http://www.cancer.org/docroot/ETO/content/ETO_1_2X_Infections_in_People_with_Cancer.asp.
- 6.Cooper JE. Pets in hospital. Br Med J. 1976;1:698–700. doi: 10.1136/bmj.1.6011.698. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Burton BJ. Pets and PWA’s: claims of health risk exaggerated. Patient Care. 1989;23:34–37. [Google Scholar]
- 8.Elliot D, Tolle S, Goldberg L, Miller J. Pet-associated illness. N Engl J Med. 1985;313:985–995. doi: 10.1056/NEJM198510173131605. [DOI] [PubMed] [Google Scholar]
- 9.McKean H, Looker S, Hartmann LC, et al. Are cancer survivors/patients knowledgeable about osteoporosis? Results from a survey of 285 chemotherapy-treated cancer patients and their companions. J Nutr Educ Behav. 2008;40:144–148. doi: 10.1016/j.jneb.2007.08.009. [DOI] [PubMed] [Google Scholar]