Working with children with cancer can be simultaneously heart-wrenching and immensely rewarding. The vitality of children tends to be much stronger than adults. They may fall sick quicker, but they also have the capacity to rebound faster. Benedict Lust, a German-born American physician, said, "The human body possesses an inherent ability to heal itself through the mechanisms of homeostasis." Integrative, functional, and root cause medicine aim to support homeostasis and can be useful in caring for children diagnosed with cancer.

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What is Integrative Pediatric Oncology?

Integrative oncology uses functional and integrative medicine alongside allopathic cancer treatment (i.e., surgery, radiation, chemotherapy, and immunotherapy). Integrative oncology aims to increase the quality of life, decrease treatment-related side effects, and support the patient after treatment to get their health back on track.

In pediatric cancers, integrative medicine can be used alongside surgery, chemotherapy, and radiation to support the child's innate vitality, decrease the side effects of chemotherapy and immunotherapy and support their health after cancer so they can thrive in adulthood. As integrative medicine providers on a child's care team, we always think long-term. How will this treatment decision impact this child in 10, 20, or 30 years? How will this treatment impact their gut? Will they be able to tolerate school lunches and after-school snacks with their friends? How will this treatment affect their cognition? Will they require additional support when it comes to memorization tasks and test-taking in school? Childhood cancers are life-changing, but they don't need to define the quality of life that the child experiences in adulthood. Let's take a closer look at the approaches in Integrative Pediatric Oncology.

What are the Integrative and Complementary Approaches Used in Integrative Pediatrics Oncology?

Regarding integrative and complementary approaches used in pediatric oncology, the aim is threefold: decrease the side effects of primary treatment, maintain the integrity of the organ systems, and promote health after treatment.

Decrease Side Effects

Children undergoing chemotherapy can experience a number of severe side effects. Gastrointestinal side effects can include nausea, vomiting, trouble eating and digesting food, and constipation. Fatigue and sleep disturbances are common and tend to be worse during chemotherapy cycles. The hospital environment and changes to the child's regular schedule can result in chronic sleep disturbances that persist after treatment is completed. Hearing loss can also be observed in children who undergo platinum-based chemotherapies. Over 96% of children on a neutropenic diet were found to be deficient in at least one micronutrient. Hair loss is a common side effect of both chemotherapy and radiation. Integrative oncologists can offer personalized, tailored recommendations to help minimize these side effects during treatment. These recommendations may include supplements, dietary recommendations, intravenous therapies, or involving therapies like acupuncture, art/music therapy, and family counseling.

Maintain the Integrity of the Organ Systems

Children who underwent therapy for cancer during childhood have an increased risk of developing gastrointestinal (GI) complications later in life. As soon as the child is done with treatment, there should be proactive recommendations to help maintain the integrity of the GI lining and restore the child's microbiome. Many chemotherapies can have a cardiotoxic effect which should be addressed immediately after treatment to prevent any long-term cardiac side effects. Depending on the cancer treatment recommended (surgery, chemotherapy, radiation, immunotherapy), integrative doctors can assess the long-term complications and risks of treatments and proactively work with the child after primary treatment is complete.

Health Promotion After Treatment

Survivors of childhood cancers are at elevated risk for anxiety and post-traumatic stress disorder (PTSD). They may experience healthcare-related trauma and are less likely to follow up with healthcare practitioners for annual visits, screening exams, and treatment recommendations. It is important to emphasize to childhood cancer survivors that their body is not a scary place. More importantly, hospitals and clinics are not always scary places. At the same time, people are given devastating news, newborns are ushered into the world, broken bones are fixed, and life-saving procedures are done. Integrative medicine practitioners tend to have anywhere between 45-60 minutes with their patients and, therefore, can build a strong therapeutic relationship. This allows for increased patient satisfaction and increased compliance.

