Use of complementary and alternative medicine in children with cancer: effect on survival

Integrative Medicine Across the Pediatric Cancer Care Trajectory: A Narrative Review

PURPOSE OF THE REVIEW

Children and adolescents with cancer, along with their parents and other informal caregivers, often report using complementary and alternative medicine (CAM) during active oncology and hemato-oncology treatment. Some adopt an "alternative" approach to conventional medical care, which often entails the use of these practices without the knowledge of the treating pediatrician. In contrast, many others search for consultation provided by a pediatric integrative oncology (IO) practitioner working with the conventional medical team. IO seeks to provide evidence-based complementary medicine therapies, many of which have been shown to augment conventional supportive and palliative care, while ensuring the patient's safety. The present narrative review examines the current state of and future direction for the IO setting of care.

RECENT FINDINGS

A large body of published clinical research supports the effectiveness of leading Pediatric IO modalities, while addressing potential safety-related concerns. Despite the growing amount of clinical research supporting the beneficial effects and implementation of Pediatric IO models of care, there is still a need for further studies in order to establish clinical guidelines in the treatment of children and adolescents with cancer. Such IO-directed guidelines will need to address both the effectiveness and the safety of the CAM modalities being used in pediatric oncology and hemato-oncology settings, promoting a better understanding among pediatric healthcare professionals and helping them understand the indications for referral to the IO treatment service.

Current use of medicinal plants for children's diseases among mothers in Southern Romania

There is a limited number of studies focusing on ethnomedical practices in children, particularly in Eastern Europe. Romania has a rich history of using medicinal plants in ethnopediatric care, and our objective was to identify the medicinal plants currently employed in treating childhood illnesses in the southern region of the country. Material and methods Our investigation used structured interviews, focusing on respondent demographics, local names of therapeutically employed herbs, the specific plant part(s) utilized, methods of preparation and administration, and local folk indications of taxa. A total of 326 mothers with children aged 0 to 18, hospitalized in the "Grigore Alexandrescu" Children Emergency Hospital Bucharest and residing in Southern Romania, were enrolled in the study. Use Value Citation Index (UVc), Informant Consensus Factor (Fic), and Fidelity Level (FL) were calculated. Results Twenty-five plants were identified for treating children's diseases in Southern Romania. The majority of informants resided in urban areas, and mothers primarily acquired knowledge from family members and healthcare professionals. The herbs most frequently employed were Mentha spp. (UV = 0.509) for diarrhea, Matricaria spp. (UV = 0.301) for skin infections (Fic = 0.99) and digestive diseases (Fic = 0.98), and Calendula officinalis L. (UV = 0.365) for skin diseases (Fic = 0.99). Less utilized were Raphanus raphanistrum subsp. sativus (L.) Domin in respiratory diseases, Prunus avium (L.) L. stalks in urinary tract ailments, Helianthus annuus L. in ear infections, Allium sativum L. in intestinal parasitosis, Viola tricolor L. in hives, Triticum aestivum L. in dermatitis and Allium ursinum L. as a tonic. In 184 cases herbal treatment was used in conjunction with conventional medications. Education level correlated with the number of employed plants and the variety of treated ailments, while residency (rural vs. urban) did not. Both residency and education influenced plant procurement methods: rural background and, surprisingly, higher education were linked to a preference for harvesting rather than purchasing plants. Conclusion Botanical remedies are still commonly used in the treatment of pediatric diseases in Southern Romania, although the variety of taxa seems reduced compared to the past. Further exploration is essential to unlock the maximum benefits of ethnopediatric practices.

