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Integrative therapies
1
Describe complementary and integrative health therapies.
Complementary and integrative health therapies (CIHTs) are nonmainstream practices used in combination or together with conventional medicine. CIHTs are divided into three categories: natural products, mind and body practices, and whole-systems. Natural products include dietary supplements such as botanicals, vitamins and minerals, and probiotics. Mind and body practices include acupuncture, acupressure, aromatherapy, healing touch, hypnotherapy, massage therapy, movement therapies, tai chi, and qigong. Whole-system approaches include traditional Chinese medicine (TCM), Ayurvedic medicine, homeopathy, and naturopathy.
2
Why do patients often seek treatment with CIHT?
Surveys have found up to 84% of children with cancer use CIHT, but this varies by geographical location. Parents of children and adolescents with cancer often seek the use of CIHT to help manage the side effects associated with cancer therapy, to augment the efficacy of conventional therapy, or to provide support for coping with the diagnosis of cancer. A smaller number of families may choose to seek the use of CIHT to treat the cancer itself. Most commonly, this is observed among children diagnosed with a malignancy that is associated with a poor prognosis or tumors that have not been responsive to frontline therapy. Of most concern are families that choose CIHT in lieu of conventional medicine; however, this is a small subset of families. Parents report pursuing the use of CIHT to ensure that they have left “no stone unturned” and feel as if they are doing all they can to help their child fight cancer or support them during cancer therapy.
3
Are there special considerations for using CIHT in children with cancer?
There are several unique factors to consider when counseling patients on the use of CIHT during and after treatment for a pediatric malignancy. In contrast to adult oncology, common childhood tumors are more sensitive to chemotherapy with survival exceeding 90% for acute lymphoblastic leukemia (ALL), Hodgkin lymphoma, and other localized and low-risk malignancies. Children also undergo treatment for a longer period of time, tend to tolerate chemotherapy better, and are less likely to have comorbid conditions. Therefore it is imperative that the use of CIHT therapies not interfere with or encourage the refusal or delay of conventional therapy. The type of CIHT and its appropriateness for the developmental age and planned conventional treatment of the child must be considered a priori. Therapies that may exacerbate common treatment-related toxicities (TRTs) should undergo detailed evaluation so as to not further increase the risk or severity of TRTs. Sociodemographic factors are important considerations in selecting the type of CIHT. The economic impact of CIHT can have detrimental effects on a family, which is especially concerning for CIHTs that have limited scientific evidence supporting efficacy. Other influential factors may be a family’s lifestyle and cultural and religious practices.
4
Where can I find reliable information on the use of CIHT?
The most reliable resources for information and scientific research on CIHTs are the National Center for Complementary and Integrative Health (NCCIH) ( https://www.nccih.nih.gov ) and the National Cancer Institute’s Physician Data Query ( https://www.cancer.gov/publications/pdq/information-summaries/cam ) on CIHT. Medline is the U.S. National Library of Medicine (NLM) database and can also provide peer-reviewed information.
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