Mothers’ Attitudes toward the Use of Complementary and Alternative Medicine in Children with Cancer

AUTHORS

Atena Dadgari 1 , Imane Bagheri 2 , Naiire Salmani 1 , * , Mahnaz Mirakhor 3

1 Nursing Faculty, Meybod Nursing School, Shahid Sadoughi University, Yazd, Iran

2 PhD Student in Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

3 Pediatric Oncology Nurse, Shahid Sadoughi Hospital, Yazd, Iran

How to Cite: Dadgari A, Bagheri I, Salmani N, Mirakhor M. Mothers’ Attitudes toward the Use of Complementary and Alternative Medicine in Children with Cancer, Int J Cancer Manag. 2020 ; 13(10):e104870. doi: 10.5812/ijcm.104870.

ARTICLE INFORMATION

International Journal of Cancer Management: 13 (10); e104870
Published Online: October 30, 2020
Article Type: Research Article
Received: May 12, 2020
Revised: August 19, 2020
Accepted: August 20, 2020
Crossmark
Crossmark
CHECKING
READ FULL TEXT

Abstract

Background: Children who have cancer suffer from a wide range of symptoms and side-effects of disease and treatment, and such conditions have harmful effects on the quality of life of a child and family. So, the families of such children turn to complementary and alternative medicine treatments for children with cancer.

Objectives: Therefore, this study aimed at determining the mothers’ attitudes toward the use of complementary and alternative medicine in children with cancer.

Methods: This cross-sectional research was conducted from January 2018 to January 2019 in the oncology section of Yazd Shahid Sadooghi Hospital in a nonrandom and convenience sampling method on 150 mothers of children with cancer. The instruments of data collection include demographic information questionnaires and a 6-part questionnaire to evaluate mothers’ performance. To investigate the face and content validity of the questionnaire, the opinions of 10 experts were considered, and to investigate the reliability of the questionnaire, the test-retest method was used, and the intraclass correlation coefficient (ICC) was reportedly 0.80. After completing the questionnaires, the collected data were analyzed, using SPSS 23 by utilizing descriptive statistics, including mean, standard deviation (SD), frequency, and percent.

Results: Overall, 83.34% of mothers mentioned praying as a way of complementary and alternative medicine, 67.34% used complementary and alternative medicine to increase child recovery chance, 74% reported general child recovery, 20% reported the occurrence of side-effects following the use of complementary and alternative medicine, 67.33% introduced their friends as their information source, 33.6% avoided informing the physician regarding the use of complementary and alternative medicine, and 76% maintained that due to the objection of physicians, they avoided informing him/her.

Conclusions: The use of complementary and alternative medicine is common among mothers but due to the occurrence of side-effects, using invalid information sources and hiding it from a physician, the oncologists must provide a suitable opportunity for asking and answering to guide mothers for correct performance in the use of complementary and alternative medicine.

1. Background

Concurrent with healthcare progression, the number of children who live with chronic and threatening diseases is increased (1). Cancer is one of the common chronic and children’s life-threatening diseases in developing nations (2) and the prevalence of this disease is increasing among children and teenagers annually (0.7% per year), but its mortality has been decreased from 1975 to 2017 (from 6.3 per 100 000 children to 2 and from 7.1 per 100 000 teenagers to 2.7) (3).

Cancer prevalence has ascending trend in childhood from 1990 to 2016 in Iran so that from 10.1 per 100 000 children under 15 increased to 11.9; the most common cancers include leukemia, malignant nervous system, and lymphoma (4). This disease, with its different types, has extraordinary effects during childhood rather than other chronic diseases (5). It has a challenging nature and its unpredictable results follow uncertainty, mental-affective, and emotional disorders from diagnosis until treatment and follow-up (6).

Children suffering from cancer suffer from a wide range of symptoms and side-effects of disease and treatment (7), and such conditions will have harmful effects on the quality of life of children and family (8). So, the families of such children turn to complementary and alternative medicine treatments. These types of treatments consist of theoretical beliefs and a practical set of methods, which are employed for disease prevention and treatment or for enhancing health and improving general health, as well as conventional medicine treatments (as complementary medicine) or instead of conventional treatments (alternative medicine) (9).

