Attitudes, Beliefs, and Communication About Complementary and Alternative Medicine Among Oncologists, Pediatricians, and Pediatric Oncologists

Abstract

The diagnosis and treatment of cancer in children and adolescents have improved considerably in the last decades. Increasingly sophisticated diagnostics, with improved staging and more differentiated treatment, have led to better chances of cure, reduced recurrence rates, and in individual cases also to a reduction of the treatment-associated toxicity and sequelae. These improvements have been made possible by national and international collaboration in the context of specialist societies and research groups. In addition to the optimization of treatment on the clinical level, research in pediatric oncology is looking increasingly at molecular and genetic issues, with increasing focus on individual patterns of tumor-inhibiting and tumor-promoting factors. However, this trend toward individualized diagnosis and treatment is paralleled by another development which is driven mainly by the patients themselves and/or their parents. The frequency with which complementary and alternative medicine (CAM) is used in the context of treatment of a child or adolescent with cancer varies from country to country but is almost always relevant in relation to the overall population. However, this development has so far played practically no part in scientific discourse in pediatric oncology. Except in the USA, where there is systematic publicly funded research on the topic of CAM and cancer (http://nccam.nih.gov/research), research on CAM in pediatric oncology, whether epidemiological, basic, or applied research, plays little more than a marginal role in the overall context of research in pediatric oncology. The large research institutions which have contributed substantially to the successes in pediatric oncology have so far given practically no attention to the topic of CAM in pediatric oncology. Where this topic has been scientifically addressed in institutions practicing conventional pediatric oncology, the relevant working groups are usually not more than a marginal phenomenon in the overall scientific context of the research institution concerned. Nevertheless, various scientific working groups do exist which have addressed the topic of CAM in pediatric oncology. Their activities have so far focused mainly on the question of the frequency with which CAM is used in children with cancer, the expected effects of this treatment, and the specific CAM practices used. Studies conducted on this are almost without exception retrospective surveys using either written questionnaires or interviews, or in some cases a combination of the two (see chapter “CAM in pediatric oncology worldwide”). Thus, numerous details regarding the CAM treatment methods used, the motivation of the parents, the general frequency of use, and the factors influencing the likelihood of using CAM have now been described for various populations. On the other hand, practically no data have been systematically collected on side effects, interactions, and adverse effects of CAM practices. Data available in the scientific literature on individual CAM medications or nonmedication interventions from some CAM sectors with a specifically pediatric oncological focus are described in the chapters of this book dealing with the respective treatment modalities.