Contributing factors and outcomes of treatment refusal in pediatric oncology in Germany.

BACKGROUND: In Germany, about 1,800 new cases of pediatric cancer under 15 years of age are diagnosed each year and survival rates approach 80%. Although treatment is covered by health insurance and is thus available for all patients at no cost, treatment refusal and treatment discontinuation have been observed. However, no data providing numbers and outcomes for developed countries have been published thus far. PROCEDURE: A questionnaire-based survey was performed among German pediatric oncology centers to ascertain the number of treatment refusals among pediatric patients who were diagnosed between January 2008 and December 2009 in Germany. RESULTS: Questionnaires from 70 of 73 centers were available, and of these 13 centers reported a total of 15 cases of treatment refusal or discontinuation within this 2-year period. Five of the 15 patients died, 7 of 15 were still alive, and the current status of 3 of 15 patients was unknown. Diseases were heterogeneous. Six of the 15 parents refused treatment for their children initially, 8 of 15 discontinued during the course of treatment. Five patients were treated after parental custody had been withdrawn due to the lack of compliance. All these five patients survived. Parents' reasons given for refusal or discontinuation of treatment were related to personal health beliefs and coping strategies. CONCLUSIONS: Although treatment refusal or discontinuation is rare, it is accompanied by a high mortality rate. Parents' personal health beliefs play a primary role in treatment refusal or discontinuation in Germany. This emphasizes the importance of sustaining a functioning and mutually communicative physician-parent-patient relationship.

Use of homeopathy in pediatric oncology in Germany.

Homeopathy is a frequently used complementary and alternative medicine (CAM) treatment. We present results comparing responses of homeopathy users (HUs) and users of other forms of CAM (NHUs) in pediatric oncology (PO) in Germany. Differences between these two groups (usage, associated demographic characteristics, previous experience with CAM) are investigated. 186 (45.2%) of the 367 CAM users were exposed to homeopathy. The treatment duration amounted to a median of 601 days for HUs and 282 days for NHUs. Parents with p (127; 76.5%) also used homeopathy for their child's cancer. Nonmedical practitioners played a considerably greater role as source of information than did treating physician. In the majority HUs received their prescriptions from nonmedical practitioners (56%; 29.4% of NHUs). HUs communicate more frequently with their physicians about the CAM-use (77.7% versus 65.2%) and recommend CAM more often than NHUs (94% versus 85.6%). Homeopathy is the most frequently used CAM treatment in PO in Germany. HUs sustain treatment and therapies considerably longer than NHUs. Most families who had used homeopathy before their child was diagnosed with cancer also used homeopathy for the treatment of their child's cancer. Compared to other CAM treatments, patient satisfaction with homeopathy appears to be very high.

Anthroposophic medicine in paediatric oncology in Germany: results of a population-based retrospective parental survey.

BACKGROUND: Anthroposophic medicine (AM) is frequently utilised in German-speaking countries as a complementary and alternative medicine (CAM) treatment approach. PROCEDURE: This study presents results of a retrospective parental questionnaire comparing responses of AM-users and users of other CAM in paediatric oncology in Germany. The differences between these two groups are investigated with respect to usage, associated demographic characteristics and previous experience with CAM. RESULTS: Ninety-eight patients (27%) of the 367 CAM-users were exposed to anthroposophic treatments or therapies. Treatment duration amounted to a median 619 days for AM and 225 days for other CAM treatments. Most parents with previous experience of AM also used AM for treatment of their child's cancer disease. AM-users had a higher social status. Physicians played a relevant role for users of AM both in procuring information (24% vs. 11%; P < 0.001) and in prescribing medicines and therapies (73.0% vs. 34.9%; P < 0.001) compared to users of other CAM. AM-users communicate more frequently with their physicians about the use of CAM treatments (89.8% vs. 63.9%) and recommend CAM more often than other CAM-users (95.9% vs. 87%). CONCLUSIONS: AM plays a major role in paediatric oncology in Germany. Patients using AM sustain treatment and therapies considerably longer than patients using other CAM treatments. Furthermore, most families who had used AM before their child was diagnosed with cancer also used AM for the treatment of their child's cancer. Compared to other CAM treatments, patient satisfaction with AM appears to be very high.