Reflexology, spiritual/religion, food supplements, aromatherapy, music therapy, traditional Chinese medicine, massage, pet therapy, special diet, Reiki, vitamins, counseling, massage therapy, Shiatsu massage, healing touch, minerals, acupuncture, herbs and supplements, relaxation therapy, yoga, hypnosis, and biofeedback are among the types of complementary and alternative medicine (10). Nowadays, different types of complementary and alternative medicine have been widely used among children suffering from cancer, and studies have reported different results (11).

This difference has various reasons, including the absence of a common definition for complementary and alternative medicine, the difference in the quality of studies and research methodology, the cultural and ethnic differences (12).

However, complementary and alternative medicine treatments have not been investigated scientifically, and so far they have not been scientifically confirmed regarding immunity and effectiveness (13). The effects of using complementary and alternative medicine treatments have not been diagnosed on the quality of cancer care and treatment during childhood (11).

Some of these methods including herbal supplements and antioxidants may intervene in routine medical treatments or may decline chemotherapy medicines effectiveness (14) or also cause digestion side-effects including diarrhea, decreased appetite, nausea and vomiting and constipation (15), stomach pain, and upset stomach (16) and some these products may intervene in chemotherapy medicines and stimulate the growth of malignant tissues and bring toxic effects (17). Sometimes, these methods may cause parents’ self-management, which breaks child medical treatment by parents earlier than standard treatment (18). Consequently, the child suffering from cancer may lose the opportunity to take advantage of scientific treatments or may delay taking advantage of standard medical treatments on time (19).

Despite the overestimation of these effects, the findings of studies show that mothers tend to use complementary and alternative medicine for children with cancer; in Turkey, 73.3% of parents (20), in Indonesia 80% of parents (21), and in Switzerland, 53% of parents (22) use complementary and alternative medicine for their children suffering from cancer.

In Iran, because it is an old country and has its own traditional medicine, complementary medicine plays an important role in Iranian culture and many Iranians use a variety of complementary medicine methods during the disease (23).

2. Objectives

Thus, focusing on the limitations of studies conducted in Iran concerning parents’ performance in the field of complementary and alternative medicine for their children suffering from cancer and the importance of investigation in this field, the present study aims at determining mothers’ attitudes toward the use of complementary and alternative medicine in children with cancer.

3. Methods

After the approval of the Research Ethics Committee of Yazd Shahid Sadooghi Medical Sciences University, this cross-sectional research was conducted on mothers with children suffering from cancer in the oncology section of Yazd Shahid Sadooghi Medical Educational Hospital. Nonrandom and convenience sampling started from January 5th, 2018 to January 5th, 2019, and the number of samples was estimated at 150 individuals according to the study of Bordbar et al. (24).

The inclusion criteria consist of mother’s satisfaction for participating in the study, being the main caregiver of the child, being able to communicate and talk in Persian, having a child suffering from cancer with registered diagnosis, being literate, and passing at least 3 months from child disease diagnosis and treatment commenced.

The exclusion criteria consist of the mother with a child in the last stages of life, the mother with a child with various diseases (having diseases except for cancer including childhood diabetes, asthma, cerebral palsy, etc.), the mother with registered mental disorders and under treatment, and those who did not complete the questionnaires.

The researcher went to the pediatric oncology department and the mothers, who had a child with cancer in the ward, entered the study if they met the inclusion criteria. At the beginning of the study, the researcher expressed the objectives of the study and satisfied the samples orally and in the documented form, and presented enough explanations about the questionnaire. The researcher, then, asked the mother to accurately answer the questions.

The instruments of data collection in this study include demographic questionnaire (child’s age and gender, mother’s age, education, occupation, economic status, and being local), clinical condition questionnaire (the type of disease, suffering duration, type of received diseases, number of hospitalizations, and disease relapse), and researcher-made 6-part questionnaire to investigate mother’s performance regarding the complementary and alternative medicine. It is noteworthy that items were extracted with a literature review.

The first part includes using or not using complementary and alternative medicine and reasons for using. The second part includes different types of complementary and alternative medicine. The third part includes the advantages of using complementary and alternative medicine. The fourth part includes the side-effects of complementary and alternative medicine. The fifth part includes sources, to which individuals refer to obtain information about complementary and alternative medicine, and the sixth part includes informing the child by the oncologist about using complementary and alternative medicine and reasons for informing the child by the oncologist.

