Wagging tails. Wet noses. Soft, warm bellies. It’s not surprising that getting a visit from a therapy dog while receiving cancer treatment boosts the spirits. But these visitors do more than put smiles on the faces of people with cancer — they may actually help some people heal.

“Getting up and moving around after surgery is important to the recovery process, but it’s hard for many people to do,” says Jane Kopelman, who runs the Caring Canines therapy dog program at Memorial Sloan Kettering. Sometimes all it takes is a nudge from a four-legged friend. “I see patients who are willing to get out of bed, and even take a walk down the hallway, just so they can spend more time with one of the dogs,” she says.

Making the Rounds

Over the past 12 years, MSK’s Caring Canines have become a fixture in almost every area of patient care. The program started on a single floor with seven dogs. Now, about 50 therapy dogs and their handlers, who are all volunteers, make the rounds throughout MSK. Both handlers and pups sport identification badges so that passersby know that they are the real deal.

In addition to visiting inpatients, therapy dogs also make regular visits to MSK’s outpatient locations, including its regional sites. When MSK’s newest facility, the David H. Koch Center for Cancer Care at Memorial Sloan Kettering Cancer Center, opened to patients in January 2020, the Caring Canines were there.

Ms. Kopelman and her mixed-breed dog, Wally, were one of the first volunteer pairs to come to MSK when the Caring Canines program launched in 2007. She quickly realized she wanted to get more involved, and she officially became the Caring Canines consultant in 2014. “It was clear that the program was going to grow a lot, and they needed someone to safely run it,” she says.

Safety is important, especially because many people being treated for cancer have compromised immune systems. Therapy dogs need a host of vaccines and frequent health screenings. They also get bathed and groomed right before visiting MSK. To make sure they don’t tire out, there are limits on how many hours the dogs can work in each shift.

Furry Motivators

In addition to their work as cheer bringers, some of MSK’s Caring Canines have taken part in published research. This got them one step closer to earning their white lab coats — and maybe eventually, their PhD(og)s.

In April 2018, a team led by Pamela Ginex, who was then a nurse researcher at MSK, published a study in the Clinical Journal of Oncology Nursing (CJON) that looked at the benefits of therapy dogs for people recovering from surgery on the 15th floor of Memorial Hospital. At the time, Caring Canines were not yet visiting this floor. People who’d had surgery, as well as their family members and the nursing staff, completed questionnaires on their levels of stress and sense of well-being before and after the visits. This was the first-ever published study to also look at whether therapy dogs can improve job satisfaction for hospital staff in an inpatient setting.

“We had many patients who were having a hard time getting out of bed after having abdominal surgery,” says MSK nurse practitioner Mary Montefusco, who was a co-author on the CJON study. “But when they heard the dogs were on the way, they wanted to get up and sit in a chair so it would be easier to pet them.”

The improvement seen in people who received visits from the dogs was not statistically significant when compared with those who didn’t get visits. (Studies done at other hospitals have shown stronger gains.) The MSK researchers believe this was the case because people progressively feel better as they recover from surgery — whether they get visits from therapy dogs or not.

Anecdotally, however, the sessions were a huge success, not only for the people with cancer but also for their family members and even for staff. “It always brightens my day when I see one of the dogs,” Ms. Montefusco says.

Since the research was published, the Caring Canines have continued visiting the 15th floor and have expanded into more inpatient areas of the hospital. Most recently they’ve started working on the 18th floor, where people recover from surgery for lung cancer. People who are receiving blood and marrow stem cell transplants can now have pooch meet-and-greets, if their immune systems are strong enough. The dogs have started visiting MSK Kids patients as well, meeting up in a play area rather than patients’ rooms to avoid disruptions.

It’s a “Ruff” Job

It takes a rare breed to make it through the rigorous training process that qualifies a dog to work in a medical setting. Not literally, though. Ms. Kopelman says that any dog is capable of becoming a therapy dog, from the tiniest Chihuahua to some really big woofers. The traits required are more about an individual dog’s personality and temperament. “You need a dog that can roll with anything,” she says. “You don’t want them to get flustered and start barking.”

Their handlers also need to complete rigorous training. They are sometimes brought into situations that are emotionally difficult, such as visiting people who are receiving intensive care or those who are at the end of life. “The dog handlers are a vital part of the team,” Ms. Kopelman says.

