Use of alternative therapy among pediatric oncology patients in Taiwan

Assessment of complementary health approaches use in pediatric oncology: Modification and preliminary validation of the "Which Health Approaches and Treatments Are You Using?" (WHAT) questionnaires

OBJECTIVE

Complementary Health Approaches (CHA) are commonly used by children with cancer; however, a few health care providers (HCPs) inquire about the use of CHA. A standardized questionnaire could facilitate such clinical discussions. We aimed to adapt and determine the face and content validity of the "Which Health Approaches and Treatments are you using?" (WHAT) child and parent-report questionnaires in pediatric oncology.

METHODS

An electronic Delphi survey that included children with cancer (8-18 years), parents, and HCPs and CHA researchers was conducted to reach consensus on the content of the WHAT questionnaires in pediatric oncology. Children and parents from the Hospital for Sick Children (SickKids), and HCPs and researchers from the International Society of Pediatric Oncology and Pediatric Complementary and Alternative Medicine Research and Education Network completed the survey. To determine the face and content validity of the questionnaires, two iterative cycles of individual interviews were conducted with purposive samples of children (8-18 years), parents, and HCPs from SickKids.

RESULTS

Consensus was reached on all domains and items of the original WHAT questionnaires after one Delphi cycle (n = 61). For face and content validity testing, the first cycle of interviews (n = 19) revealed that the questionnaires were mostly comprehensive and relevant. However, the paper-based format of the original WHAT was not user-friendly, and generic items were vague and not aimed at facilitating clinical dialogues about CHA use. The WHAT questionnaires were then modified into electronic cancer-specific self- and proxy-report questionnaires including 13 and 15 items, respectively. The second cycle (n = 21) showed no need for further changes.

CONCLUSIONS

The modified electronic cancer-specific WHAT questionnaires showed adequate face and content validity. The next step is to determine inter-rater reliability, construct validity, and feasibility of administration of the modified WHAT questionnaires in pediatric oncology.

Complementary Health Approaches for the Symptoms of Pediatric Oncology Patients

This study was conducted to determine the complementary health approaches (CHAs) used by pediatric oncology patients' parents for symptoms, their positive-negative effects, and the factors that influence their usage. The study was a descriptive design. The data were collected between March and November 2014 from the parents of 156 pediatric oncology patients in 2 different university hospitals in Turkey using the face-to-face interview method. In total, 99.4% of the parents who participated in the study used at least 1 CHA for their children. Complementary health approaches frequently adopted by the parents included praying (96.8%), oblation/sacrifice (50.6%), carob molasses (27.6%), grape molasses (22.4%), and massage (22.4%). Forty-three parents reported that they gave carob molasses to their children to reduce the symptoms of neutropenia, whereas 32 parents reported that they gave them grape molasses and 34 parents reported that they massaged their children to mitigate symptoms of pain. The parents reported that they used CHAs to enhance their child's immune system (61.3%), to do everything in their power to treat their child (42%), and to combat the side effects of medication/radiotherapy (25.8%). None of parents stated that they had observed any side effects from using CHAs. Almost all of the parents use one of the CHAs. The health personnel especially nurses should inform pediatric oncology patients and their parents about CHAs, which have no evidence and are potentially harmful and encourage them to approaches supportive to medical treatment.

Prevalence of the Use of Herbal Medicines among Patients with Cancer: A Systematic Review and Meta-Analysis

Background

Although herbal medicines are used by patients with cancer in multiple oncology care settings, the magnitude of herbal medicine use in this context remains unclear. The purpose of this review was to establish the prevalence of herbal medicine use among patients with cancer, across various geographical settings and patient characteristics (age and gender categories).

Methods

Electronic databases that were searched for data published, from January 2000 to January 2020, were Medline (PubMed), Google Scholar, Embase, and African Index Medicus. Eligible studies reporting prevalence estimates of herbal medicine use amongst cancer patients were pooled using random-effects meta-analyses. Studies were grouped by World Bank region and income groups. Subgroup and meta-regression analyses were performed to explore source of heterogeneity.

Results

In total, 155 studies with data for 809,065 participants (53.95% female) met the inclusion criteria. Overall, the pooled prevalence of the use of herbal medicine among patients with cancer was 22% (95% confidence interval (CI): 18%–25%), with the highest prevalence estimates for Africa (40%, 95% CI: 23%–58%) and Asia (28%, 95% CI: 21%–35%). The pooled prevalence estimate was higher across low- and middle-income countries (32%, 95% CI: 23%–42%) and lower across high-income countries (17%, 95% CI: 14%–21%). Higher pooled prevalence estimates were found for adult patients with cancer (22%, 95% CI: 19%–26%) compared with children with cancer (18%, 95% CI: 11%–27%) and for female patients (27%, 95% CI: 19%–35%) compared with males (17%, 95% CI: 1%–47%).

Conclusion

Herbal medicine is used by a large percentage of patients with cancer use. The findings of this review highlight the need for herbal medicine to be integrated in cancer care.

Applying an Ethical Framework to Herbal Medicine

Herbal medicines make a vital contribution to healthcare globally, but from production through to practice, there are ethical challenges that require attention. Ethical challenges are often analysed through application of an ethical framework because this can facilitate a consistent and structured approach. In healthcare, the most commonly used framework over recent decades has been that of the four principles: beneficence, nonmaleficence, autonomy, and justice. However, for various reasons that are explained, this approach to ethical analysis is not the most fitting for the global phenomenon of herbal medicine. In this paper, a relatively new moral framework that is based upon the globally accepted values of care, respect, honesty, and fairness is explored in relation to herbal medicine for the first time. Through application of this framework, the ethical challenges and actions needed to address them become clear, thus resulting in practical recommendations for enhancing ethical standards in herbal medicine.

The Lived Experiences of Adolescents With Cancer: A Phenomenological Study

This descriptive phenomenological study was conducted to explore the lived experiences of adolescents with cancer. Purposive sampling was used to recruit participants. In-depth, nonstructured interviews were conducted to collect data, and narratives were analyzed using Colaizzi's seven-step method. Data saturation was achieved after interviewing 16 participants. The study was divided into three main themes and 16 subthemes: suffering (caused by symptoms, therapy, cancer recurrence, the feeling of being trapped in hospital, the burden of food therapy, delayed education, the absence of peer relationships, and limited activities), emotional reactions (fear, worry, sadness, anger, and loneliness), and rebalancing (strong family relationships, optimistic thinking, and healthy lifestyles). While adolescents with cancer experience changes in lifestyle, and physical, psychological, and social burden, they also have positive life experiences. Building appropriate learning systems, improving communication skill, and providing appropriate food therapy may alleviate the psychological burden experienced by young patients.

