A comprehensive definition for pediatric integrative oncology through an international consensus
Suzi Tortora, Nirupa J. Raghunathan, Georg Seifert, Erica Maria Smit Sibinga, Ricardo Ghelman
Complementary Therapies in Medicine: Special Issue: Integrative Pediatrics
"The Society of Integrative Oncology (SIO), is a leading international organization focusing on complementary and integrative, evidence-informed cancer care practices that promote physical, mental, psychological and spiritual health for all family members at all stages of treatment. SIO organized a Pediatrics Special Interest Group (SIG) in 2017 to advance the field of pediatric integrative oncology by promoting awareness of practices that may prevent or reduce the side effects of cancer and its treatment for children, adolescents and young adults, from diagnosis through survivorship or palliative care. Members of…"
The diagnosis of cancer is overwhelming at any stage of life. Receiving this diagnosis during childhood, adolescence or young adulthood – periods marked by essential and complex developmental stages that set the trajectory for the rest of life – adds unique challenges that complicate cancer treatment. Without mature coping skills in place, pain, physical weakness and emotional suffering can be overpowering for this population. Pediatric patients demonstrate significant reactions to symptoms including high levels of insomnia, fatigue and pain during active treatment, as well as long-term physical and psychological sequelae and late effects, with pediatric medical trauma stress that can endure for many years after the completion of treatment. 1,2 Globally, childhood cancer is the sixth leading cause of total cancer burden and the ninth leading cause of childhood disease burden. The global incidence is 416,500, with an absolute mortality of 142,300 deaths and a global burden of 11.5 million (95% CI 10.6–12.3 million) disability-adjusted life-years due to childhood cancer. 3 The strain and responsibility a pediatric cancer diagnosis places on caregivers and other family members who already play an integral role in a child’s life suggests that they also need support during this stressful period. With such compounded issues, optimizing physical and emotional symptom management to support the pediatric patient and their families during, between and after medical treatment of the disease is a crucial aspect of comprehensive cancer care. 4,5
Advances in conventional cancer therapy over the past 30 years have resulted in significantly improved prognosis and reduced mortality in 80–90% of pediatric oncologic patients. Therefore, recent focus has been on improving quality of life and mitigation against adverse effects and negative sequelae, with a growing use of complementary and integrative treatment approaches. The demand for these complementary therapies has been reported with a wide variation from 12% in Italy to 85% in Southwest Asia. 6,7 Integrative Medicine (IM) is of growing interest in the context of pediatric cancer treatment and is uniquely positioned to provide services to the patient and family members during all phases of cancer treatment and aftercare. In IM, patient-centered complementary and conventional therapies are well-coordinated with the oncologists and other members of the medical team to treat both physical and psychological symptoms. 8, 9, 10
The Society of Integrative Oncology (SIO), is a leading international organization focusing on complementary and integrative, evidence-informed cancer care practices that promote physical, mental, psychological and spiritual health for all family members at all stages of treatment. SIO organized a Pediatrics Special Interest Group (SIG) in 2017 to advance the field of pediatric integrative oncology by promoting awareness of practices that may prevent or reduce the side effects of cancer and its treatment for children, adolescents and young adults, from diagnosis through survivorship or palliative care. Members of this group from North America, Europe and South America, through an iterative process, created the following definition to underscore the scope and practice of pediatric integrative oncology:
“Pediatric Integrative Oncology provides a relationship-centered, evidence-informed personalized approach to the whole child and family system utilizing mind and body practices, natural products and/or lifestyle modifications alongside conventional oncology care. Pediatric Integrative Oncology is offered throughout the illness trajectory to optimize health and wellness, enhance healing, minimize suffering, improve quality of life and empower children and families to become active participants before, during, and beyond cancer treatment.”
Though a complete explanation of these practices goes beyond the scope of this Editorial, it includes: the creative arts therapies such as dance/movement psychotherapy, 11,12 music therapy 13,14 and art therapy 15; adaptive martial arts & fitness 16; mind/body therapies 17,18 such as relaxation and guided imagery, 19 mindfulness-based practices, 20 yoga 21; acupuncture/acupressure 22; massage, touch therapies and external therapies 22,23; animal-assisted therapy 24; nutrition and dietary supplements 25 and whole medical system approaches like anthroposophic medicine and Ayurveda. 26, 27, 28, 29
As a relatively new field, research evidence to support the use of IM in adult oncology has led to these therapies to be included in practice guidelines. 30,31 Developing a research base for IM is more challenging in the pediatric oncology field. The rarity of pediatric cancers and their heterogeneity can complicate recruitment to studies. Studies must also navigate the complexities of variation in developmental stages in study design as well as caregiver involvement in consent. Despite these challenges, there is a growing body of quality research showing the benefits of IM therapies in pediatric oncology populations 22,32 and serves as a foundation for much-needed research to come. In 2013 a comprehensive text summarized the scientific status of integrative pediatric oncology at that time, serving as an important resource. 33
In the pediatric oncology population, IM can provide critical supportive care during a very challenging period for both the patient as well as caregivers. We join the SIO in advocating for continuing medical education in IM therapies, support for IM program access and increasing high-quality research for IM therapies in pediatric oncology patients. The important areas of education, access, and research are aimed at developing evidence-informed guidelines for the use of IM therapies in pediatric oncology patients, for the benefit of the whole child and family system affected by cancer and cancer treatment.
We would like to thank the following members of the SIO Pediatrics SIG for their contributions to the iterative process of defining Pediatric Integrative Oncology (in alphabetical order):
Ricardo Ghelman, MD PhD - Instituto de Tratamento do Câncer Infantil (ITACI), Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Tracey Jubelirer, MD – Children’s Hospital of Philadephia, Philadephia, PA USA
Jennifer Pope, MD - Levine Children’s Cancer & Blood Disorders, Charlotte, NC USA
Nirupa Raghunathan, MD MS – Memorial Sloan Kettering Cancer Center, New York, NY USA
Holly Spraker-Perlman, MD MS – St. Jude Children’s Research Hospital, Memphis, TN USA
Amii Steele, PhD – Levine Children’s Cancer & Blood Disorders, Charlotte, NC USA
Suzi Tortora Ed. D LCAT - Memorial Sloan Kettering Cancer Center, New York, NY USA
Acknowledgment
This work is supported in part by grants from the National Cancer Institute / National Institutes of Health (P30-CA008748), The Translation and Integrative Medicine Research Fund, The Andréa Rizzo Foundation, Software AG–Stiftung.
A comprehensive definition for pediatric integrative oncology through an international consensus, Complementary Therapies in Medicine, Volume 57, 2021, 102678, ISSN 0965-2299, https://doi.org/10.1016/j.ctim.2021.102678
https://www.sciencedirect.com/science/article/pii/S0965229921000194