Complementary Health Approaches for the Symptoms of Pediatric Oncology Patients

This study was conducted to determine the complementary health approaches (CHAs) used by pediatric oncology patients' parents for symptoms, their positive-negative effects, and the factors that influence their usage. The study was a descriptive design. The data were collected between March and November 2014 from the parents of 156 pediatric oncology patients in 2 different university hospitals in Turkey using the face-to-face interview method. In total, 99.4% of the parents who participated in the study used at least 1 CHA for their children. Complementary health approaches frequently adopted by the parents included praying (96.8%), oblation/sacrifice (50.6%), carob molasses (27.6%), grape molasses (22.4%), and massage (22.4%). Forty-three parents reported that they gave carob molasses to their children to reduce the symptoms of neutropenia, whereas 32 parents reported that they gave them grape molasses and 34 parents reported that they massaged their children to mitigate symptoms of pain. The parents reported that they used CHAs to enhance their child's immune system (61.3%), to do everything in their power to treat their child (42%), and to combat the side effects of medication/radiotherapy (25.8%). None of parents stated that they had observed any side effects from using CHAs. Almost all of the parents use one of the CHAs. The health personnel especially nurses should inform pediatric oncology patients and their parents about CHAs, which have no evidence and are potentially harmful and encourage them to approaches supportive to medical treatment.

Ruqyah and Its Use among Patients with Cancer

In this article, we reviewed ruqyah from past to present and its use among patients with cancer to attract attention to the importance of ruqyah. Ruqyah, one of the mind–body interventions among complementary and alternative medicine therapies, refers to the healing method based on the Quran and hadith through the recitation of the Quran, seeking of refuge, remembrance, and dua (supplication) that is used as a means of treating sickness and other problems, by reading ayats of the Quran, the names and attributes of Allah, or by using the duas in Arabic or in an understandable language. Ruqyah is frequently used in patients with cancer in combination with medical treatment, and many patients benefit from ruqyah practices. It is usually used to improve emotional and physical well-being, relax, cope with the disease, strengthen the immune system, increase vitality, decrease pain and stress, treat disease, accelerate the healing process, increase the duration of life, improve sleep quality, reduce side effects associated with treatment, and to be self-sufficient. Ruqyah is a complementary method for modern cancer treatment. It is not an alternative to chemotherapy and cannot directly replace medical treatment. Patients can perform ruqyah by themselves without applying to Muslim faith healers or spiritual healing centers. It can be by everyone regardless of their religion and belief. Although ruqyah has been successfully used in various social, mental, spiritual, and physical disorders for over 1,440 years, there are limited randomized controlled trials about its use in patients with cancer due to lack of cooperation between health professionals and Muslim faith healers applying ruqyah. Therefore, we suggest that health professionals develop joint projects and studies with Muslim faith healers and Islamic religion professionals on this subject. Finally, we strongly believe that ruqyah must be integrated into mainstream modern medicine as in the “Malaysia model” in both developing and developed countries.

Complementary and alternative medicine use by pediatric oncology patients before, during, and after treatment

Background

The prevalence of complementary and alternative medicine (CAM) use and the modalities used by pediatric oncology patients vary widely across studies. In addition, the changes in the use of CAM over the course of treatment are understudied. Thus, this study aimed to explore (1) CAM use by pediatric oncology patients in relation to specific time intervals and (2) communication about CAM use between parents and oncologists.

Methods

This retrospective cross-sectional study was conducted among parents of children diagnosed with cancer at a Swiss pediatric hematology-oncology center by means of an online questionnaire. Questions were related to their child’s CAM use over different time intervals, sources of information about CAM use, and communication with the oncologists.

Results

Among 140 respondents, CAM was used by 54.3% of patients before diagnosis and 69.3% of patients after diagnosis. During each defined time interval, between 50 and 58.8% of the patients used at least one CAM. Homeopathy was the most popular CAM modality used during oncology treatment, during the first year after treatment, and between 1 and 5 years after the end of treatment. Osteopathy was the most popular CAM ≥5 years after the end of oncology treatment. Forty percent of respondents did not discuss CAM with their oncologist.

Conclusions

The high prevalence of CAM use and the different trends of use during the oncology care pathway and afterward underline the need to increase communication about CAM in the pediatric oncology setting, notably regarding benefits and risks of interaction with oncology treatment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-021-03271-9.