Does honey have a role in paediatric wound management?

Topical honey treatment has been shown to possess antimicrobial properties, promote autolytic debridement, stimulate growth of wound tissues to hasten healing, and to start the healing process in dormant wounds, stimulating anti-inflammatory activity that rapidly reduces pain, oedema and exudate production. This article provides an overview of the use of honey as a medicinal substance, particularly its use in wound treatment, and reviews the published data concerning honey as a form of complementary and alternative medicine in paediatric wound management. The literature reviewed was found by searching the PubMed, BIOSIS, and ISI Web of Science databases for the term honey. Exclusion criteria were articles where honey was used in a mixture with other therapeutic substances.

Attitudes and beliefs of paediatric oncologists regarding complementary and alternative therapies.

The last decades have seen increasing patient use of complementary and alternative treatment methods (CAM) in paediatric oncology, too. However, there have been few scientific studies of paediatric oncologists' views and attitudes on CAM to date. We report the results of a cross-sectional questionnaire survey amongst paediatric oncologists in Germany. In addition to descriptive statistics, dichotomous subgroups were formed and univariate and multivariate analyses performed. There were 175 evaluable questionnaires (response rate 26.5%). Almost half of the responders (48%) had not been taught anything about CAM at medical school. Knowledge about CAM was found significantly more often in younger doctors (<43 years), in doctors who brought up the subject of CAM with the parents and in doctors working in non-university hospitals with fewer than 50 new admissions per year. A little over half of the responders (56%) had never used CAM when they had been ill themselves. Most of the doctors (78.9%) agreed fully or somewhat with the statement "CAM should be used after completion of the conventional treatment". Older doctors agreed significantly more often that CAM should be used after failure of the conventional treatment. Paediatric oncologists were worried about CAM use by their patients because of possible interactions (76%) or side-effects (65.7%), additional costs (75.4%), possible prevention or delay of conventional treatment (68%) and their own lack of competence to provide advice. The topic of CAM was raised at the first consultation by 41.1% of the responders. A wish for more continuing medical education on CAM was expressed by 85.2%. In summary, the data presented here indicate that the majority of the responding German paediatric oncologists is open towards continuing medical education on CAM, not least in the interest of becoming more competent to advise their patients. This is in contrast to the fact that German paediatric oncologists currently tend not to actively bring up the topic of CAM in their consultations with parents. Younger doctors with shorter professional experience in paediatric oncology currently have a fundamentally more positive attitude towards CAM issues.

Diastolic heart murmur, nocturnal back pain, and lumbar rigidity in a 7-year girl: an unusual manifestation of lyme disease in childhood.

A 7-year-old girl presented with nocturnal pain in her back and legs. The physical examination revealed a loud opening sound of the mitral valve and lumbar rigidity. With the exception of significantly increased anti-nuclear antibody (ANA) levels, the immunological findings did not show any other abnormal parameters, also spinal magnetic resonance imaging (MRI) and ultrasound examination of the abdomen and pelvis yield no pathological findings. The lumbar puncture showed a lymphocytic pleocytosis as well as an intrathecal synthesis of Borrelia-specific antibodies. Echocardiography showed a thickened mitral valve with mild regurgitation. No other signs of florid endocarditis or myocarditis could be detected. Due to these findings, the diagnosis Lyme neuroborreliosis was made and an intravenous antibiotic therapy was given. The clinical symptoms subsided. Six months later, she had an almost normal mitral valve with only trivial mitral insufficiency. The association between the lumbar rigidity and the thickened mitral valve remains unclear. The case of our patient with nocturnal back and leg pain may be considered a rare case of Lyme neuroborreliosis with meningoradiculitis in children, and to our knowledge these symptoms together with cardiac involvement, such as a significantly thickened mitral valve, have not yet been described in the literature.