There are some options for answering in each part that the responder may choose one or more than one option, or she may register her answer if there is an answer except the existing options through the “mention if there is another item” option.

To investigate the face and content validity of the questionnaire, the opinions of 10 experts (PhD professors of nursing [n = 6], oncologists [n = 2], and nurse of oncology department [n = 2]) were considered to find the level of difficulty, incompatibility, the ambiguity of expressions or insufficiency in word meanings and their comments were applied as minor changes to the questionnaire.

To investigate the reliability of the questionnaires, the test-retest method was used. Ten mothers with inclusion criteria completed the questionnaires; after a week, the mothers completed the questionnaires and the intraclass correlation coefficient (ICC) was calculated 0.80 between these two periods, and the reliability of the questionnaire was approved.

The data were analyzed by SPSS (V 23), utilizing descriptive statistics, including mean, standard deviation (SD), frequency, and percent.

4. Results

During the study, 150 samples were included in the study. Table 1 presents the findings related to the demographic variables of mothers and children.

Table 1. Demographic Variables; Frequency of Children Suffering From Cancer and Mothersa
VariablesValues
Locality
Yes 78 (52)
No 72 (48)
Gender
Girl 70 (46.66)
Boy 80 (53.34)
Disease type
All94 (62.66)
Aml20 (13.34)
Neuroblastoma 13 (8.66)
Nephroblastoma 5 (3.34)
Sarcoma 5 (3.34)
Lymphoma 13 (8.66)
Disease relapse
Yes 30 (20)
No 120 (80)
Suffering duration, y
< 164 (42.66)
1 - 3 72 (48)
4- 612 (8)
> 62 (1.33)
Hospitalization times
1 - 3 times 8 (5.33)
4 - 6 times 38 (25.34)
7 - 10 times18 (12)
> 10 years86 (57.33)
Types of received medical treatments
Chemotherapy 75 (50)
Chemotherapy + radiotherapy 38 (25.34)
Chemotherapy + surgery27 (18)
Chemotherapy + surgery + radiotherapy 10 (6.66)
Mother education
Below diploma54 (36)
Diploma 56 (37.34)
BA37 (24.66)
MA3 (2)
Mother occupation
Housewife 123 (82)
Employee 24 (16)
self-employment3 (2)
Economic status
Poor 38 (25.34)
Medium 99 (66)
Good 13 (8.66)

Abbreviation: ALL, acute lymphocytic leukemia; AML, acute myeloid leukemia.

aValues are expressed as No. (%).

In the first part of the questionnaire (using or not using complementary and alternative medicine and related reasons), 100% of samples have used complementary and alternative medicine, in which 16.66% (25) mentioned only praying and 83.34% (125) mentioned other ways. As 3 reasons with the most frequency, 67.34% (101) used complementary and alternative medicine to increase child recovery chance, 62% (93) to reduce treatment side-effects, and 51.33% (77) to improve the immunity system.

In the second part of the questionnaire (types of complementary and alternative medicine methods), as 3 ways with the most frequency, 100% (150) appealed to praying, 86.66% (130) used herbal products, and 65.33% (99) consumed vitamins and minerals.

In the third part of the questionnaire (advantages of using complementary and alternative medicine), as 3 advantages, 74% (111) used complementary and alternative medicine for the child’s general health improvement, 57.33% (86) for physical condition improvement, and 53.33% (80) for removing treatment side-effects.

In the fourth part of the questionnaire (side-effects of using complementary and alternative medicine), 20% (25) of mothers reported the occurrence of side-effects following the use of complementary and alternative medicine, among which 3 common side-effects included 12.8% (16) diarrhea, 4.8% (6) vomiting, and 3.2% (4) skin rash.

In the fifth part of the questionnaire (investigating sources that mothers have used them to obtain information about complementary and alternative medicine), the findings showed that 67.33% (101) selected friends, 62% (93) selected family, 52% (78) were informed based on their previous experiences, and 39.33% (59) selected Internet as the main source to obtain the information.

In the sixth part of the questionnaire (informing pediatric oncologist to use complementary and alternative medicine for the child), 66.4% (83) informed the physician and 33.6% (42) avoided informing the physician; 76% (32) have mentioned fear from physician objection and 40.47% (17) mentioned that the physician does not have time to talk about complementary and alternative medicine.

