Komplementäre und alternative Behandlungsmethoden in der Kinderonkologie

 

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Zusammenfassung

Viele Familien krebskranker Kinder wenden komplementäre und alternative Behandlungsmethoden bei ihren Kindern an, obwohl die wissenschaftliche Datenlage hinsichtlich der Wirksamkeit und der möglicherweise damit verbundenen Risiken gering ist. Die vorliegende Arbeit informiert über die Anwendungshäufigkeit und die Gründe für die Anwendung dieser Methoden. Häufig angewendete Methoden wie Ernährungsumstellung, Homöopathie, anthroposophische Medizin, pflanzliche Präparate und Akupunktur werden ebenso beleuchtet wie eine Reihe seltener angewandter Methoden, die mit speziellen Risiken und/oder hohen Kosten für den Nutzer verbunden sind. Die behandelnden Ärzte sollten sich bewusst sein, dass ein großer Teil ihrer Patienten diese Methoden einsetzt und sie nicht immer davon in Kenntnis setzt. Dies sollte bei den behandelnden Ärzten dazu führen, das Thema komplementäre und alternative Methoden mit den Betroffenen offen und unvoreingenommen anzusprechen, um Barrieren abzubauen und einzuschätzen, ob eine Methode ungefährlich und möglicherweise vorteilhaft oder aber mit nicht vertretbaren Risiken für den Patienten verbunden ist.

Abstract

For many families of pediatric cancer patients the use of complementary and alternative medicine (CAM) is an accepted adjunct to conventional therapy, even if data regarding effects and risks are scarse. This report provides information about the prevalence of CAM use and reasons for CAM use among pediatric cancer patients. Frequently used CAM like nutrition (incl. diets and vitamins), homeopathy, anthroposophic medicine, phytotherapy, and acupuncture are highlighted, as were CAM bearing a special risk for their users. Physicians need to be more aware that a substantial percentage of their patients may use CAM without telling them for different reasons. Physicians need to be open-minded and should discuss CAM with parents. A differentiation between potentially useful and potentially dangerous CAM is necessary aiming at minimising the risks for CAM users.