Complementary Therapies and Childhood Cancer

BACKGROUND

The use of complementary and alternative therapies by children with cancer is common. Up to 84% of children have used complementary therapies along with conventional medical treatment for cancer.

METHODS

We reviewed the PubMed and CINAHL databases for studies published between 1994 and 2004 on the use of complementary and alternative therapies by children with cancer and reports from any publication year through 2004 of clinical trials involving complementary and alternative therapies for children with cancer.

RESULTS

Fourteen studies were retrieved reporting the results of survey or interview data collected from parents on children's use of complementary and alternative therapies during or after childhood cancer. Across studies, the use of such therapies ranged from 31% to 84%. Common reasons for using complementary and alternative therapies were to do everything possible for their child, to help with symptom management, and to boost the immune system. Many parents indicated they also hoped to treat or cure the cancer. In most cases, the child's treating physician had not been informed of the child's use of complementary and alternative therapies.

CONCLUSIONS

Use of complementary therapies by children with cancer is common, although methodological variations limit the ability to compare results across studies. Treating physicians often do not know the child is using complementary therapies in addition to medical treatments. The scientific evidence is limited regarding the effects and mechanisms of action of complementary or alternative therapies, but research is being conducted on these topics.

Characteristics of Traditional Chinese Medicine Use in Pediatric Dislocations, Sprains and Strains

BACKGROUND AND OBJECTIVES

Dislocations, sprains and strains are common childhood musculoskeletal injuries, requiring medical attention. We investigated the characteristics associated with using traditional Chinese medicine (TCM) for children suffering from these injuries.

METHODS

From a nationwide representative insurance database of Taiwan, this cross-sectional study identified 50,769 children with dislocations, sprains and strains under 18 years of age, newly diagnosed between 1999 and 2009, without previous TCM experience. Children who initiated treatment with TCM (n = 24,063, 47.4%) were defined as TCM users, others were in the non-TCM group. Multivariable logistic regression models estimated odds ratios (ORs) of TCM use.

RESULTS

Girls and children living in central Taiwan (vs. northern) were associated with higher TCM use. The adjusted ORs (95% confidence interval (CI)) of TCM uses were 1.60 (1.42-1.79) for patients of 3-5 years, 2.20 (1.99-2.42) of 6-12 years and 1.82 (1.64-2.01) of 13-17 years, compared with those of the <2 years group. TCM users were less likely to have outpatient visits for Western medicine care and hospitalizations in the previous year. The TCM group was nearly twice more likely than the non-user group to receive treatments at local clinics (99.1% vs. 53.3%, p < 0.001).

CONCLUSIONS

This study reveals important demographic and medical factors associated with TCM uses for children with dislocations, sprains and strains. Interestingly, local clinics are the main healthcare facilities providing TCM services. Further studies are needed to evaluate the outcomes of TCM treatment for these musculoskeletal injuries.

Global Use of Traditional and Complementary Medicine in Childhood Cancer: A Systematic Review

Purpose

Traditional and complementary medicine (T&CM) strategies are commonly used in pediatric oncology. Patterns may vary based on country income. We systematically reviewed published studies describing T&CM use among pediatric oncology patients in low-income countries (LIC/LMIC), middle-income countries (UMIC), and high-income countries (HIC). Objectives included describing estimated prevalence of use, reasons for use, perceived effectiveness, modalities used, rates of disclosure, and reporting of delayed or abandoned treatment.

Methods

MEDLINE, EMBASE, Global Health, CINAHL, PsycINFO, Allied and Complementary Medicine Database, Cochrane Database of Systematic Reviews, and ProceedingsFirst were searched. Inclusion criteria were primary studies involving children younger than the age of 18 years, undergoing active treatment of cancer, and any T&CM use. Exclusion criteria included no pediatric oncology–specific outcomes and studies involving only children off active treatment. Data were extracted by two reviewers using a systematic data extraction form determined a priori.

Results

Sixty-five studies published between 1977 and 2015 were included, representing 61 unique data sets and 7,219 children from 34 countries. The prevalence of T&CM use ranged from 6% to 100%. Median rates of use were significantly different in LIC/LMIC (66.7% ± 19%), UMIC (60% ± 26%), and HIC (47.2% ± 20%; P = .02). Rates of disclosure differed significantly by country income, with higher median rates in HIC. Seven studies reported on treatment abandonment or delays.

Conclusion

The use of T&CM in pediatric oncology is common worldwide, with higher median prevalence of use reported in LIC/LMIC. Further research is warranted to examine the impact on treatment abandonment and delay.

Characteristics of Traditional Chinese Medicine Use in Pediatric Cancer Patients: A Nationwide, Retrospective, Taiwanese-Registry, Population-Based Study

BACKGROUND

Large-scale surveys of complementary traditional Chinese medicine (TCM) use in pediatric cancer patients are lacking. The aim of our study was to investigate the use of TCM in pediatric cancer patients.

METHODS

We analyzed cancer patients younger than 18 years (n = 12 965) who were registered in the National Health Insurance Research Database in Taiwan between 2001 and 2011. Patients were categorized into TCM or non-TCM users based on their use of TCM.

RESULTS

In Taiwan, 8086 (62.4%) children with cancer sought TCM treatment at some point. Children in older age groups, including school-aged children and adolescents, were more likely to use TCM. There was no significant difference in the distributions of gender and urbanization. The 3 most common diseases for which TCM users visited the clinic were neoplasm (33.2%), respiratory system disease (32.9%), and infectious disease (8.86%). The most commonly utilized TCM therapy was Chinese herbal remedies. Patients who had comorbid conditions such as allergic rhinitis, dyspepsia, disorders of menstruation, and disease of the musculoskeletal system and connective tissue tended to visit TCM clinics.

CONCLUSIONS

Adjunctive TCM use is not low in Taiwanese children with cancer. Further studies to investigate the efficacy and safety of TCM in children with cancer are warranted.

Parental Involvement in Restoring the Health of a Child with Cancer in Hong Kong

The parents of 93 children with cancer in Hong Kong participated in a research study to identify concepts related to the category of restoring health in their child with cancer. These concepts included providing adequate nutrition such as attempting to increase the child's appetite, the preparation of soups, providing food supplements, and restricting the intake of certain foods; using alternative therapy to supplement the Western medicine, using tonics to strengthen the body, using Chinese medicine to regulate the body functions, using Chinese herbs to prevent metastasis or reoccurrence, as well as providing another chance of a cure when Western medicine was not effective; and preventing infections by reducing exposure to crowded places, having a clean home environment, using a face mask to protect the child from infections, and screening visitors.