Table 2 presents the findings related to the mothers’ performance concerning complementary and alternative medicine.

Table 2. Frequency of Mothers’ Performance Questionnaire Concerning the Use of Complementary and Alternative Medicine for Children Suffering From Cancera
VariablesValues
Using CAM
Yes150 (100)
No 0 (0)
CAM using reasons
Increasing recovery chance101 (67.33)
Reducing treatment side-effects93 (62)
Reinforcing immune system77 (51.33)
Prevention from disease relapse66 (44)
Pain relief53 (35.33)
Removing toxins from the body50 (33.33)
Improving mental status45 (30)
Participation in treatment37 (24.66)
Uncertainty to medical treatments8 (5.3)
Different types of CAM
Appealing to praying100 (100)
Using herbal products 130 (86.66)
Consuming vitamins and minerals73 (48.66)
Massage39 (26)
Energy therapy38 (25.33)
Art therapy32 (21.33)
Relaxation6 (4)
Aromatherapy3 (6.38)
Yoga 3 (6.38)
Acupuncture 3 (6.38)
Biofeedback3 (6.38)
Healing touch3 (6.38)
Homeopathy0 (0)
CAM advantages
Child’s general health improvement111 (74)
Physical condition improvement86 (57.33)
Removing disease side-effects80 (53.33)
Improving spiritual condition73 (48.66)
Fast response to treatment73 (48.66)
Pain reduction 70 (46.66)
Short hospitalization period54 (36)
Reducing the number of hospitalization45 (30)
CAM side-effects
Diarrhea16 (12.8)
Vomiting6 (4.8)
Skin rash4 (3.2)
Dyspnea3 (2.4)
Frequent urination3 (2.4)
Information sources
Friends101 (67.33)
Family93 (60)
One’s previous experiences78 (52)
Internet59 (39.33)
Not informing oncologist
Fear from physician’s objection32 (76)
Physician not having time for talking17 (33.6)
CAM not being important for the physician13 (30.95)
Physician ignorance of CAM3 (7.14)

Abbreviation: CAM, complementary and alternative medicine.

aValues are expressed as No. (%).

5. Discussion

Concern about complementary and alternative medicine applications is gradually increasing in the world. This interest is particularly pronounced in patients with cancer. This study aimed at determining the mothers’ attitudes regarding the use of complementary and alternative medicine for children with cancer.

The findings revealed that 100% of mothers had used complementary and alternative medicine for children with cancer, among whom 83.9% mentioned praying and 86.66% used herbal products. This result is in line with the study of Al-Qudimat et al. (25), who maintained that 100% of families with children suffering from cancer pray for their children. In some countries like Turkey, 73.3% of parents (20) and in Indonesia 80% of parents (21) maintained the use of complementary and alternative medicine for their children suffering from cancer, but some other countries reported less percent rather than the present study; for example, in Switzerland, 53% of parents (22) and in Germany, 31% of parents (12) reported the use of complementary and alternative medicine for the children, who suffer from cancer.

Reviewing the results show that the use of complementary and alternative medicine is spreading among children suffering from cancer between 6% and 91% (11), and the difference in reports may be due to different cultural backgrounds (12). In Iran, the high use of plant materials can be due to people’s satisfaction with the effects of these substances, the availability of herbal medicine companies, the ease of using herbal products, the breadth of information on herbal products, and, ultimately, the country’s policy. Iran encourages people to start using herbal products for economic reasons and reduced dependence (26).

Three popular reasons for increasing child recovery chance, reducing treatment side-effects, and improving the immune system have been mentioned among the reasons for complementary and alternative medicine use. In line with this result, Magi et al. (22) have introduced improving a child’s general health. Gottschling et al. (12) mentioned reducing treatment side-effects, improving the immune system, physical condition stability, and increasing recovery chance. O’Connor et al. (27) introduced physical condition improvement. Bishop et al. (11) introduced freeing from treatment side-effects and Naja et al. introduced the immune system and increasing recovery chance (15) as parents’ main reasons for turning to complementary and alternative medicine.

