Majority of Pediatric Cancer Patients Use Alternative Therapies

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Majority

of Pediatric Cancer Patients Use Alternative Therapies: Fred Hutchinson Cancer

Research Center Survey

http://news.excite.com/news/pr/011101/wa-fred-hutchin-cancr

 

SEATTLE, Nov. 1 /PRNewswire/ -- Nearly

three-quarters of pediatric cancer patients in western Washington use alternative

therapies to treat the cancer or cope with side effects from standard medical

treatments, according to a survey conducted by the Fred Hutchinson Cancer

Research Center.

The results of this survey -- the first

population-based study in the United States to look at alternative-medicine

use in children with cancer -- appear in the November issue of Preventive

Medicine.

Marian L. Neuhouser, Ph.D., R.D., and

colleagues in the Hutchinson Center's Public Health Sciences Division led

the study, which was supported by grants from the National Cancer Institute

and funds from the Hutchinson Center. Researchers at Bastyr University in

Kenmore, Wash., also consulted on the project.

"The use of alternative medicine is

well known among adult cancer patients, but until now, little has been known

about the use of these therapies in children with cancer," said Neuhouser,

a senior staff scientist in cancer-prevention research.

"The bottom line is that the majority

of pediatric cancer patients in western Washington -- 73 percent of those

surveyed -- are using some form of alternative medicine or therapy. In addition,

most patients and their families report substantial improvements in health

and well-being as a result of using alternative medicine," she said.

The survey was based on telephone interviews

with the parents of 75 living pediatric cancer patients (ages 0-18 years)

who had been first diagnosed with invasive cancer between February 1997 and

December 1998. The patients were located through the Hutchinson Center's

Cancer Surveillance System, a population-based registry of cancer incidence

in western Washington that is part of a nationwide cancer registry funded

by the National Cancer Institute.

Since there is no single, consistent

definition of alternative medicine in the published literature or in the

mind of the public, the researchers based their survey on the "domains" of

alternative medicine described by the National Institutes of Health's National

Center for Complementary and Alternative Medicine. To streamline the survey

process, the researchers collapsed the domains into three subgroups:

 

alternative providers (such as acupuncturists,

massage therapists, naturopathic doctors or homeopathic physicians);

dietary supplements (vitamin, mineral,

herbal or other supplements, such as shark cartilage); and

"other" therapies (diet or physical

activity; mental and spiritual therapies such as prayer, meditation and support

groups; and energetic interventions such as crystals and magnets).

 

Patients were considered a user of alternative

medicine if they received care from an alternative provider within the past

year or had used at least one alternative supplement or therapy.

The most pervasive form of alternative

treatment among those surveyed was the use of herbal and high-dose vitamin

supplements, which were used, respectively, by 54 percent and 59 percent

of the patients, many of whom also used several such products simultaneously.

"While the data are conflicting about harm or benefit regarding use of these

products among children undergoing cancer treatment, some caution may be

advisable," Neuhouser said.

For example, antioxidants such as vitamins

C and E may reduce the effectiveness of chemotherapy, while herbs such as

yew needle and the herbal tea essiac have been associated with heart and

kidney impairment, particularly when taken in conjunction with certain cancer

drugs.

"Anyone who is in active cancer treatment

should communicate with their medical team about the use of vitamins and

supplements, which may need to be curtailed during treatment," Neuhouser

said.

At the Hutchinson Center, for example,

registered dietitians ask patients not to use antioxidants while in active

cancer treatment.

Because multivitamin use is often part

of standard medical treatment, the researchers did not consider routine multivitamins

as alternative. However, special formulations such as "antioxidant supplements,"

"stress supplements" and high-dose single supplements (such as vitamin C)

typically contain nutrient doses hundreds to thousands of times higher than

the Recommended Daily Allowance for children, and so were considered alternative.

More than 20 percent of patients surveyed

received care from an alternative provider such as a naturopathic doctor,

Native American healer or massage therapist.

The vast majority -- 90 percent --

of such alternative providers and mental therapies were used to treat cancer

symptoms or treatment side effects. About a third of alternative providers

and dietary supplements were used to prevent recurrence or spread of the

cancer. The most common alternative intervention, however, was the use of

herbs and dietary supplements to promote general health and treat non-cancer

conditions, such as colds.

Other findings:

 

Although use of alternative therapy

was high, none of the parents surveyed had abandoned conventional cancer

treatment for their child. In fact, there was a high level of satisfaction

with standard medical care. "About 75 percent of all parents reported being

very satisfied with their child's conventional treatment and they trusted

their child's oncologist," Neuhouser said. "This finding should be reassuring

to clinicians who fear that patients may refuse effective medical treatments

in favor of alternative therapies."

However, parents who were dissatisfied

with their child's physician were nearly nine times more likely to have children

who used alternative treatments compared to parents who were very satisfied

with their child's doctor.

Parents attributed substantial improvement

in their child's health and well-being to alternative treatments and therapies.

Between 60 percent and 90 percent reported improvements due to alternative

providers, vitamin and herbal supplements, dietary changes, physical activity,

and mental and spiritual therapies.

There was no association between

disease progression and use of alternative medicine, contrary to previous

studies in adults that have found a positive relationship between the two.

"I had expected that patients in a latter stage of disease would be higher

users of alternative medicine, but that wasn't the case," Neuhouser said.

Overall frequency of alternative

medicine use was higher among white patients compared to minorities, and

higher among middle-income families compared to those at the lower and higher

ends of the socioeconomic scale.

Contrary to previous studies of

alternative medicine use in adults, most parents had discussed the use of

alternative therapy with their child's physician. Among those who hadn't,

all said they'd be comfortable doing so. In addition, among parents who reported

that their primary physician was aware of their child visiting alternative

providers, 25 percent reported that the suggestion to seek alternative care

originated with their physician.

 

The results of this study suggest a high

degree of integration between conventional and alternative treatment in the

state of Washington. This may be due largely to the fact that health insurers

are required by state law to provide coverage for licensed alternative providers.

As such, the results of this survey may not be applicable to cancer patients

in other states with less liberal coverage of alternative-health services,

Neuhouser cautioned.

"Larger studies involving patients

from multiple cancer registries throughout the nation are needed to determine

whether specific alternative treatments are associated with improved clinical

outcome or enhanced quality of life among children with cancer," she said.

"In the meantime, the findings from

this study suggest that clinicians and researchers need to stay informed

about the pros and cons of alternative therapies, talk to their patients

about their various treatment options -- including those considered alternative

-- and make referrals when appropriate. They also should document treatments

from all sources -- including those outside the formal medical system --

and advise caution around the use of high-dose vitamins or herbal supplements,

particularly during chemotherapy or radiation treatments."

CONTACT: Kristen Woodward of Fred Hutchinson

Cancer Research Center, +1-206-667-5095, or

kwoodwar@

fhcrc.org

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