Literatur

• 1 Arends J, Zürcher G, Fietkau R, Aulbert E, Frick B, Holm M, Kneba M, Mestrom H J, Zander A. DGEM-Leitlinie enterale Ernährung: Onkologie.  Aktuel Ernaehr Med. 2003;  28 (Suppl 1) S61-S68
  PubMedGoogle Scholar
• 2 Bachmann S, Längler A. Traditionelle Hausmittel in der modernen Medizin. Urban und Fischer, München 2005
  Google Scholar
• 3 Bettermann H, Bonin D, Frühwirth M, Cysarz D, Moser M. Effects of speech therapy with poetry on heart rate rhythmic and cardiorespiratory coordination.  Int J Cardiol. 2002;  84 77-88
  CrossrefPubMedGoogle Scholar
• 4 Beuth J. Grundlagen der Komplementäronkologie-Theorie und Praxis. Hippokrates, Stuttgart 2003
  Google Scholar
• 5 Bode U, Hasan C, Hulsmann B, Fleischhack G. Recancostat compositum therapy does not prevent tumor progression in young cancer patients.  Klin Padiatr. 1999;  211 353-355
  PubMedGoogle Scholar
• 6 Böker D K, Winking M. Die Rolle von Boswellia-Säuren in der Therapie maligner Gliome.  Dt Ärztebl. 1997;  94 1197-1199
  PubMedGoogle Scholar
• 7 Bold J, Leis A. Unconventional therapy use among children with cancer in Saskatchewan.  J Pediatr Oncol Nurs. 2001;  18 16-25
  CrossrefPubMedGoogle Scholar
• 8 Cameron E, Pauling L, Leibovitz B. Ascorbic acid and cancer: a review.  Cancer Res. 1979;  39 663-681
  PubMedGoogle Scholar
• 9 Cassileth B R, Vickers A J. High prevalence of complementary and alternative medicine use among cancer patients: implications forresearch and clinical care.  J Clin Oncol. 2005;  23 2590-2592
  PubMedGoogle Scholar
• 10 Creutzig U, Jurgens H, Herold R, Gobel U, Henze G. [Concepts of the Society of Paediatric Oncology and Haematology (GPOH) and the German Competence Network in Paediatric Oncology and Haematology for the quality controlled development in paediatric oncology].  Klin Padiatr. 2004;  216 379-383
  Article in Thieme ConnectPubMedGoogle Scholar
• 11 Cuzzolin L, Zaffani S, Murgia V, Gangemi M, Meneghelli G, Chiamenti G, Benoni G. Patterns and perceptions of complementary/alternative medicine among paediatricians and patients' mothers: a review of the literature.  Eur J Pediat. 2003;  162 820-827
  CrossrefPubMedGoogle Scholar
• 12 Dorfer L, Moser M, Spindler K, Bahr F, Egarter-Vigl E, Dohr G. 5 200-year-old acupuncture in central Europe?.  Science. 1998;  282 242-243
  PubMedGoogle Scholar
• 13 Dundee J W, Ghaly R G, Fitzpatrick K T, Lynch G A, Abram W P. Acupuncture to prevent cisplatin-associated vomiting.  Lancet. 1987;  1 1083
  PubMedGoogle Scholar
• 14 Dupuis L L, Nathan P C. Options for the prevention and management of acute chemotherapy-induced nausea and vomiting in children.  Paediatr Drugs. 2003;  5 597-613
  PubMedGoogle Scholar
• 15 Ernst E, Cassileth B R. The prevalence of complementary/alternative medicine in cancer: a systematic review.  Cancer. 1998;  83 777-782
  CrossrefPubMedGoogle Scholar
• 16 Faw C, Ballentine R, Ballentine L, van Eys J. Unproved cancer remedies. A survey of use in pediatric outpatients.  JAMA. 1977;  238 1536-1538
  PubMedGoogle Scholar
• 17 Fearon K C, Meyenfeldt M F, Moses A G, van Geenen R, Roy A, Gouma D J, Giacosa A, van Gossum A, Bauer J, Barber M D, Aaronson N K, Voss A C, Tisdale M J. Effect of a protein and energy dense N-3 fatty acid enriched oral supplement on loss of weight and lean tissue in cancer cachexia: a randomised double blind trial.  Gut. 2003;  52 1479-1486
  CrossrefPubMedGoogle Scholar
• 18 Friedman T, Slayton W B, Allen L S, Pollock B H, Dumont-Driscoll M, Mehta P, Graham-Pole J. Use of alternative therapies for children with cancer.  Pediatrics. 1997;  100 E1
  PubMedGoogle Scholar
• 19 Fernandez C V, Stutzer C A, MacWilliam L, Fryer C. Alternative and complementary therapy use in pediatric oncology patients in British Columbia: prevalence and reasons for use and nonuse.  J Clin Oncol. 1998;  16 1279-1286
  PubMedGoogle Scholar
• 20 Graf N, Gobel U. [Clinical trials and studies of the German Society for Paediatric Oncology and Haematology (GPOH) and the European Directive for the Implementation of Good Clinical Practice in the Conduct of Clinical Trials].  Klin Padiatr. 2004;  216 129-131
  Article in Thieme ConnectPubMedGoogle Scholar
• 21 Gottschling S. Welchen Einfluss hat die Ernährung auf die Prognose krebskranker Kinder.  Kinderkrankenschwester. 2005;  24 32-34
  PubMedGoogle Scholar
• 22 Ivkovic S, Deutsch U, Silberbach A, Walraph E, Mannel M. Dietary supplementation with the tribomechanically activated zeolite clinoptilolite in immunodeficiency: effects on the immune system.  Adv Ther. 2004;  21 135-147