Among the different ways of complementary and alternative medicine, prayer therapy has been mentioned as the most popular method. This study is in line with the study of Post-White et al. (28) in Minnesota, in which parents have introduced prayer therapy as the first way for their children suffering from cancer. Also, in Greece, praying has been mentioned as the most common way for parents interference for children in the oncology section so that parents appealed to praying and doing religions sacred rituals and expected good results by collecting holy images, cross and holy stick and putting them under child’s pillow (29). In Lebanon, parents prayed for their children suffering from leukemia and mentioned this as a common tradition (15). The tendency toward religion and spirituality is more obvious during illness more than any other time and when a human feels that his life is at risk, s/he appeals to praying, which is a link between him/her and God (30). In Iranian society, the present findings are an expected result because of the rich religious beliefs and daily payers as external demonstrations of these beliefs.

Using herbal products is the second way used by mothers, which is in line with the study conducted in Turkey that the majority of parents have mentioned the use of herbal products like grape syrup and herb pollens (20). In Lebanon, also, the use of different herbal products including nigella seeds, green tea, and rosemary is the most popular way reported by parents (15). In some other studies, the use of herbal products has not been mentioned as the parents’ priority (12, 22), and this is due to geographical region diversity (31) and cultural-social differences existing in different populations of study (12).

Using vitamins and minerals is the third used method by mothers, which is in line with different studies (Connor- Seven- Bordbar- Janis), and the reason for the popularity of vitamins and minerals may be accessibility, easy providing, and low cost of these supplements (32).

It is worth mentioning that other ways, including massage therapy, energy therapy, and art therapy have been mentioned less than other ways, and few mothers have used some others like aromatherapy, acupuncture, yoga, healing touch, and relaxation. The use of homeopathy has never been mentioned, and this is because different methods of complementary and alternative medicine are unknown in the cultural-social background of the present Iranian society. Some others are inaccessible so that in Germany, homeopathy has been considered a well-known and popular method among people as the first choice of parents among different ways of complementary and alternative medicine (33).

Thus, differences in the selected patterns may be influenced by local, national, and academic level diversities (34). Also, other factors such as harmfulness, expensiveness, unpopularity, and ineffectiveness of complementary and alternative medicine methods may influence the selection of these methods (35).

The advantages that mothers have mentioned following the use of different ways of complementary and alternative medicine in sick children are child’s general recovery, physical condition improvement, and removing treatment side-effects. The findings of the study conducted by Al-Qudimat et al. (25) showed that 45.5% of families observed advantages following the use of complementary and alternative medicine in sick children. Gottschling et al. (12) maintained that 65% of children and 55% of teenagers, who used complementary and alternative medicine, had experienced its advantages. Isaac-Otero et al. (18) mentioned physical condition improvement, prevention from toxicity, tumor growth stoppage, immune system reinforcement, and pain relief as the advantages of complementary and alternative medicine use (18), and these findings are consistent with the present results.

Investigating the side-effects of complementary and alternative medicine use showed that diarrhea, vomiting, and skin rash are among the experienced side-effects. In line with these results, Isaac-Otero et al. (18) revealed that 20% of families observed diarrhea, vomiting, skin reactions, and fever in children following the use of complementary and alternative medicine. In contrast, Clerici et al. (36) said that parents reported no side-effects and this difference might be due to the used methods that herbal products have been the most common way after praying in the current study; whereas, in the study conducted by Clerici et al. (36), homeopathy has been the most popular method used by parents.

The sources that mothers have used to get informed about complementary and alternative medicine include friends, family, previous experiences, and the Internet. The literature review showed neighbors and relatives in Turkey (37), and family and neighbors in southern Iran are among the sources that inform about complementary and alternative medicine, which are in line with the present study. As information of family and neighbors are confusing instead of being useful, individuals have to obtain information and guides about complementary and alternative medicine from the physicians (38).

Regarding informing the child’s oncologist about the use of complementary and alternative medicine for the child suffering from cancer, the majority of mothers informed the physician, and some of them who have avoided informing the physician maintained fearing from physician and physician’s lack of time to talk with them about complementary and alternative medicine as their reasons.

In line with these results, Post-White et al. (28) also argued that most of the parents inform healthcare providers about the use of complementary and alternative medicine. Those parents who have hidden this matter maintained that healthcare providers not asking parents about complementary and alternative medicine, providers’ ignorance of complementary and alternative medicine, and not being supported by healthcare providers are the reasons for such avoidance. The most important problem, which follows this avoidance, is the probable interference between medical treatment and complementary and alternative medicine interventions, especially following the use of herbal products and supplements, of which the physicians have to be informed (28). However, parents avoid counseling about the problem that the physicians may be pessimistic about complementary and alternative medicine and they are worried that what the physician’s answer will be. Hence, physicians must always provide an atmosphere for talking to motivate parents to ask and answer about complementary and alternative medicine and to receive physicians’ opinions (35).