Cultural Influences in Pediatric Cancer

Objective: To review the literature on cultural factors influencing clinical care and family management of pediatric cancer. Methods: A literature review including 72 articles related to cultural issues in pediatric cancer was conducted. Information was organized around several clinically driven themes. Results: Cultural factors influenced many aspects of the cancer experience including illness representations, reaction to diagnosis, illness disclosure patterns, complementary and alternative medicine use, management of medical procedures, coping strategies, and end of life issues. Conclusion: Increased awareness of cultural factors is needed to improve clinical care and reduce health disparities. Specific strategies to approach cultural differences are provided to enhance patient and family care from diagnosis to cure/end of life.

Use of traditional and complementary/alternative medicine (TCAM) in children with cancer in Guatemala

BACKGROUND

International surveys have demonstrated that use of traditional and complementary/alternative medicine (TCAM) is highly prevalent among children with cancer; however, little is known about its use among children with cancer in Latin America. As part of a regional initiative, we present the results of the first survey exploring use of TCAM among children with cancer residing in Latin America.

PROCEDURE

A cross-sectional sample of 100 parents whose children received treatment in Guatemala City were interviewed from May 2008 to February 2010. Upon consent, an in-person interview was performed during a routine clinical visit. Information on the form, duration, cost, and satisfaction of TCAM was collected. Approval from the institutional review board was obtained.

RESULTS

The median age of patients was 9.2 years with 63% undergoing treatment. Use of TCAM was reported by 90% of parents. Most often, more than one type of therapy was utilized. Most patients (67%) relied on TCAM for supportive care indications; however, a significant percentage (34%) used TCAM for curative purposes. The most commonly reported form was the use of oral supplements with the majority perceiving TCAM as effective for the intended purpose.

CONCLUSIONS

Use of TCAM was highly prevalent among children with cancer residing in Guatemala. Most importantly, TCAM was used alongside conventional therapy for supportive care indications. These findings underscoring the need for open lines of communication between clinicians and families. Future research may consider exploring the role of TCAM within the scope of supportive care and its effect on existing supportive care interventions.

Differences in use of complementary and alternative medicine between children and adolescents with cancer in Germany: a population based survey

BACKGROUND

Use of complementary and alternative medicine (CAM) in children with cancer is common and probably increasing. However, data concerning differences between children and adolescents focusing on prevalence, reasons for use/non-use, costs, adverse effects, and socio-demographic factors are lacking.

PROCEDURE

A population-based survey over a 1 year period with 497 participants was conducted.

RESULTS

Of the 457 respondents (92%) 322 were children and 135 adolescents (>16 years of age) with malignancies. 31% reported CAM use from the time when being diagnosed, compared to an overall lifetime prevalence rate of 41% before cancer diagnosis. Among CAM users the most prevalent therapies were homeopathy, massage, anthroposophic medicine, acupuncture, and Bach flowers. The main reasons for use were to reduce therapy-related side effects, to strengthen the immune system, to achieve physical stabilization and to increase healing chances. Socio-demographic factors associated with CAM use were higher parental education and higher family income. A majority of CAM users (97%) would recommend CAM use. Most users (78%) informed a physician about CAM use. Side effects were rarely reported (5%), minor and self-limiting.

CONCLUSIONS

The high prevalence rates seem to represent the parental or patients needs for additional treatment perceived as successful and devoid of side-effects. Clinical care and the physician-patient relation would profit from an enhanced understanding of CAM and a greater candidness towards the parental needs. Safety and efficacy - especially of CAM with high prevalence rates - should be studied in rigorous basic and clinical research.

Complementary and alternative approaches used by parents of children with epilepsy on epilepsy management

The aim of this study was to determine the complementary and alternative approaches used by parents of children with epilepsy on epilepsy management. This descriptive study included a total of 304 parents of children with epilepsy aged between 0 and 18years evaluated at the Pediatric Neurology Clinic of Akdeniz University Hospital in Turkey between January and May 2013. Data were collected by using a questionnaire developed by the researchers. It was determined that all the parents use complementary and alternative approaches for their children with epilepsy, and the most common approaches are praying (99.3%); keeping their children away from the effects of smoking (79.8%); feeding their children walnuts (79.6%), butter (59.2%), and bone marrow (58.6%); providing their children with good quality sleep (58.6%); and enabling their children to play games (51%). The approaches commonly applied during seizures include praying (96.2%), comforting their children in their arms and showing affection (55.6%), waiting for seizures to finish at home (45.7%), and laying children on their side (41.1%). Of parents, 98% stated that alternative approaches enable them to control their child's seizures, 100% said that alternative approaches have no adverse effect, and 98.4% stated that they will continue to use these approaches. The children's approaches to cope with epilepsy included looking after pets (72.7%), listening to music (70.1%), watching television (64.5%), playing games (55.3%), praying (51%), and spending time with friends (48.7%). Most of the approaches used by parents and children with epilepsy for the management of illness are determined to consist of complementary approaches that may contribute to management of epilepsy. Knowing the approaches of parents and children with epilepsy that could adversely affect disease management is important for educating parents and children to avoid these potentially harmful interventions.

Self-Reported Use of Complementary and Alternative Medicine among the Health Care Consumers at a Tertiary Care Center in Ajman, United Arab Emirates

Background:

Complementary and alternative medicine (CAM) covers a wide range of approaches, including herbal medicine, manual healing techniques, traditional therapies and mind-body interventions. CAM is widely used throughout the world to treat a variety of illnesses and to maintain health.

Aim:

Complementary and alternative medicine (CAM) is popular across the world, and is widely practiced. Utilization pattern and reasons for use and non-use among patients attending a tertiary care center are assessed in this study.

Subjects and Methods:

One hundred and thirty-five patients of different nationalities, above the age of 18 years, Gulf Medical College Hospital and Research Centre, Ajman, UAE, were interviewed using an open-ended structured questionnaire. In addition to socio-demographic characteristics, the acceptability, utilization pattern and reasons for use and non-use were elicited from the participants after obtaining consent from them. PASW 18 version was used to perform Chi-square test and descriptive statistics.

Results:

Among the 135 participants were 20-81 years old, those from the Far East used most 85.7% (6/7), then Pakistan 38.5% (15/39) and India 23% (16/70). The most common system used was homeopathy. Physicians advised 28.2% (11/39) of users, whereas others used non-medical information. Around 71.8% (28/39) reported good outcome for themselves and family; however, only 10% (4/39) recommended it to others. Most of the users, 75% (101/135), were not sure whether CAM was based on scientific evidence, while 18% (24/135) felt it was. Good previous experience and less treatment complications were the most common reasons for using CAM and non-use due to lack of knowledge or need.

