Bringing Evidence to Complementary and Alternative Medicine for Children With Cancer

Abstract

Over the past decade, we pediatric oncologists, along with most practitioners trained in the Western medical tradition, have struggled with the fact that our patients are using complementary and alternative medicine (CAM) at increasing rates. Studies have shown that 31% to 84% of children with cancer and approximately 30% of adults with cancer will utilize some form of CAM during their treatment regimen. The use of CAM as a social phenomenon has been well documented and was initially consumer driven, often with physicians as an oppositional force. Increasingly, however, conventionally trained medical scientists have been designing and conducting research studies evaluating the safety and efficacy of CAM modalities. Pediatric research studies are particularly important as results from studies in adults cannot always be extrapolated to a pediatric population because of children’s unique developmental, social, and metabolic aspects. This report, and the others in the series to follow, will attempt to define the scope of CAM use in the pediatric oncology population and the issues which ensue from its use, and outline several intriguing research avenues. The term CAM has become a convenient acronym to describe a broad domain of healing resources that refers to those therapies generally falling outside the mainstream of conventional medicine. ‘‘Complementary’’ has referred to those methods that augment conventional therapies, and ‘‘alternative’’ has referred to methods used instead of mainstream treatments. CAM therapies for cancer encompass a wide variety of approaches, including touch therapies such as massage, mind-body medicine techniques such as hypnosis, energy healing, acupuncture, and nutritional and pharmacologic therapies such as herbs and other dietary supplements. The National Center for Complementary and Alternative Medicine defines CAM therapies in 5 main domains (Table 1, Ref 17). The boundaries between CAM and conventional medicine are not always clearly defined, because the list of practices considered CAM changes continually as those therapies that are proven safe and effective through research, and become accepted as mainstream. The newer term ‘‘integrative oncology’’ implies an evolving evidencebased specialty that uses complementary therapies in concert with medical treatment to enhance efficacy, improve symptom control, alleviate patient distress and reduce suffering. For the purposes of these reports, we will employ the less comprehensive but more commonly used term CAM. The treatment of children with cancer is one of the great medical success stories of the latter half of the 20th century. The diagnosis of acute lymphoblastic leukemia has gone from a certain death sentence to a disease with an almost 80% cure rate in some subgroups. More than three-quarters of all children diagnosed with cancer will now be cured. This is in contradistinction to many adults in whom cancers are now being treated almost as chronic conditions, rather than as curable diseases. These remarkable gains have all been through careful, cumulative research, primarily under the umbrella of cooperative trial groups, sponsored by cooperative groups throughout the world. The rationale has been that the number of children with cancer is relatively low, and that few single institutions will have sufficient numbers to answer important questions. A similar approach is important as we seek to answer questions about CAM use in children. For example, a Complementary Therapies Task Force was initiated at the April 1998 Children’s Cancer Group (CCG) meeting under the auspices of the Epidemiology and Cancer Control Strategy Group. The task force was charged with evaluating the potential role of CCG in conducting research and providing information in the rapidly growing field of complementary medicine. With the merger of CCG and the Pediatric Oncology Group into the Children’s Oncology Group (COG), the task force has evolved into the Complementary and Alternative Medicine (CAM) Subcommittee of the Cancer Control Committee. The long-term goals of the Committee are to promote scientific investigation of complementary therapies as they relate to childhood cancer and to Copyright r 2006 by Lippincott Williams & Wilkins Received for publication January 27, 2006; accepted January 27, 2006. From the *Division of Hematology/Oncology, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN; and wDivision of Pediatric Oncology, Department of Pediatrics, Columbia University Medical Center, Morgan Stanley Children’s Hospital of New York-Presbyterian-New York, NY. Reprints: Kara M. Kelly, MD, Columbia University Pediatric Oncology, 161 Fort Washington Avenue, IP-7, New York, NY 10032 (e-mail: kk291@columbia.edu). COMPLEMENTARY AND ALTERNATIVE MEDICINE