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Lopes-Júnior LC, de Lima RAG. Utilizing complementary therapy to enhance quality of life and reduce stress and fatigue in pediatric cancer patients. World J Clin Cases 2025; 13:98013. [PMID: 40242229 PMCID: PMC11718577 DOI: 10.12998/wjcc.v13.i11.98013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 11/05/2024] [Accepted: 12/05/2024] [Indexed: 12/26/2024] Open
Abstract
The international scientific literature presents still incipient results regarding the management of cancer symptom clusters by oncology nursing, especially in pediatric oncology. This is a promising field of investigation for clinical nurses and researchers, and when it is subsidized by medium-range theories, they corroborate the diagnoses and interventions of nursing in oncology, enhancing the science of nursing care. This minireview article aims to discuss the utilizing the hospital clowns as a complementary therapy, to enhance quality of life and reduce stress and fatigue in pediatric cancer patients. Overall, the evidence presented so far pointed out that complementary therapy might help improve the quality of life of pediatric cancer patients, and that complementary therapy usage should be part of a health comprehensive care model, delivering therapeutic approaches that might enhance the mind-body during a pediatric cancer patients' life span. The results of scientific investigations by nurses, particularly those linked to the basic sciences, play a critical role in advancing personalized care in pediatric integrative oncology.
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Affiliation(s)
- Luis Carlos Lopes-Júnior
- Department of Nursing, Federal University of Espírito Santo, Vitoria 29043-900, Espirito Santo, Brazil
| | - Regina Aparecida Garcia de Lima
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, Sao Paulo, Brazil
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Holly SP, Heidelberg RE, Wright RP, Ly AG, Meyer M, Vukadinovich C, Baker JN, Levine DR. Pediatric Hematology-Oncology Provider Attitudes and Beliefs About the Use of Integrative Modalities for Their Patients: A Cross-Sectional Survey. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2025. [PMID: 40111908 DOI: 10.1089/jicm.2024.0623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2025]
Abstract
Purpose: Children with cancer suffer from physical and psychological symptoms. Integrative medicine modalities (IMMs) for symptom management are increasingly popular, but whether these are acceptable to pediatric hematology-oncology (PHO) providers remains unknown. To address this knowledge gap and guide integrative medicine (IM) program development, a needs assessment was conducted to understand PHO provider knowledge, attitudes, and beliefs regarding IMMs for symptom management in children with hematologic or oncologic disorders. Methods: A detailed survey instrument was crafted using primary literature and expert opinion, iteratively reviewed for validity, and piloted tested by health care providers (HCPs). The survey was distributed electronically to patient-facing staff and stratified by clinical role. Survey response data from physicians and advanced practice providers (APPs) underwent descriptive analysis using SAS v.9.4 (Cary, NC). Results: A total of 78 PHO physicians and APPs completed this survey (response rate 29.5%). While most PHO physicians and APPs do not feel confident discussing incorporation of IMMs into the care of PHO patients, they are willing to (1) receive additional education in IM and (2) refer to a trusted IM provider. Providers do not believe that families typically disclose use of IMM to HCPs, and many worry about the use of entities such as high-dose vitamins and chiropractic care. Conclusions: PHO providers are concerned about the use of specific IMMs in their patients' care but support massage and mindfulness almost universally. Most PHO clinicians are willing to engage trained IM providers and support strategies that may contribute to improved quality of life for their patients and families.