Conclusion:

About one-third of the seekers of modern medicine care also use CAM, and mostly without physician advice; hence, the importance of discussing the same while taking the clinical history. In view of the belief that CAM has fewer side-effects, there is even more need for physician-initiated discussion.

High prevalence of complementary and alternative medicine use in the Dutch pediatric oncology population: a multicenter survey

Although complementary and alternative medicine (CAM) is widely used in the pediatric population, research on the use of these therapies in the pediatric oncology population is of mixed quality. In this multicenter survey, we investigated the prevalence of CAM use, possible determinants of use, and parental attitude towards communication and research on CAM therapies. The prevalence of CAM use in the past 12 months was assessed by using a questionnaire based on the European guidelines on CAM research, filled out by parents of children visiting pediatric oncology outpatient clinics of six academic hospitals in the Netherlands. The questionnaire consisted of 26 questions on the child's clinical status, CAM use, and attitude towards communication and research on CAM therapies. One hundred and twenty-two of 288 respondents (42.4 %) reported CAM use. The most frequently used categories were homeopathy (18.8 %) and dietary supplements (11.5 %). Female gender and parental CAM use were significant predictors for the use of CAM (p < 0.001). Only one third of the parents had discussed CAM use with their pediatric oncologist. More than 80 % of the respondents identified a need for information about CAM from their pediatrician and 85.7 % was positive towards research on CAM. Half of the parents were interested in participating in future CAM trials. Conclusion, with more than 40 % of parents of Dutch pediatric oncology patients providing complementary and alternative medicine to their child and with lacking evidence on efficacy and safety of most CAM modalities, there is a clear need for high-quality research in this field. This study shows that most parents have an open attitude towards CAM research and that almost half of the parents would consider participating in future CAM trials, paving the way for research on CAM and aiming for its evidence-based use in pediatric oncology.

Complementary and alternative medicine use in children with thalassaemia

AIMS AND OBJECTIVES

The aims of this study were to: (1) determine the types of complementary and alternative medicine use among children with thalassaemia as reported by parents and (2) describe sociodemographic and medical factors associated with the use of such treatments in families residing in southern Turkey.

BACKGROUND

Thalassaemia is one of the most common human genetic diseases. Despite the therapeutic efforts, patients will encounter a variety of physical and psychological problems. Therefore, the use of complementary and alternative medicines among children thalassaemia is becoming increasingly popular.

DESIGN

This is a descriptive study of complementary and alternative medicine.

METHODS

This study was conducted in the Hematology Outpatient Clinic at Akdeniz University Hospital and in the Thalassemia Centre at Ministry of Health Antalya Education and Research Hospital, Antalya, Turkey, between January 2010-December 2010. Parents of 97 paediatric patients, among 125 parents who applied to the haematology outpatient clinic and thalassaemia centre between these dates, agreed to take part in the study with whom contact could be made were included. Data were collected by using a questionnaire.

RESULTS

The proportion of parents who reported using one or more of the complementary and alternative medicine methods was 82·5%. Of these parents, 61·8% were using prayer/spiritual practice, 47·4% were using nutritional supplements and 35·1% were using animal materials.

CONCLUSION

It was determined that a significant portion of the parents using complementary and alternative medicine use it to treat their children's health problems, they were informed about complementary and alternative medicine by their paediatricians and family elders, and they have discussed the use of complementary and alternative medicine with healthcare professionals.

RELEVANCE TO CLINICAL PRACTICE

To sustain medical treatment and prognosis of thalassaemia, it is important for nurses to consult with their patients and parents regarding the use and potential risks of some complementary and alternative medicine.

Complementary and alternative medicine use in children with cancer at the end of life

BACKGROUND

The use of complementary and alternative medicines (CAM) in patients with cancer is well recognized. Little is known, however, about the use of CAM in children with cancer during the end-of-life period.

METHODS

We interviewed 96 parents of children who had died of cancer in Melbourne, Australia between 1996 and 2004 to establish the prevalence of CAM use during the end-of-life period. Factors affecting the use of CAM were explored. We also determined the perceived efficacy of CAM use and its effect on the overall experience of end-of-life care.

RESULTS

Thirty percent of parents caring for a child with cancer reported using some form of CAM during the end-of-life period, with 44% of these families using more than one type. The most common therapies used were organic foods, faith healing, and homeopathy. There was a strong correlation between open discussion about treatment alternatives with the treating physician and parental use of CAM. The majority (78%) of respondents felt CAM use had benefited their child significantly and most felt it had not caused additional suffering.

CONCLUSIONS

A significant number of children with cancer are administered CAM during the end-of-life period and most families in our study had found it beneficial. The main focus should continue to be on open and honest communication between caregivers and families in order to provide the best possible holistic care.

Characteristics of pediatric traditional Chinese medicine users in Taiwan: a nationwide cohort study

BACKGROUND AND OBJECTIVES

Traditional chinese medicine (TCM) is one of the most commonly used complementary and alternative medicines. However, there is a paucity of epidemiologic reports on features of pediatric TCM users. As TCM services are fully reimbursed by National Health Insurance in Taiwan, this study used a nationwide cohort database to investigate demographics, diseases patterns, and parents' characteristics of pediatric TCM users.

METHODS

Children aged <12 years were extracted from the National Health Insurance Research Database for analysis. These pediatric TCM users' demographics, medical conditions, and reasons for medical services were compared with users of Western medicine by Poisson regression. Children who did not use any medical services were excluded.

RESULTS

Of 107,337 children who were enrolled and followed up in 2005, 19,669 children (18.3%) used TCM. Compared with Western medicine-only users, school-age children (aged 6-12 years), preschool age children (3-5 years), and toddlers (1-2 years) were more likely to use TCM than infants (<1 year; rate ratio = 4.47, 3.66 and 2.59, respectively; P < .001 for all). Parental factors were associated with more TCM use, including female gender, age >35 years, past experience with TCM, and higher income levels. Allergic reactions and respiratory tract, gastrointestinal tract, and musculoskeletal problems were also associated with higher TCM use.

CONCLUSIONS

The use of TCM was correlated with both patient and parental factors, among which children's age and parental TCM use were the most prominent. Additional studies on the efficacy of TCM are warranted.

