What is the Prevalence of Complementary and Alternative Medicine for Children with Cancer in India?

A collection of health care systems, practices and products which does not fall within conventional medicine is called Complementary and Alternative Medicine (CAM). When it is used as an adjunct to conventional medicine it is called Complementary, and when used as a substitute, it is called Alternative. Included among these are homeopathy, ayurveda, yoga, acupuncture, herbal remedies, nutritional-based therapies and others.

The use of CAM is particularly prevalent in those with cancer. Reasons for use include hope for therapeutic benefit, reduced risk as well as alleviation of adverse-effects. In a recently published systematic review (Ref - Bishop et al, Pediatrics, April 2010) the overall prevalence of CAM was 6% to 91%. Use of individual therapies were 2% to 48% for herbal remedies, 3% to 47% for nutritional interventions, 3% to 30% for faith healing and 1% to 17% for homeopathy. Notably, 23 of the 28 studies in the systematic review were from North America and Europe, and none of the studies were from India. By doing a literature search on Pubmed I was unable to identify any studies which could give me the information of CAM in this context in India.

CAM is associated with children with cancer in India in a multitude of ways. Prior to accurate diagnosis and appropriate treatment, children with cancer in India often have been receiving some form of treatment from CAM practitioners. This leads to a delay in presentation which then contributes to a higher stage, more intense treatment and poorer outcomes. Then during treatment with chemotherapy and radiotherapy, these children often take some form of complementary therapy to reduce the adverse effects. Lack of adequate supportive care and good, honest communication lead families to expend valuable energy and resources in the pursuit of CAM. Finally, when treatment is refused or abandoned (not an uncommon outcome in India) parents try to find answers with CAM practitioners. There is a need to study and better understand CAM use in children with cancer in India.

CHK4WTK4Z4R9

Music Therapy Reduces Procedural Pain in Children with Cancer

Repeated procedures like lumbar puncture and bone marrow aspiration are routine part of management of several childhood cancers (in particular acute lymphoblastic leukaemia). Adequate sedation and analgesia for these procedures in a safe environment is desirable and there are guidelines available in Europe and North America in this context. The mainstay of sedation in such settings is general anaesthesia.

A recent survey shows that the practice of sedation and analgesia for lumbar punctures and bone marrow aspiration in children with cancer in India is varied and includes no sedation/analgesia, local anaesthesia or some systemic sedation/analgesia but no general anaesthesia (unpublished data). Further research is needed to identify reasons for these variations.

The recently published report from Vietnam (in collaboration with Swedish investigators) shows reduced pain and anxiety in children aged 7-12 years with leukaemia during and after lumbar puncture who were randomised to receive music therapy compared to no music. (Ref - Nguyen et al, Journal of Pediatric Oncology Nursing, May-June 2010). What makes this clinical trial particularly relevant to the Indian context is the fact that besides music therapy, there was no use of any form of sedation/analgesia for the procedure. Such a practice of lack of any sedation/analgesia during the procedure is standard in Vietnam and also a common occurrence in India. Music therapy is a low cost, safe and easily available option which should be considered (in isolation or as an adjunct) for these procedures.