Integrative Medicine in Childhood Cancer: Practices That Can Help Pediatric Patients
Clinicians should become familiar with the integrative and complementary medical interventions that are safe and effective in pediatric patients.
When a child is ill, especially with such a devastating disease as cancer, parents often feel desperate and helpless. There is so little they can do for their child, yet they want to be proactive in any way they can. Therefore, parents often consider complementary and integrative medicine practices.
Integrative medicine is defined by the American Board of Integrative Medicine® (ABOIM) and the Consortium of Academic Health Centers for Integrative Medicine as “the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing.”1 Integrative medicine incorporates complementary health approaches including mind and body practices as well as a variety of products and dietary supplements, such as herbs or botanicals, vitamins, minerals, and probiotics.2
Elena J. Ladas, PhD, RD, associate professor of nutrition (in Epidemiology, Pediatrics, and in the Institute of Human Nutrition) and director, Integrative Therapies Program at Columbia University Medical Center in New York City, investigated the use of integrative and complementary medicine in pediatric patients with cancer.3
Incidence of childhood cancers has increased worldwide in the last decade, most likely as a result of heightened awareness and better access to treatment. Survival rates for children with acute lymphoblastic leukemia (ALL) is now more than 90%, while survival rates for all other childhood cancers are as high as 70%.3 To keep those numbers heading in a positive direction, practitioners should become familiar with the integrative and complementary medical interventions that are safe and effective in pediatric patients. Similarly, clinicians should be aware of treatments that raise concerns so they can educate anxious parents and offer alternatives.
Nutrition Researchers have been studying the role nutrition plays in the supportive care of pediatric patients with cancer. A 2016 meta-analysis of studies that included a combined total of more than 10,000 patients with ALL or acute myeloid leukemia (AML) found that a higher body mass index (BMI) at diagnosis correlated with significantly poorer survival compared with those patients with a lower BMI.4
The adverse effects of the disease were ameliorated after initiating a dietary intervention that corrected poor nutrition, allowing for a better chance of survival. Those pediatric patients whose nutritional status remained either too low or too high experienced increased toxicity and decreased survival. Thus, clinicians can have a positive impact on pediatric patients' outcomes through counseling patients and their families on healthful eating. This includes specialized diets such as neutropenic/low microbial diets that minimize the risk of infection and the ketogenic diet, which addresses the role of sugar in the growth of cancer. 3
Diet and exercise The benefits of a proper diet and exercise extend to everyone. Such lifestyle interventions are proven to have a beneficial effect on lowering risk of cancer in adults. However, data on whether pediatric patients experience similar benefits are limited, and studies are observational as opposed to interventional.
A study of 170 survivors of childhood cancer found that fatigue and quality of life were improved when national dietary guidelines were followed. Other analyses found survivors who continued to follow recommended diets participated in more physical activity and other healthy behaviors; however, cancer survivors are less active than their siblings or others in the general population. They are also less inclined to report enjoying leisure activities and other components of cancer prevention guidelines.3
Nutritional supplements Nutritional supplements can interact with conventional cancer treatments, making this a fraught subject. One recent study researched clinical trials using supplements for mucositis, toxicities of treatment and hepatotoxicity, appetite and weight management, neutropenia and fever, neuropathy, chemotherapy-induced nausea and vomiting (CINV), GI symptoms, and bone mineral density. Although not all outcomes were positive, there were promising results for the use of glutamine and honey to treat mucositis, essential fatty acids to prevent weight loss, milk thistle to treat hepatic toxicity, and zinc for the prevention of infections and weight loss.3
Probiotics Although they are a fairly new area in childhood cancer treatment, probiotics hold some promise. A number of studies have shown that cancer therapy has a negative effect on the microbiome that is often compounded by antibiotic prophylaxis. Probiotics may be valuable in those cases, since current studies show their benefit for pediatric patients with diarrhea caused by antibiotics, chemotherapy, radiation, or Clostridium difficile.