Predictors for the use of herbal and dietary supplements in children and adolescents with kidney and urinary tract diseases

Complementary and alternative medicine are treatments administered alone or in combination with conventional medical treatments. Data on complementary and alternative medicine use in children with kidney and urinary tract diseases are limited. In this cross-sectional study, the frequency and preferred methods of complementary and alternative medicine use and factors associated with their use were evaluated in 201 patients (48% female; median age, 11 years; median disease duration, 5.1 years) with kidney and urinary tract diseases and 260 healthy (without chronic disease) controls. Data were collected through a questionnaire-based interview and patients' medical records. Herbal and dietary supplements, including fish oil, were the most commonly used complementary and alternative medicine agents in both groups. There was no difference in herbal and dietary supplement use between the groups when fish oil was excluded (29% vs. 28%; p = 0.88). Herbal and dietary supplements were mainly used to improve/mitigate renal disease (52%). Logistic regression analysis revealed that disease duration > 7 years (odds ratio (OR), 3.70; 95% confidence interval (CI), 1.48-9.20), current use of six or more drugs (OR, 5.6; 95% CI, 1.28-24.41), and recurrent urinary tract infection or nephrolithiasis (OR, 3.92; 95% CI, 1.02-15.09) were the independent risk factors for herbal and dietary supplement use, except fish oil. Middle socioeconomic status was associated with decreased herbal and dietary supplement use, except fish oil, compared with low socioeconomic status (OR, 0.30; 95% CI, 0.11-0.81). Herbal and dietary supplements were used by 78% patients, despite knowing that these products could have side effects; only 42% of the patients shared the information about herbal and dietary supplement use with their doctors.Conclusion: Herbal and dietary supplement use is frequent in children with kidney and urinary tract diseases. Educating health professionals regarding such use is mandatory for developing strategies to prevent critical consequences. What is Known: • Complementary and alternative medicine (CAM) practices are therapeutic approaches that do not have sufficient efficacy and safety evidence. • CAM is widely used in healthy children and in certain chronic diseases. What is New: • Herbal and dietary supplements (HDSs) were the most commonly used method in kidney and urinary tract diseases. • Duration of disease, number of drugs, and socioeconomic status are determinants of HDS use except fish oil.

Recurrence of Breast Cancer After Primary Treatment: A Matched Comparison Study of Disease-Free Survival in Women Who Do and Do Not Receive Adjunctive Naturopathic Oncology Care

PURPOSE

To compare disease free survival experienced by women who received usual oncologic care compared to a cohort of women who received naturopathic oncology care in addition to usual care.

METHODS

Women with breast cancer who received naturopathic oncology (NO) care in Western Washington State (WA) (N = 176) were recruited to a prospective study of clinical health-related quality of life outcomes and then matched to women who received usual care (UC) only (N = 334).

RESULTS

Among 510 women with breast cancer stages 1 to 3, a total of 50 women (10%) experienced a disease-free survival (DFS) ending event within the observation period; 23 (6.8% of those in the UC cohort, and 27 (15.3% of those in the NO cohort (P < .05). Although, women in the 2 cohorts received similar surgical, chemotherapy, and radiation treatment, women with breast cancer who received naturopathic oncology adjunctive care were less likely to use anti-estrogen therapy, and experienced poorer DFS (logrank test, P < .05). However, differences in DFS could not be shown to be due to cohort differences in anti-estrogen therapy, baseline HRQOL, or naturopathic oncology therapies prescribed. The stage 3 women in the naturopathic oncology group had more advanced disease at diagnosis. They were more likely to have 5 or more metastatic lymph nodes at baseline (18.5%) compared to their usual care matched control group (13%). Women in the naturopathic oncology group also had higher grade tumors at diagnosis.

CONCLUSIONS

Results show that recurrence of breast cancer was associated with more advanced malignant lymph node involvement; and that naturopathic oncology services provided in 2009-2015 did not improve disease-free survival in these high-risk breast cancer patients.

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

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.

Bee products and their role in cancer prevention and treatment

OBJECTIVES

Apitherapy, a method from the field of complementary and alternative medicine, promises better survival and even cure in cases of cancer.

DESIGN

129 books on apitherapy in English, French and German languages were analysed regarding the recommendations concerning cancer. The recommendations were compared to the results from clinical studies in the literature.

