Elsevier

European Journal of Cancer

Volume 44, Issue 15, October 2008, Pages 2233-2240
European Journal of Cancer

Complementary and alternative treatment methods in children with cancer: A population-based retrospective survey on the prevalence of use in Germany

https://doi.org/10.1016/j.ejca.2008.07.020Get rights and content

Abstract

Introduction

Few studies have been conducted to date on the prevalence of use of complementary and alternative treatment methods (CAMs) in paediatric oncology, and those that have been conducted are often not representative. We therefore decided to study a representative sample of children with cancer in the German population.

Patients and methods

The study took the form of a retrospective survey amongst all parents whose children were first diagnosed with a disease covered by the German Childhood Cancer Registry in 2001. The primary objectives of the survey were to establish the prevalence of use of CAM and the factors related to its use.

Results

Of the 1595 questionnaires sent out, 1063 (67%) could be evaluated. 35% of the responders had used CAM. The most frequently used methods were homeopathy, dietary supplements and anthroposophic medicine including mistletoe therapy. Factors which increased the probability of using CAM were the previous use of CAM, higher social status and poor prognosis of the child’s disease. The most frequently named reasons for use of CAM were physical stabilisation, strengthening the immune system and improving the chance of cure. Whilst the sources of information about CAM were in most cases not doctors, 71% of users had nevertheless spoken to a doctor about using CAM. The effects of the CAM perceived by the parents were for the most part positive. 89% of the users reported that they would recommend CAM to other parents.

Conclusions

CAMs are administered alongside standard therapy to 35% of children with cancer in Germany, usually by the parents. Prospective studies on the effects and side-effects of the most frequently used methods are urgently needed, and paediatric oncologists should have sufficient knowledge of CAM to enable them to advise parents professionally and competently about these treatments, too.

Introduction

Patients are showing an increasing interest in the use of complementary and alternative treatment methods (CAMs) in the treatment of acute and chronic diseases,1, 2 both in adults3, 4 and in children5, 6, 7 and particularly in the Western industrial nations.8 Professional organisations such as medical societies and the WHO9, 10, 11 are also devoting increasing attention to traditional and complementary medicine in the scientific debate. In adult oncology CAM is used to a significant extent.12, 13 Depending on the population studied, the prevalence of use is well above 50%14, 15, 16 and in all populations a trend towards increasing prevalence of use over time can be seen.17 Many of the CAMs used have not yet been scientifically studied or only to an insufficient extent. So far only a few smaller studies have been published on the prevalence of the use of CAM in children with cancer and factors related to its use.18, 19, 20, 21, 22, 23, 24, 25, 26 With sometimes very different study populations and in the absence of a uniform definition of CAM there is considerable variation in the reported prevalences of CAM use and the related factors. The largest population based study published to date18 reported a prevalence of CAM use of 42% for British Columbia/Canada. There are practically no representative data available on the prevalence of CAM use in Europe. Only Molassiotis and colleagues14 have reported a prevalence of 33% in the United Kingdom. To date there are no figures on CAM use in children with cancer in Germany. In view of the general increase in the prevalence of CAM and the fact that very little is known about the effects and side-effects of these methods there is an urgent need for better investigation of these treatment strategies.

As the first step we now present the first nationwide, registry-based, population-based retrospective survey of the prevalence of CAMs use in children with cancer, the types of therapies used and the factors related to its use.

The data obtained in our survey provide a basis for subsequent prospective studies on the use particularly of the more frequently used CAM methods in paediatric oncology. They can also serve as a source of information for paediatric oncologists around the world as an opening for frank and competent dialogue with parents of children with cancer on the subject of CAM.

Section snippets

Selection of patients

The survey was conducted from 1st of January to 15th September 2004. All families with a child under the age of 15 years who was first diagnosed with a disease defined in the International Childhood Cancer Classification (ICCC)27 or with myelodysplastic syndrome (MDS), severe aplastic anaemia (SAA) or Langerhans cell histiocytosis (LCH) between 1st of January and 31st December 2001 and registered in the German Childhood Cancer Registry (GCCR), were eligible for inclusion. Approximately 95% of

Patient characteristics

Eighty of the Eighty one German hospitals which had reported cases to the GCCR during the period in question, consented in principle to include their patients in the survey. A total of 79 patients were excluded by the hospitals from the survey (the most frequently given reasons were, in decreasing order of frequency: death of the patient, language problems and patient had left Germany). Of the 1768 patients registered in the GCCR in the year 2001 (time of first diagnosis) who met the inclusion

Discussion

This is the most extensive as well as the first population-based study on the prevalence of use of CAM in paediatric oncology. Only one small study from Canada18 with 44 interviewees was based on a cancer registry. The prevalence of CAM use in our survey population was 35%. The very narrow confidence interval [31.7%; 37.4%] and the high statistical power of the study on account of the sample size can be taken to indicate that the figure found for the prevalence of use is very reliable. The

Conflict of interest statements

Alfred Laengler has got honoraria for lectures held for anthroposophic pharmaceutical companies (WELEDA, Helixor).

Claudia Spix: no conflict of interest.

Georg Seifert is running a clinical study sponsored by anthroposophic pharmaceutical companies (Wala, WELEDA, Helixor).

Sven Gottschling: no conflict of interest.

Norbert Graf: no conflict of interest.

Peter Kaatsch: no conflict of interest.

Authors contributions

Alfred Laengler designed the study, was involved in the conception of the questionnaire, did the data analysis, interpretation and wrote the manuscript.

Claudia Spix was involved in the study and questionnaire conception, data management and did the statistical analysis. She participated in writing the manuscript.

Georg Seifert was involved in the study conception and data analysis. He participated in writing the manuscript.

Sven Gottschling was involved in the study and questionnaire conception

Acknowledgements

We would like to thank Ms Irene Jung of the GCCR for her excellent support with the distribution of the questionnaire and with the data logistics and analysis, Barbara Pfrengle-Längler for her help with the data input, the hospitals and particularly the families participating in the survey. We would also like to express our thanks to Prof Dr. H. Jürgens and Prof. Dr. F. Berthold for their kind support of the project in the Society of Paediatric Oncology and Haematology (GPOH). The study

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