Complementary and alternative medicine use for supportive care in childhood cancer - Prevalence of use, effectiveness, safety and clinical practice

Childhood cancer treatment protocols have been successful due to the prompt and accurate diagnosis, availability of care, and access to high-quality medical resources. As the survival rates increase in high-income countries (HIC), the emphasis has shifted from survival to survival, emphasizing quality of life. The health complaints and adverse effects of cancer treatment are burdensome for children, yet many of the most burdensome ones lack adequate conventional medical treatment. To help cope with and alleviate these health challenges, parents seek ways to improve their children's quality of life and use supportive care modalities, including complementary and alternative medicine (CAM). The global aim of this doctoral thesis was to delineate the use, effectiveness, safety, and practice of supportive care in childhood cancer. The project was conducted in different stages to achieve the aims, and mixed methods were used. A cross-sectional survey was implemented to assess the prevalence and associations of supportive care use in Norway among children with cancer. Two systematic literature reviews were conducted to evaluate the effect, safety, and types of modalities used to help patients cope with the adverse effects and health complaints of cancer treatment. Semi-structured interviews were used to assess the clinical experiences and perceptions healthcare providers working with pediatric oncology patients have regarding supportive care. Finally, interviews were also used to evaluate how providers perceive and evaluate risk when patients use conventional and supportive care. Over half of the parents who participated in the survey used supportive care, and 47% used CAM to help their children cope with the adverse effects of cancer treatment. Less than 10% reported adverse effects from supportive care modalities. Results from the meta-analysis demonstrated that CAM (including acupuncture and hypnosis) has a significant effect (p<.00001) on the intensity and/or episodes of chemotherapy-induced nausea and vomiting (CINV). Furthermore, over 60% of the included studies lacked reporting the absence or presence of adverse effects. This result makes it difficult to evaluate the safety associated with these modalities. The semi-structured interviews showed that healthcare providers' main aim is to identify the parent's treatment goals and help the children with their most immediate complaints. Among providers, safety was the most important criterion considered when recommending a supportive care modality. This criterion was based on a risk versus benefit evaluation. Providers emphasized the importance of open and respectful communication with parents about supportive care modalities, as these modalities empower parents through the care of their children. Parents in Norway widely use supportive care modalities; therefore, they need information on the effectiveness and safety of these modalities. Healthcare providers such as doctors, nurses, and rehabilitation personnel should have access to reliable information on these modalities to communicate with patients properly. As survival rates increase and late and long-term effects become more prevalent, it is essential to investigate safe and non-invasive treatments to alleviate this burden in children with cancer and survivors. Further methodologically rigorous research should be conducted to investigate the effectiveness and safety of supportive care modalities. In conclusion, if appropriately used by professional healthcare providers, supportive care modalities may decrease health complications from cancer treatment and contribute to a better quality of life for children with cancer and their families.Behandlingsprotokoller for barn med kreft har vært vellykket på grunn av hurtige og tydelige diagnoser, tilgjengelig behandling og tilgang til medisinsk personell med høy faglig kompetanse. Tidligere ble det fokusert bare på overlevelse. Nå blir det lagt mer vekt på livskvalitet fordi overlevelsesraten har økt i høyinntekstland. Helseutfordringer og bivirkninger som følge av kreftbehandling er svært belastende for barn. Likevel får disse barna ikke tilstrekkelig medisinsk behandling for mange av disse plagene. Foreldre søker derfor alternativer som kan hjelpe barna med å håndtere og lindre disse helseutfordringene. Slike alternativer er bruk av støttende behandlingsformer som inkluderer alternativ behandling. Målet med denne doktorgradsavhandlingen var å kartlegge hvordan barn med kreft bruker støttende behandlingsformer, hvor effektiv og trygg disse behandlingene er og hvordan behandlingsformene blir praktisert. Forskningsprosjektet ble utført i flere trinn og det ble benyttet en mixed methods tilnærming. Vi gjennomførte en spørreundersøkelse for å evaluere forekomsten og assosiasjonene knyttet til støttende behandlingsformer av barn med kreft i Norge. Vi gjennomførte to systematiske litteraturgjennomganger for å evaluere effekt, trygghet og hvilke behandlingsformer som ble brukt for å hjelpe pasienter med å håndtere bivirkninger og helseplager knyttet til kreftbehandling. Vi benyttet semistrukturerte intervjuer for å evaluere hvilke kliniske erfaringer og holdninger pediatrisk helsepersonell har med å gi støttende behandling til barn med kreft. Til slutt brukte vi data fra disse intervjuene til å kartlegge hvordan helsepersonell oppfatter og vurderer risiko når pasienter bruker konvensjonell og støttende behandlingsformer som del av sin kreftomsorg. Mer enn halvparten av foreldrene som deltok i spørreundersøkelsen brukte støttende behandlingsformer, og 47% brukte alternativ behandling for å hjelpe barna sine med å håndtere bivirkninger av kreftbehandling. Færre enn 10% rapporterte om bivirkninger ved bruk av disse behandlingsformene. Resultatene fra meta-analysen viste at alternativ behandling (inkludert akupunktur og hypnose) har en signifikant effekt (p<.00001) på intensitet og/eller tilfeller av kvalme og oppkast etter cellegiftbehahandling. Mer enn 60% av de inkluderte studiene i oppsummeringene manglet informasjon om bivirkninger. Dette gjør det vanskelig å evaluere sikkerheten knyttet til disse behandlingsformene. De semistrukturerte intervjuene viste at hovedmålet til behandlerne var å kartlegge foreldrenes mål for behandlingen og hjelpe barna med de verste plagene. Når behandlerne anbefalte pasientene å bruke støttende behandlingsformer, var det viktigste kriteriet at behandlingen skulle være trygt. Dette kriteriet var basert på en risiko -nytte evaluering. I tillegg understreket behandlerne hvor viktig det var å snakke åpent og respektfullt med foreldrene om disse behandlingsformene. En slik samtale er viktig fordi ved bruk av disse behandlingsformene blir foreldrene involvert i kreftomsorgen av sine barn. Dette styrker foreldrene. Foreldre til barn som har kreft, benytter ofte støttende behandlingsformer. Helsepersonell som leger, sykepleiere og rehabiliteringspersonell bør derfor ha tilgang til pålitelig informasjon om disse behandlingsformene for å kunne kommunisere med pasientene på en god og informativ måte. Overlevelsesraten øker, og seneffekter blir mer utbredt blant kreftoverlevere. Derfor er det viktig å undersøke hvilke behandlinger some er trygge og mindre belastende for barnekreft-overlevere. Det er nødvendig å gjennomføre mer (grundig) forskning for å kartlegge hvor effektive og trygge disse behandlingsformene er. Konklusjon: Støttende behandlingsformer kan redusere helseplager etter kreftbehandling hos barn hvis de brukes på en riktig måte, utført av kompetente behandlere. Dette kan bidra til bedre livskvalitet for barn med kreft og familiene deres

