Table 1.

Methodological Assessment of Quasi-Experimental Studies.

Quasi-experimental studies (n = 10)
Study ID	Indication	Participants		Criteria		Intervention	Dropout	Objectives	Duration of treatment (follow-up)	Main results	Funding
		Sample size	Baseline comparability	Inclusion	Exclusion	Treatment vs control (n)	Treatment vs control (n)
Barrera et al 40	Music therapy for anxiety	Hospitalized children with cancer (n = 70)	The participants differ regarding age and stages of cancer and treatment. These differences were accounted for in the statistical analysis.	Hospitalized children with cancer 0 to 17 y of age	NR	A music therapist was with the child for more than 15 min, engaging in calming interactive music experiences leading the child to other activities. About 1 to 3 sessions for each child ranging from 15 to 45 min.	n = 5	Examine the general benefits of music therapy for hospitalized pediatric cancer patients	Depended on the length of time the child stayed at the hospital. Participants received no more than 3 music sessions.	Significant improvement in children’s rating of their feelings from pre to post music therapy (P < .01). However, the results varied with the age of the children.	Association of families of children with cancer, Toronto, Ontario; Hematology/Oncology Program, Hospital for Sick Children
Diorio et al 42	The feasibility of a 3-wk yoga program for fatigue	Children receiving chemotherapy or HSCT (n = 22)	NA (a single group)	Inpatient children with AML, relapsed ALL, stages 3 and 4 Burkitt’s lymphoma; about to receive HSCT, 7 to 18 y old at enrollment, expected to be an inpatient for at least 3 wk after initiation of chemotherapy or conditioning	Unable to perform yoga; motor disability; cardiopulmonary symptoms; fractures; parents who do not understand English	Yoga, 3 times weekly (n = 11)	n = 11	Determine the feasibility of individualized yoga for hospitalized children receiving chemotherapy	3 wk	The yoga program was feasible. Qualitative feedback from both children and parents indicated the physical and psychological benefits of yoga.	No grant funding for this study
Favera-Scacco et al 43	Art therapy for painful procedures during cancer treatment	Children with leukemia who underwent lumbar puncture or bone marrow aspiration (n = 49)	The children in the intervention group were younger than those in the control group	Children with leukemia who were candidates for lumbar puncture and bone marrow aspiration	NR	Art therapy (n = 32) vs usual care (n = 17). Art therapy consisted of: Introduction of a toy: a safe person; visual imagination; medical play; drawing; reading; dramatization	NR	Investigate art therapy as support (reduce stress and anxiety) for children with leukemia during painful procedures	NR	Art therapy can be a useful intervention that can prevent trauma and support children and parents during intrusive interventions	Supported by a grant from Regione Sicilia and MURST (40% grant)
Geyer et al 51	Yoga to improve quality of life	Children and adolescents with oncological diagnoses (Edwin sarcoma, All, AML, Fanconi’s anemia [n = 6] parents/caregivers [n = 4])	NA (a single group)	Children and adolescents with oncological diagnoses. Platelet counts more than 5000, absolute neutrophil count more than 200, and hemoglobin 8 to 10 g/dL	Comorbid diseases, or developmental disorders, in the induction phase of treatment	Therapeutic yoga (1 h) 5 consecutive weekly section	No dropout	To describe the effect of therapeutic yoga on child and parental reports of quality of life in children hospitalized with oncological diagnoses	5 wk	Therapeutic yoga positively affected child’s perception of gross motor function (P = .016)	Lance Armstrong Foundation
Govardhan et al 52	To establish the feasibility and therapeutic effect of yoga on pediatric brain tumor and to provide a foundation for the development of an RCT	Children and adolescents between 6 and 18 planned for either radiation or chemotherapy for brain tumors (n = 18)	NA (a single group)	Children and adolescents between 6 and 18 planned for either radiation or chemotherapy for brain tumors	Children with metastasis, developmental or intellectual disorders, and prior exposure to yoga	Individualized yoga for an hour at least 3 times a week over a 4-wk timeframe after conventional cancer treatment (n = 13)	NR	To establish the feasibility and therapeutic effect of yoga to address the effects of radiotherapy and chemotherapy in pediatric brain tumor	4 wk	The yoga intervention was feasible. A significant difference was reported in respect to pain (P = .0001), relief in headache (P = .0005), increase in appetite (P = .0005), better sleep (P = .0003), and reduced fatigue (P = .007), and overall daily activity (P = .0018)	NR in publication