RESULTS

Eighteen books recommend apitherapy for cancer prevention, thirty-nine for complementary cancer treatment and seventeen books considered apitherapy able to cure cancer. Pollen and Propolis were mainly recommended in order to stimulate the immune system and/or to improve cancer nutrition. Interestingly, few books provided specific information and no book provided adequate information in comparison to what is known from clinical studies on bee products. Data on relevant aspects of cancer treatment were not mentioned. This especially refers to data of bee products and radiotherapy, chemotherapy and radio-chemotherapy-induced oral mucositis, radiotherapy-induced skin toxicity, radiotherapy-induced xerostomia, cancer-related fatigue, febrile neutropenia, cisplatin-induced nephrotoxicity, tyrosine kinase inhibitor-induced toxicity, side effects of antihormonal treatment and cancer-related wounds.

CONCLUSIONS

Apitherapeutic books are not good advisors regarding all aspects of cancer. However, the potential of some bee products justifies further trials, especially on cancer prevention and complementary treatment.

[Complementary and alternative medicine use in two French pediatric oncology centers: A common practice]

BACKGROUND

The use of complementary and alternative medicine (CAM) in children with cancer is commonly used. However, studies and data on this topic are still scarce in France.

METHODS

Our aim was to investigate the prevalence of CAM usage in pediatric cancer patients and describe the modality of use. Our study population comprised children and young people treated from 2011 to 2012 in 2 French centers (Nantes, Paris). An anonymous self-administered questionnaire was addressed to families and data was collected from them and from the medical record.

RESULTS

Out of the 202 patients selected for the study, 111 families answered the questionnaire (55%). Fifty-four (48.6%) of respondents reported CAM used. Forty-seven (87%) patients used CAM during initial therapy of cancer. Thirty-two (59.3%) of them talked about their CAM usage with health professionals, whose 25 (75.8%) with their oncologist. The three most common therapies used were homeopathy (75.8%), chiropractic (31.5%) and faith healing (42.6%). The main reason for the use of CAM was to control the side effects of conventional treatment (85.2%). Overall perceived satisfaction was rated 7.4/10.

CONCLUSION

The prevalence of complementary and alternative medicines administration is high, even if scientific evidence is limited regarding the effects, mechanisms of action and security of CAM. Research is necessary to improve the communication and council quality to the family, optimize supportive cares and reinforce the pharmacovigilance.

New Trends and Recent Care Approaches in Pediatric Oncology Nursing

Increased incidence of children diagnosed with cancer and survivors was an impact on changes in pediatric hemato-oncology nursing care. In this review article, it is aimed to investigate the new trends and recent care approaches in pediatric oncology nursing. The recent care topics were common in the literature as family-centered care, technology-based care, program development, primary care of child, health-care provider, survivors and home care, and nonpharmacological care. All of the topics contribute to perform evidence-based care for health promotion and well-being in pediatric hemato-oncology nursing. Research reviews showed that many current topics for the care of children and their parents have entered in the literature. There is a need for more randomized controlled studies to improve the level of evidence of new nursing approaches.

Traditional and complementary medicine used with curative intent in childhood cancer: A systematic review

Traditional and complementary medicine (T&CM) strategies are widely utilized in pediatric oncology, with many families reporting T&CM use with the intention to cure cancer. Study of T&CM agents presents many challenges, as a heterogeneous group of agents and techniques are used for a variety of different purpose in many different oncologic conditions. We present a systematic review of the literature examining published reports in which T&CM agents are used with an intention of cure. Twenty-two reports were identified, with most reports being of poor quality. Novel paradigms are likely needed to further investigate T&CM agents.