  PubMedGoogle Scholar
• 23 Jankovic M, Spinetta J J, Martins A G, Pession A, Sullivan M, D'Angio G J, Eden T, Arush M W, Sutaryo X, Punkko L R, Epelman C, Masera G. [Non-conventional therapies in childhood cancer: guidelines for distinguishing non-harmful from harmful therapies: a report of the SIOP Working Committee on Psychosocial Issues in Pediatric Oncology].  Klin Padiatr. 2004;  216 194-197
  PubMedGoogle Scholar
• 24 Janssen G, Bode U, Breu H, Dohrn B, Engelbrecht V, Gobel U. Boswellic acids in the palliative therapy of children with progressive or relapsed brain tumors.  Klin Padiatr. 2000;  212 189-195
  Article in Thieme ConnectPubMedGoogle Scholar
• 25 Kennedy D D, Tucker K L, Ladas E D, Rheingold S R, Blumberg J, Kelly K M. Low antioxidant vitamin intakes are associated with increases in adverse effects of chemotherapy in children with acute lymphoblastic leukemia.  Am J Clin Nutr. 2004;  79 1029-1036
  PubMedGoogle Scholar
• 26 Kienle G S, Kiene H. Die Mistel in der Onkologie. Fakten und konzeptionelle Grundlagen. Schattauer, Stuttgart, New York 2003
  Google Scholar
• 27 Kienle G S, Berrino F, Bussing A, Portalupi E, Rosenzweig S, Kiene H. Mistletoe in cancer - a systematic review on controlled clinical trials.  Eur J Med Res. 2003;  8 109-119
  PubMedGoogle Scholar
• 28 Kelly K M, Jacobson J S, Kennedy D D, Braudt S M, Mallick M, Weiner M A. Use of unconventional therapies by children with cancer at an urban medical center.  J Pediatr Hematol Oncol. 2000;  22 412-416
  CrossrefPubMedGoogle Scholar
• 29 Kolstad A, Risberg T, Bremnes Y, Wilsgaard T, Holte H, Klepp O, Mella O, Wist E. Use of complementary and alternative therapies: a national multicentre study of oncology health professionals in Norway.  Support Care Cancer. 2004;  12 312-318
  PubMedGoogle Scholar
• 30 Ladas E J, Jacobson J S, Kennedy D D, Teel K, Fleischauer A, Kelly K M. Antioxidants and cancer therapy: a systematic review.  J Clin Oncol. 2004;  22 517-528
  PubMedGoogle Scholar
• 31 Längler A, Kaatsch P, Jung I. Pilotstudie zur Häufigkeit der Anwendung unkonventioneller Behandlungsmethoden in der pädiatrischen Onkologie in Deutschland.  WIR. 2003;  1 10-12
  PubMedGoogle Scholar
• 32 Längler A, Spix C, Gottschling S, Graf N, Kaatsch P. [Parents-interview on use of complementary and alternative medicine in pediatric oncology in Germany].  Klin Padiatr. 2005;  217 357-364
  Article in Thieme ConnectPubMedGoogle Scholar
• 33 Längler A. Phytotherapie. In: Schönau E, Naumann EG, Längler A, Beuth J (Hrsg). Pädiatrie integrativ. Urban und Fischer, München 2005
  Google Scholar
• 34 Lempp R. [Emotional developement - what determines it - what disturbs it ?].  Klin Padiatr. 2004;  216 189-193
  Article in Thieme ConnectPubMedGoogle Scholar
• 35 Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges L V, Jonas W B. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials.  Lancet. 1997;  350 834-843
  CrossrefPubMedGoogle Scholar
• 36 Madeleyne R, Soldner G, Tautz C, Laue B. Hirntumore bei Kindern - Therapieverläufe.  Der Merkurstab. 2001;  54 397-408
  PubMedGoogle Scholar
• 37 Mank A, van der Lelie H. Is there still an indication for nursing patients with prolonged neutropenia in protective isolation? An evidence-based nursing and medical study of 4 years experience for nursing patients with neutropenia without isolation.  Eur J Oncol Nurs. 2003;  7 17-23
  CrossrefPubMedGoogle Scholar
• 38 Martel D, Bussieres J F, Theoret Y, Lebel D, Kish S, Moghrabi A, Laurier C. Use of alternative and complementary therapies in children with cancer.  Pediatr Blood Cancer. 2005;  44 660-668
  CrossrefPubMedGoogle Scholar
• 39 Momcilovic B. [Megamin, faith, hope and placebos - a critical review].  Arh Hig Rada Toksikol. 1999;  50 67-78
  PubMedGoogle Scholar
• 40 Mottonen M, Uhari M. Use of micronutrients and alternative drugs by children with acute lymphoblastic leukemia.  Med Pediatr Oncol. 1997;  28 205-208
  CrossrefPubMedGoogle Scholar
• 41 Neuhouser M L, Patterson R E, Schwartz S M, Hedderson M M, Bowen D J, Standish L J. Use of alternative medicine by children with cancer in Washington state.  Prev Med. 2001;  33 347-354
  CrossrefPubMedGoogle Scholar
• 42 Oberbaum M, Yaniv I, Ben-Gal Y, Stein J, Ben-Zvi N, Freedman L S, Branski D. A randomized, controlled clinical trial of the homeopathic medication TRAUMEEL S in the treatment of chemotherapy-induced stomatitis in children undergoing stem cell transplantation.  Cancer. 2001;  92 684-690
  CrossrefPubMedGoogle Scholar