The study had limitations such as the available sampling method, the location of the sampling (an oncology center), the use of a self-reported questionnaire, and the possibility of bias reminders about the use of complementary and alternative medicine methods.

5.1. Conclusions

All mothers used prayer therapy and the majority of mothers used herbal products, citing the increase in the child’s chances of recovery as the main reason for using complementary and alternative medicine methods. In most cases, they saw an improvement in the child’s general condition. The side-effects were gastrointestinal. Mothers introduced their friends as a source of information, often informing the oncologist about the use of complementary and alternative medicine, and fear of the oncologist’s opposition was a major obstacle to awareness.

Therefore, by focusing on the prevalence of the use of complementary and alternative medicine, the mentioned side-effects, the resources used, and not informing the oncologists in some cases, oncologists must provide a discussion opportunity for parents in the field of using complementary and alternative medicine and present correct information and refer them to experts in such domains. Through creating a suitable team communication with active experts in the field of complementary and alternative medicine, the oncologists must design and operate planned measures compatible with the medical treatments process to help merge this type of treatment with the medical treatment process without any side-effect for children suffering from cancer and also achieve the presupposed goals.

Acknowledgements

Footnotes

References

  • 1.

    Bogetz JF, Schroeder AR, Bergman DA, Cohen HJ, Sourkes B. Palliative care is critical to the changing face of child mortality and morbidity in the United States. Clin Pediatr (Phila). 2014;53(11):1030-1. doi: 10.1177/0009922814534767. [PubMed: 24817074].

  • 2.

    Panganiban-Corales AT, Medina MJ. Family resources study: part 1: family resources, family function and caregiver strain in childhood cancer. Asia Pac Fam Med. 2011;10(1):14. doi: 10.1186/1447-056X-10-14. [PubMed: 22040272]. [PubMed Central: PMC3233495].

  • 3.

    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7-30. doi: 10.3322/caac.21590. [PubMed: 31912902].

  • 4.

    Shabani M, Saeedi Moghaddam S, Ataeinia B, Rezaei N, Mohebi F, Mohajer B, et al. Trends of National and Subnational Incidence of Childhood Cancer Groups in Iran: 1990-2016. Front Oncol. 2019;9:1428. doi: 10.3389/fonc.2019.01428. [PubMed: 31993366]. [PubMed Central: PMC6970968].

  • 5.

    Perrin JM, Anderson LE, Van Cleave J. The rise in chronic conditions among infants, children, and youth can be met with continued health system innovations. Health Aff (Millwood). 2014;33(12):2099-105. doi: 10.1377/hlthaff.2014.0832. [PubMed: 25489027].

  • 6.

    Carreira H, Williams R, Muller M, Harewood R, Stanway S, Bhaskaran K. Associations Between Breast Cancer Survivorship and Adverse Mental Health Outcomes: A Systematic Review. J Natl Cancer Inst. 2018;110(12):1311-27. doi: 10.1093/jnci/djy177. [PubMed: 30403799]. [PubMed Central: PMC6292797].

  • 7.

    Lee ES, Lee MK, Kim SH, Ro JS, Kang HS, Kim SW, et al. Health-related quality of life in survivors with breast cancer 1 year after diagnosis compared with the general population: a prospective cohort study. Ann Surg. 2011;253(1):101-8. doi: 10.1097/sla.0b013e3181f662ce. [PubMed: 21294288].

  • 8.

    Wiebe LA, Von Roenn JH. Working with a palliative care team. Cancer J. 2010;16(5):488-92.

  • 9.

    World Health Organization. WHO global report on traditional and complementary medicine in 2019. Geneva: WHO; 2019.

  • 10.

    Cho WC. Evidence-based anticancer complementary and alternative medicine. Springer; 2011.

  • 11.

    Bishop FL, Prescott P, Chan YK, Saville J, von Elm E, Lewith GT. Prevalence of complementary medicine use in pediatric cancer: a systematic review. Pediatrics. 2010;125(4):768-76. doi: 10.1542/peds.2009-1775. [PubMed: 20308209].

