Correspondence
Alternative Therapies for the Treatment of Childhood Cancer
N Engl J Med 1998; 339:846-847September 17, 1998
- Article
To the Editor:
Recently, we have been deeply disturbed by the decision of several families to use alternative therapies exclusively as front-line treatment for their children's cancer, or to use alternative rather than adjuvant therapy after radical surgery. We report here on two patients, in both of whom we documented tumor growth after the use of alternative therapies.
Patient 1, a 15-year-old boy, received a diagnosis of stage IIA nodular, sclerosing Hodgkin's disease in April 1998. Treatment with multiagent chemotherapy and low-dose irradiation to the involved field was recommended. Despite lengthy discussion, the patient, with the approval of his mother, instead elected to use Matol Biomune OSF Plus (Matol Botanical International). This compound contains the herb astragalus in combination with a special extract of dairy colostrum and whey, and it is alleged, according to the manufacturer's promotional literature, to “create a synergistic effect on the immune system, resulting in the elevation of natural killer (NK) cell activity.” Case reports provided by Matol Botanical International indicate that the compound has beneficial effects on a wide range of disorders, including environmental illnesses, a variety of cancers, AIDS, hepatitis C, and the chronic fatigue syndrome.
When it was clear that the patient could not be persuaded to alter his decision, we urged him to keep visiting our outpatient clinic so that we could monitor his condition. Initially, no change in the tumor burden was noted, but in early August, both clinical and radiologic evidence of marked disease progression was seen. Two weeks later severe night sweats developed, and the patient requested the previously recommended conventional therapy. On restaging, we determined that the patient had stage IIB disease and therefore required more intensive therapy, including increased dosages of doxorubicin, etoposide, and bleomycin.
Patient 2, a nine-year-old girl, underwent a complete resection of a primitive neuroectodermal tumor of the right parietotemporal lobe in the brain. Since the three-year survival rate after adjuvant therapy for this tumor is more than 50 percent,1 we recommended multiagent chemotherapy and radiotherapy after surgery. The parents, however, opted instead to treat their daughter with shark cartilage. Four months later, marked tumor progression was documented, and the patient subsequently died.
Conventional cancer treatments are recommended only after formal scientific study of their safety, tolerability, and efficacy. We refer to these therapies as “evidence-based.” This approach has resulted in important improvements in the outcome of childhood cancer,2,3 and we find it difficult to understand how conventional treatments for childhood cancer can be repudiated in favor of alternative approaches for which any evidence of efficacy is lacking.
In recent years, we physicians seem to have come to accept alternative therapies. We are even advised to seek better integration of conventional and alternative therapies because “it is what the patient wants.”4 To continue to have a laissez-faire attitude reinforces the public's notion that alternative therapies are devoid of potential harm. It is time to remember that each of us has taken an oath to uphold “the good of the sick to the utmost of my power, holding myself aloof from wrong.” As a medical community, we have a responsibility to educate the public not only about the great benefits of evidence-based medicine but, in addition, about the risks of using therapies for which any evidence of efficacy or safety is lacking.
4 ReferencesMax J. Coppes, M.D., Ph.D.
Ronald A. Anderson, M.D.
R. Maarten Egeler, M.D., Ph.D.
Johannes E.A. Wolff, M.D.
Alberta Children's Hospital, Calgary, AB T3H 1N5, Canada1
Cohen BH ,Zeltzer PM ,Boyett JM , et al. Prognostic factors and treatment results for supratentorial primitive neuroectodermal tumors in children using radiation and chemotherapy: a Childrens Cancer Group randomized trial. J Clin Oncol 1995;13:1687-1696
Web of Science | Medline2
Murphy SB . The national impact of clinical cooperative group trials for pediatric cancer. Med Pediatr Oncol 1995;24:279-280
CrossRef | Medline3
Bleyer WA . The U.S. pediatric cancer clinical trials programmes: international implications and the way forward. Eur J Cancer 1997;33:1439-1447
CrossRef | Web of Science | Medline4
Best A ,Herbert C . Two solitudes of complementary and conventional medicine: where are we going? Can Fam Physician 1998;44:953-5, 960
Web of Science | Medline
- Citing Articles (26)
Citing Articles
1
Rosy Rajbhandary, Samir Bhangle, Sheetal Patel, Deepali Sen, Adam Perlman, Richard S. Panush. (2011) Perspectives About Complementary and Alternative Medicine in Rheumatology. Rheumatic Disease Clinics of North America 37:1, 1-8
CrossRef2
Li-Li Chen, Li-Chi Huang, Shu-Chuan Lin, Marlaine Smith, Shwu-Jiuan Liu. (2009) Use of Folk Remedies among Families of Children Hospitalised in Taiwan. Journal of Clinical Nursing 18:15, 2162-2170
CrossRef3
May Loo. 2009. Introduction. , 1-4.