Hooke et al 53	Yoga to improve fatigue, anxiety, balance, and sleep	Children and adolescents between 10 and 18 who completed therapy in the past 2 to 24 mo (n = 18)	NA (a single group)	Children and adolescents (10-18 y) who completed therapy in the past 2 to 24 mo for pediatric cancer, received chemo, radiotherapy, or if CNS tumor was treated with surgery, had not participated in a yoga class the previous 3 mo	Had an antecedent neurological, developmental, or genetic disorder before their cancer diagnoses	45-min yoga classes, for 6 wk (n = 13)	n = 2 due to relapse	Determine if children and adolescents who were cancer survivors had less fatigue, better balance, and sleep quality, and less psychological distress compared with baseline measurements	6 wk	The anxiety score decreased significantly among children (P = .04) but not for adolescents. The scores for fatigue, sleep, and balance showed no significant changes	Alex’s Lemonade Stand Foundation
							n = 3 dropped out
Nilsson et al 47	Non-immersive virtual reality (VR) for painful procedures	Children and adolescents with cancer (n = 42)	The groups did not differ at baseline	Children and adolescents 5 to 18 y old, who have undergone painful procedures at least once before	Children with cognitive impairment; children of parents who did not understand Swedish	Children played the virtual world game that started 1 to 5 min before the procedure and continued until the procedure was completed (n = 21) vs no game application (usual care) (n = 21)	n = 5	Examine the effect of using non-immersive VR a 3 D display during a needle procedure on reported pain or distress of children/adolescents with cancer	For how long the needle procedure lasted	No statistical difference was found between the intervention group and the control group	Children’s Cancer Foundation at the Queen Silvia Children’s Hospital, the Sigurd and Elsa Goljes Foundation, the Federation of Swedish County Councils (VG-region), the Ebba Danelius Foundation, and the Wilhelm and Martina Lundgrens Foundation
Orsey et al 54	This study had 2 objectives: (1) To assess the feasibility of the study and (2) To assess the efficacy of yoga intervention for pain management, fatigue, stress, anxiety, and overall QoL for pediatric cancer patients and their families	(1) Children undergoing cancer treatment (n = 20) parents (n = 20) and (2) Dyads (n = 22)	NA (a single group)	Children 8 to 18, with cognitive ability at least at 8-y old level undergoing cancer treatment, parents older than 18, parents and children physically able to do yoga. English speakers. (2) ability to attend at least 8 yoga sessions over 8 wk	NR	A weekly yoga intervention. Patients could pick from (a) bedside yoga (b) classroom yoga (c) chair yoga (n = 10)	12 dyads withdrew (study 2)	(1) To study the feasibility of a yoga intervention (2) To test the efficacy of yoga intervention on the well-being of pediatric patients during active cancer treatment	8-wk	Study (1) Demonstrated high levels of interest from patients and family members Study (2) Results trend toward improvement of QoL for patients and their parents	In CHIP Seed Grant Funding in Cancer Control
Thygeson et al 48	Yoga for anxiety and distress	Children with cancer (n = 20); adolescents with cancer (n = 12); parents of children with cancer (n = 45)	NA	Children/adolescents 7 to 18 y old, who were hospitalized with cancer or blood disorders; spoke English; activity level appropriate for yoga; no previous yoga experience. Parents: Had a child with cancer, who spoke English, no previous experience with yoga.	NR	A total of (n = 49) participants: (n = 11) children; (n = 5) adolescents and (n = 33) parents received one yoga session	n = 28	Explore the feasibility of a single yoga session for children/adolescents (and parents) hospitalized with cancer or other blood disorders	45 min	Adolescents (P = .04) and parents (P < .01) experienced a significant decrease in anxiety scores. Children’s anxiety scores did not change from pre-class (P = .21).	No grant funding for this study
Wurz et al 49	Yoga for physical benefits (health-related quality of life [HRQL]; physical fitness outcomes and physical activity levels [PAL])	Children with cancer (n = 11)	NA (1 group only)	Children 5 y and older (5-17 y old); outpatient; limited previous yoga experience; not meeting the Canadian society for exercise physiology guidelines	NR	A total of (n = 8) received yoga 2 times weekly for 12 wk	n = 3	Explore the feasibility and benefits of yoga for pediatric cancer patients	12-wk Yoga intervention 2 times/weekly/60-min sessions	This 12-wk yoga program was feasible and provided preliminary evidence for the benefits of yoga (P = .02); Parent-reported HRQL (P = .03), functional mobility (P = .01), and total PAL (P = .02)	Grant from Canadian Institutes of Health Research; Alberta Children’s Hospital Research Institute; Psychosocial Oncology Research Training Program, University of Calgary

Abbreviations: ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; HSCT, hematopoietic stem cell transplantation; NR, not reported; NA, not applicable.