Use of complementary and alternative medicine in children with cancer: effect on survival

The objective of the present study was to determine the type, frequency, the reason why complementary and alternative medicine (CAM) treatments are used, the factors related with their use, and the effects of CAM usage on long-term survival. Families of a total of 120 children with cancer between 0-18 years of age, including 50 (41.7%) girls and 70 (58.3%) boys, participated in our study. The authors found that 88 patients (73.3%) used at least one CAM method, the most common (95.5%) of which was biologically based therapies. Most frequently used biologically based therapies were dietary supplements and herbal products. The most commonly used dietary supplement or herbal product was honey (43.2%) or stinging nettle (43.2%), respectively. We found that patients used such CAM methods as complementary to, but not instead of, conventional therapy. Sixty-nine out of 88 patient families (78.4%) shared the CAM method they used with their physicians. No statistically significant relation was found between socioeconomic, sociodemographic, or other factors or items and CAM use. The mean follow-up period of the CAM users and nonusers groups was 79.4 ± 36.7 (21.3-217.9) and 90.9 ± 50.3 (27.4-193.7) months, respectively. Five-year survival rates for CAM users and nonusers were found as 81.5% and 86.5%, respectively (P > .05). In conclusion, families of children with cancer use complementary and alternative treatment frequently. They do not attempt to replace conventional treatment with CAM. Higher rates of CAM use was found in families with higher educational level. CAM usage did not affect the long-term survival.

Use of complementary and alternative medicine and the anxiety levels of mothers of children with chronic diseases

AIMS

This study aimed to determine the use of complementary and alternative medicine (CAM) by mothers with a chronically ill child and their anxiety levels.

METHODS

This study used a descriptive design. The study was conducted with 135 mothers of a chronically ill child at a general pediatric and oncology unit in Uludağ University Hospital, Bursa, Turkey. A questionnaire, including sociodemographic items and the State-Trait Anxiety Inventory, were given to the mothers.

RESULTS

In the study, 42.29% of the mothers reported using one or more CAM therapies for their child with a chronic disease, including herbal medicine, taking the child to hodja (prayers), a special diet, and a special massage. The mothers experienced anxiety and the presence of a disease within the close family circle increased the anxiety level of the mothers.

CONCLUSION

Herbs and other alternative supplements were used by some children with a chronic disease in Turkey. The most commonly used CAM therapies included oral herbal medicine, taking the child to hodja, massage, and diets. Therefore, it is important to consider the implications of the popularity of complementary therapies. Most of the mothers used more than one of these therapies for their child and the anxiety level of the mothers was found to be moderate.

Traditional Arabic and Islamic Medicine, a Re-emerging Health Aid

Complementary medicine is a formal method of health care in most countries of the ancient world. It is expected to become more widely integrated into the modern medical system, including the medical curriculum. Despite the perception of modern medicine as more efficacious, traditional medicine continues to be practiced. More than 70% of the developing world's population still depends primarily on the complementary and alternative systems of medicine (CAM). In rural areas, cultural beliefs and practices often lead to self-care, home remedies or consultation with traditional healers. Herbal medicine can be broadly classified into four basic systems as follows: Traditional Chinese Herbalism, Ayurvedic Herbalism, Western Herbalism-which originally came from Greece and Rome to Europe and then spread to North and South America and Traditional Arabic and Islamic Medicine (TAIM). There is no doubt that today the concept of Arabic traditional herbal medicine is a part of modern life in the Middle East, and it is acquiring worldwide respect, with growing interest among traditional herbalists and the scientific community. TAIM therapies have shown remarkable success in healing acute as well as chronic diseases and have been utilized by people in most countries of the Mediterranean who have faith in spiritual healers. TAIM is the first choice for many in dealing with ailments such as infertility, epilepsy, psychosomatic troubles and depression. In parallel, issues of efficacy and safety of complementary medicine have become increasingly important and supervision of the techniques and procedures used is required for commercial as well as traditional uses. More research is therefore needed to understand this type of medicine and ensure its safe usage. The present review will discuss the status of traditional Arab medicine (particularly herbal medicine), including the efficacy and toxicity of specific medicinal preparations, with an emphasis on the modern in vitro and in vivo techniques.

Anthroposophic medicine in paediatric oncology in Germany: results of a population-based retrospective parental survey

BACKGROUND

Anthroposophic medicine (AM) is frequently utilised in German-speaking countries as a complementary and alternative medicine (CAM) treatment approach.

PROCEDURE

This study presents results of a retrospective parental questionnaire comparing responses of AM-users and users of other CAM in paediatric oncology in Germany. The differences between these two groups are investigated with respect to usage, associated demographic characteristics and previous experience with CAM.

RESULTS

Ninety-eight patients (27%) of the 367 CAM-users were exposed to anthroposophic treatments or therapies. Treatment duration amounted to a median 619 days for AM and 225 days for other CAM treatments. Most parents with previous experience of AM also used AM for treatment of their child's cancer disease. AM-users had a higher social status. Physicians played a relevant role for users of AM both in procuring information (24% vs. 11%; P < 0.001) and in prescribing medicines and therapies (73.0% vs. 34.9%; P < 0.001) compared to users of other CAM. AM-users communicate more frequently with their physicians about the use of CAM treatments (89.8% vs. 63.9%) and recommend CAM more often than other CAM-users (95.9% vs. 87%).

CONCLUSIONS

AM plays a major role in paediatric oncology in Germany. Patients using AM sustain treatment and therapies considerably longer than patients using other CAM treatments. Furthermore, most families who had used AM before their child was diagnosed with cancer also used AM for the treatment of their child's cancer. Compared to other CAM treatments, patient satisfaction with AM appears to be very high.

Complementary and alternative medicine use among pediatric patients with leukemia: the case of Lebanon

BACKGROUND

International evidence indicates that caretakers of pediatric leukemia patients are increasingly using complementary and alternative medicine (CAM) therapies. Such a trend has never been substantiated in the Arab world.

OBJECTIVE

Examine the frequency, types, modes, and reasons of CAM use among pediatric leukemia patients in Lebanon.

METHODS

A cross-sectional design was utilized to survey (by phone) the caregivers of all pediatric leukemia patients on the rosters of the 2 largest cancer treatment facilities in Lebanon for years 2005-2009. A total of 125 parents out of 175 (71.4%) completed the questionnaire, which included 3 sections: socio-demographic characteristics, clinical information and CAM use details. Data analysis employed univariate descriptive statistics, t-test, and χ(2)

RESULTS

Overall, 15.2% of respondents reported using one or more CAM therapies for their child (95% confidence interval: 8.9% to 22.0%). The main CAM therapies used included dietary supplements, prayer/spiritual healing, and unconventional cultural practices (ingesting bone ashes). CAM therapies were used for strengthening immunity (42.1%) and improving the chance of cure (21%). Pediatric users of CAM were 2 years older than nonusers and had been diagnosed with leukemia for a longer period of time (4.76 ± 3.24 vs 3.49 ± 2.38, P<.05). The percentage of males among CAM users was higher than that among nonusers (89.5% vs 56.6%, P<.05).

