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Kajencki M, Turcotte L, Claar M, Weinfurter EV, Whipple MO. The Use of Complementary and Integrative Medicine in Combination With Pharmacological Antiemetics to Address Chemotherapy-Induced Nausea and Vomiting in Pediatric Oncology: A Scoping Review. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024:27527530241267294. [PMID: 39197861 DOI: 10.1177/27527530241267294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2024]
Abstract
Background: Chemotherapy is a common treatment in childhood cancer but causes significant side effects, among the most notable being nausea and vomiting, known as chemotherapy-induced nausea and vomiting (CINV). Pharmacological antiemetics and complementary and integrative medicine (CIM) have been studied separately to manage CINV, but a gap exists in understanding their use together. We aimed to investigate the potential multimodal effects of CIM and pharmacological antiemetics on CINV in pediatric oncology patients undergoing chemotherapy. Method: Systematic searches were conducted in four databases to identify studies evaluating the efficacy of CIM in combination with pharmacological antiemetics in patients ages 0-21 with cancer undergoing chemotherapy. Relevant data were extracted from each study and evaluated. Results: Eighteen sources examining CIM therapies in three distinct categories (herbal, physical, and psychological) were identified. Three of four herbal interventions yielded significant results, all of which implemented oral ginger. Physical interventions included manual and wristband acupressure, auricular acupuncture, and needle and laser acupuncture. Significant results were found in only four of these 10 studies. Among psychological interventions, two of four yielded significant results. Discussion: There is no clear evidence of benefit from CIM therapies in addition to pharmacological antiemetics to better control CINV. However, this review provides support and direction for future research to examine potential effects. Complementary therapies generally have little potential for harm, are relatively low cost, and low burden. Therefore, if there is a perceived benefit for patients and families, complementary and integrative therapies should be considered.
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Affiliation(s)
- Madeleine Kajencki
- Pediatric Hematology/Oncology and Bone Marrow Transplant, M Health Fairview Masonic Children's Hospital, Minneapolis, MN, USA
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Lucie Turcotte
- Division of Pediatric Hematology Oncology, M Health Fairview Masonic Children's Hospital, Minneapolis, MN, USA
| | - Melissa Claar
- Pediatric Integrative Health & Wellbeing, M Health Fairview Masonic Children's Hospital, Minneapolis, MN, USA
| | | | - Mary O Whipple
- Adult and Gerontological Health Cooperative, School of Nursing, University of Minnesota, Minneapolis, MN, USA
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Ruan H, Sun J, Zhao K, He M, Yuan C, Fu L, Shen N. Subjective Toxicity Profiles of Children With Cancer During Treatment: A Latent Class Analysis. Cancer Nurs 2024; 47:E1-E9. [PMID: 36881644 DOI: 10.1097/ncc.0000000000001223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Children and adolescents may experience a variety of subjective adverse events (AEs) caused by cancer treatment. The identification of distinct groups of patients is crucial for guiding symptomatic AE management interventions to prevent AEs from worsening. OBJECTIVE The aim of this study was to identify subgroups of children with cancer experiencing similar patterns of subjective toxicities and evaluate differences among these subgroups in demographic and clinical characteristics. METHODS A cross-sectional survey was conducted of 356 children in China with malignancies who received chemotherapy within the past 7 days using the pediatric Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events. A latent class analysis (LCA) was conducted to identify subgroups of patients with distinct profiles of symptomatic AE occurrence. RESULTS Nausea (54.5%), anorexia (53.4%), and headache (39.3%) were the top 3 AEs children experienced. Nearly all participants (97.8%) experienced ≥1 core AEs, and 30.3% experienced ≥5 AEs. The LCA results identified 3 subgroups ("high gastrotoxicity and low neurotoxicity" [53.2%], "moderate gastrotoxicity and high neurotoxicity" [23.6%], and "high gastrotoxicity and high neurotoxicity" [22.8%]). The subgroups were differentiated by monthly family per-capita income, time since diagnosis, and Karnofsky Performance Status score. CONCLUSIONS Children experienced multiple subjective toxicities during chemotherapy, especially gastrotoxicity and neurotoxicity. Heterogeneity was found in the LCA in the patients' toxicities. The prevalence of toxicities could be distinguished by the children's characteristics. IMPLICATIONS FOR PRACTICE The results showing different subgroups in our study may assist clinical staff in focusing on patients with higher toxicities to provide effective interventions.
