Complementary or alternative medicine commonly used in childhood cancer survivors

A study by researchers from the Chinese University of Hong Kong (CUHK) finds a high prevalence of use of complementary or alternative medicine (CAM) among childhood cancer survivors in Hong Kong, with potential CAM-drug interactions detected in nearly a third of those on long-term medications. Future studies focusing on behaviour and motivations of survivors for CAM use are suggested.

“Childhood cancer survivors in Hong Kong are encouraged to have open discussions with their healthcare providers regarding their use of CAM, particularly if they are on long-term medications [ie, prescription or over-the-counter (OTC) Western medications taken daily for ≥30 days or used as needed for ≥6 months cumulatively within the past 12-month period],” said Professor Yin-Ting Cheung of the School of Pharmacy, CUHK.

“Whilst it can be challenging for paediatric oncologists to be well-equipped in CAM knowledge, clinicians are encouraged to stay attentive to childhood cancer survivors’ needs and proactively identify potential CAM-drug interactions,” said Professor Chi-Kong Li of the Department of Paediatrics, CUHK. “We hope that referral pathways for promoting evidence-based integrative therapies for childhood cancer survivors can be developed in the near future.”

In the cross-sectional study, 393 childhood cancer survivors (male, 57.8 percent; mean current age, 17.7 years; leukaemia, 44.0 percent; mean years after cancer treatment, 8.8) were recruited from the Ambulatory Paediatric Oncology Clinic at the Prince of Wales Hospital between October 2018 and April 2019. [J Cancer Surviv 2021;doi:10.1007/s11764-021-01051-5]

More than half (n=205; 52.2 percent) of the respondents reported using at least one type of CAM, including traditional Chinese medicine (TCM) (n=127; 62.0 percent), natural products (55.3 percent) and non-oral therapy (25.7 percent). Chinese herbal medicine and proprietary Chinese medicine (pCM) were used in 45.4 percent and 25.9 percent of TCM users. Nutritional supplements (41.5 percent) and mind-body practices (23.4 percent) were the most common natural products and non-oral therapy used, respectively.

The main reasons for using CAM included strengthening the immune system (13.5 percent), regulating functional status of the body (10.3 percent), and improving general health (9.5 percent).

A third of the CAM users (n=69; 33.7 percent) were on at least one long-term medication. Notably, 63 drug-CAM combinations potentially susceptible to pharmacokinetic (PK; 57.1 percent), pharmacodynamic (PD; 34.9 percent), or both PK and PD (7.9 percent) interactions were identified in 21 (30.4 percent) of these 69 individuals.

Adult survivors were 2.35 times more likely to use CAM than adolescent (>12–18 years old) survivors. Similarly, survivors with vs without central nervous system (CNS) solid tumours were 2.7 times more likely to use non-oral therapies.

The research team recently developed an education programme to promote safe and effective use of TCM among childhood cancer survivors. The first initiatives under the programme included an online seminar on dietary therapies and educational materials guiding the use of CAM for childhood cancer survivors.

“Given the likelihood of harmful CAM-drug interactions with inappropriate use of TCM, childhood cancer survivors are advised to seek professional advice from registered traditional Chinese medicine practitioners before initiating TCM and other treatments,” said Dr Katy Ho-Kee Koon of the School of Chinese Medicine, CUHK.