How to Talk to Your Health Care Team About Combining Integrative Medicine With Conventional Treatments

Communication is crucial amongst healthcare specialties to provide safe and effective patient care. As the patient, it is important to be honest and transparent with your primary oncology team if you are seeking integrative or functional medicine. A recommended tip to patients is to keep an organized document with all your providers, their role on your team, and their phone and fax numbers. For example:

Patient Jane Doe’s Care Team Example

Hand a copy of this to each of your providers to keep them apprised of your care team. Ask each of your providers (functional, integrative, allopathic, massage, acupuncture, etc.) to fax their chart notes to one another. This allows everyone to be on the same page and fosters interprofessional collaboration. It also allows for multiple eyes to be looking for drug-herb interactions or contraindications in treatment recommendations.

Common Integrative Medicine Labs Used in Integrative Pediatric Oncology To Help Personalize Treatment

We have taken a look at some of the short-term and long-term effects of pediatric oncology treatment. So what can be done? Let's start off with some lab testing that can be useful in the setting of pediatric oncology.

CBC w/ Diff

This lab recommendation won't come as a surprise to anyone who has undergone cancer treatment. A complete blood count with differential (also known as CBC w/ diff) takes a look at white blood cells (WBCs) and red blood cells (RBCs) and gives a breakdown of the different types of WBCs (that's the differential part.) There are five different types of white blood cells: neutrophils, lymphocytes, basophils, monocytes, and eosinophils. In oncology, neutrophil and lymphocyte count are very important to monitor. Chemotherapy can greatly depress the levels of neutrophils and can lead to immunosuppression– this is known as neutropenia. Additionally, the ratio between neutrophils and lymphocytes can act as a prognostic marker in oncology. It is also an indicator of inflammation levels.

Micronutrient Testing

Micronutrient testing can be helpful both during and after treatment is completed. Chemotherapy is known to cause micronutrient deficiencies– these are important to correct after treatment to prevent any long-term complications. Micronutrient deficiencies can also be a result of decreased appetite during chemotherapy, nausea/vomiting, taste changes, and food aversions.

Comprehensive Stool Test

A stool test can be helpful for two reasons: 1) the microbiome is impacted by chemotherapy, and 2) the state of the microbiome can result in worse chemotherapy-related side effects. For example, in stage III colorectal cancer patients receiving a chemotherapy regimen known as CapeOx (capecitabine and oxaliplatin), a less diverse microbiome resulted in more chemotherapy-related diarrhea during treatment. Chemotherapy given to young adults can result in more intestinal permeability, which can lead to increased systemic inflammation after treatment. The GI-MAP + Zonulin Test measures a variety of gastrointestinal microbiota DNA using qPCR technology. It detects a microbial imbalance, microbes contributing to illness, and indicators of digestion, absorption, inflammation, and immune function.

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Integrative and Complementary Therapies Used in Integrative Pediatrics Oncology

Integrative pediatrics oncology involves the incorporation of complementary and integrative therapies alongside conventional medical treatments for children with cancer. While it's important to note that integrative therapies should always be used in conjunction with standard medical care, they can help support the overall well-being of the child, improve quality of life, and reduce some treatment-related side effects. Here are some commonly used integrative and complementary therapies in pediatric oncology:

Nutrition and Dietary Counseling

Anyone who has spent time with children will agree that children can sometimes be difficult eaters. This adds to the complexity when it comes to nutrition in the pediatric oncology population. Children undergoing cancer treatment will feel tired, lose their appetite, experience nausea/vomiting, or develop a brand-new aversion to food. They are at higher risk for eating and feeding problems and can develop orthorexia. Meal times should not be a time for increased stress for the child or the parent. Working with a skilled nutritionist to develop a customized plan to suit the child's likes and dislikes that are balanced in macro and micronutrients can be helpful in this setting. Dietary recommendations around a neutropenic diet (avoiding raw food to reduce the risk of getting an infection from foodborne bacteria) should also be taken into consideration. Guidance from registered dietitians who specialize in pediatric oncology can help optimize the child's nutritional intake during treatment while also managing side effects like nausea and taste changes, and support overall health.