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Affiliation(s)
- Haishan Ruan
- Author Affiliations: Department of Hematology and Oncology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Ms Ruan and Ms He); School of Nursing, Shanghai Jiao Tong University, Shanghai, China (Ms Zhao); Department of Nursing, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Ms Sun and Ms Shen); School of Nursing, Fudan University, Shanghai, China (Dr Yuan); Fujian Children's Hospital, Fujian, China (Ms Fu)
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Raybin JL, Zhou W, Pan Z, Hendricks-Ferguson VL, Jankowski C. Creative Arts Therapy Among Children With Cancer: Symptom Assessment Reveals Reduced Anxiety. Cancer Nurs 2024; 47:12-19. [PMID: 36624566 DOI: 10.1097/ncc.0000000000001186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Symptom distress is related to decreased quality of life (QOL) among children with cancer, with high levels of pain, nausea, and anxiety reported. Creative arts therapy (CAT) has been related to improved QOL and symptoms in pediatric oncology, but the quality of evidence is mixed. OBJECTIVE This article aims to examine the QOL symptom subscales in relation to CAT over time in children during the first year of cancer treatment. METHODS A secondary analysis of prospective data was performed with linear mixed modeling on 267 observations with predictors of 2 groups: No CAT (n = 18) vs CAT (n = 65). The covariate of time (6 months) was used to explore the CAT relationship with the Pediatric Quality of Life Inventory (PedsQL) symptom subscales (pain and hurt, nausea, procedural anxiety, treatment anxiety, worry, cognitive problems, perceived physical appearance, and communication). RESULTS Children (n = 83) were between 3 and 17 years old (M = 6), 51.2% female, and 32% minority. All tumor types were represented: liquid (37.3%), solid (24.1%), and central nervous system (38.6%). Reduced child report of procedural anxiety was significantly related to receiving CAT with a medium magnitude of association (adjusted effect size = 0.58, P = .01). CONCLUSION Creative arts interventions were associated with a longitudinal improvement in anxiety in children with cancer. Further work is needed to target interventions to the appropriate specific burdensome symptoms. IMPLICATION FOR PRACTICE Pediatric oncology nurses can advocate for CAT as an effective intervention to ameliorate the burdensome procedural anxiety experienced by patients.
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Affiliation(s)
- Jennifer L Raybin
- Author Affiliations: Oregon Health & Sciences University, Schools of Nursing and Medicine, Pediatric Hematology Oncology, Doernbecher Children's Hospital (Dr Raybin); College of Nursing and School of Medicine, University of Colorado Anschutz Medical Campus (Drs Raybin, Pan, and Jankowski); Colorado School of Public Health-Biostatistics and Informatics (Ms Zhou); and Trudy Busch Valentine School of Nursing, Saint Louis University (Dr Hendricks-Ferguson), Missouri
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Esplana L, Olsson M, Nilsson S. 'Do you feel well or unwell?' A study on children's experience of estimating their nausea using the digital tool PicPecc. J Child Health Care 2023; 27:654-666. [PMID: 35452297 PMCID: PMC10676616 DOI: 10.1177/13674935221089746] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research with childhood cancer has progressed greatly in recent years, resulting in much improved treatment that is more intensive. However, with this new treatment children often experience negative symptoms, and research shows that nausea is a symptom that most affects them. Pictorial support in person-centred care for children (PicPecc) is a digital picture-based tool for children who undergo treatment due to their cancer diagnosis and helps them more effectively communicate and self-report their symptoms and emotions. The aim of the study was to investigate children's experience of (i) using mHealth in nausea management and (ii) their acceptability of using an application (App). Semi-structured interviews were conducted with eight children aged five to fifteen years. Data were analysed with qualitative content analysis. The findings were presented in three categories: 1) Communicating feelings, 2) Playfulness generated in motivation and 3) App adaptable to children's capabilities. Using an App contributed to new opportunities for the children to participate in their care. They experienced their treatment in different ways and used different strategies to manage and distract themselves from their symptoms. Using the PicPecc App can increase healthcare staff's understanding of how children experience nausea when they undergo chemotherapy.
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Affiliation(s)
- Linda Esplana
- Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children´s Hospital, Gothenburg, Sweden
| | - Malin Olsson
- Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children´s Hospital, Gothenburg, Sweden
| | - Stefan Nilsson
- Institute of Health and Care Sciences, and University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Vieira C, Bergantim R, Madureira E, Barroso JC, Labareda M, Parreira ST, Castro A, Macedo A, Custódio S. Portuguese consensus on the prevention and treatment of nausea and vomiting induced by cancer treatments. Porto Biomed J 2023; 8:e234. [PMID: 37846304 PMCID: PMC10575355 DOI: 10.1097/j.pbj.0000000000000234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/08/2023] [Accepted: 09/01/2023] [Indexed: 10/18/2023] Open
Abstract
Chemotherapy-induced nausea and vomiting (CINV) and radiotherapy-induced nausea and vomiting (RINV) strongly affect the quality of life of patients with cancer. Inadequate antiemetic control leads to the decline of patients' quality of life, increases rescue interventions, and may even compromise adherence to cancer treatment. Although there are international recommendations for controlling CINV and RINV, these recommendations focus mainly on pharmacological management, with scarce information on additional measures that patients may adopt. Moreover, the prophylaxis and management of CINV/RINV are not always applied. Thus, we identified the need to systematize the strategies for preventing and managing CINV/RINV and the associated risk factors to implement and promote effective prophylactic antiemetic regimens therapy in patients with cancer. This review sought to create a set of practical recommendations for managing and controlling CINV/RINV, according to the current international recommendations for antiemetic therapy and the main risk factors. Conclusively, we intended to produce a patient-centered guidance document for health care professionals focused on the awareness, monitoring, and treatment of CINV/RINV.
