Complementary Therapies

Complementary therapies are treatments that are used along with standard medical care for a disease or illness. In pediatric cancer, complementary therapies are used to treat symptoms or side effects of cancer or cancer treatments.

General types of complementary therapies used to help children with cancer include:

• Body-based therapies
• Mind/body exercises
• Prayer and spiritual practices
• Relaxation and meditation
• Vitamins, supplements, and special diets
• Music, art, and play therapy

Some complementary therapies may interfere with medical treatment or cause adverse reactions. As a rule, always check with the care team before using any complementary therapy.

Benefits of Complementary Therapies

Complementary therapies are used to help with a variety of cancer symptoms and side effects. These include:

• Pain
• Nausea and vomiting
• Headaches
• Fatigue
• Sleep
• Stress and anxiety
• Depression
• Digestive problems such as constipation and diarrhea
• Immunity
• Appetite

Evidence for Complementary Therapies

Some therapies have been well-studied and have significant research to support their use. Examples include relaxation, guided imagery, and biofeedback. Yoga and other mind/body exercises have also been widely studied. Other therapies have very little science to support their use, and risks and benefits are largely unknown.

Compared to traditional medicine, less is known about how and why these therapies work, especially in children with cancer. Some ways that different therapies might act include:

• Improving positive feelings and sense of control
• Decreasing worry and stress
• Providing distraction from pain and other physical symptoms
• Improving blood flow
• Reducing swelling and inflammation
• Influencing chemical processes and nerve signals
• Belief that the therapy will work (placebo effect)

There is a general lack of evidence-based research using complementary therapies in pediatric cancer. However, there is some agreement that:

• Mind and body practices can often help children with symptoms such as worry and stress. Guided imagery, hypnotherapy, yoga, and creative arts are usually considered low-risk. 
• Dietary supplements and nutritional therapies may cause allergies or other adverse events. These types of therapies include diets, creams, multivitamins and megavitamins, and other homeopathic remedies. Children’s small size and developing organs make them more vulnerable than adults. A weakened immune system can also increase risk.

Patients vary in how they respond to a complementary therapy. Some complementary therapies can also have serious side effects. Talk to the medical team before trying any complementary therapy, even if it is something the patient has used before.

Types of Complementary Therapy

• Acupuncture is a technique in which specific points on the body are stimulated, often by inserting thin needles through the skin. This therapy is often used to reduce pain or nausea.
• Aromatherapy and essential oils includes the use of plant-based oils to improve well-being and address symptoms such as fatigue, nausea, and stress.
• Biofeedback is a technique where patients learn to control breathing, heart rate, and blood pressure to manage their response to stress.
• Chiropractic care is a type of treatment that focuses on the relationship between the body's structure and function through adjustment of the spine or other parts of the body. 
• Diets include a wide spectrum of dietary practices involving specific food choices such low fat, high fiber, vegetarian, gluten free, and other eating plans.
• Guided imagery is a type of meditation in which patients use their imaginations and senses to relax and focus their attention.
• Hypnosis is a form of therapy that encourages a trance-like state with increased focus and openness to suggestion. Hypnosis might help to reduce stress and increase sense of control in specific situations such as medical procedures.
• Massage uses physical pressure and other techniques to manipulate muscle and soft tissue.
• Relaxation, deep breathing, and meditation include a variety of strategies that decrease the effects of stress on the mind and body. 
• Spirituality involves the use of religious and spiritual resources—including prayer and pastoral counseling—to improve health, well-being, and quality of life.
• Vitamins, supplements, and herbal products include a variety of substances usually taken by mouth or applied to the skin such as:
  • Multivitamins – dietary supplements that contains a combination of vitamins and minerals, and sometimes other ingredients with the goals of building immunity and preventing or treating disease.
  • Megavitamins – large doses of vitamins, often many times greater than the recommended dietary allowance, taken in an attempt to prevent or treat disease.
  • Probiotics – dietary supplements that contain live microorganisms to support digestive health.
• A variety of products that fall into this category are advertised with a range of reported health benefits. The evidence for the risks and benefits of these products vary widely.
• Yoga, Tai chi, and Qigong are mind-body exercises that involve movement and controlled breathing. These exercises can have a variety of benefits including improving balance and flexibility and reducing feelings of stress and fatigue.

Risks of Complementary Therapy in Children with Cancer

Many types of complementary therapies are safe and effective for children with cancer. But families need to take them as seriously as they would a traditional treatment or medication. Just because a product can be bought over the counter, does not mean it is safe. In fact, more care is needed because the treatments don’t have the same regulations or standards.

Complementary therapies such as acupuncture, chiropractic care, massage, biofeedback, and yoga should be given by a qualified health professional with appropriate certifications and licenses. A provider should also have experience working with children with cancer.

Specific risks of complementary therapies include:

• Supplements may contain additional substances that could be harmful.
• Supplements may not have dose information for children.
• Substances ingested or absorbed through the skin:
  • Can enter the blood stream and affect a wide range of body functions.
  • Can interact with other medications and treatments to make them less effective or cause health problems.
• While receiving cancer treatments, skin may be weak and more sensitive to anything put on the skin (oils, lotions) or pressure applied to the skin (massage).
• Specific diets that limit certain foods may cause weight loss or make it hard for children to get nutrients.

Complementary Therapy vs Alternative Medicine

Complementary and alternative therapies are often described together as complementary and alternative medicine (CAM). But they are actually distinct practices.

• Complementary therapies are treatments that are used in addition to standard medical care. They are usually used during or after cancer treatment to relieve pain, manage symptoms, or ease side effects.
• Alternative therapies are treatments that are used instead of standard medical treatments. Families often turn to alternative medicine to treat cancer when traditional medical options have not worked.

Talking With the Care Team About Complementary Therapies

Families should be honest and open about complementary therapies. 

The medical team can help families:

• Explore benefits of different complementary therapies.
• Identify potential risks. The therapy might interfere with medication or other medical treatment or increase the chance of side effects.
• Monitor the therapy to see if it helps, and watch for problems that might occur.