Supplements and Herbs Used In Integrative Pediatric Oncology

When thinking about supplements and herbs in pediatric oncology, it is important to take into consideration the dose and the delivery format. The recommended dietary allowance (RDA) is affected by the weight and age of the child. In regards to the delivery format, not all children are able to swallow capsules or tablets, and when possible, liquids, powders (added to smoothies or foods), and chewables should be considered. Here are some of the common supplements used in integrative pediatric oncology:

Magnesium for Constipation

If chemotherapy results in constipation, magnesium can be an easy and effective fix. Magnesium can usually be found in powdered and liquid form and, therefore, can be taken by children without any concerns about swallowing tablets or pills. Magnesium is usually taken up to bowel tolerance, so start slow and work your way up until symptoms are relieved.

Multivitamins to Prevent Micronutrient Deficiency

If dietary nutrition is inadequate due to chemotherapy-related side effects, then dosing a multivitamin daily can be helpful to meet the RDA. In a study in children with acute lymphoblastic leukemia (ALL), greater intake of vitamin C, E, and beta-carotene was associated with fewer therapy delays, less toxicity, lower incidence of infection, and fewer days spent in the hospital.

Anthocyanins for Prevention

Anthocyanins are a type of flavonoid that has been associated with the prevention of cardiovascular disease, obesity control, and anti-tumor activity. Dietary sources of anthocyanins are found in foods that have vibrant red, blue, or purple colors (think blueberries, purple cabbage, pomegranates, and strawberries). Increased anthocyanin consumption is associated with a decreased risk of colorectal and esophageal cancer. A favorite anthocyanin supplement amongst children is Dr. William Mitchell's Fruit Anthocyanins– a combination of Red Grape, Elderberry, Blueberry, Aronia Berry, Pomegranate, and Red Raspberry.

Aromatherapy

The use of essential oils derived from plants to promote relaxation, improve sleep, alleviate nausea, and enhance overall well-being. However, it's important to ensure the safety and appropriate dilution of essential oils, especially in pediatric patients.

Acupuncture

This ancient Chinese therapy involves the insertion of thin needles into specific points on the body to stimulate healing and alleviate symptoms such as pain, nausea, and fatigue.

Massage therapy

Gentle manipulation of the body's soft tissues to promote relaxation, relieve pain, and improve sleep quality. Massage therapy can also provide emotional support for children undergoing cancer treatment.

Mind-Body Techniques

These include various practices that focus on the mind's influence on the body, such as meditation, relaxation techniques, guided imagery, and hypnotherapy. They aim to reduce stress, anxiety, and improve overall well-being.

Yoga and Tai Chi

These mind-body practices combine movement, breathing exercises, and meditation to improve flexibility, strength, relaxation, and emotional well-being. Adaptations can be made to suit the needs of pediatric cancer patients.

Music Therapy

The use of music and musical activities to promote emotional expression, reduce anxiety, and enhance relaxation. Music therapy can also help distract from treatment-related discomfort and pain.

Art Therapy

Utilizing creative processes and art materials to help children express their emotions, reduce anxiety, and cope with the challenges of cancer treatment. Art therapy can provide a sense of control and empowerment.

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Summary

Integrative medicine in the setting of pediatric oncology can be helpful in decreasing side effects and improving quality of life. Ultimately, the care team wants to see these children thrive both in childhood and well into adulthood. Proactively thinking about the long-term effects of conventional cancer treatment can be helpful in creating customized treatment recommendations to support the child during and after treatment is complete. If you have a child recently diagnosed with cancer, find a skilled integrative medicine practitioner and encourage collaboration amongst your child's care team. After treatment is complete, make sure that your child has access to resources to process their experience and discuss any health-related anxiety that resulted from their diagnosis.