CONCLUSION

Increasing awareness of both caretakers and physicians of pediatric leukemia patients on the effects and risks of CAM therapies is essential should rational, safe, and evidence-based utilization of CAM therapies be achieved.

Use of homeopathy in pediatric oncology in Germany

Homeopathy is a frequently used complementary and alternative medicine (CAM) treatment. We present results comparing responses of homeopathy users (HUs) and users of other forms of CAM (NHUs) in pediatric oncology (PO) in Germany. Differences between these two groups (usage, associated demographic characteristics, previous experience with CAM) are investigated. 186 (45.2%) of the 367 CAM users were exposed to homeopathy. The treatment duration amounted to a median of 601 days for HUs and 282 days for NHUs. Parents with p (127; 76.5%) also used homeopathy for their child's cancer. Nonmedical practitioners played a considerably greater role as source of information than did treating physician. In the majority HUs received their prescriptions from nonmedical practitioners (56%; 29.4% of NHUs). HUs communicate more frequently with their physicians about the CAM-use (77.7% versus 65.2%) and recommend CAM more often than NHUs (94% versus 85.6%). Homeopathy is the most frequently used CAM treatment in PO in Germany. HUs sustain treatment and therapies considerably longer than NHUs. Most families who had used homeopathy before their child was diagnosed with cancer also used homeopathy for the treatment of their child's cancer. Compared to other CAM treatments, patient satisfaction with homeopathy appears to be very high.

Prevalence of complementary medicine use in pediatric cancer: a systematic review

CONTEXT

Complementary and alternative medicine (CAM) is used by pediatric patients with cancer, but the actual frequency of CAM use is undetermined.

OBJECTIVE

In this systematic review we summarize the current evidence on the prevalence of CAM use in pediatric patients with cancer and assess the reported quality of included studies.

METHODS

We systematically searched 6 major electronic databases, reference lists of existing reviews, and personal files. We included full articles about primary research studies (without language restriction) that reported the prevalence of CAM use if all or a defined subsample of participants were pediatric patients with cancer. Detailed information regarding methods and results was extracted from the original articles. A quality-assessment tool was rigorously developed on the basis of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and used to assess reported study quality. Formal tests of interrater agreement were conducted.

RESULTS

We included 28 studies with survey data (collected from 1975 to 2005) from 3526 children. In 20 studies with 2871 participants, the prevalence of any CAM use (since cancer diagnosis) ranged from 6% to 91%; considerable heterogeneity across studies precluded meta-analysis. Study quality was mixed and not correlated with CAM prevalence. Herbal remedies were the most popular CAM modality, followed by diets/nutrition and faith-healing. Commonly reported reasons for CAM use included to help cure or fight the child's cancer, symptomatic relief, and support of ongoing use of conventional therapy. There was little evidence of an association between CAM use and patients' sociodemographic characteristics.

CONCLUSIONS

Many pediatric patients with cancer use CAM. It is important that pediatricians be aware of this fact and encourage open communication with patients and their parents. Using standardized survey methods and CAM definitions in future studies could improve their quality and help generate comparable data. Our quality-assessment tool could prove valuable for other reviews of prevalence studies.

Use of folk remedies among families of children hospitalised in Taiwan

AIMS

To describe the attitudes toward and the use of folk remedies among caregivers of children who were hospitalised in Taiwan.

BACKGROUND

Parents incorporate folk remedies into the care of sick children in many cultures, including Taiwan. Twelve common folk remedies are commonly used in the Taiwanese culture for the care of sick children.

DESIGN

The study employed a descriptive, exploratory design using survey methods. Participants were 92 caregivers (parents) whose children were hospitalised for at least three days in a hospital in the middle district of Taiwan.

RESULTS

Sixty per cent of the participants used some form of folk remedies in the care of their hospitalised children. The most frequently used remedies were: spirit-calling (63%); carrying a cross or incense bag (47%), praying a Buddhist mantra (36%). There was a positive relationship between a positive attitude towards folk remedies and current use with children (p < 0.05). Logistic regression analysis revealed that parents' previous experience of using folk remedies (odds ratio = 0.272, p = 0.037), and parents' knowledge of the care of disease (odds ratio = 18.044, p = 0.015) were the strongest predictors of use of folk remedies. Almost three-fourths (73%) of all participants expected that health care providers would respect and not interfere with their use of folk remedies; 72% of parents stated that they would not tell healthcare providers about the use of folk remedies.

CONCLUSIONS

The majority of the parents of hospitalised children in Taiwan can be expected to use folk remedies for the purpose of psychological and spiritual support during child hospitalised.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers need to be aware of the folk remedies used within various cultural groups so that culturally appropriate and safe care can be provided for the child and family.

Pediatric oncologists' views toward the use of complementary and alternative medicine in children with cancer

BACKGROUND

Pediatric oncology patients commonly use complementary and alternative medicine (CAM), yet approximately only 50% of these patients discuss CAM with their oncologist.

OBJECTIVE

The aim of this study is to assess barriers to CAM communication in pediatric oncology.

DESIGN/METHODS

A 33-question survey was sent via electronic mail to 358 pediatric oncologists in the United States.

RESULTS

Ninety pediatric oncologists completed the survey. Ninety-nine percent of pediatric oncologists think it is important to know what CAM therapies their patients use. However, less than half of pediatric oncologists routinely ask their patients about CAM. This is primarily because of a lack of time and knowledge. Many physicians think some forms of CAM may improve quality of life, such as massage (74%) and yoga (57%). Over half of physicians thought that dietary supplements, herbal medicine, special diets, vitamins, and chiropractic might be harmful to patients.

CONCLUSIONS

Pediatric oncologists believe it is important to know which CAM therapies their patients use; however, they are not asking about them owing to lack of time and knowledge. To improve communication about CAM, increased physician education is needed. In addition, physicians should identify patients using potentially harmful CAM therapies. Furthermore, CAM research in pediatric oncology should focus on those modalities physicians believe may improve patient quality of life.

Prevalence and parental perceptions of complementary and alternative medicine use by children with cancer in a multi-ethnic Southeast Asian population

BACKGROUND

The purpose of the current study was to determine the prevalence of use of complementary and alternative medicine (CAM) by children with cancer and to compare the characteristics of CAM users and CAM nonusers.

METHODS

A cross-sectional study was performed at a pediatric oncology center in Kuala Lumpur, Malaysia. The parents of 97 children with cancer were interviewed using a structured questionnaire.