“Currently, the demand for therapy dogs is much higher than the supply,” Ms. Kopelman concludes. “We would love to have more dogs and volunteers. The most common thing we hear from patients when we arrive at their bedside with a dog is ‘I’ve been waiting all day for this visit.’ ”

In recent years, advanced melanoma has been transformed from a disease that was almost always fatal to one that often can be brought under control for years or even cured. Thanks to new drugs, people with advanced disease now have a five-year survival rate of about 50%.

“The landscape for melanoma has changed dramatically,” says Memorial Sloan Kettering medical oncologist Paul Chapman, who specializes in treating advanced forms of the disease. “Here at Memorial, because we were involved in the early trials, outcomes started to really improve in 2006 or 2007. For the rest of the world, they changed in the early 2010s, after these new drugs were approved and went into wider use.”

Treatments for melanoma have advanced on two fronts: immunotherapy and targeted therapy — both of which have contributed to the remarkable changes that have occurred. But some patients don’t do as well with those drugs, so researchers continue to focus on new therapies and treatment combinations.

Harnessing the Immune System to Fight Cancer

In the area of immunotherapy, the first drug to show significant promise was ipilimumab (Yervoy^®). The drug works by exploiting the ability of the body’s own immune system to attack cancer. Specifically, it blocks the activity of a protein called CTLA-4. This takes the brakes off the immune system and enables immune cells called T cells to go after cancer.

Ipilimumab was developed in 1996 by immunologist James Allison, who served as Chair of the Sloan Kettering Institute Immunology Program between 2004 and 2012. Dr. Allison later won a Nobel Prize for this work. MSK physician-scientist Jedd Wolchok led the clinical trials that resulted in the drug’s approval by the US Food and Drug Administration in 2011.

Additional immunotherapy drugs for melanoma, including pembrolizumab (Keytruda^®) and nivolumab (Opdivo^®), soon followed. They work in a similar way but block a different protein, called PD-1. (Still more immunotherapy drugs that block a related protein called PD-L1 have also been approved.)

Research led by Dr. Wolchok and presented in 2015 showed that, for many people, the combination of ipilimumab and nivolumab was safe and worked better than either drug on its own. That therapy is now standard for many people with metastatic melanoma.

Since the approval of these immunotherapy drugs for melanoma, they have also become a standard treatment for several other types of cancer, including lung cancer, bladder cancer, and head and neck cancers. Investigators are continuing to study how these drugs work in order to optimize their use and extend these treatments to more people with cancer.

Targeting the Factors that Drive Cancer

The first-ever targeted drug for melanoma to show a profound effect was vemurafenib (Zelboraf^®). It targets a specific mutation in a gene called BRAF and blocks its cancer-causing actions. The mutation is found in about half of all melanomas.

“The drug was designed specifically for people whose cancer contained this mutation,” says Dr. Chapman, who led the phase III trial that resulted in the FDA’s approval of the drug in 2011. “When we saw how well vemurafenib was working, it was a very exciting time.”

Since it was approved for melanoma, vemurafenib has also been approved for cases of a rare blood disorder called Erdheim-Chester disease that have the same BRAF mutation. Other drugs that block the BRAF protein have also been approved.

Another class of targeted therapy for melanoma is called a MEK inhibitor. These drugs block the activity of a growth pathway that is often overactive in melanoma and other cancers. They may be used alone or in combination with BRAF inhibitors.

“Unfortunately, the data show that about 80% of people will eventually develop resistance to BRAF and MEK inhibitors,” Dr. Chapman says. “We’re now looking at new strategies for delivering these drugs.”

Research Aims at Further Gains

“It turns out that melanoma is one of the most responsive cancers to both immunotherapy and targeted therapy,” Dr. Chapman says. “The challenge is to learn more about how to treat the 50% of people whose tumors don’t respond to these treatments.”

Research from MSK and other institutions published in 2013 found that the combination of vemurafenib and ipilimumab led to significant side effects, and therefore the drugs should not be used together. But since then, investigators at MSK and elsewhere have been studying new combinations with different kinds of drugs.

“We’re trying to figure out what’s different about these tumors and if there is some way that we can convert a nonresponsive tumor to a responsive one,” Dr. Chapman adds. “One strategy involves introducing inflammatory molecules to the tumor to see if we can convert it to an environment that’s more receptive to T cell activity.”

Another important aspect of current research is to figure out the smallest dose that can be given to people with cancer while still achieving beneficial effects. “Toxicity and side effects are always a concern when treating any kind of cancer,” Dr. Chapman says. “Part of the history of oncology, whether you’re talking about chemotherapy or some of these more recent drugs, is looking at how much you can dial a treatment back and still cure people. This is an important area of research going forward.”