Glutamine for the treatment of vincristine-induced neuropathy in children and adolescents with cancer.

BACKGROUND: Vincristine is an integral treatment component of many childhood tumors with potentially dose-limiting sensory and/or motor neuropathy. Results from a pilot study on the incidence of vincristine-induced peripheral neuropathy (VIPN) as well as the efficacy and safety of glutamine in reducing signs and symptoms of VIPN in children with cancer are presented. METHODS: Fifty-six patients between the ages of 5-21 with newly diagnosed leukemia, lymphoma, extracranial solid tumor or medulloblastoma and expected to receive a minimum cumulative dose of 6 mg/m2 of vincristine over a 30-week period were eligible. Patients' neurological functioning was monitored every 3 weeks using clinical history, exam, and assessment of motor functioning. Upon identification of neuropathy, patients were randomized to either glutamine (6 g/m2 per dose twice daily, maximum 10 g/dose) or placebo for a 3-week period followed by 3-week wash out period (Time 3). RESULTS: Forty-nine patients were fully evaluable and 100 % developed neuropathy per study definitions. No significant differences in demographics or side effects were noted between the randomized groups. The distribution of sensory neuropathy scores between the two groups was statistically significant after the intervention (p = 0.022). Children receiving glutamine also rated their quality of life (QoL) as 8.42 points higher on the PedsQL total score than those receiving placebo (p = 0.031). CONCLUSIONS: Glutamine supplementation is well tolerated and associated with improvements in sensory function and self-reported overall quality of life. Future studies are warranted to confirm the efficacy of glutamine for the treatment of vincristine-related sensory neuropathy in pediatric cancer patients.

Use of traditional and complementary/alternative medicine (TCAM) in children with cancer in Guatemala.

BACKGROUND: International surveys have demonstrated that use of traditional and complementary/alternative medicine (TCAM) is highly prevalent among children with cancer; however, little is known about its use among children with cancer in Latin America. As part of a regional initiative, we present the results of the first survey exploring use of TCAM among children with cancer residing in Latin America. PROCEDURE: A cross-sectional sample of 100 parents whose children received treatment in Guatemala City were interviewed from May 2008 to February 2010. Upon consent, an in-person interview was performed during a routine clinical visit. Information on the form, duration, cost, and satisfaction of TCAM was collected. Approval from the institutional review board was obtained. RESULTS: The median age of patients was 9.2 years with 63% undergoing treatment. Use of TCAM was reported by 90% of parents. Most often, more than one type of therapy was utilized. Most patients (67%) relied on TCAM for supportive care indications; however, a significant percentage (34%) used TCAM for curative purposes. The most commonly reported form was the use of oral supplements with the majority perceiving TCAM as effective for the intended purpose. CONCLUSIONS: Use of TCAM was highly prevalent among children with cancer residing in Guatemala. Most importantly, TCAM was used alongside conventional therapy for supportive care indications. These findings underscoring the need for open lines of communication between clinicians and families. Future research may consider exploring the role of TCAM within the scope of supportive care and its effect on existing supportive care interventions.

Associations between healthy lifestyle behaviors and complementary and alternative medicine use: integrated wellness.

BACKGROUND: Conventional medicine, lifestyle modification, and complementary and alternative medicine (CAM) are potential strategies to decrease the risk of late effects in pediatric cancer survivors. This study aimed to compare the characteristics and usage patterns of CAM and lifestyle therapies among survivors of childhood cancer. METHODS: We report the results of a cross sectional survey comparing usage patterns of CAM and lifestyle therapies among childhood cancer survivors. CAM therapies were defined by NCCAM classifications and lifestyle therapies were defined as dietary changes, conventional supplements with dietary reference intake values, and exercise. RESULTS: One hundred fifty-five (95%) patients approached in person and 45 (34%) patients approached by mail consented to participate. Sixty-eight used at least one lifestyle therapy and 58% used at least one CAM therapy. CAM users had 4.7 times the odds of using lifestyle therapies than non-CAM users (P < .0001); the odds of using dietary change and conventional supplements was greater in CAM users than non-CAM users (odds ratio [OR] = 3.55, P < .0001 and OR = 4.80, P < .0001 respectively). Use of the top three CAM therapies was associated with overall lifestyle therapy use (OR = 12.52 and P < .0001, OR = 7.071 and P = .0004, and OR = 2.925 and P = .0089 for juicing, yoga/movement, and touch therapies, respectively). Lifestyle therapies and CAM had similar perceived efficacy (92%-90%, respectively). CONCLUSIONS: This data reports a strong association between CAM and lifestyle therapies and may identify a population with commitment to general wellness. Use of one therapy may promote use of other therapies and this potential synergistic relationship can be targeted in future interventions.

Use of complementary and alternative medicine among children, adolescent, and young adult cancer survivors: a survey study.

