Rheingans, J.I. (2007). A systematic review of nonpharmacologic adjunctive therapies for symptom management in children with cancer. Journal of Pediatric Oncology Nursing: Official Journal of the Association of Pediatric Oncology Nurses, 24(2), 81–94.

To assist the health care practitioner by summarizing research studies that have examined the use of nonpharmacologic adjunctive therapies (NATs) for symptom management in pediatric oncology patients

• Databases searched were Cochrane Library, PubMed, CINAHL, and PsycINFO.
• Authors included an extensive list of search keywords. Of particular relevance to the pediatric oncology setting were pain, cancer, oncology, self-care, nausea, vomiting, fatigue, and coping.
• Studies were included if they dealt with nonpharmacologic therapies to help alleviate symptoms associated with cancer treatment in children.

Investigators retrieved and reviewed 41 studies. Their review related to symptoms studied, modalities used, study design, sample size, and study results. The analysis included all 41 studies. The studies pertained to multiple modalities, including hypnosis, imagery, breathing, distraction, relaxation, cognitive behavioral therapy, art therapy, and music therapy.

• Sample sizes ranged from N – 1 to 122 patients.
• Across studies, participants included in the samples were pediatric patients receiving chemotherapy, needlesticks, radiation, lumbar punctures, bone marrow aspiration, IV insertion, MRI, or port placement for the treatment of unspecified disease.

Over all the studies, the results are mixed in regard to the effect of NATs on procedural pain. Some studies indicated that hypnosis produced promising results in reducing procedural pain. Cognitive behavioral therapy and distraction showed both an effect and no effect on pain. One study (based on observation and self-reporting) indicated that NATs had no effect on procedural pain. In a few studies, hypnosis (along with distraction and relaxation and cognitive behavioral therapy) produced significant pain reduction. Studies found that music therapy had little to no effect on the pain of bone marrow aspiration.

This review of NATs produced mixed results.

• The samples studied were inconsistent in regard to modality.
• Some terms (e.g., anxiety and distress) were found to be interchangeable; on the other hand, hypnosis encompassed several definitions.
• The sample size of some of the studies was small.
• In the pediatric populations studied, the intervention provider (patient, professional, or parent) was unclear.

More research needs to be done in this area. Health care practitioners, patients, and families need education about NATs and their application to pediatric oncology.