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Affiliation(s)
- Spraker-Perlman Holly
- Divisions of Pediatric Oncology & Pediatric Palliative Care, Department of Pediatrics, University of Utah, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - R Elyse Heidelberg
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Rachel P Wright
- University of Colorado, Pediatrics, Children's Hospital of Colorado, Denver, California, USA
| | - Amy G Ly
- Division of Neurology, Department of Pediatrics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Maggi Meyer
- Department of Rehabilitation, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Chris Vukadinovich
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Justin N Baker
- Division of Quality of Life and Pediatric Palliative Care, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Deena R Levine
- Department of Oncology, Division of Quality of Life & Palliative Care, St. Jude Children's Research Hospital, Memphis, TN, USA
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Wu HWV, Dominguez Garcia D, Glade Bender JL, Mao JJ, Raghunathan NJ. Exploring the Landscape of Integrative Medicine in Pediatric Oncology: Characterization of an Outpatient Consultative Service. CHILDREN (BASEL, SWITZERLAND) 2025; 12:198. [PMID: 40003300 PMCID: PMC11854236 DOI: 10.3390/children12020198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2025] [Revised: 01/28/2025] [Accepted: 02/04/2025] [Indexed: 02/27/2025]
Abstract
Background/Objectives: Symptoms from cancer and treatments often cause pediatric patients and their families to seek complementary and integrative medicine (IM) for relief. The aim of this study was to better describe the characteristics of pediatric patients at a tertiary cancer center who utilize an IM consultative service in the outpatient setting and the associated discussions with a pediatric-focused IM physician. Methods: A retrospective study was conducted on initial IM visits for patients aged less than 19 years old at the time of the visit from January 2019 through April 2022 at a tertiary cancer center. Patient demographics, clinical characteristics, and visit information were abstracted from electronic medical records, and discussions with the provider (presenting symptoms and recommendations) were described. Results: In total, 207 patients and their associated visit discussions met the criteria. About half (47%, n = 97) of the patients were female with a mean patient age of 10 years old (median age 11 years, range 0 to 18 years). The overall most common presenting symptoms were nausea (35%, n = 72), pain (30%, n = 62), and poor appetite (26%, n = 53) with variations between age groups. The most discussed topics were supplements (94%), diet (91%), stress management (82%), IM therapies (60%), and medical cannabis (54%). Conclusions: Priority symptoms reported by patients and referred to the IM outpatient consultative service included nausea, pain, and poor appetite. Concerns were addressed during tailored discussions with patients and their families. Having an outpatient consultative IM service may benefit providers, patients, and families to facilitate receiving evidence-informed recommendations in a dedicated, consolidated setting.
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Affiliation(s)
- Han-Wei V. Wu
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | | | - Julia L. Glade Bender
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jun J. Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Nirupa J. Raghunathan
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Martínez García E, López de San Roman Fernández C, Nishishinya Aquino MB, Pérez-Jaume S, Fernández-Jané C, Cruz Martínez O, Morales La Madrid A. Patient Acceptability of the First Integrative Pediatric Oncology Unit in Spain-The Pediatric Cancer Center Barcelona Experience: A Retrospective Study. Cancers (Basel) 2025; 17:222. [PMID: 39858004 PMCID: PMC11764332 DOI: 10.3390/cancers17020222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Revised: 01/09/2025] [Accepted: 01/09/2025] [Indexed: 01/27/2025] Open
Abstract
BACKGROUND/OBJECTIVES Pediatric cancer patients and their families are increasingly combining conventional treatment with complementary therapies. These therapies are not covered by most public healthcare systems, and Spain is not an exception. To address this need, the Pediatric Cancer Center Barcelona, at the Hospital Sant Joan de Déu (Spain), established the first integrative pediatric oncology unit in 2019. The objective of this study is to describe the feasibility of implementing a pediatric integrative oncology unit, in terms of the acceptance of the interventions, as well as to present initial data on the care activities; Methods: This is a retrospective single-center study, conducted in the Pediatric Cancer Center Barcelona, at the Hospital Sant Joan de Déu. Data from patients during a two-year period were collected by reviewing medical records in a pseudonymous manner; Results: From 1 September 2019 to 30 September 2021, the unit was visited by 433 patients. The median age of patients was 9 years [range 0-34 years], with 266 boys (61.4%) and 167 girls (38.6%). Of these patients, 90.1% were in active treatment, 7.6% were survivors, and 2.3% were at the end of life. Acupuncture was recommended to 227 patients, with a 94.7% acceptance rate. Aromatherapy was recommended to 114 patients, with a 100% acceptance. The reflexology team visited 129 patients, delivering a total of 414 sessions, with a 96.1% acceptance.; Conclusions: The findings of our study support the feasibility of implementing an Integrative Pediatric Oncology Unit within a patient-centered care model in a comprehensive pediatric cancer center. The high acceptance rates of various complementary therapies highlight their potential role in enhancing supportive care for pediatric oncology patients.