PURPOSE: The main objective of this study was to investigate the prevalence of complementary and alternative medicine (CAM) use, types and reasons for use, and determinants of use among survivors of childhood cancer. METHODS: An interviewer-based survey of CAM use was administered to 197 survivors or their guardians. Demographic data, CAM therapies used, purpose and referral for use, and communication about use was collected. RESULTS: A total of 115 (58%) survivors reported using CAM in survivorship, 72% of which used biologically based therapies. The majority of therapies were used for relaxation and stress management (15%), referred for use by the parent (25%), reported as very effective (62%), and initiated 0 to 4 years after completion of cancer treatment (41%). Among CAM users, young adults used manipulative and body-based therapies [odds ratio (OR)=3.3; 95% confidence interval (CI), 1.4-7.8] and mind-body therapies (OR=2.8, 95% CI: 1.2-6.4) more than children. Use of mind-body therapies was associated with not attending religious services regularly (OR=2.4; P<0.01). Half (51%) of all CAM therapies were disclosed to the physician. CONCLUSIONS: Survivors of childhood cancer frequently use CAM for health promotion and mitigation of physical and psychological conditions. Clinicians should consider the role of CAM in the adoption of healthy lifestyles among this population.

Inhalation aromatherapy in children and adolescents undergoing stem cell infusion: results of a placebo-controlled double-blind trial.

OBJECTIVE: Though often lifesaving, stem cell transplantation (SCT) is a period of great distress for both child and parent. METHODS: We conducted a double-blind, placebo-controlled randomized study evaluating the effect of the respiratory administration of bergamot essential oil on the anxiety, nausea, and pain of 37 pediatric patients with malignant and non-malignant disorders undergoing stem cell infusion and their parents. Patients were assessed at the time of recruitment, prior to infusion, upon infusion completion, and one hour post-infusion using the Spielberger State-Trait Anxiety Inventory (STAI) for parents and the STAIC, Children's Behavioral Style Scale (CBSS), visual analogue scale (VAS) for pain and nausea, and the Emotionality Activity Sociability and Impulsivity instrument (EASI) for children. RESULTS: Children and adolescents in the treatment group experienced greater anxiety (p = 0.05) and nausea (p = 0.03) one hour post-infusion. Reported pain in both groups was no longer significant one hour post-infusion. Parental anxiety declined in both groups but did not reach statistical significance. Child's monitoring coping style was significantly predictive of transitory anxiety post-infusion (p = 0.01). CONCLUSIONS: Although this trial did not report a benefit of inhalation aromatherapy for reducing anxiety, nausea, or pain when added to standard supportive care, it provides the first experimental rather than descriptive report on testing a single therapeutic essential oil among children and adolescents undergoing stem cell infusion. Future research may consider exploring the cutaneous application of essential oil through massage or other psychoeducational counseling interventions among parents with elevated anxiety and patients with greater information seeking coping styles during SCT.

The safety of acupuncture in children and adolescents with cancer therapy-related thrombocytopenia.

PURPOSE: Acupuncture is frequently used to manage the side effects associated with cancer therapy. In acupuncture practice, the presence of thrombocytopenia is a relative contraindication to acupuncture use among patients with cancer. However, the safety of acupuncture in patients with cancer treatment-related thrombocytopenia has not been previously investigated. METHODS: Medical records of 32 patients receiving acupuncture at an academic medical center with an established acupuncture program during treatment for cancer or during stem cell transplantation were reviewed. RESULTS: Of 237 acupuncture sessions, 20%, 8%, and 19% of the sessions were administered to patients with severe, moderate, and mild thrombocytopenia, respectively. No bleeding side effects were observed. CONCLUSIONS: This retrospective case series provides descriptive data on the safety of acupuncture using Japanese J-type Seirin needles, with mild manual stimulation administered at 0.5-cun depth in patients with cancer with and without thrombocytopenia. Prospective trials are needed to confirm these initial observations.

A randomized, controlled, double-blind, pilot study of milk thistle for the treatment of hepatotoxicity in childhood acute lymphoblastic leukemia (ALL).

BACKGROUND: Despite limited preclinical and clinical investigations, milk thistle (MT) is often used for the treatment of chemotherapy-associated hepatotoxicity. Limited treatment options exist for chemotherapy-related hepatoxicity. Given the wide use of MT, the authors investigated MT in both the laboratory and a clinical setting. METHODS: In a double-blind study, children with acute lymphoblastic leukemia (ALL) and hepatic toxicity were randomized to MT or placebo orally for 28 days. Liver function tests were evaluated during the study period. To assess MT in vitro, the authors evaluated supratherapeutic concentrations in an ALL cell line. RESULTS: Fifty children were enrolled. No significant differences in frequency of side effects, incidence and severity of toxicities, or infections were observed between groups. There were no significant changes in mean amino alanine transferase (ALT), aspartate amino transferase (AST), or total bilirubin (TB) at Day 28. At Day 56, the MT group had a significantly lower AST (P = .05) and a trend toward a significantly lower ALT (P = .07). Although not significantly different, chemotherapy doses were reduced in 61% of the MT group compared with 72% of the placebo group. In vitro experiments revealed no antagonistic interactions between MT and vincristine or L-asparaginase in CCRF-CEM cells. A modest synergistic effect with vincristine was observed. CONCLUSIONS: In children with ALL and liver toxicity, MT was associated with a trend toward significant reductions in liver toxicity. MT did not antagonize the effects of chemotherapy agents used for the treatment of ALL. Future study is needed to determine the most effective dose and duration of MT and its effect on hepatotoxicity and leukemia-free survival.