  • 12.

    Gottschling S, Gronwald B, Schmitt S, Schmitt C, Langler A, Leidig E, et al. Use of complementary and alternative medicine in healthy children and children with chronic medical conditions in Germany. Complement Ther Med. 2013;21 Suppl 1:S61-9. doi: 10.1016/j.ctim.2011.06.001. [PubMed: 23578919].

  • 13.

    Singendonk M, Kaspers GJ, Naafs-Wilstra M, Meeteren AS, Loeffen J, Vlieger A. High prevalence of complementary and alternative medicine use in the Dutch pediatric oncology population: a multicenter survey. Eur J Pediatr. 2013;172(1):31-7. doi: 10.1007/s00431-012-1821-6. [PubMed: 22991098].

  • 14.

    Yasueda A, Urushima H, Ito T. Efficacy and Interaction of Antioxidant Supplements as Adjuvant Therapy in Cancer Treatment: A Systematic Review. Integr Cancer Ther. 2016;15(1):17-39. doi: 10.1177/1534735415610427. [PubMed: 26503419]. [PubMed Central: PMC5736082].

  • 15.

    Puataweepong P, Sutheechet N, Ratanamongkol P. A survey of complementary and alternative medicine use in cancer patients treated with radiotherapy in Thailand. Evid Based Complement Alternat Med. 2012;2012:670408. doi: 10.1155/2012/670408. [PubMed: 22474513]. [PubMed Central: PMC3296367].

  • 16.

    Berretta M, Della Pepa C, Tralongo P, Fulvi A, Martellotta F, Lleshi A, et al. Use of Complementary and Alternative Medicine (CAM) in cancer patients: An Italian multicenter survey. Oncotarget. 2017;8(15):24401-14. doi: 10.18632/oncotarget.14224. [PubMed: 28212560]. [PubMed Central: PMC5421857].

  • 17.

    Demain AL, Vaishnav P. Natural products for cancer chemotherapy. Microb Biotechnol. 2011;4(6):687-99. doi: 10.1111/j.1751-7915.2010.00221.x. [PubMed: 21375717]. [PubMed Central: PMC3815406].

  • 18.

    Isaac-Otero G, Molina-Alonso D, Asencio-López L, Leal-Leal C. The use of alternative or complementary treatment in pediatric oncologic patients: Survey of 100 cases in a level III attention institute. Gaceta Médica de México. 2016;152(1):7-12.

  • 19.

    Ozcebe H, Sevencan F. Evaluation of researches about complementary and alternative medicine in children. J Pediatr Health Dis. 2009;52:183-94.

  • 20.

    Karali Y, Demirkaya M, Sevinir B. Use of complementary and alternative medicine in children with cancer: effect on survival. Pediatr Hematol Oncol. 2012;29(4):335-44. doi: 10.3109/08880018.2012.670368. [PubMed: 22568796].

  • 21.

    Ben-Arye E, Frenkel M, Klein A, Scharf M. Attitudes toward integration of complementary and alternative medicine in primary care: perspectives of patients, physicians and complementary practitioners. Patient Educ Couns. 2008;70(3):395-402. doi: 10.1016/j.pec.2007.11.019. [PubMed: 18201857].

  • 22.

    Magi T, Kuehni CE, Torchetti L, Wengenroth L, Luer S, Frei-Erb M. Use of Complementary and Alternative Medicine in Children with Cancer: A Study at a Swiss University Hospital. PLoS One. 2015;10(12). e0145787. doi: 10.1371/journal.pone.0145787. [PubMed: 26694320]. [PubMed Central: PMC4687920].

  • 23.

    Behnood-Rod A, Afzali Poor Khoshkbejari M, Pourzargar P, Hassanzadeh M, Moharamzad Y, Foroughi F. Complementary and alternative medicine use among Iranian patients attending urban outpatient general practices. Complement Ther Clin Pract. 2018;30:58-63. doi: 10.1016/j.ctcp.2017.12.008. [PubMed: 29389480].

  • 24.

    Bordbar M, Kamfiroozi R, Fakhimi N, Jaafari Z, Zarei T, Haghpanah S. Complementary and alternative medicine in pediatric oncology patients in South of Iran. Iran J Pediatr Hematol Oncol. 2016;6(4):216-27.