Alternativ behandling som støttebehandling til kovensjonell behandling hos barn og uge med kreft

At barnet ditt får en kreftdiagnose er en rystende beskjed som snur livet opp ned for mange familier. Behandlingen er krevende og mange barn og unge får plager de må leve med lenge. Foreldrene ønsker naturlig nok å gjøre det de kan for å lindre disse plagene. Mange velger derfor alternativ behandling som støttebehandling til konvensjonell behandling og for å bedre barnas livskvalitet

Prevalence of late and long-term effects of cancer (treatment) and use of complementary and alternative medicine in Norway

Background The increasing number of patients surviving cancer leads to more people experiencing late and long term-effects from the disease and its treatment. Fatigue, sleep disorders, early menopause, pain, and nerve damage are commonly reported. Methods helping people to recover after cancer treatment are therefore essential. The aims of this study were threefold; (1) to determine the level of cancer patients suffering from late and long-term effects of cancer diagnosis and treatment in Norway, (2) explore complementary and alternative medicine (CAM) modalities used for managing these adversities, and (3) describe self-perceived benefits and harms of the CAM interventions. Methods The study was conducted in cooperation with the Norwegian Cancer Society (NCS) and consisted of an online cross-sectional study among members of the NCS user panel with present or previous cancer (n = 706). The study was carried out in September/October 2021 using a modified cancer-specific version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q). A total of 315 women and 153 men agreed to participate, resulting in a response rate of 67%. Results Most of the participants (83%) suffered from late and long-term effects of cancer treatment; mostly fatigue (59.2%), sleep disorder (41.5%), hot flashes (39.2%), nerve damage (polyneuropathy, 38.0%), and pain (36.6%) with a mean number of 5.1 different late and long-term effects. Late and long-term effects were positively associated with younger age and college/university education. Nearly half of the participants experiencing late and long-term effects (43%) reported having used CAM to treat these complaints. Most frequently used were self-help practices (26%) such as relaxation therapy (19%), yoga (14%) and meditation (13%), but also visits to CAM providers were reported by 22%. Herbal- and other natural remedies to treat late and long-term effects were used by 13%. A high percentage of CAM users reported self-perceived improvements of their symptoms (86% for self-help practices, 90% for visits to CAM providers). Few experienced adverse effects of the CAM treatment. Conclusion A large proportion of cancer patients suffered from a wide range of late and long-term effects of cancer diagnosis and treatment, and they use CAM to treat these complaints to a rather high degree. Relaxation therapy, yoga, meditation, massage, and acupuncture were the most frequently used therapies regardless of complaint. The therapies used are generally considered to be both safe and beneficial for the respective complaint, indicating that the participants seem to be well informed about the choices they make

Alernativ behandling som støttebehandling til konvensjonell behandling hos barn og unge med kreft

Source at https://nnh.no/stikkord/tidsskriftet-naturterapeuten/.At barnet ditt får en kreft diagnose er en rystende beskjed som snur livet opp ned for mange familier. Behandlingen er krevende og mange barn og unge får plager de må leve med lenge. Foreldrene ønsker naturlig nok å gjøre det de kan for å lindre disse plagene. Mange velger derfor alternativ behandling som støttebehandling til konvensjonell behandling og for å bedre barnas livskvalitet

Conventional health care service utilization among cancer survivors that visit traditional and complementary providers in the Tromsø study: a cross-sectional study

Background: Traditional and complementary medicine (T&CM) is commonly used among cancer patients worldwide. Cancer patients in Norway mainly visit T&CM providers in addition to conventional health care services. It is not known how their utilization of T&CM providers influences their use of conventional health care services. The aim of this study was to investigate the difference between the utilization of conventional health care services among cancer survivors that visit T&CM providers and those that do not, and their associated factors. Method: Health care service utilization data were obtained from cancer survivors 40 years and above participating in the Tromsø Study: Tromsø 7 conducted in 2015–2016. Data were collected from self-administered questionnaires. Pearson chi-square tests, Fisher exact tests, t-test, and logistic regression were used, with the significance level considered at p<0.05. Results: Of 1553 individuals, 10% (n=155) reported visiting T&CM providers in the past 12 months. As both cancer survivors visiting and not visiting T&CM providers were frequent users of conventional health care, no significant differences were found in the overall use of conventional health care (98.1vs.94.5%, p=.056). Users of T&CM providers were however more likely to visit physiotherapists (40.1% vs 25%, p<.001), emergency rooms (29.2% vs 16.5%, p<.001), chiropractors (17% vs 6%, p<.001), and psychologist/psychiatrist (8.9% vs 3.4%, p<.001). They also had more frequent visits to conventional health care (11.45 vs 8.31 yearly visits, p=0.014), particularly to general practitioners (5.21 visits vs. 3.94 visits, p=.002). Conclusion: Results from this study show that visits to T&CM providers are associated with more visits to conventional health care services among cancer survivors. Further studies are needed to investigate the reasons for this high use behavior

Supportive care for cancer-related symptoms in pediatric oncology: a qualitative study among healthcare providers

Background The aim of this study is to gain insight into the clinical experiences and perceptions that pediatric oncology experts, conventional healthcare providers, and complementary and alternative medicine (CAM) providers in Norway, Canada, Germany, the Netherlands, and the United States have with the use of supportive care, including CAM among children and adolescents with cancer. Methods A qualitative study was conducted using semi-structured in-depth interviews (n=22) with healthcare providers with clinical experience working with CAM and/or other supportive care among children and adolescents with cancer from fve diferent countries. Participants were recruited through professional associations and personal networks. Systematic content analysis was used to delineate the main themes. The analysis resulted in three themes and six subthemes. Results Most participants had over 10 years of professional practice. They mostly treated children and adolescents with leukemia who sufered from adverse efects of cancer treatment, such as nausea and poor appetite. Their priorities were to identify the parents’ treatment goals and help the children with their daily complaints. Some modalities frequently used were acupuncture, massage, music, and play therapy. Parents received information about supplements and diets in line with their treatment philosophies. They received education from the providers to mitigate symptoms and improve the well-being of the child. Conclusions Clinical experiences of pediatric oncology experts, conventional health care providers, and CAM providers give an understanding of how supportive care modalities, including CAM, are perceived in the feld and how they can be implemented as adaptational tools to manage adverse efects and to improve the quality of life of children diagnosed with cancer and the families