RESULTS

Overall, 84.5% of the respondents had used CAM, and most of them believed that CAM provided a boost to the immune system, and used CAM with the intention to complement conventional treatment. The most frequently used CAM was water therapy (78%), followed by spirulina (33%), vitamin C (27%), multivitamin (23%), visit to traditional healers (22%), sea cucumber (Stichopus horrens) (15%), and Chinese traditional medicine (12%). The Malay (n = 67) were using more often (93%) CAM than non-Malay (n = 30, use 67%, P = 0.001).

CONCLUSIONS

CAM use is common among Malaysian children with cancer. Understanding the sociocultural dimension of patients' health beliefs is important to a successful treatment, and pediatric oncologists should ask for the use of CAM.

Complementary and alternative medicine use in children with cancer and general and specialty pediatrics

The objective of this survey is to determine the frequency, reasons, and factors influencing use of complementary and alternative medicine (CAM) in general and specialty pediatrics within the same geographic area. Of the 281 surveys completed, CAM use was higher in children with epilepsy (61.9%), cancer (59%), asthma (50.7%), and sickle cell disease (47.4%) than in general pediatrics (36%). Children most often used prayer (60.5%), massage (27.9%), specialty vitamins (27.2%), chiropractic care (25.9%), and dietary supplements (21.8%). Parents who used CAM for themselves (68.7%) were more likely to access CAM for their child. Most parents (62.6%) disclosed some or all of their child's use of CAM to providers. This study confirms that within the same geographic region, children with chronic and life-threatening illness use more CAM therapies than children seen in primary care clinics. Children with cancer use CAM for different reasons than children with non-life-threatening illnesses.

Complementary and alternative treatment methods in children with cancer: A population-based retrospective survey on the prevalence of use in Germany

INTRODUCTION

Few studies have been conducted to date on the prevalence of use of complementary and alternative treatment methods (CAMs) in paediatric oncology, and those that have been conducted are often not representative. We therefore decided to study a representative sample of children with cancer in the German population.

PATIENTS AND METHODS

The study took the form of a retrospective survey amongst all parents whose children were first diagnosed with a disease covered by the German Childhood Cancer Registry in 2001. The primary objectives of the survey were to establish the prevalence of use of CAM and the factors related to its use.

RESULTS

Of the 1595 questionnaires sent out, 1063 (67%) could be evaluated. 35% of the responders had used CAM. The most frequently used methods were homeopathy, dietary supplements and anthroposophic medicine including mistletoe therapy. Factors which increased the probability of using CAM were the previous use of CAM, higher social status and poor prognosis of the child's disease. The most frequently named reasons for use of CAM were physical stabilisation, strengthening the immune system and improving the chance of cure. Whilst the sources of information about CAM were in most cases not doctors, 71% of users had nevertheless spoken to a doctor about using CAM. The effects of the CAM perceived by the parents were for the most part positive. 89% of the users reported that they would recommend CAM to other parents.

CONCLUSIONS

CAMs are administered alongside standard therapy to 35% of children with cancer in Germany, usually by the parents. Prospective studies on the effects and side-effects of the most frequently used methods are urgently needed, and paediatric oncologists should have sufficient knowledge of CAM to enable them to advise parents professionally and competently about these treatments, too.

Complementary and alternative therapy use in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study

BACKGROUND

Little information is available on the use of complementary and alternative medicine (CAM) in long-term survivors of childhood and adolescent cancer.

PROCEDURE

The Childhood Cancer Survivor Study (CCSS) is a resource evaluating the long-term effects of cancer and associated therapies in 5-year survivors of childhood and adolescent cancer diagnosed between 1970 and 1986 before the age of 21 years. A survey of CAM use during the previous year was distributed in 2000-2001 and completed by 9,984 survivors and 2,474 sibling controls.

RESULTS

CAM use reporting was similar in cases (39.4%) and siblings (41.1%). Compared to female siblings, female survivors were more likely to use biofeedback (odds ratio (OR) = 3.3; 95% CI = 1.0-10.8) and hypnosis/guided imagery (OR = 3.2; 95% CI = 1.6-6.8); male survivors were more likely than male siblings to use herbal remedies (OR = 1.3; 95% CI = 1.1-1.6). Factors associated with CAM use in survivors included elevated scores on the brief symptom inventory (BSI)-18 (OR = 1.6; 95% CI = 1.3-1.9), prolonged pain (OR = 1.5; 95% CI = 1.3-1.7), and having seen a physician in the past 2 years (OR = 1.6; 95% CI = 1.4-1.8). Survivors reporting low alcohol intake and excellent or good general health reported lower levels of CAM use (OR = 0.7; 95% CI = 0.7-0.8 and OR = 0.8; 95% CI = 0.7-0.9, respectively).

CONCLUSIONS

Survivors have a similar reported use of CAM compared to a sibling cohort. However, our data suggest that survivors turn to CAM for specific symptoms related to previous diagnosis and treatment. Future research is needed to determine whether CAM use reflects unmet health needs in this population.

Complementary/alternative medicine use in a pediatric oncology unit in Turkey

BACKGROUND

Important in the cancer therapy is the increasingly use of complementary/alternative medicine (CAM). The current study aims to establish the extent of use, the types of therapies employed, factors influencing, the reasons for choosing and the cost of CAM used in pediatric cancer patients in our clinic in Ankara, Turkey.

PROCEDURE

A detailed questionnaire regarding demographic data and information about the use of CAM was completed by 95 patients who have attended the clinic between 1999 and 2000.

RESULTS

Forty-nine patients (51.6%) had used one or more than one type of CAM. The most frequent (71.4%) was herbal medicine and biologic intake (stinging nettle, plant essence, honey of Anzer). The second one was religious therapy (40.8%). No correlation could be found between the use of CAM and parents education status, the level of income, number of siblings, the prognosis of the disease, the rate of satisfaction with the level of information given by the doctor at the time of diagnosis or the belief in the information given by the doctor about the prognosis (P > 0.05). All patients used CAM in addition to conventional therapy.

CONCLUSIONS

More than half of the patients used CAM, with stinging nettle being the most common agent. Our patients place a high level of trust in their physicians and the conventional therapies offered by them; however, they also believe that the complementary therapies are harmless and, therefore, worth trying.

Complementary and alternative therapies: survey of knowledge and attitudes of health professionals at a tertiary pediatric/women's care facility

Nurses, physicians, and allied health professionals at the IWK Health Centre, Halifax, NS, Canada, a tertiary care, regional center for a population of 2.5 million were surveyed. We examined personal attitudes and professional practice in addressing the use of complementary and alternative medicine (CAM) use by patients. We also examined the availability of CAM-related information to health professionals. The findings suggest that health professionals: (1) are supportive of the use of selected CAM therapies by patients; (2) have almost no personal experience of CAM; (3) have limited knowledge about CAM and acquire that information mainly from the Internet, friends or family rather than professional journals; (4) are uncomfortable discussing CAM with patients and; (5) rarely or never ask patients about CAM use. We have identified barriers for health professionals to effective communication about CAM use by their patients and families. Improved access to existing policies and scientific publications, and specific continuing professional development opportunities focused on speaking openly and non-judgmentally with patients are likely to enhance accurate guidance of patients in the highly prevalent use of CAM.