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Affiliation(s)
- Cláudia Vieira
- Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), Porto, Portugal
- Research Center, Molecular Oncology Group, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), University of Porto, Porto, Portugal
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- Sociedade Portuguesa de Oncologia, Coimbra, Portugal
| | - Rui Bergantim
- Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
- i3S—Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
- Cancer Drug Resistance Group, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Department of Hematology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Elsa Madureira
- Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Department of Nutrition, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Juan C.M. Barroso
- Medical Oncology Service, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
- iOncoCare - International Group for Oncologic Supportive Care Study, Valencia, Spain
| | | | - Sara T. Parreira
- Department of Medical Oncology, Hospital CUF Tejo, Lisbon, Portugal
| | - Ana Castro
- Department of Pharmacy, Centro Hospitalar Universitário Lisboa Norte—Hospital de Santa Maria, Lisboa, Portugal
| | - Ana Macedo
- Evidenze, Lisboa, Portugal
- Faculty of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
| | - Sandra Custódio
- Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Medical Oncology Service, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Nogéus M, Nilsson S, Björk M. Pediatric Nurses' Person-Centered Approach to Nausea Management in Children With Cancer. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:91-99. [PMID: 36718504 DOI: 10.1177/27527530221140056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background: Nausea is a problematic side effect of childhood cancer treatment. However, it is not clear what interventions and assessments pediatric oncology nurses make when caring for a child with nausea. A person-centered approach can illuminate nausea management in pediatric care. The aim was to investigate how pediatric nurses retrieve the patient's narrative, establish partnership, and document nausea in hospitalized children with cancer. Methods: Individual interviews with nurses were conducted and analyzed using deductive content analysis with the framework of person-centered care. Results: The pediatric nurses described retrieving the patient's narrative regarding their nausea by listening to and observing the child. The pediatric nurses tried to establish a partnership with the child by allowing previous knowledge and the child's own preferences guide the interventions that focus on decreasing the child's nausea. The pediatric nurses also documented the effect of the given interventions and described the child's nausea using subjective words. When planning for the child's care it was rare for the nurses to have a documented care plan, but they did review documentation of previously administered interventions to plan for future care. Discussion: The results highlight the pediatric nurses' willingness to listen to the child, but also emphasize the need to further include the child and the parents in the partnership and documentation of nausea management. Collaboration with the child and the parents contributes to higher quality care and a partnership with trust.
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Affiliation(s)
| | - Stefan Nilsson
- 174416Institute of Health and Care Sciences, University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Björk
- CHILD Research Group, Department of Nursing, School of Health and Welfare, 4161Jönköping University, Jönköping, Sweden
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Tröndle M, Matheus de Souza D, Tiziana Verardo Polastrini R, Odone Filho V, Seifert G, Stritter W, Blakeslee SB, dos Santos Teco Mucci AL, Lage Pasqualucci P. Perceptions of Health Professionals on the Implementation of Integrative and Complementary Practices at a University Pediatric Hospital in Brazil: A Qualitative Interview Study. Integr Cancer Ther 2023; 22:15347354231192004. [PMID: 37641952 PMCID: PMC10467235 DOI: 10.1177/15347354231192004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/30/2023] [Accepted: 07/19/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Despite an increase in use of pediatric complementary and integrative health (PCIH), many healthcare professionals still have an inadequate understanding of such practices and consider their use inappropriate, which might thwart implementation processes. In a qualitative interview study we examined the feedback of conventional healthcare professionals about the integrative practices provided to pediatric patients by an integrative team in a pediatric oncological hospital. METHODS Fifteen semi-structured interviews were carried out with various conventional healthcare professionals in an university pediatric hospital in São Paulo, Brazil. The interviews were audio-recorded, transcribed and pseudonymized. DSCsoft® and MAXQDA® software assisted in a profound qualitative analysis using the collective subject discourse and thematic analysis method in order to display participants' perspectives on PCIH and the project in their hospital. RESULTS Interviewees acknowledged their lack of knowledge about PCIH practices and reflected on the limits of their care as well as on new possibilities PCIH could offer. PCIH was perceived by interviewees as an effective supportive tool of care to promote patients' wellbeing, assist overall compliance, strengthen cooperation between professionals, children and their relatives and hence facilitated general patient care. Since PCIH was implemented in their clinic, perceptions led interviewees to wish for increased PCIH offering and a more profound integration of its therapists into the standard of care. DISCUSSION The coexistence of integrative and conventional practices in the conventional healthcare setting is important to give visibility to the possibilities offered by the integrative pediatrics field. Regular and constant encounters with integrative practices, as well as information access seem crucial to reach a wider openness for PCIH and subsequently a broader application and dissemination of it.
