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Alternative and complementary therapies in childhood cancer

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Medical and Pediatric Oncology 34:27–28 (2000)
EDITORIAL
Alternative and Complementary Therapies in Childhood Cancer
Ronald A. Anderson,
Alternative and complementary therapies have greatly
increased in popularity and usage in recent years, and
many are discussed by J. Metz in this issue of Medical
and Pediatric Oncology (pp. 20–26). Accompanying this
is an increased interest in and implementation of these
treatments by parents of children being treated for cancer
[1]. Their impact and potential effectiveness, however,
remain largely unstudied. As well, potential harmful effects, whether from toxicity, interaction with ongoing
therapy, or withdrawal of known effective treatments, are
emerging as significant concerns.
By contrast, the practice of evidence-based medicine
is founded on the conviction that therapy must be based
on persuasive data. Evidence for effectiveness is obtained
by formulating a hypothesis that is subsequently tested. It
has been through this approach that most children with
cancer can now be cured [2]. Dramatic progress has occurred through individual institutional research and international collaborative efforts using hypothesis-driven,
clinical, and laboratory-based investigations. The large
multiinstitutional collaborative groups, consisting of the
Pediatric Oncology Group, the Children’s Cancer Group,
the National Wilms Tumor Study Group, the International Rhabdomyosarcoma Study Group, and the International Society of Paediatric Oncology, provide the
backbone for continued progress in an international, multidisciplinary setting. Rigorously audited clinical practice
and data analyses continue to be employed. Both funding
of clinical trials and publication of results have been
through a strict peer-review process. Society should be
made more aware of the very dramatic progress that has
occurred over the last 3 decades and the remarkable collaborative efforts that have been responsible. It is in light
of such concrete progress that the rapidly increasing and
largely unquestioned usage of unproved alternative
therapies is of such concern.
Refusal of standard anticancer therapy and use of alternative therapy may be emerging as a new phenomenon. We recently reported [3] an experience with two
families who refused standard therapy for which cure
rates of greater than 50% were expected. One of these
children subsequently died; the other developed progressive disease and only then accepted therapy.
It is with great frustration that pediatric oncologists
© 2000 Wiley-Liss, Inc.
MD
face such situations. However, the dramatic promises
made by certain alternative medicine practitioners can be
very appealing even if the success of their therapies lacks
any evidence. This was exemplified recently by the investigation into the validity of the claims made by Dr.
Luigi Di Bella of Modena, Italy. He was touted by many
in the past year to be a hero who had a cancer cure that
physicians and government were refusing to recognize.
The government cancer and pharmaceutical commissions
of Italy had refused permission to have the treatment
recognized on several occasions. Finally, under public
pressure, his treatment of somatostatin and vitamin A
derivatives was studied in 385 patients and found to be a
failure [4]. In the meantime though, this treatment had
been promoted in the world media as a possible breakthrough in cancer treatment that was not being made
available to all in need.
Alternative therapies that show potential in preliminary work deserve study. The investigation and application of these treatments must progress with the same
rigorous scientific scrutiny that has led to the current cure
rates in childhood cancer. Scientific investigation of alternative therapies is proceeding under the guidance of
the U.S. National Institute of Health (NIH). Whether this
will yield useful treatments remains to be seen. Under
congressional mandate in 1992, an office of alternative
medicine was established within the NIH. In 1993, a
request for application was issued to allow for grants of
up to $30,000 each. Unfortunately, the outcome of this
initiative has been disappointing. From 30 research
grants awarded, only 9 published papers have resulted,
none of which reported a controlled clinical trial [5,6]. In
October, 1996, the U.S. Congress established a National
Center for Complementary and Alternative Medicine
(NCCAM), with an appropriation of $50 million to fund
its establishment. The goal is to provide a mechanism for
objective scientific investigation of the potential uses of
alternative therapies.
Parents cannot be denied the option of using alternative therapies when cure cannot be guaranteed or is no
longer possible. Mothers and fathers only wish to do
everything possible to help their children. However, in
light of the progress that has been achieved in pediatric
oncology over the past 40 years it is deplorable to see
28
Editorial
families or patients forfeit or decrease their chances for
cure by pursuing phantoms at critical times in the course
of the illness.
The facts detailed by Dr. Metz are sobering. The lack
of rationale and objective evidence of potential benefit
are enough to give one pause. When the costs are
weighed in addition, the arguments against the wanton
use of alternative therapies become compelling. Practicing oncologists will profit from reading the article by Dr.
Metz.
Ronald A. Anderson, MD
Departments of Oncology and Pediatrics
Faculty of Medicine
University of Calgary
Calgary, Alberta, Canada
REFERENCES
1. Fernandez CV, Stutzer CA, MacWilliam L, and Fryer C. Alternative and complementary therapy use in pediatric oncology patients in British Columbia: prevalence and reasons for use and
nonuse. J Clin Oncol 1996;16:1279–1286.
2. Murphy SB. The national impact of clinical cooperative group
trials for pediatric cancer. Med Pediatr Oncol 1995;24:279–280.
3. Coppes MJ, Anderson RA, Egeler RM, Wolff JEA. Alternative
therapies for the treatment of childhood cancer. N Engl J Med
1998;339:846–847.
4. Associated Press Report (Rome): Cancer-cure cocktail branded a
failure. Calgary Herald. Nov. 14, 1998.
5. Angell M, Kassirer JP. Alternative medicine—the risks of untested and unregulated remedies. N Engl J Med 1998;339:839–841.
6. National Institute of Health, National Center for Complementary
and Alternative Medicine Web site. See: http://altmed.od.nih.gov/
nccam/
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