  • 25.

    Al-Qudimat MR, Rozmus CL, Farhan N. Family strategies for managing childhood cancer: using complementary and alternative medicine in Jordan. J Adv Nurs. 2011;67(3):591-7. doi: 10.1111/j.1365-2648.2010.05517.x. [PubMed: 21118291].

  • 26.

    Hosseini E; Mahmoudian A. Using Complementary and Alternative Medicine in Multiple Sclerosis. J Isfahan Med Sch. 2015;32(320):2501-10.

  • 27.

    O'Connor N, Graham D, O'Meara A, Devins M, Jennings V, O'Leary D, et al. The use of complementary and alternative medicine by irish pediatric cancer patients. J Pediatr Hematol Oncol. 2013;35(7):537-42. doi: 10.1097/MPH.0b013e31829f408a. [PubMed: 24060836].

  • 28.

    Post-White J, Fitzgerald M, Hageness S, Sencer SF. Complementary and alternative medicine use in children with cancer and general and specialty pediatrics. J Pediatr Oncol Nurs. 2009;26(1):7-15. doi: 10.1177/1043454208323914. [PubMed: 18936292].

  • 29.

    Pourtsidis A, Doganis D, Baka M, Varvoutsi M, Bouhoutsou D, Xatzi P, et al. Prayer and blessings focused for healing is the most popular complementary intervention in a paediatric oncology unit in Greece. J BUON. 2015;20(2):602-7. [PubMed: 26011356].

  • 30.

    Abedi H, Naji SA, Alimohammadi N, Azizi F. Prayer experiences in cancer patient's life hospitalization under chemotherapy. J Med Cultivat. 2016;25(2):81-94.

  • 31.

    Sanchez HC, Karlson CW, Hsu JH, Ostrenga A, Gordon C. Complementary and Alternative Medicine Use in Pediatric Hematology/Oncology Patients at the University of Mississippi Medical Center. J Altern Complement Med. 2015;21(11):660-6. doi: 10.1089/acm.2014.0371. [PubMed: 26302151].

  • 32.

    Turhan AB, Bor O. Use of herbs or vitamin/mineral/nutrient supplements by pediatric oncology patients. Complement Ther Clin Pract. 2016;23:69-74. doi: 10.1016/j.ctcp.2016.03.009. [PubMed: 27157962].

  • 33.

    Laengler A, Spix C, Seifert G, Gottschling S, Graf N, Kaatsch P. Complementary and alternative treatment methods in children with cancer: A population-based retrospective survey on the prevalence of use in Germany. Eur J Cancer. 2008;44(15):2233-40. doi: 10.1016/j.ejca.2008.07.020. [PubMed: 18809313].

  • 34.

    Horneber M, Bueschel G, Dennert G, Less D, Ritter E, Zwahlen M. How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis. Integr Cancer Ther. 2012;11(3):187-203. doi: 10.1177/1534735411423920. [PubMed: 22019489].

  • 35.

    Susilawati D, Sitaresmi M, Handayani K, Ven P, Kaspers G; Sutaryo, et al. HealthCare Providers' and Parents' Perspectives on Complementary Alternative Medicine in Children with Cancer in Indonesia. Asian Pac J Cancer Prev. 2016;17(7):3235-42. [PubMed: 27509956].

  • 36.

    Clerici CA, Veneroni L, Giacon B, Mariani L, Fossati-Bellani F. Complementary and alternative medical therapies used by children with cancer treated at an Italian pediatric oncology unit. Pediatr Blood Cancer. 2009;53(4):599-604. doi: 10.1002/pbc.22093. [PubMed: 19492321].

  • 37.

    Genc RE, Senol S, Turgay AS, Kantar M. Complementary and alternative medicine used by pediatric patients with cancer in western Turkey. Oncol Nurs Forum. 2009;36(3):E159-64. doi: 10.1188/09.ONF.E159-E164. [PubMed: 19403444].

  • 38.

    Fesharakinia A, Abedini M. Prevalence of using complementary and alternative medicine in children and its related factors in East iran. Iran J Pediatr. 2014;24(1):111-4. [PubMed: 25793055]. [PubMed Central: PMC4359593].

  • Copyright © 2020, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
    COMMENTS

    LEAVE A COMMENT HERE: