Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA.
Division of Hematology and Oncology, Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
Support Care Cancer. 2018 Feb;26(2):375-391. doi: 10.1007/s00520-017-3908-0. Epub 2017 Oct 13.
Traditional and complementary medicine (T&CM) use in children with cancer is well established among high-income, upper middle-income, low-middle-income, and low-income countries (HIC, UMIC, LMIC, LIC, respectively). In HIC, a developing body of evidence exists for several T&CM therapies; however, evidence in other income settings is less well described despite a significantly higher use when compared to reports from HIC. The aim of this systematic review was to evaluate the evidence for T&CM for a variety of supportive care indications among children with cancer.
We performed a systematic review following the PRISMA guidelines of randomized, controlled clinical trials from inception through September 2016. Our eligibility criteria were limited to T&CM studies performed in children and adolescents undergoing treatment for a pediatric malignancy.
Of 6342 studies identified, 44 met inclusion criteria. Two clinical trials reported on acupuncture, 1 reported on aromatherapy, 9 evaluated massage therapy, and 32 reported on dietary supplements. Twenty-two studies were performed in HIC, 15 in UMIC, and 7 in LMIC. T&CM therapies were most commonly investigated for the prevention or management of mucositis, weight loss, and febrile neutropenia. Encouraging results were reported for select interventions; however, the majority of studies were classified as poor to fair quality.
Our search revealed numerous clinical studies investigating the use of T&CM for supportive care purposes in pediatric oncology in HIC, UMIC, and LMIC. Although limited, these results could inform supportive care resource allocation and indicate where T&CM may serve to fill gaps where access to care may be limited.
在高收入国家（HIC）、中上收入国家（UMIC）、中下收入国家（LMIC）和低收入国家（LIC），传统医学和补充医学（T&CM）在癌症儿童中的应用已经得到证实。在 HIC，有相当数量的证据表明，几种 T&CM 疗法是有效的；然而，在其他收入水平的国家，证据描述得较少，尽管与 HIC 的报告相比，这些国家的 T&CM 使用率明显更高。本系统评价的目的是评估 T&CM 对癌症儿童多种支持性护理指征的证据。
我们按照 PRISMA 指南，对截至 2016 年 9 月的所有随机对照临床试验进行了系统评价。我们的纳入标准仅限于在接受儿科恶性肿瘤治疗的儿童和青少年中进行的 T&CM 研究。
在 6342 项研究中，有 44 项符合纳入标准。两项临床试验报告了针刺，一项报告了芳香疗法，九项评估了按摩疗法，三十二项报告了膳食补充剂。二十二项研究在 HIC 进行，十五项在 UMIC 进行，七项在 LMIC 进行。T&CM 疗法最常用于预防或治疗粘膜炎、体重减轻和发热性中性粒细胞减少症。一些干预措施的结果令人鼓舞，但大多数研究的质量被归类为差到中等。
我们的搜索结果显示，在 HIC、UMIC 和 LMIC 中，有许多临床研究调查了 T&CM 用于儿科肿瘤支持性护理的用途。尽管数量有限，但这些结果可以为支持性护理资源的分配提供信息，并表明 T&CM 可能有助于填补可能受到限制的护理途径的空白。
