Keeping the balance – an overview of mind–body therapies in pediatric oncology
Introduction
The treatment of children with cancer is one of the great medical success stories of the last half-century. In the field of pediatric oncology more than three-quarters of all children diagnosed with cancer will now be cured.1 Nevertheless, the side effects like distress, fatigue or pain of the numerous and repeated painful medical procedures are still prevalent.2, 3 Families report that symptoms of anorexia, nausea, vomiting and pain are not adequately treated with conventional medicine.4, 5 Side effects influence quality of life, months, years, even decades beyond treatment6, 7 and also the family functioning decreases over the first year after diagnosis.8
CAM is defined as a group of diverse medical health care system practices and products that are not presently considered to be a part of conventional medicine. In general they tend to help and re-structure the recovery of health and quality of life in cancer patients promoting symptom reduction after invasive treatments.
Mind–Body Therapies (MBTs), as part of CAM, comprise various techniques based on body work and relaxation to enhance the mind's capacity to affect bodily function and symptoms promoting cure. Mind–Body interventions have a holistic approach towards health and care. These therapies include meditation, yoga, tai chi, deep-breathing exercises, guided imagery, hypnotherapy, relaxation techniques and expressive therapies such as music, art, dance and movement therapy.9 The National Institutes of Health (NIH) defines MBTs as practices “that focus on the interactions among the brain, mind, body, and behaviour, with the intention to use the mind to affect physical functioning and promote health”.9 Coming up in the early 1960, MBTs were inspired by research into stress physiology and psychology10 and the core concept of salutogenesis by Antonovsky.11 MBTs are no alternatives to the conventional medicine but moreover an enlargement to focus on the individual needs of the patients and to motivate the patient to become an active part in his recovery.
In pediatric oncology MBTs have had a wide use range particularly among educated population15, 16 in western countries.13, 14 Results of previous work indicated that 31–84% of children used some form of CAM along with conventional anti-cancer therapy.16
In a survey of various complementary therapy modalities, MBTs were found to be the most used by cancer patients18 and have been especially recommended to reduce pain, nausea, fatigue, sleep disturbance and avoid side effects of pharmacological treatments regularly used for these symptoms.15, 19, 20
General aims of MBTs are to contribute to symptom management during invasive treatments, avoid unspecific side effects in particular pain or fatigue and to improve quality of life of cancer patients. According to Post-White,7 MBTs are or of low risk in comparison with herbal therapies which might interfere with medical treatments. The goals of MBTs are also consistent with those of the Initiative for Pediatric Palliative Care, a consortium of institutions and academic centres whose aim is to enhance the care delivered to children living with life threatening illness.21
Another important goal for the use of MBTs in pediatric cancer treatment is the application of MBTs for the parents. In a group survey22 of 125 families in pediatric oncology, all parents except one reported post traumatic stress symptoms and mean scores on the post-traumatic stress disorder reaction index. Interventions directed at parents should therefore be included as part of the treatment plan.23
In the following section we will discuss most used MBTs that have been applied in children with cancer.
Section snippets
Relaxation techniques
Relaxation is a biological response that minimizes sympathetic nervous system activity which in turn decreases oxygen demand and slow heart rate.24 Relaxation therapies are techniques designed to elicit a state of relative freedom from mental and physical tension. They have been used since the early 1900s with Jacobsen's muscle relaxation technique.25 The literature suggests that for cancer patients, symptom improvement occur as a result of eliminating physical tension, emotional stressors and
Hypnosis
Clinical hypnosis can be defined as an altered state of consciousness, awareness and perception.29 Hypnosis is a highly relaxed state in which the patients’ conscious and unconscious mind is open to therapeutic suggestion. The impact of hypnosis on pain reduction during painful procedures in pediatric oncology has been examined in several clinical trials.30, 31, 32, 33, 34 Hypnosis is proposed to be an appropriate medium for pain management in children because they tend to be more hypnotically
Discussion
This review gives an overview of promising MBTs in oncology, focussing on those which have already been used or might be of relevance for paediatric oncology.
The majority of studies have been conducted in adult cancer patients, and not many studies in children are available in the literature. The few clinical currently available data are in part very weak and scarcely. Nevertheless, we have attempted to summarise and evaluate published studies with regard to their potential use in pediatric
Conclusion
In sum, MBTs can be an enhancement of conventional medicine to motivate patients to participate in their recovery and promote self-regulation. Furthermore, MBTs aim to ameliorate quality of life of patients and their families during the enormous difficult period of cancer treatment. MBTs in paediatric oncology attempt to manage the side effects of cancer therapy, increasing child's internal strength and providing support for coping with the illness. Most MBTs are of low risk and are accessible
Conflict of interest
The authors declare that they have no conflicting interests.
Acknowledgement
This work was kindly supported financially by the SOFTWARE AG–Stiftung (Germany).
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Contributed equally to this work.