Complementary and Alternative Medicine Use in Pediatric Oncology Patients in Eastern Turkey

The use of complementary and alternative medicines (CAM) among children with cancer is becoming increasingly popular. Therefore, it is important to gain insight into the prevalence and factors related to the use of CAM. This study presents findings from a study of parents of 88 children with cancer who were receiving or had received conventional therapy for treatment of childhood cancer at a pediatric oncology unit in eastern Turkey. The findings indicated that 48.9% of the respondents reported the use of 1 or more CAM therapies. The most commonly used modality was herbal products such as herbal tea and herbal meal, mostly stinging nettle (Urtica dioica). The findings of this study indicate that CAM users were children who were an average of 3 years older than nonuser children and that CAM use was more prevalent among the children who had been diagnosed with cancer for a longer time than nonusers. There were no significant difference between users and nonusers regarding sociodemographic characteristics (such as age education level, economic status), hopelessness score of parents, gender of child, and treatment status. Healthcare providers should remain informed about the benefits and adverse effects of complementary and alternative therapies to discuss treatment options with patients and their families and to monitor treatment efficacy.

Complementary and alternative medicine in pediatric oncology

Children with cancer and their families use complementary and alternative medicine (CAM) to reduce symptoms, cope with life-threatening illness, and improve overall well-being. Despite numerous published surveys on the use of CAM in pediatric oncology, few studies have tested CAM therapies for safety and efficacy. A growing body of literature in adult oncology provides evidence for the role of CAM to help manage symptoms and reduce distress. Translating this research to children requires studies with new models that address family roles and include measurement of outcomes relevant to children's developmental stages and unique responses. One of the limitations in pediatrics is the small samples available to single institutions. Conducting clinical trials through the cooperative group mechanism is one way of obtaining sufficient sample sizes to determine effectiveness and safety of CAM therapies. This article summarizes research to date and describes a beginning approach to measuring outcomes of supportive CAM therapies in children with cancer.

Herbal medicine research in Taiwan

Of all the countries in the world, why did you choose Taiwan to pursue your study? It is a question that I (comments of the first author) have answered a thousand times. My first visit to a laboratory at National Taiwan University opened my eyes to the possibilities of herbal medicine research, especially in the area of veterinary medicine. It became my ambition to link the knowledge of Traditional Chinese Medicine (TCM) and Ayurveda from the Indian subcontinent and their integration with other systems of medicine, including Western medicine (WM), to achieve the concept of Sustainable Medicine, firstly for animals and then for humans. The Ministry of Economic Affairs (MOEA) has implemented a technology development program to quickly establish the key technologies, and this is a moment of opportunity for Taiwan's traditional herbal medicine industry to upgrade and transform itself. This paper, initially intended to be a student's narration, has evolved into a multi-author treatise on the present state and likely future scenario of herbal medicine research in Taiwan.

Use of alternative and complementary therapies in children with cancer

BACKGROUND AND OBJECTIVES

The use of complementary and alternative medicines (CAM) is becoming increasingly popular. Although considered beneficial by users, the potential for interaction or substitution with conventional treatment should not be overlooked by health care professionals. It is therefore important to gain insight into the prevalence and the factors related to the use of CAM. To establish the prevalence of use of CAM among children with cancer treated in a large pediatric hospital, describe the profile of use and factors related with use. As a secondary objective we aimed at measuring quality of life of the children aged 5 or more and compare the scores between users and non-users.

METHODS

The study is a cross-sectional survey of parents whose child was treated at the oncology clinic or ward of Sainte-Justine Hospital, a large pediatric hospital in Montreal. Data on socio-demographic variables, the use of CAM and the quality of life was collected through a self-administered questionnaire. Quality of life was measured with the Child Health Questionnaire CHQ-PF50, while clinical data was collected from medical records.

RESULTS

A total of 115 patients were recruited and 92 parents completed and returned the questionnaire, resulting in a 80% response rate. According to this survey, 49% of the children used at least one type of CAM and 20% used herbal remedies/homeopathy/vitamins in the 2 months preceding the survey. Most popular CAM were spiritual/mental and physical strategies used by 35 and 33% of children under study, respectively. Only one parent reported having delayed a conventional treatment because of CAM. Although quality of life results must be interpreted with caution, they tend to favor non-users.

CONCLUSIONS

CAM is likely to be used by a wide variety of people. In our study, we found that about half of the children with cancer has used CAM in the 2 preceding months. No specific profile of CAM users emerged from this study. The high prevalence of CAM warrants further studies to better understand the reasons and consequences of CAM use particularly on quality of life.

Complementary and Alternative Medicine in Pediatric Oncology

OBJECTIVES

To summarize research in complementary and alternative medicine (CAM) therapies used for children with cancer and to explore issues and directions for measuring outcomes of CAM therapies in children.

DATA SOURCES

Scientific and research articles, internet for active research studies.

CONCLUSION

CAM is increasingly used as adjunctive cancer therapies in pediatrics. Mind-body and touch therapies have the greatest evidencefor effectiveness in reducing psychological and physical stressors. Supplements and herbal therapies receive the greatest interest, however, and more research is needed to determine efficacy in improving symptoms or outcomes in children with cancer.

IMPLICATIONS FOR NURSING PRACTICE

Mind-body and touch therapies can be used by nurses to reduce symptoms and anxiety in children. Potential risks and benefits should be determined for therapies that have no evidence.

Complementary and alternative medical therapies for children with cancer

Complementary and alternative medical therapies (CAM) are treatments that generally fall outside of the mainstream of conventional medicine. CAM therapies are used by 31-84% of children with cancer, including many children enrolled on clinical trials. CAM therapies are often used for the treatment of side-effects of cancer or cancer therapy, and only rarely as an alternative to conventional therapy. Regulation of CAM therapies varies worldwide, and many therapies have not been subject to scientifically conducted analyses. Adverse events have been described, especially from the contamination of herbs. Only rare reports of interactions of CAM therapies with conventional anticancer treatments have been reported. Several research studies of CAM in children with cancer are underway. In the interim, non-pharmacological therapies such as mind-body medicine, manipulative and body-based therapies and energy therapies may be used for supportive therapy. Research is needed before biologically based CAM therapies may be recommended in conjunction with conventional therapy.