Utilización de terapias complementarias y alternativas en niños con cáncer

<p>Determinar frecuencia, características y factores asociados al uso de terapias complementarias y alternativas en pacientes pediátricos en un departamento de oncología en Colombia.</p><p><strong>Métodos </strong>Estudio transversal en el que se aplica una encuesta a 398 cuidadores de pacientes pediátricos con cáncer en el Instituto Nacional de Cancerología en Bogotá, Colombia. Se registró información sociodemográfica y clínica, se evaluó el tipo de terapia, mecanismos de acción propuestos y patrones de uso de los tratamientos. Con regresión logística se evaluaron factores asociados con el uso de estas terapias.</p><p><strong>Resultados </strong>Todos los casos correspondieron a terapias complementarias usadas para efectuar curación o controlar síntomas de la enfermedad o del tratamiento. Un 81,9 % de los pacientes (IC95 %: 77,8% a 85,6 %) había recibido algún tipo de 81 diferentes modalidades utilizadas. Lo más utilizado fueron las terapias basadas biológicamente (especialmente jugos de frutos rojos). Quienes más frecuentemente usaron estas terapias fueron mujeres con mayor nivel educativo. El tiempo desde el diagnóstico y haber recibido tratamiento quirúrgico también se asociaron con el uso de estas terapias. El mecanismo de acción más frecuentemente atribuido fue el refuerzo inmunológico.</p><p><strong>Conclusión</strong> Se encontró una alta prevalencia de uso de terapias complementarias en esta muestra. Los pediatras deberían explorar en los pacientes el uso de estas terapias dado el potencial de interacciones con tratamientos farmacológicos o efectos adversos.</p>

Complementary and alternative medicine for Duchenne and Becker muscular dystrophies: characteristics of users and caregivers

BACKGROUND

Complementary and alternative medicine is frequently used in the management of chronic pediatric diseases, but little is known about its use by those with Duchenne or Becker muscular dystrophy.

METHODS

Complementary and alternative medicine use by male patients with Duchenne or Becker muscular dystrophy and associations with characteristics of male patients and their caregivers were examined through interviews with 362 primary caregivers identified from the Muscular Dystrophy Surveillance, Tracking, and Research Network.

RESULTS

Overall, 272 of the 362 (75.1%) primary caregivers reported that they had used any complementary and alternative medicine for the oldest Muscular Dystrophy Surveillance, Tracking, and Research Network male in their family. The most commonly reported therapies were from the mind-body medicine domain (61.0%) followed by those from the biologically based practice (39.2%), manipulative and body-based practice (29.3%), and whole medical system (6.9%) domains. Aquatherapy, prayer and/or blessing, special diet, and massage were the most frequently used therapies. Compared with nonusers, male patients who used any therapy were more likely to have an early onset of symptoms and use a wheel chair; their caregivers were more likely to be non-Hispanic white. Among domains, associations were observed with caregiver education and family income (mind-body medicines [excluding prayer and/or blessing only] and whole medical systems) and Muscular Dystrophy Surveillance, Tracking, and Research Network site (biologically based practices and mind-body medicines [excluding prayer and/or blessing only]).

CONCLUSIONS

Complementary and alternative medicine use was common in the management of Duchenne and Becker muscular dystrophies among Muscular Dystrophy Surveillance, Tracking, and Research Network males. This widespread use suggests further study to evaluate the efficacy of integrating complementary and alternative medicine into treatment regimens for Duchenne and Becker muscular dystrophies.

Polish natural bee honeys are anti-proliferative and anti-metastatic agents in human glioblastoma multiforme U87MG cell line

Honey has been used as food and a traditional medicament since ancient times. However, recently many scientists have been concentrating on the anti-oxidant, anti-proliferative, anti-inflammatory and other properties of honey. In this study, we investigated for the first time an anticancer effect of different honeys from Poland on tumor cell line - glioblastoma multiforme U87MG. Anti-proliferative activity of honeys and its interferences with temozolomide were determined by a cytotoxicity test and DNA binding by [H³]-thymidine incorporation. A gelatin zymography was used to conduct an evaluation of metalloproteinases (MMP-2 and MMP-9) expression in U87MG treatment with honey samples. The honeys were previously tested qualitatively (diastase activity, total phenolic content, lead and cadmium content). The data demonstrated that the examined honeys have a potent anti-proliferative effect on U87MG cell line in a time- and dose-dependent manner, being effective at concentrations as low as 0.5% (multifloral light honey - viability 53% after 72 h of incubation). We observed that after 48 h, combining honey with temozolomide showed a significantly higher inhibitory effect than the samples of honey alone. We observed a strong inhibition of MMP-2 and MMP-9 for the tested honeys (from 20 to 56% and from 5 to 58% compared to control, respectively). Our results suggest that Polish honeys have an anti-proliferative and anti-metastatic effect on U87MG cell line. Therefore, natural bee honey can be considered as a promising adjuvant treatment for brain tumors.