CrossRef4
Cesar Ramos-Remus, Ashwinikumar Raut. (2008) Complementary and alternative practices in rheumatology. Best Practice & Research Clinical Rheumatology 22:4, 741-757
CrossRef5
Stefania Milazzo, Edzard Ernst. (2006) Newspaper coverage of complementary and alternative therapies for cancer—UK 2002–2004. Supportive Care in Cancer 14:9, 885-889
CrossRef6
Jan Styczynski, Mariusz Wysocki. (2006) Alternative medicine remedies might stimulate viability of leukemic cells. Pediatric Blood & Cancer 46:1, 94-98
CrossRef7
A ALWINDI. (2004) Determinants of complementary alternative medicine (CAM) use. Complementary Therapies in Medicine 12:2-3, 99-111
CrossRef8
Elizabeth M. Gagnon, Christopher J. Recklitis. (2003) Parents' decision-making preferences in pediatric oncology: The relationship to health care involvement and complementary therapy use. Psycho-Oncology 12:5, 442-452
CrossRef9
Grace Powers Monaco, Gilbert Smith. (2002) Informed consent in complementary and alternative medicine: Current status and future needs. Seminars in Oncology 29:6, 601-608
CrossRef10
M. Tandon, S. Prabhakar, P. Pandhi. (2002) Pattern of use of complementary/alternative medicine (CAM) in epileptic patients in a tertiary care hospital in India. Pharmacoepidemiology and Drug Safety 11:6, 457-463
CrossRef11
Catherine Ulbricht, Paul Hammerness, Catherine Ulbricht, Ernie-Paul Barrette, Heather Boon, Philippe Szapary, David Sollars, Michael Smith, Candy Tsouronis, Steve Bent, Ethan Basch. (2002) Shark Cartilage Monograph. Journal of Herbal Pharmacotherapy 2:2, 71-93
CrossRef12
N.J. Gogtay, H.A. Bhatt, S.S. Dalvi, N.A. Kshirsagar. (2002) The Use and Safety of Non-Allopathic Indian Medicines. Drug Safety 25:14, 1005-1019
CrossRef13
Marian L. Neuhouser, Ruth E. Patterson, Stephen M. Schwartz, Monique M. Hedderson, Deborah J. Bowen, Leanna J. Standish. (2001) Use of Alternative Medicine by Children with Cancer in Washington State. Preventive Medicine 33:5, 347-354
CrossRef14
Abdul Rahman Jazieh, Maisaa Khalil. (2001) Hematologic Complications of Alternative Remedies. International Journal of Hematology 74:4, 405-408
CrossRef15
Roland J. Lamarine. (2001) Alternative Medicine: More Than A Harmless Option. Journal of School Health 71:3, 114-116
CrossRef16
Ronald A. Anderson. (2000) Alternative and complementary therapies in childhood cancer. Medical and Pediatric Oncology 34:1, 27-28
CrossRef17
Cesar Ramos-Remus, Sergio Gutierrez-Ureña, Paul Davis. (1999) EPIDEMIOLOGY OF COMPLEMENTARY AND ALTERNATIVE PRACTICES IN RHEUMATOLOGY. Rheumatic Disease Clinics of North America 25:4, 789-804
CrossRef18
Neil Kramer. (1999) WHY I WOULD NOT RECOMMEND COMPLEMENTARY OR ALTERNATIVE THERAPIES: A PHYSICIAN'S PERSPECTIVE. Rheumatic Disease Clinics of North America 25:4, 833-843
CrossRef19
Robert J. Hilsden, Marja J. Verhoef. (1999) Complementary therapies: evaluating their effectiveness in cancer. Patient Education and Counseling 38:2, 101-108
CrossRef20
A Zoubek, I Slavc, G Mann, G Trittenwein, H Gadner. (1999) Natural course of a Wilms' tumour. The Lancet 354:9175, 344
CrossRef21
Curtis E Margo. (1999) The Placebo Effect. Survey of Ophthalmology 44:1, 31-44
CrossRef22
Burstein, Harold J., Gelber, Shari, Guadagnoli, Edward, Weeks, Jane C., . (1999) Use of Alternative Medicine by Women with Early-Stage Breast Cancer. New England Journal of Medicine 340:22, 1733-1739
Full Text23
David Orentlicher, Michael K. Hehir. (1999) Advertising Policies of Medical Journals: Conflicts of Interest for Journal Editors and Professional Societies. The Journal of Law, Medicine & Ethics 27:2, 113-121
CrossRef24
(1999) Alternative Therapies in Childhood Cancer. New England Journal of Medicine 340:7, 569-570
Full Text25
Gail Pisarcik Lenehan. (1998) On alternative theme issues. Journal of Emergency Nursing 24:6, 476-477
CrossRef26
Angell, Marcia, Kassirer, Jerome P., . (1998) Alternative Medicine — The Risks of Untested and Unregulated Remedies. New England Journal of Medicine 339:12, 839-841
Full Text
- Letters