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Affiliation(s)
- Marc Tröndle
- Department of Pediatric Oncology/Hematology, Otto-Heubner Centre for Pediatric and Adolescent Medicine (OHC), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Danton Matheus de Souza
- Unit of Integrative Pediatrics, Department of Pediatrics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Vicente Odone Filho
- Unit of Integrative Pediatrics, Department of Pediatrics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Georg Seifert
- Department of Pediatric Oncology/Hematology, Otto-Heubner Centre for Pediatric and Adolescent Medicine (OHC), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Unit of Integrative Pediatrics, Department of Pediatrics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Wiebke Stritter
- Department of Pediatric Oncology/Hematology, Otto-Heubner Centre for Pediatric and Adolescent Medicine (OHC), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sarah B. Blakeslee
- Department of Pediatric Oncology/Hematology, Otto-Heubner Centre for Pediatric and Adolescent Medicine (OHC), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | | | - Paula Lage Pasqualucci
- Unit of Integrative Pediatrics, Department of Pediatrics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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Thouvenin-Doulet S, Mouffak S, Bertrand A, Cardine AM, Letort-Bertrand M, Levy D, Wiart-Monger V, Lervat C, Poirée M. [Antineoplastic drug-induced nausea and vomiting in pediatric onco-hematology: 2022: Guidelines from the supportive care committee of the French Society of Childhood Cancer (SFCE)]. Bull Cancer 2022; 109:1144-1153. [PMID: 36220696 DOI: 10.1016/j.bulcan.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/10/2022] [Accepted: 08/13/2022] [Indexed: 11/07/2022]
Abstract
Nausea and vomiting induced by cancer treatment (CINV) remain one of the most common and feared side effects in children despite the use of new drugs to prevent them. The existing recommendations for the prophylaxis and treatment of CINV are based on adult patients in Anglo-Saxon societies. Based on a recent review of the literature, we focused on specific pediatric issues in order to offer recommendations validated by the supportive care committee of the French society for childhood cancer.
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Affiliation(s)
- Sandrine Thouvenin-Doulet
- CHU de Saint-Étienne, service d'hématologie et d'oncologie pédiatrique, rue Alber-Raimond, 42055 Saint-Étienne cedex 02, France.
| | - Samia Mouffak
- Centre hospitalier La Rochelle, service pharmacie, rue du Docteur Schweitzer, 17019 La Rochelle, France
| | - Amandine Bertrand
- Institut d'hématologie et d'oncologie pédiatrique, IHOPe, 1, place Joseph-Renaut, 69373 Lyon cedex 08, France
| | - Aude Marie Cardine
- CHU de Rouen, service d'immuno-hémato-oncologie pédiatrique, 1, rue de Germont, 76000 Rouen, France
| | - Maïna Letort-Bertrand
- Hôpital Sud, CHU de Rennes, onco-hématologie pédiatrique, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - Dominique Levy
- Clinique Edouard-Rist, service d'onco-hématologie AJA, 14, rue Boileau, 75016 Paris, France
| | | | - Cyril Lervat
- Centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - Marilyne Poirée
- CHU de Nice, service onco hématologie pédiatrique, 151, route Saint-Antoine-de-Ginestière, 06202 Nice, France
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Merrow M, King N. Optimizing antiemetic therapy for children undergoing chemotherapy. J Pediatr Nurs 2022; 66:136-142. [PMID: 35759994 DOI: 10.1016/j.pedn.2022.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/30/2022] [Accepted: 06/11/2022] [Indexed: 11/25/2022]
Abstract
Chemotherapy-induced nausea and vomiting (CINV) is a common side effect of most chemotherapy agents. Suboptimal management of CINV impacts quality of life, nutrition, gastrointestinal (GI) integrity, and adherence to chemotherapy treatment plans. This article reviews the principles of CINV management, planning and implementation of antiemetic regimens, and pharmacology of the antiemetics currently available in the United States appropriate for pediatric use. With the advent of more targeted therapies, increased use of immunotherapy, and the effects of radiotherapy to the brain, spine, and abdomen, treatment of CINV now has a broader application than just for chemotherapeutics alone.
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Affiliation(s)
- Mya Merrow
- Department of Pharmacy, Children's Hospital Colorado, 13123 East 16(th) Avenue, Aurora, CO 80045, United States of America.
| | - Nancy King
- Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, 13123 East 16(th) Avenue, Aurora, CO 80045, United States of America
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Akdeniz Kudubes A, Bektas M, İnce D, Olgun N. The effect of text message reminders on nausea, vomiting and quality of life in children with cancer receiving cisplatin. J Pediatr Nurs 2022; 64:e109-e118. [PMID: 34955361 DOI: 10.1016/j.pedn.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 12/11/2021] [Accepted: 12/11/2021] [Indexed: 10/30/2022]
Abstract
PURPOSE This study was conducted to examine the effect of text message reminders on nausea, vomiting, and quality of life in children with cancer receiving cisplatin. METHODS The study was conducted with a pretest-posttest unpaired group model design. The study included 80 children with cancer and their parents (40 controls and 40 experiments) aged between 8 and 18 years, who were on cisplatin treatment, who did not have cognitive disability as a clinical diagnosis, who received chemotherapy during their stay in the clinic, who were literate in Turkish and who volunteered to participate in the study. The educational contents prepared by the researchers to reduce nausea and vomiting were sent to the parents in the experimental group in the form of a text message every day for three weeks. Descriptive statistics, correlation analysis, and regression analysis were used to evaluate the data. RESULTS While NVTS, ARINVc, ARINVp, Quality of Life Scale pretest and posttest mean scores of both 8-12 and 13-18 age control group children were similar, it was determined that the experimental group's posttest mean scores were higher than the pretest mean scores, and there was a statistically significant difference between the experimental group's pretest and posttest mean scores in terms of the group, time and group*time. In this study, the education program explains 42%, 15%, 16%, 43%, and 43% of the increase in the mean scores of NVTS, ARINVc, ARINVp, Quality of Life Scale Child and Parent Form, respectively, in children aged 8-12. Also, the education program explains 10%, 27%, 28%, 38%, and 39% of the increase in the mean scores of NVTS, ARINVc, ARINVp, Quality of Life Scale Adolescent and Parent Form, respectively, in children aged 13-18. CONCLUSIONS It has been observed that text message reminders effectively reduce the level of nausea and vomiting and increase the quality of life. PRACTICE IMPLICATIONS The results of this study, text message reminders can be applied as an alternative intervention method, and including technology-based practices in the care of children with cancer is important in increasing the quality of care.