Differences in use of complementary and alternative medicine between children and adolescents with cancer in Germany: a population based survey

BACKGROUND

Use of complementary and alternative medicine (CAM) in children with cancer is common and probably increasing. However, data concerning differences between children and adolescents focusing on prevalence, reasons for use/non-use, costs, adverse effects, and socio-demographic factors are lacking.

PROCEDURE

A population-based survey over a 1 year period with 497 participants was conducted.

RESULTS

Of the 457 respondents (92%) 322 were children and 135 adolescents (>16 years of age) with malignancies. 31% reported CAM use from the time when being diagnosed, compared to an overall lifetime prevalence rate of 41% before cancer diagnosis. Among CAM users the most prevalent therapies were homeopathy, massage, anthroposophic medicine, acupuncture, and Bach flowers. The main reasons for use were to reduce therapy-related side effects, to strengthen the immune system, to achieve physical stabilization and to increase healing chances. Socio-demographic factors associated with CAM use were higher parental education and higher family income. A majority of CAM users (97%) would recommend CAM use. Most users (78%) informed a physician about CAM use. Side effects were rarely reported (5%), minor and self-limiting.

CONCLUSIONS

The high prevalence rates seem to represent the parental or patients needs for additional treatment perceived as successful and devoid of side-effects. Clinical care and the physician-patient relation would profit from an enhanced understanding of CAM and a greater candidness towards the parental needs. Safety and efficacy - especially of CAM with high prevalence rates - should be studied in rigorous basic and clinical research.

Young women's experiences with complementary therapies during cancer described through illness blogs

Many young women with cancer have a high symptom burden and negative psychosocial consequences as a result of their disease. To offset some of these experiences, a growing number of young women with cancer are writing about their experience with complementary therapies through online illness blogs. The purpose of this qualitative study was to examine descriptions of complementary therapy use among young women (diagnosed between 20 and 39 years of age) who maintained an online cancer blog. Women's narratives describe several themes of the experience of using complementary therapies including awakening, new identities (that incorporate loss), the good stuff, and release. Online illness blogs allow researchers to understand the complete experience of the patient through personal accounts and substantially contributes to the body of knowledge surrounding cancer in young adulthood and complementary therapy use.

A double blind randomised placebo controlled study of propolis (bee glue) effectiveness in the treatment of severe oral mucositis in chemotherapy treated children

OBJECTIVES

Chemotherapy-induced oral mucositis (OM) is a debilitating side effect. In addition to standard therapy, patients often use complementary and alternative medicine to treat OM.

DESIGN

Double blind randomised placebo controlled study assessing propolis (bee glue) efficacy for chemotherapy-induced severe OM treatment.

SETTING

University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.

INTERVENTIONS

Paediatric patients undergoing chemotherapy were randomly assigned to propolis (n=19) or placebo groups (n=21). Patients were introduced to a unified oral care protocol and asked to apply propolis or placebo to vestibular mucosa twice daily. Oral mucosa was assessed with the Oral Assessment Guide (OAG) twice a week when the patients were in hospital. Patients were followed for the period of the chemotherapy or for the first 6 months of the chemotherapy. An OAG score of 3 was considered to be severe OM and analysed.

MAIN OUTCOME MEASUREMENTS

Three dependent variables (a) OM episode frequency, (b) mean number of assessment visits, at which an OAG 3 score was noted, expressing mean OM duration, (c) mean number of OAG 3 scores expressing mean OM severity) were reduced to a single variable using principal component analysis. A new variable (FDS) was used as the dependent variable in ANCOVA model analysis to show the differences between study groups.

RESULTS

Severe OM was seen in 42% and 48% of patients in the propolis and placebo group, respectively. FDS was not statistically significant between study groups (p=0.59).

CONCLUSIONS

According to our study results, propolis cannot be recommended for severe OM treatment.