Structural Vulnerability and Occupational Injury Among Latinx Child Farmworkers in North Carolina

Children as young as ten-years-old can legally work as hired farm labor in the United States. In North Carolina, many hired children are part of the Latinx farmworker community. Agriculture is a hazardous industry, and child workers experience high rates of injury, illness, and mortality. As part of a community-based participatory research study, we draw from thirty in-depth interviews with Latinx child farmworkers aged ten to seventeen to describe their experiences of personal and observed workplace injury and close calls. Nearly all child workers had experienced or observed some form of injury, with several reporting close calls that could have resulted in severe injury or fatality. Overall, children reported a reactive approach to injury prevention and normalized pain as part of the job. Highlighting Latinx child farmworkers’ structural “vulnerability, this analysis contextualizes understanding of workplace injury among this largely hidden population. We offer policy recommendations to protect and support these vulnerable workers

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

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

Complementary and alternative medicine modalities used to treat adverse effects of anti‑cancer treatment among children and young adults: a systematic review and meta‑analysis of randomized controlled trials

Background - Dealing with the symptom burden of cancer diagnosis and treatment has led parents to seek different self-management strategies including Alternative and Complementary Medicine (CAM). The aim of this study was to perform a systematic review and meta-analysis about the use and effect of CAM modalities to treat adverse effects of conventional cancer treatment among children and young adults. Methods - Six scientific research databases were used to identify randomized controlled trials (RCTs) from 1990 to September 2020. Included studies investigated the use of CAM to treat cancer treatment related adverse effects in children and young adults compared to controls. Results - Twenty RCTs comprising 1,069 participants were included in this review. The included studies investigated acupuncture, mind–body therapies, supplements, and vitamins for chemotherapy-induced nausea and vomiting (CINV), oral mucositis, and anxiety among children and young adults who underwent conventional cancer treatment. Seven studies (315 participants) were included in the meta-analysis. The overall effect of CAM (including acupuncture and hypnosis only) on chemotherapy-induced nausea and/or vomiting and controls was statistically significant with a standard mean difference of -0.54, 95% CI [-0.77, -0.31] I2 = 0% (p  Conclusion - Current evidence from this meta-analysis of randomized controlled trials shows that CAM, including acupuncture and hypnosis only, is effective in reducing chemotherapy-induced nausea and vomiting in children and young adults. More rigorous trials and long-term effects should be investigated if acupuncture and hypnosis are to be recommended for clinical use

Musculoskeletal injury symptoms among hired Latinx child farmworkers in North Carolina

Background - Although children 10–17 years can be hired to work in agriculture, little research has addressed possible musculoskeletal injuries. Children may be at particular risk for these injuries because of the repetitive and load bearing nature of work tasks. Existing research relies on child workers to self-report musculoskeletal injuries. Methods - In 2017, 202 Latinx child farmworkers ages 10–17 employed across North Carolina completed survey interviews. In 2018, 145 of these children (94 [64.8%] current farmworkers) completed a physical examination and second interview. The examination obtained findings for upper and lower extremity as well as back injuries. Results - Positive indicators for musculoskeletal symptoms were few in either current or former child farmworkers. The knee was most common site for positive indicators with 15.4% of children having at least one. Combining all anatomical sites, 29.0% of children had at least one positive indicator, with no significant difference between current and former farmworkers. Overall, boys had significantly more indicators of knee injuries than girls (21.3% vs. 4.1%), indicators of ankle injuries were found only in the youngest workers (9.5% of children 11–13 years), and significantly fewer current farmworkers had indicators of lower back injuries than former farmworkers (6.4% vs. 17.7%). Conclusions - Expectations of injuries come from previous studies using child farmworker self-reports, adult farmworker injury rates, and sports medicine pediatric findings. Hired child farmworkers may not perform activities as repetitious and load-bearing as children in sports training or adult farmworkers. Additional research using physical examination is needed to confirm these findings