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Affiliation(s)
- Aslı Akdeniz Kudubes
- Department of Pediatric Nursing, Bilecik Şeyh Edebali University Faculty of Health, Bilecik, Turkey.
| | - Murat Bektas
- Department of Pediatric Nursing, Faculty of Nursing, Dokuz Eylul University, İnciraltı, İzmir, Turkey.
| | - Dilek İnce
- Pediatric Oncology Department, Oncology Institute, Dokuz Eylul University, İnciraltı, İzmir, Turkey.
| | - Nur Olgun
- Pediatric Oncology Department, Oncology Institute, Dokuz Eylul University, İnciraltı, İzmir, Turkey.
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A Scoping Review of Biological Pathways of Integrative Interventions Used to Manage Chemotherapy-induced Nausea and Vomiting in Children with Cancer. Nurs Res 2022; 71:227-240. [PMID: 35067646 DOI: 10.1097/nnr.0000000000000579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND As with pharmacologic management approaches, characteristics of complementary and alternative medicine (CAM) interventions for managing chemotherapy-induced nausea and vomiting (CINV) in children with cancer should be considered when developing and testing these interventions and reporting the outcomes. OBJECTIVES This systematic scoping review aimed to identify gaps and weaknesses in studies of CAM and integrative interventions to prevent and manage CINV in children being treated for cancer, according to the CINV biological pathways. METHODS This systematic scoping review was conducted in accordance with the PRISMA-ScR guideline. Included studies were published in English prior to May 2020 and examined the effects of integrative interventions on CINV in children being treated for cancer. Computerized searches and manual review were performed by two authors; these authors also extracted data about study characteristics, intervention characteristics, and CINV outcomes from the studies included in the review. RESULTS 26 studies of 29 CAM interventions met eligibility criteria. Most of these studies used RCT designs and measured CINV outcomes at least once prior to and then after the intervention. Some studies did not explicate the interval between exposure to the intervention and outcome measurements. The CAM interventions studied included 15 cognitive-behavioral interventions, eight acupoint stimulation interventions, five herb/supplementation interventions, and one educational intervention. The one study tested two CAMs explicated the underlying biological pathways, while 25 studies (27 CAMs) did not explicate pathways; the pathways were deduced from information provided in the articles. DISCUSSION Considering the biological pathways underlying CINV while developing integrative interventions, including the CAM component could improve intervention efficacy. Measurement of biomarkers of activity in these pathways would provide a means to test whether changes in underlying pathways mediate change in CINV. Better reporting of intervention details and study processes is needed to support replication of CAM interventions and inform translation into clinical practice.
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Raybin JL, Hendricks-Ferguson V, Cook P, Jankowski C. Associations between demographics and quality of life in children in the first year of cancer treatment. Pediatr Blood Cancer 2021; 68:e29388. [PMID: 34626456 DOI: 10.1002/pbc.29388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/05/2022]
Abstract
Symptom distress and decreased quality of life (QOL) among children with cancer are well documented. Research is emerging on the child's voice in QOL-symptom reports, but existing QOL questionnaires are burdensome and objective biologic markers are lacking. We examined children's symptoms and QOL from parent and child perspectives and compared the results to one biologic marker (body posture). A cross-sectional secondary analysis of prospective data from children receiving creative arts therapy explored potential associations among demographics with and between QOL measures (PedsQL, Faces Scale, posture). Children (n = 98) ranged in age from 3 to 17 years (M = 7.8) and were in the first year of cancer treatment. No significant associations were found among the child's sex, race/ethnicity, socioeconomic status (SES), or distance from hospital, and total PedsQL. Older age was associated with worse total PedsQL, pain, nausea, worry, and posture (all P < 0.05). Greater worry (β = 0.51) and worse posture (β = 0.41) were the QOL variables most strongly correlated with older age. Poorer posture was associated with worse child PedsQL (total score, nausea, treatment anxiety, cognitive) and parent PedsQL (pain, nausea). Worse scores on the Faces Scale, PedsQL, and posture were all correlated (r = 0.21-0.39, all P < 0.05). Interventions to improve QOL could target nausea, worry, and older patients. Accuracy and interpretation of symptom distress in children are problematic. The Faces Scale and posture may be suitable, readily obtained measures of QOL in pediatric oncology that hold promise.
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Affiliation(s)
- Jennifer L Raybin
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colorado.,University of Colorado Anschutz Medical Campus, College of Nursing and School of Medicine, Aurora, Colorado
| | | | - Paul Cook
- University of Colorado Anschutz Medical Campus, College of Nursing and School of Medicine, Aurora, Colorado
| | - Catherine Jankowski
- University of Colorado Anschutz Medical Campus, College of Nursing and School of Medicine, Aurora, Colorado
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Tröndle M, Stritter W, Odone V, Peron K, Ghelman R, Seifert G. Beyond the Standard of Care: An Exploratory Qualitative Study of an Implemented Integrative Therapeutic Care Program in a Brazilian Pediatric Oncology Unit. J Altern Complement Med 2021; 27:1002-1010. [PMID: 34668735 DOI: 10.1089/acm.2021.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: This article examines the feedback of health care providers within the implementation of an integrative care project in a clinic for pediatric oncology in São Paulo, Brazil. Since 2017, the project has implemented external anthroposophic therapies in the activities of daily nursing. The objective is to evaluate how the project evolved and what impact it had on the daily operation of the hospital. A special focus emphasizes the perspective of study nurses. Materials and Methods: Twelve qualitative semistructured interviews were conducted. Audio files were transcribed, translated to German, and underwent a MAXQDA software-assisted analysis. Using a thematic approach, coherent cross-case topics were defined. Results: Three main topics emerged from analysis of the data. (1) The implementation and its effects on daily patient care demonstrated positive outcomes in patients and were well accepted with minimal changes in daily activities. (2) The perspective of study nurses showed a large motivation due to beneficial and stress-relieving effects of the application and a growing patient-health care provider relationship. (3) Problems and aspirations for improvement were the lack of time and the urge to make the project grow in the future. Conclusion: Not only patients but also health care providers seem to benefit from integrative methods. They have the potential to improve the working atmosphere and to strengthen relations between patients, caregivers, and family members. General feedback was positive and acceptance in the team arose over time when beneficial effects became visible.
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Affiliation(s)
- Marc Tröndle
- Department of Pediatric Oncology/Hematology, Otto-Heubner Centre for Pediatric and Adolescent Medicine (OHC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Wiebke Stritter
- Department of Pediatric Oncology/Hematology, Otto-Heubner Centre for Pediatric and Adolescent Medicine (OHC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Vicente Odone
- Departamento de Pediatria, Faculdade de Medicina, Instituto de Tratamento do Câncer Infantil (ITACI), Universidade de São Paulo, São Paulo, Brazil
| | - Karina Peron
- Departamento de Pediatria, Faculdade de Medicina, Instituto de Tratamento do Câncer Infantil (ITACI), Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Ghelman
- Departamento de Pediatria, Faculdade de Medicina, Instituto de Tratamento do Câncer Infantil (ITACI), Universidade de São Paulo, São Paulo, Brazil
| | - Georg Seifert
- Department of Pediatric Oncology/Hematology, Otto-Heubner Centre for Pediatric and Adolescent Medicine (OHC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Departamento de Pediatria, Faculdade de Medicina, Instituto de Tratamento do Câncer Infantil (ITACI), Universidade de São Paulo, São Paulo, Brazil
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Toniolo J, Delaide V, Beloni P. Effectiveness of Inhaled Aromatherapy on Chemotherapy-Induced Nausea and Vomiting: A Systematic Review. J Altern Complement Med 2021; 27:1058-1069. [PMID: 34283916 DOI: 10.1089/acm.2021.0067] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Chemotherapy-induced nausea and vomiting (CINV) are among the most common and feared side effects of cancer treatments. Their presence has a negative impact on the quality of life and morbidity associated with the disease. Despite increasingly effective antiemetic treatments, 40% of cancer patients experience CINV during the acute or delayed phase of their treatment. This distressing experience lived through by a large number of people makes it a priority in the improvement of cancer patients and a daily concern for nurses in cancer care units. In an attempt to alleviate this problem, the idea of using aromatherapy as supportive care has led the authors to research the knowledge available on this subject. Objective: The purpose of this systematic review was to examine the existing scientific evidence regarding the effectiveness of respiratory aromatherapy on CINV in addition to standard treatment compared with their recommended management in people with cancer. Design: Systematic review. Methods: This review was conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines and queried six databases (PubMed, Scopus, Cochrane Database, Embase, CINAHL, and Google Scholar). An analysis of the risk of bias using the Cochrane "Risks of Bias" tools and a qualitative synthesis of the results of the studies were carried out. Results: Eleven studies were included, nine in adults and two in children. Seven out of nine studies showed statistically significant results in adults with either direct or dry inhalation. Four out of seven alleviated both nausea and vomiting thanks to peppermint, ginger essential oil; three decreased nausea only with chamomilla, ginger or cardamom essential oil. Atmospheric diffusion and the use of inhaled aromatherapy in children did not show any benefit. Conclusions: Results appear promising for the use of direct inhaled aromatherapy in the management of CINV. However, most of the studies found the women concerned suffered from gynecologic cancers and had certain methodological limitations. Indeed, small samples and a wide variety of interventions were studied (different essential oils, number of drops of essential oils used, method of administration, etc.), making it impossible so far to generalize these results. Studies with a more robust methodology and larger samples will make it possible to confirm the potential usefulness of this complementary treatment.
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Affiliation(s)
- Jean Toniolo
- UMR INSERM 1094 Tropical Neuroepidemiology, Faculty of Medicine, University of Limoges, Limoges, France.,Haematology Department, Limoges University Hospital Center, Limoges, France
| | - Valérie Delaide
- Medical Clinic Pole, Limoges University Hospital Center, Limoges, France
| | - Pascale Beloni
- UMR INSERM 1094 Tropical Neuroepidemiology, Faculty of Medicine, University of Limoges, Limoges, France
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The Effect of Concealing the Hydration Fluid on Anticipatory Nausea-Vomiting in Pediatric Hematology-Oncology Patients Undergoing Chemotherapy Treatment: A Randomized Controlled Study. J Pediatr Nurs 2021; 59:181-187. [PMID: 33932648 DOI: 10.1016/j.pedn.2021.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE The aim of this study was to assess the effectiveness of concealing the hydration fluid bottle in order to reduce the experience of anticipatory nausea and vomiting before chemotherapy treatment in pediatric hematology oncology patients undergoing chemotherapy treatment. DESIGN AND METHODS The study was carried out as a randomized controlled clinical trial. The study was conducted sixty-two pediatric oncology patients who underwent chemotherapy in a hospital in Ankara, Turkey. The patients were randomly alloceted to an intervention group (n = 32) or a control group (n = 30). Patients in the intervention group concealing the hydration fluid bottle throughout the duration of hydration; patients in the control group received routine procedure (No concealment intervention) during hydration degree of nausea and vomiting were measured by the Baxter Retching Faces (BARF) scale. RESULTS This study found no differences in the characteristics of the patients or in degree of nausea and vomiting between groups at enrollment. After concealing the hydration fluid bottle during the hydration, BARF scores were lower in the intervention group (p < .001). CONCLUSION Concealing the hydration fluid had significant effects on degree of nausea and vomiting in pediatric oncology patient who received hydration before chemotherapy. APPLICATION TO PRACTICE This approach can be added as routine care as an effective non pharmacological intervention for pediatric oncology patient with receiving chemotherapy.
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Varejão CDS, Santo FHDE. Laser Acupuncture for Relieving Nausea and Vomiting in Pediatric Patients Undergoing Chemotherapy: A Single-Blind Randomized Clinical Trial. J Pediatr Oncol Nurs 2020; 36:44-54. [PMID: 30798684 DOI: 10.1177/1043454218810140] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Nausea and vomiting are frequent side effects associated with chemotherapy treatments. The aim of this study was to evaluate the efficacy of laser acupuncture in relieving nausea and vomiting in children and adolescents undergoing laser treatment. This is an experimental, randomized, single-blind study. The research was carried out at the INCA (Instituto Nacional de Câncer), a reference institution in the control and treatment of cancer, located in the city of Rio de Janeiro, Brazil. The research project was approved by the INCA Research and Ethics Committee under Registration No. 164/14 and CAAE 3374551.0.3001.5274. Children and adolescents between the ages of 6 and 17 years who were undergoing chemotherapy with drugs of high and medium degrees of emetogenic toxicity were selected. The participants were divided into two groups, A and B. In A, the active acupuncture was applied, and in B, the placebo acupuncture was applied. Analysis of the data indicated that there was significant relief from nausea in the intervention group when compared with the placebo group. A decrease in the number of episodes of vomiting on the second and third days of chemotherapy was also observed. On Days 1, 4, and 5, there was no significant difference in the number of episodes of vomiting in the intervention group as compared with the placebo group. The study concluded that laser acupuncture was effective in relieving nausea within 5 days of chemotherapy and in reducing the number of episodes of vomiting on Days 2 and 3 after chemotherapy.
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Affiliation(s)
- Cristiane da Silva Varejão
- 1 Cancer Chemotherapy Center of the National Cancer Institute, Rio de Janeiro, RJ, Brazil.,2 Aurora de Afonso Costa School of Nursing, Fluminense Federal University, (MPEA/EEAAC/UFF), Niterói, RJ, Brazil
| | - Fátima H do Espírito Santo
- 2 Aurora de Afonso Costa School of Nursing, Fluminense Federal University, (MPEA/EEAAC/UFF), Niterói, RJ, Brazil
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Luo H, Galvão DA, Newton RU, Fairman CM, Taaffe DR. Sport Medicine in the Prevention and Management of Cancer. Integr Cancer Ther 2020; 18:1534735419894063. [PMID: 31838880 PMCID: PMC6913064 DOI: 10.1177/1534735419894063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Physical inactivity is a major concern in cancer patients despite the established preventative and therapeutic effects of regular physical exercise for this patient group. Sport not only plays an important role in supporting the development and maintenance of a physically active lifestyle but also is increasingly used as a health promotion activity in various populations. Nevertheless, the potential of sport as an effective strategy in the prevention and management of cancer has gained little attention. Based on the scant evidence to date, participation of cancer patients in supervised, well-tailored sport programs appears to be safe and feasible and is associated with an array of physical and psychological benefits. We propose that sport participation may serve as an alternative strategy in the prevention of cancer and sport medicine in the management of cancer. As with the traditional exercise modes, benefits derived from sport participation will be dependent on the sport undertaken and the physical/physiological, motor, and cognitive demands required. To this end, further work is required to develop a solid evidence base in this field so that targeted sport participation can be recommended for cancer patients.