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Affiliation(s)
- Esther Martínez García
- Integrative Pediatric Oncology Unit, Pediatric Cancer Center Barcelona, Sant Joan de Déu Barcelona Children’s Hospital, 08950 Barcelona, Spain; (E.M.G.); (C.L.d.S.R.F.); (M.B.N.A.)
| | - Cristina López de San Roman Fernández
- Integrative Pediatric Oncology Unit, Pediatric Cancer Center Barcelona, Sant Joan de Déu Barcelona Children’s Hospital, 08950 Barcelona, Spain; (E.M.G.); (C.L.d.S.R.F.); (M.B.N.A.)
| | - M. Betina Nishishinya Aquino
- Integrative Pediatric Oncology Unit, Pediatric Cancer Center Barcelona, Sant Joan de Déu Barcelona Children’s Hospital, 08950 Barcelona, Spain; (E.M.G.); (C.L.d.S.R.F.); (M.B.N.A.)
| | - Sara Pérez-Jaume
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Carles Fernández-Jané
- Health Department, Tecnocampus, Universitat Pompeu Fabra, Mataró-Maresme, 08302 Barcelona, Spain
| | - Ofelia Cruz Martínez
- Pediatric Neuro-Oncology, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain; (O.C.M.); (A.M.L.M.)
| | - Andrés Morales La Madrid
- Pediatric Neuro-Oncology, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain; (O.C.M.); (A.M.L.M.)
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Assessing Effects of Mandala Painting on Anxiety of 9–14-Year-Old Children with Cancer. ADVANCES IN INTEGRATIVE MEDICINE 2023. [DOI: 10.1016/j.aimed.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Barr RD, Antillon-Klussmann F. Cancer and nutrition among children and adolescents in low- and middle-income countries. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2022; 27:987-993. [PMID: 36094475 DOI: 10.1080/16078454.2022.2115437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE : The primary purpose of this review is to investigate the relationships between cancer and nutrition in children and adolescents living in resource-poor, low- and middle-income countries (LMICs) in order to explore potential opportunities for interventions which could improve clinical outcomes in this population. METHOD : The implications of overlapping age groups of children and adolescents with cancer are examined, as are the adverse influences of under-nutrition and socio-economic deprivation on the efficacy of treatment and cancer survival. Evidence suggestive of novel avenues to enhance prospects for cure, based on increased understanding of the dynamic of nutrition and cancer, is evaluated. RESULT : Cancer adds to the burden of under-nutrition in disadvantaged populations which is reflective, in large measure, on inadequate governmental expenditure on health which demands public-private partnerships and the use of hospital-based foundations. Structured approaches to the measurement of nutritional status and the design of effective programmes of nutritional supplementation are of proven benefit. Initial results from studies of the perturbed gut microbiome hold considerable promise for further gains. CONCLUSION A large minority of children with cancer in LMICs are never diagnosed and the same may be true of adolescents. Investing in the training of nutritionists will have substantial returns as will increasing access to essential medicines. Recognition of these challenges has stimulated WHO and other entities to devise major strategies for comprehensive changes in the care of children and adolescents with cancer in LMICs, offering realistic prospects for improved clinical outcomes.
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Affiliation(s)
- Ronald D Barr
- Departments of Pediatrics and Medicine, McMaster University, Hamilton, Canada
| | - Federico Antillon-Klussmann
- Unidad Nacional de Oncología Pediátrica, and School of Medicine, Francisco Marroquín University, Guatemala, Guatemala
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Lam CS, Au KY, Hung HY, Chou HW, Leung AWK, Li CK, Koon HK, Cheung YT. Integrating Complementary Medicine Into the Care of Childhood Cancer Survivors: A Brief Report on the Preliminary Framework and Implementation of an Educational Program. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:897677. [PMID: 36189053 PMCID: PMC9397837 DOI: 10.3389/fresc.2022.897677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/16/2022] [Indexed: 11/24/2022]
Abstract
Background Existing educational programs typically include limited information on traditional, complementary, and integrative medicine (TCIM) for survivors of childhood cancer. Objectives This brief report presents the preliminary results of an educational program that aims to promote the safe and effective use of Chinese medicine (CM) among survivors in Hong Kong. Methods Survivors of childhood cancer, their caregivers, and oncology practitioners were invited to participate in a program that consists of two didactic seminars and a written educational booklet that disseminated information on the use of CM. A structured questionnaire was used to evaluate participants' receptivity toward and perceived relevance of the program. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to discuss the impact of the intervention. Results Reach: A total of 174 participants attended the seminars, and the seminar recording received over 380 views on social media platforms since April 2021. The hardcopy of the educational booklet was distributed to 43 recipients. The web-version of the booklet was sent to 67 participants and downloaded 143 times. Efficacy: The majority found that the content of the seminar useful (mean score = 5.04/6 points), especially the CM exercise (mean score = 4.88/6 points) and dietary advice (mean score = 4.99/6 points). Intention to adopt: The survivors (or their caregivers) reported that they would adopt advice on food therapies (83.3%) and traditional Chinese health exercises (55.6%) during survivorship. Conclusion The preliminary data on patient preferences will be applied to further develop educational materials and to establish a TCIM referral network within the cancer survivor community.
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Affiliation(s)
- Chun Sing Lam
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kwok Yin Au
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Hing Yu Hung
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ho Wing Chou
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Alex Wing Kwan Leung
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong, Hong Kong SAR, China
| | - Chi Kong Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ho Kee Koon
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Ho Kee Koon
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- *Correspondence: Yin Ting Cheung
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Mora DC, Kristoffersen AE, Overvåg G, Jong MC, Mentink M, Liu J, Stub T. Safety of Complementary and Alternative Medicine (CAM) treatment among children and young adults who suffer from adverse effects of conventional cancer treatment: A systematic review. Integr Cancer Ther 2022; 21:15347354221105563. [PMID: 35726681 PMCID: PMC9218455 DOI: 10.1177/15347354221105563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/04/2022] [Accepted: 03/21/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Complementary and Alternative Medicine (CAM) is widely used around the world to treat adverse effects derived from cancer treatment among children and young adults. Parents often seek CAM to restore and maintain the child's physical and emotional condition during and after cancer treatment. OBJECTIVES The objectives of this review were (i) to identify literature that investigates CAM use for treating adverse effects of conventional cancer treatment, (ii) to investigate the safety of the included CAM modalities, and (iii) to evaluate the quality of included studies. METHODS Five scientific research databases were used to identify observational, quasi-experimental, and qualitative studies from January 1990 to May 2021. Included studies investigated the use of CAM to treat adverse effects of cancer treatment in childhood cancer. RESULTS Fifteen studies were included in this review. Ten quasi-experimental, 3 observational studies (longitudinal/prospective), 2 qualitative studies, and 1 study with a quasi-experimental and qualitative arm were identified. Less than half (n = 6; 40%) of the studies included reported adverse effects for the CAM modality being studied. Among the studies that reported adverse effects, they were mostly considered as direct risk, as 13% reported mainly bleeding and bruising upon acupuncture treatment, and dizziness with yoga treatment. All adverse effects were assessed as minor and transient. CAM modalities identified for treating adverse effects of cancer treatment were alternative medical systems, manipulative and body-based therapies, biologically-based therapies, and mind-body therapies. CAM modalities were used to alleviate anxiety, pain, toxicity, prevent trauma, and improve health-related quality of life, functional mobility, and physical activity levels. All studies assessed scored 70% or above according to the Joanna Briggs Institute critical appraisal for study quality checklists. CONCLUSION Most of the studies (58.3%) included in this review did not report adverse effects from CAM modalities used to treat adverse effects of cancer treatment in children and young adults. This lack of safety information is of concern because parents need to know whether the modality represents an extra burden or harm to the child. To improve awareness about safety in the field, a universal and uniform reporting system for adverse effects in CAM research is needed.
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Affiliation(s)
- Dana C. Mora
- UiT The Arctic University of Norway, Tromsø, Norway
| | | | | | - Miek C. Jong
- UiT The Arctic University of Norway, Tromsø, Norway
| | - Marit Mentink
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Jianping Liu
- Beijing University of Chinese Medicine and Pharmacology, Beijing, China
| | - Trine Stub
- UiT The Arctic University of Norway, Tromsø, Norway
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Chung JH, Phalke N, Hastings C, Killilea DW, Feusner JH, Fung EB. Zinc deficiency and its association with treatment-related toxicity in children with cancer. Pediatr Blood Cancer 2021; 68:e29104. [PMID: 34061438 DOI: 10.1002/pbc.29104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/24/2021] [Accepted: 04/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nutritional deficiencies in children with cancer at time of diagnosis and during treatment may negatively affect disease outcome and increase treatment-related toxicity. Yet zinc, an essential nutrient important for supporting immune function and known for reducing diarrheal episodes, is rarely assessed in these children. PROCEDURES Fifty children (1 month to 18 years) with recently diagnosed cancer were enrolled in this study. An age and gender matched control group (n = 50) was also recruited. Plasma and urinary zinc, plasma copper, and C-reactive protein (CRP) levels were measured at baseline, 3, and 6 months following diagnosis. A retrospective review of the toxicity profile was performed in the cohort of children with cancer for the first 4 years after initial diagnosis. RESULTS CRP and plasma copper (both acute-phase reactants) were elevated in patients with cancer compared to controls at baseline, both p < .03. Plasma zinc levels were not significantly different from controls at baseline, but decreased by 11% in the cancer group over 6 months of treatment, 83.2 ± 15.6 to 74.3 ± 14.8 μg/dl, p = .01. Plasma zinc dropped to deficient levels in 35% of cases over the initial 6 months. Zinc deficiency at 6 months was related to an increased incidence of severe diarrhea during 4 years of follow-up, p < .001. CONCLUSIONS Zinc deficiency is an underrecognized problem among patients undergoing treatment for cancer and is associated with severe diarrhea. Further studies are needed to evaluate causes for zinc deficiency, related effects, and a possible role for zinc supplementation.
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Affiliation(s)
- Jong H Chung
- Department of Pediatrics, Hematology Oncology, University of California Davis Medical Center, Sacramento, California, USA
| | - Neelam Phalke
- Department of Otolaryngology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Caroline Hastings
- Department of Hematology Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - David W Killilea
- Children's Hospital Oakland Research Institute, Oakland, California, USA
| | - James H Feusner
- Department of Hematology Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Ellen B Fung
- Department of Hematology Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA.,Children's Hospital Oakland Research Institute, Oakland, California, USA
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Stub T, Quandt SA, Kristoffersen AE, Jong MC, Arcury TA. Communication and information needs about complementary and alternative medicine: a qualitative study of parents of children with cancer. BMC Complement Med Ther 2021; 21:85. [PMID: 33685422 PMCID: PMC7938468 DOI: 10.1186/s12906-021-03253-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 02/17/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Many parents choose support such as Complementary and Alternative Medicine (CAM) for themselves and their children who have cancer. The aim of this paper is to describe, how parents who have children with cancer communicated with conventional health care providers about CAM, and what types and sources of information they would like to receive about CAM when the child was ill. METHOD This focused ethnography draws from in-depth, semi-structured interviews conducted with 22 families in Norway with 24 adult participants (two couples), including two individuals who had had cancer themselves. Four domains were explored in the data analysis: the use of CAM, advice from laypeople about CAM, communication with conventional health care providers about CAM, and parents' information needs about CAM. RESULTS Many of the participants had personal experiences with CAM before the child received the cancer diagnosis. The health care providers did not raise the question about CAM in the consultations. However, when the parents raised the question, they were mostly met in a positive way. The participants did not receive any information about CAM at the hospital, which they would have appreciated. Instead, they received recommendations about CAM from laypersons, which were mostly rejected, as the advice was not in line with their health values/philosophy. CONCLUSION The reason participants did not disclose CAM use is that physicians did not ask them about it. However, positive communication about conventional treatment facilitated fruitful conversations about CAM. The participants wanted information about CAM from authoritative sources, primary from health care providers at the hospital and the Children's Cancer Society. They demand information about risks and benefits when using CAM as well as whether CAM can improve the immune system, fight the cancer, and improve the quality of life of the family. An evidence-based decision aid is warranted to enable health care providers and parents of children with cancer to make well-informed decisions about CAM.
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Affiliation(s)
- Trine Stub
- Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Hansine Hansens veg 19, 9037, Tromsø, Norway.
- Wake Forest School of Medicine, Department of Epidemiology and Prevention, Division of Public Health Sciences, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Sara A Quandt
- Wake Forest School of Medicine, Department of Epidemiology and Prevention, Division of Public Health Sciences, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Agnete E Kristoffersen
- Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Hansine Hansens veg 19, 9037, Tromsø, Norway
| | - Miek C Jong
- Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Hansine Hansens veg 19, 9037, Tromsø, Norway
| | - Thomas A Arcury
- Wake Forest School of Medicine, Department of Family and Community Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
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Rogers PC, Barr RD. The relevance of nutrition to pediatric oncology: A cancer control perspective. Pediatr Blood Cancer 2020; 67 Suppl 3:e28213. [PMID: 32096351 DOI: 10.1002/pbc.28213] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 02/06/2023]
Abstract
It is indisputable that adequate and appropriate nutrition is fundamental to the health, growth, and development of infants, children, and adolescents, including those with cancer. Nutrition has a role in most of the accepted components of the cancer control spectrum, from prevention through to palliation. The science of nutrigenomics, nutrigenetics, and bioactive foods (phytochemicals), and how nutrition affects cancer biology and cancer treatment, is growing. Nutritional epigenetics is giving us an understanding that there are possible primary prevention strategies for pediatric cancers, especially during conception and pregnancy, which need to be studied. Primary prevention of cancer in adults, such as colorectal cancer, should commence early in childhood, given the long gestation of nutritionally related cancers. Obesity avoidance is definitely a target for both pediatric and adult cancer prevention, commencing in childhood. There is now compelling evidence that the nutritional status of children with cancer, both overweight and underweight, does affect cancer outcomes. This is a potentially modifiable prognostic factor. Consistent longitudinal nutritional assessment of patients from diagnosis through treatment and long-term follow-up is required so that interventions can be implemented and evaluated. While improving, there remains a dearth of basic and clinical nutritional research in pediatric oncology. The perspective of evaluating nutrition as a cancer control factor is discussed in this article.
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Affiliation(s)
- Paul C Rogers
- British Columbia Children's Hospital and University of British Columbia, Vancouver, Canada
| | - Ronald D Barr
- Department of Pediatrics, McMaster University, Hamilton, Canada
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12
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Stub T, Kristoffersen AE, Overvåg G, Jong MC. An integrative review on the information and communication needs of parents of children with cancer regarding the use of complementary and alternative medicine. BMC Complement Med Ther 2020; 20:90. [PMID: 32183808 PMCID: PMC7079450 DOI: 10.1186/s12906-020-02882-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Parents often choose Complementary and Alternative Medicine (CAM) as a supportive agent with the aim to reduce cancer treatment-related symptoms in their children. Therefore, it is necessary to understand parents´ information and communication needs regarding CAM. The aim of the present study was to review the research literature as to identify the information and communication needs of parents of children with cancer, and the children themselves, regarding the use of CAM. Methods An integrative systematic review design was chosen. Searches were performed in AMED, CAMbase, CINAHL (Ebsco), EMBASE, PubMed and PsycInfo, Theme eJournals and Karger. The search was limited to studies published in English, German, Dutch, and the Scandinavian languages. Using predefined inclusion and exclusion criteria, two reviewers independently screened the title and abstracts of the relevant papers. A data extraction form and critical appraisal checklists were used to extract data for analysis, and a mixed methods synthesis was applied. Results Out of 24 studies included, 67% were of quantitative and 33% of qualitative study design. Five main themes emerged from the analysis of 21 studies: Information on CAM, sources of CAM information, communication about CAM, informed decision-making on CAM, and Risk/benefit of CAM. The majority of the parents did not disclose the CAM use of their children because they feared negative reactions from the attending oncologist. To make informed treatment decisions for their children, parents wanted unbiased information about CAM and would act accordingly. They demand open communication about these modalities and respect for the family’s autonomy when choosing CAM for their children. Conclusion There is an urgent need for parents of children with cancer for high quality information on CAM from reliable and scientific sources. Development of authoritative evidence-based decision tools is thus warranted to enable health care professionals and parents of children with cancer to make well informed, individual decisions concerning CAM.
