Abstract
Dear Editor:
We read with interest the work by Heath and colleagues on the use of complementary and alternative medicine (CAM) in pediatric oncology patients at the end of life. 1 The authors demonstrated a prevalence of 30% of CAM medicine use in their study population. 1 The most frequently used categories were organic foods, faith healing, and homeopathy, which are somewhat comparable to data from our group, which assessed the use of CAM in children with cancer and chronic medical conditions in Germany.2,3 Previous reports have shown that only one third of the parents had communicated the use of CAM to their pediatric oncologist. 4 This may be of great importance, since it has been shown that CAM medications may interfere with standard oncology drugs, leading to undue drug interactions and side effects. 5
So far, no formal analysis of all published systematic Cochrane reviews in the field of CAM in children has been performed with regard to its overall utility and practical implications for the physician caring for children. To systematically assess the role and limitations of CAM in children, we performed a literature review of all Cochrane reviews published between 1996 and 2012 in pediatrics. The main outcome variables in our study were: percentage of reviews that concluded that a certain intervention provides a benefit, percentage of reviews that concluded that a certain intervention should not be performed, and percentage of studies that concluded that the current level of evidence is inconclusive.
In total, we enrolled 163 Cochrane reviews in children. In only 7/163 of reviews a recommendation in favor of a certain intervention was given; 33/163 issued a conditional positive recommendation, while 14/163 reviews concluded that certain interventions should not be performed. Inconclusive reviews numbered 109/163. The proportion of inconclusive reviews increased during three a priori defined time intervals (1995–2000: 16/29; 2001–2006: 37/54; and 2007–2012: 56/80). The three most common criticisms with regard to quality of enrolled studies were: more research needed (95/163), low methodological quality (65/163), and small number of study participants/studies (52/163).
Given these results we conclude that there is an ongoing need for high-quality research to assess the potential role of CAM in children. Our data may be helpful for pediatric oncologists in providing their patients and families with important and up-to-date information on the role and shortcomings of CAM therapies in the pediatric oncology population. Given the fact that the majority (78%) of respondents felt CAM use had benefited their child significantly and most felt it had not caused additional suffering, 1 we agree with Heath and colleagues that it is important to offer a pragmatic, nondogmatic approach to the family “in order to provide the best possible holistic care.”
The disproportionate high number of inconclusive reviews in our analysis strongly emphasizes that CAM needs to undergo the same rigorous evaluation process using standardized techniques as for “conventional medicine” (i.e., randomized controlled trials) in order to scientifically substantiate its role in modern medicine. Unless the study of CAM is submitted to the same science-based standards as “conventional therapies,” CAM therapies risk being perpetually marginalized by mainstream medicine.