• 43 Omenn G S, Goodman G E, Thornquist M D, Balmes J, Cullen M R, Glass A, Keogh J P, Meyskens F L, Valanis B, Williams J H, Barnhart S, Hammar S. Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease.  N Engl J Med. 1996;  334 1150-1155
  CrossrefPubMedGoogle Scholar
• 44 Ostrander G K, Cheng K C, Wolf J C, Wolfe M J. Shark cartilage, cancer and the growing threat of pseudoscience.  Cancer Res. 2004;  64 8485-8491
  CrossrefPubMedGoogle Scholar
• 45 Pendergrass T W, Davis S. Knowledge and use of “alternative” cancer therapies in children.  Am J Pediatr Hematol Oncol. 1981;  3 339-345
  PubMedGoogle Scholar
• 46 Piao B K, Wang Y X, Xie G R, Mansmann U, Matthes H, Beuth J, Lin H S. Impact of complementary mistletoe extract treatment on quality of life in breast, ovarian and non-small cell lung cancer patients. A prospective randomized controlled clinical trial.  Anticancer Res. 2004;  24 303-309
  PubMedGoogle Scholar
• 47 Reindl T K, Geilen W, Hartmann R, Wiebelitz K R, Kan G, Wilhelm I, Lugauer S, Behrens C, Weiberlenn T, Hasan C, Gottschling S, Wild-Bergner T, Henze G, Driever P H. Acupuncture against chemotherapy-induced nausea and vomiting in pediatric oncology Interim results of a multicenter crossover study.  Support Care Cancer. 2006;  14 172-176
  PubMedGoogle Scholar
• 48 Rentea R, Lyon E, Hunter R. Biologic properties of iscador: a Viscum album preparation I. Hyperplasia of the thymic cortex and accelerated regeneration of hematopoietic cells following X-irradiation.  Lab Invest. 1981;  44 43-48
  PubMedGoogle Scholar
• 49 Sawyer M G, Gannoni A F, Toogood I R, Antoniou G, Rice M. The use of alternative therapies by children with cancer.  Med J Aust. 1994;  160 320-322
  PubMedGoogle Scholar
• 50 Semiglasov V F, Stepula V V, Dudov A, Lehmacher W, Mengs U. The standardised mistletoe extract PS76A2 improves QoL in patients with breast cancer receiving adjuvant CMF chemotherapy: a randomised, placebo-controlled, double-blind, multicentre clinical trial.  Anticancer Res. 2004;  24 1293-1302
  PubMedGoogle Scholar
• 51 Shang A, Huwiler-Muntener K, Nartey L, Juni P, Dorig S, Sterne J A, Pewsner D, Egger M. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy.  Lancet. 2005;  366 726-732
  CrossrefPubMedGoogle Scholar
• 52 Sparreboom A, Cox M C, Acharya M R, Figg W D. Herbal remedies in the United States: potential adverse interactions with anticancer agents.  J Clin Oncol. 2004;  22 2489-2503
  CrossrefPubMedGoogle Scholar
• 53 Tautz C. Die Krebskrankheit des Kindes. In: Fintelmann V (Hrsg.) Onkologie auf anthroposophischer Grundlage. Mayer, Stuttgart 2002
  Google Scholar
• 54 Tautz C, Längler A. Komplementäre Therapie bei krebskranken Kindern aus Sicht der Eltern und der Ärzte.  pädiat prax. 2006;  67 451-462
  PubMedGoogle Scholar
• 55 Uglyanitsa K N, Nefyodov L I, Doroshenko Y M, Nowicky J W, Volchek I V, Brzosko W J, Hodysh Y J. Ukrain: a novel antitumor drug.  Drugs Exp Clin Res. 2000;  26 341-356
  PubMedGoogle Scholar
• 56 Vickers A J, Straus D J, Fearon B, Cassileth B R. Acupuncture for postchemotherapy fatigue: a phase II study.  J Clin Oncol. 2004;  22 1731-1735
  CrossrefPubMedGoogle Scholar
• 57 Walsh D, Nelson K A, Mahmoud F A. Established and potential therapeutic applications of cannabinoids in oncology.  Support Care Cancer. 2003;  11 137-143
  PubMedGoogle Scholar
• 58 Winking M, Sarikaya S, Rahmanian A, Jodicke A, Boker D K. Boswellic acids inhibit glioma growth: a new treatment option?.  J Neuro Oncol. 2000;  46 97-103
  CrossrefPubMedGoogle Scholar
• 59 Witt C, Brinkhaus B, Jena S, Linde K, Streng A, Wagenpfeil S, Hummelsberger J, Walther H U, Melchart D, Willich S N. Acupuncture in patients with osteoarthritis of the knee: a randomised trial.  Lancet. 2005;  366 136-143
  CrossrefPubMedGoogle Scholar
• 60 Yeh C H, Tsai J L, Li W, Chen H M, Lee S C, Lin C F, Yang C P. Use of alternative therapy among pediatric oncology patients in Taiwan.  Pediatr Hematol Oncol. 2000;  17 55-65
  CrossrefPubMedGoogle Scholar
• 61 Zemskov V, Prokopchuk O, Susak Y, Zemskov S, Tkachenko O, Hodysh Y, Nowicky W. Efficacy of ukrain in the treatment of pancreatic cancer.  Langenbecks Arch Surg. 2002;  387 84-89
  CrossrefPubMedGoogle Scholar
• 62 http://nccam.nih.gov/health/whatiscam/. 
  Google Scholar
• 63 http://whglibdoc.who.int/publications/2005/9 241 593 237 ref annex.pdf. 
  Google Scholar

Dr. Sven Gottschling

Universitätsklinikum des Saarlandes · Klinik für pädiatrische Hämatologie und Onkologie

Kirrbergerstraße

66421 Homburg

Phone: +49/68 41/1 62 83 99

Fax: +49/68 41/1 62 84 24

Email: kisgot@uniklinik-saarland.de