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Affiliation(s)
- Trine Stub
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens veg 19, 9019, Tromsø, Norway.
| | - Agnete E Kristoffersen
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens veg 19, 9019, Tromsø, Norway
| | - Grete Overvåg
- Science and Health Library, UiT The Arctic University of Norway, Hansine Hansens veg 19, 9019, Tromsø, Norway
| | - Miek C Jong
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens veg 19, 9019, Tromsø, Norway
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Hu H, Shear D, Thakkar R, Thompson-Lastad A, Pinderhughes H, Hecht FM, Lown EA. Acupressure and Therapeutic Touch in Childhood Cancer to Promote Subjective and Intersubjective Experiences of Well-being During Curative Treatment. Glob Adv Health Med 2019; 8:2164956119880143. [PMID: 31632842 PMCID: PMC6769200 DOI: 10.1177/2164956119880143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/05/2019] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Acupressure and therapeutic touch may be beneficial for symptom management and increasing general well-being for children undergoing cancer treatment. Acupressure has the benefit of stimulating targeted acupuncture points while providing therapeutic touch. We sought to explore the relationship between acupressure and the experience of well-being among children being treated for cancer who received acupressure. METHODS In the Acupressure for Children in Treatment for a Childhood Cancer trial, hospitalized children received acupressure using specified acupressure points for symptom control as well as points for general well-being. Acupressure was delivered by professionals and by caregivers, following training by the professional. Qualitative data were collected through semistructured interviews with a purposive sample of professional acupressure providers (n = 3) and primary caregivers (n = 13), combined with participant observation during the acupressure intervention. Data were analyzed using grounded theory methods. RESULTS Analysis of provider interview, caregiver interview, and participation observation yielded 3 prominent themes: (1) well-being elicited by acupressure, (2) well-being elicited by touch, and (3) well-being experienced as relational and intersubjective. These themes, taken together, illustrate the intricate ways in which an intervention like acupressure can help alleviate the difficulties of a childhood cancer illness experience by promoting well-being in the child as well as the caregiver. Acupressure brought symptom relief, physical relaxation, and comforting touch to the child, allowing the caregiver to also feel relief and relaxation as caregiver-child experience of well-being are closely intertwined. CONCLUSIONS Data from the 3 sources provided distinct and overlapping insights suggesting the versatile benefits of acupressure in promoting well-being during childhood cancer treatment. Professional acupressure combined with training of caregivers for childhood cancer may be a relational intervention that facilitates the experience of well-being for both the caregiver and the child.
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Affiliation(s)
- Hiroe Hu
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California
- College of Osteopathic Medicine, Touro University, Vallejo, California
| | - Deborah Shear
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California
| | - Radhika Thakkar
- Division of Pediatric Allergy, Immunology, & Blood and Marrow Transplantation, University of California, San Francisco, San Francisco, California
| | - Ariana Thompson-Lastad
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, California
| | - Howard Pinderhughes
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California
| | - Frederick M Hecht
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, California
| | - E Anne Lown
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, California
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Jong MC, Boers I, van Wietmarschen H, Busch M, Naafs MC, Kaspers GJL, Tissing WJE. Development of an evidence-based decision aid on complementary and alternative medicine (CAM) and pain for parents of children with cancer. Support Care Cancer 2019; 28:2415-2429. [PMID: 31493135 PMCID: PMC7083801 DOI: 10.1007/s00520-019-05058-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/28/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE To develop an evidence-based decision aid for parents of children with cancer and to help guide them in the use of complementary and alternative medicine (CAM) for cancer care. METHODS This study had a mixed research design. The needs of parents were investigated by survey and focus group. A systematic review and meta-analysis were performed on the effectiveness of CAM using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Clinical experts were interviewed and a decision aid on CAM treatment for pain was developed. RESULTS Parents emphasized the importance of reliable information on CAM, focusing primarily on communication and a broad spectrum of complaints related to cancer treatment. The decision aid on CAM for pain included five modalities based on 11 randomized control trials (RCTs): hypnotherapy, mind-body techniques, massage, healing touch, and music therapy. Meta-analysis could be performed on hypnotherapy, which significantly reduced cancer-related procedural pain compared with standard care (MD, - 1.37; 95% CI, - 1.60, - 1.15; P < 0.00001) and attention control (MD, - 1.13; 95% CI, - 1.34, - 0.94; P < 0.00001), and massage, demonstrating no effect on pain compared with standard care (MD, - 0.77; 95% CI, - 1.82, 0.28; P = 0.15). Research evidence and supplementary information from clinical practice and patient were incorporated in a website-based decision aid. CONCLUSIONS An evidence-based decision aid was developed to support parents of children with cancer in making decisions about CAM for pain management. Next steps will be to expand the website to include additional childhood cancer-related complaints and to evaluate its use in practice.