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Affiliation(s)
- Hao Luo
- Guangdong Vocational Institute of Sport, Guangzhou, Guangdong, China.,Edith Cowan University, Joondalup, Western Australia, Australia
| | - Daniel A Galvão
- Edith Cowan University, Joondalup, Western Australia, Australia
| | - Robert U Newton
- Edith Cowan University, Joondalup, Western Australia, Australia.,University of Queensland, Brisbane, Queensland, Australia.,The University of Hong Kong, Hong Kong
| | | | - Dennis R Taaffe
- Edith Cowan University, Joondalup, Western Australia, Australia.,University of Queensland, Brisbane, Queensland, Australia
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[Prevention and treatment of antineoplastic drug-induced nausea and vomiting in pediatric onco-hematology: An update]. Bull Cancer 2020; 107:800-812. [PMID: 32418660 DOI: 10.1016/j.bulcan.2020.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/25/2020] [Accepted: 03/29/2020] [Indexed: 11/21/2022]
Abstract
Antineoplastic drug induced nausea and vomiting are common adverse events in cancer care of paediatric patients ; therefore, prevention and management of these adverse events is a major concern for healthcare professionals. There are common features between paediatric and adult patients in terms of the emetogenic level depending on antineoplastic agents or about available medicines. However, there are also specificities for paediatric population including individual risk factors of emesis or nausea assessment for example. Knowledge relative to available medicines is also limited in the paediatric population, especially for recent medicines. This review aims to provide a comprehensive overview about antiemetics in paediatric oncology to clinicians and other healthcare professionals involved in paediatric cancer care. First of all, we describe physiopathological paediatric specificity, risk factors and clinical assessment of antineoplastic drug induced nausea and vomiting. Secondly, we focus on available medicines and also address the issue of complementary and alternative medicines.
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CE: Hematologic Childhood Cancers: An Evidence-Based Review. Am J Nurs 2019; 119:34-44. [PMID: 31764050 DOI: 10.1097/01.naj.0000615784.09785.ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Every year in the United States, thousands of children and adolescents are diagnosed with a hematologic cancer. That diagnosis and the prescribed course of treatment profoundly affect both the child and the family. This article provides a brief overview of the therapies used to treat such cancers, describes the presentations and diagnoses of the various hematologic cancers, and explains the treatments specific to each. Nursing care of the child and family is discussed, with an emphasis on education and supportive care.
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Information and Training Needs of Pediatric Oncologists in Complementary and Integrative Medicine: A Cross-Sectional Study. J Pediatr Hematol Oncol 2019; 41:551-556. [PMID: 31403489 DOI: 10.1097/mph.0000000000001578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
More than one third of all German pediatric patients with cancer use complementary and integrative medicine (CIM). Parents want to discuss the topic of CIM with their pediatric oncologists (POs); however, POs mostly do not feel confident discussing these topics. POs report openness to receiving further information and training, but CIM training opportunities in medical education seem rare. We investigated POs' information and training needs and preference patterns regarding CIM training content with a paper-based or online survey. A total of 101 POs from Germany completed the survey. Only 11.4% agreed to being sufficiently informed of CIM. The participants stated needing further CIM information very often (8.6%), often (38.7%), or occasionally (44.1%). They considered an overview of CIM therapies and information about relaxation methods, herbal remedies, and acupuncture for cancer-related symptoms such as lack of appetite, nausea, or vomiting as most important in CIM training material, and also the topics of adverse effects and summary of evidence. Finally, POs reported on clinical situations in which a need for further information on CIM emerged. The results of our study indicate that there is a need for a structured training that offers knowledge and skills on the subject of patient counseling on CIM in pediatric oncology.
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Abstract
PURPOSE OF REVIEW Advances in the field of Pediatric Oncology have led to increased survival rates in children with cancer, and addressing the emotional well-being and quality of life of this specific population is a critical component of care. Mind-body therapies (MBTs) are an adjuvant modality of treatment that appears to have a positive impact on patient quality of life, patient mental health, and family perceptions toward illness. In this review, we describe several evidence-based MBTs, such as art therapy, meditation, prayer, music therapy, hypnosis and relaxation techniques, their use, and our personal experience with MBT in our institution. RECENT FINDINGS Current data suggests that MBTs have been effective in decreasing symptoms related to oncologic pathology in children. Based on experience in our institution, the administration of these therapies can be expanded with the use of technology and also foster family inclusion in care, which can lead to improved quality of life for the patient and family. Further studies are warranted to ascertain the effects of MBTs in childhood cancer. MBTs are increasingly important in the care of youth with oncologic disease. It is necessary to increase the quantity and quality of research for the selection and inclusion of MBT in this population.
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Abstract
High-quality systematic reviews of use of herbal or homeopathic remedies in children often suffer from design flaws, such as not following PRISMA guidelines, inconsistent outcome measurements, and paucity of high-quality studies. Herbal remedies have modest demonstrated benefits with insufficient evidence to recommend any particular supplement. Homeopathic remedies have no role in treatment of pediatric conditions, and have been associated with great harm in infants given homeopathic teething products. Two types of herbal supplements are associated with high risk in adolescents, energy drinks and adulterated weight-loss products. Parents should be counseled about risks of these products.
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