Nearly three-quarters of pediatric cancer patients in Western Washington use alternative therapies to treat their cancer or cope with side effects from standard medical treatments, says a Hutch survey.
The results of this survey - the first population-based study in the United States to look at alternative-medicine use in children with cancer - appears online in Preventive Medicine and will appear in print later this year.
Dr. Marian Neuhouser and colleagues in the Public Health Sciences Division led the study, which was supported by National Cancer Institute grants and Hutch funds. Bastyr University researchers in Kenmore 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 - use 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."
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 Hutch'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 NCI.
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 Center forComplementary and Alternative Medicine of the National Institutes of Health. To streamline the survey process, the researchers collapsed the domains into three subgroups:
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.
Most pervasive form
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 his or her medical team about the use of vitamins and supplements, which may need to be curtailed during treatment," Neuhouser said.
At the Hutch, 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.
High degree of integration
Results of the study suggest a high degree of integration between conventional and alternative treatment in Washington state.
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.