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Affiliation(s)
- Miek C Jong
- Department of Health Sciences, Mid Sweden University, Holmgatan 10, 851 70, Sundsvall, Sweden.
| | - Inge Boers
- Department Nutrition & Health, Louis Bolk Institute, Kosterijland 3-5, 3981 AJ, Bunnik, The Netherlands
| | - Herman van Wietmarschen
- Department Nutrition & Health, Louis Bolk Institute, Kosterijland 3-5, 3981 AJ, Bunnik, The Netherlands
| | - Martine Busch
- Van Praag Institute, Springweg 7, 3511 VH, Utrecht, The Netherlands
| | - Marianne C Naafs
- Netherlands Childhood Cancer Parent Organization VOKK, Schouwstede 2b, 3431 JB, Nieuwegein, The Netherlands
| | - Gertjan J L Kaspers
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Paediatric Oncology, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department Paediatric Oncology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Birch S, Lee MS, Alraek T, Kim TH. Evidence, safety and recommendations for when to use acupuncture for treating cancer related symptoms: a narrative review. Integr Med Res 2019; 8:160-166. [PMID: 31304088 PMCID: PMC6600712 DOI: 10.1016/j.imr.2019.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/11/2019] [Accepted: 05/13/2019] [Indexed: 12/17/2022] Open
Abstract
Background Recently research on acupuncture for cancer related symptoms has significantly increased. To what extent have medical professionals recommended to use acupuncture in light of that evidence? Methods Evidence of effectiveness and safety was found by searching Pubmed for reviews to identify for what conditions and general results. Publications that recommend acupuncture in oncology were searched in the database of an ongoing general search for publications that recommend acupuncture. This database was developed by searching google for publications that recommend the use of acupuncture with the terms ‘name of symptom’ and ‘clinical practice guideline’ or ‘treatment guideline’. Results Acupuncture is moderately or weakly effective for 19 symptoms in patients with cancer and cancer survivors. Acupuncture is a safe therapy in cancer care if administered by trained acupuncturists. Acupuncture is targeted to improve symptoms associated with the cancer and different cancer treatments, not to treat the cancer itself. More than 350 publications by clinical practice guideline groups and expert groups, including public health statements made by national and government agencies recommended the use of acupuncture for 61 cancer related symptoms many with positive evidence of effectiveness. Conclusion The strength of evidence is weak for many indications, however the evidence for many standard therapies is either not very strong or if stronger, the incidence of adverse events is more, which makes acupuncture a treatment option despite the weak evidence. We have found evidence that many oncologists around the world have started to incorporate acupuncture into the treatment of various cancer related symptoms.
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Affiliation(s)
- Stephen Birch
- Department of Health Sciences, Kristiania University College, Oslo, Norway
| | - Myeong Soo Lee
- Clinical Medicine Division, Korean Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Terje Alraek
- Department of Health Sciences, Kristiania University College, Oslo, Norway.,National Research Centre in Complementary and Alternative Medicine, Faculty of Medicine, Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Tae-Hun Kim
- Clinical Trial Center, Kyung-Hee University, Korean Medical Hospital, Seoul, Republic of Korea
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