Pediatr Blood Cancer Anthroposophic Medicine in Paediatric Oncology in Germany: Results of a Population-Based Retrospective Parental Survey † ‡ Alfred Laengler,¨ MD1,2,, * Claudia Spix, PhD,3 Friedrich Edelhauser,¨ MD,2 David D. Martin, MD,4 § Genn Kameda, MD,1 Peter Kaatsch, PhD,3 and Georg Seifert, MD5 Background. Anthroposophic medicine (AM) is frequently status. Physicians played a relevant role for users of AM both in utilised in German-speaking countries as a complementary and alter- procuring information (24% vs. 11%; P < 0.001) and in prescribing native medicine (CAM) treatment approach. Procedure. This study medicines and therapies (73.0% vs. 34.9%; P < 0.001) compared to presents results of a retrospective parental questionnaire compar- users of other CAM. AM-users communicate more frequently with ing responses of AM-users and users of other CAM in paediatric their physicians about the use of CAM treatments (89.8% vs. 63.9%) oncology in Germany. The differences between these two groups and recommend CAM more often than other CAM-users (95.9% vs. are investigated with respect to usage, associated demographic char- 87%). Conclusions. AM plays a major role in paediatric oncology in acteristics and previous experience with CAM. Results. Ninety-eight Germany. Patients using AM sustain treatment and therapies consid- patients (27%) of the 367 CAM-users were exposed to anthropo- erably longer than patients using other CAM treatments. Furthermore, sophic treatments or therapies. Treatment duration amounted to a most families who had used AM before their child was diagnosed with median 619 days for AM and 225 days for other CAM treatments. cancer also used AM for the treatment of their child’s cancer. Com- Most parents with previous experience of AM also used AM for treat- pared to other CAM treatments, patient satisfaction with AM appears ment of their child’s cancer disease. AM-users had a higher social to be very high. Pediatr Blood Cancer © 2010 Wiley-Liss, Inc. Key words: cancer; children; eurythmy therapy; mistletoe preparations; population-based registry INTRODUCTION been published to date. This retrospective representative population- based survey investigates the differences in CAM-usage behaviour, Complementary and alternative medicine (CAM) is frequently associated circumstances and previous experience of CAM between used in treating acute and chronic diseases in Germany and also the group of AM-users and a group using other CAM treatments only worldwide. This applies equally to adults [1–3] and children [4–7]. in paediatric oncology. Data concerning frequency of CAM-use, particularly in paediatric oncology, has been published mostly in the form of small, single- centre studies [8–17]. The current study is part of the largest and 1Gemeinschaftskrankenhaus Herdecke, Department of Paediatric and to date the only population-based survey of CAM-use in paediatric Adolescent Medicine, Herdecke, Germany; 2Witten/Herdecke, Univer- oncology. Results of the general questionnaire previously published, sity Integrated Curriculum of Anthroposophic Medicine, Chair for The- showed that 35% of 1,063 patients whose parents responded to the ory of Medicine, Integrative and Anthroposophic Medicine, Herdecke, Germany; 3German Childhood Cancer Registry (GCCR) at the Institute survey used CAM (of 1,595 patients surveyed) [18]. A multifactorial of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Uni- analysis showed that the following factors influenced the probability versity Mainz, Mainz, Germany; 4Department of General Paediatrics, = < of CAM use: earlier experience of CAM (OR 4.72, P 0.0001), Haematology, Oncology, University Children’s Hospital, Tubingen¨ Uni- diagnosis with poor prognosis (OR = 1.63, P = 0.0013), child died versity, Tubingen,¨ Germany; 5Charite—Universit´ atsmedizin¨ Berlin, before the survey (OR = 1.97, P = 0.0063) and higher social status Otto Heubner Centre of Paediatric and Adolescent Medicine, Depart- (OR = 1.44, P = 0.1264). ment of Paediatric Oncology and Haematology, Berlin, Germany Anthroposophic medicine (AM) may be used as an extension Grant sponsor: Deutsche Kinderkrebsstiftung Bonn; Grant number: to conventional medicine or a replacement. The spectrum of thera- DKS 2003.13; Grant sponsor: Software AG Stiftung. peutic modalities offered by AM range from customised remedies Conflict of interest: Alfred Laengler received honoraria for lectures held derived from minerals, plants and animals to various artistic ther- on behalf of anthroposophic pharmaceutical companies (WELEDA, apies, rhythmical massage, eurythmy therapy [19] (specific body Helixor). Friedrich Edelhauser¨ works part-time for the University of movements with accompanying meditative aspects, carried out in Witten/Herdecke, Germany, Integrated curriculum of Anthroposophic conjunction with guided imagery), external treatments (compresses, Medicine, which receives a small amount of funding from anthropo- oils and ointments, baths), medical consultations and counselling sophic pharmaceutical companies (WELEDA, WALA, Helixor). Georg (partly psychotherapeutic), and anthroposophically extended nurs- Seifert is running a clinical study sponsored by anthroposophic phar- ing and care. These modalities aim to stimulate and strengthen maceutical companies (Wala, WELEDA, Helixor). the patient’s own healing forces and are practiced by physicians, † Director. therapists, and nurses. AM physicians are trained in both AM and ‡ Director Prof. Dr. Rupert Handgretinger. § Head. conventional medicine [20]. In German-speaking countries, that is, Germany, Austria, and Director Prof. Dr. Guenther Henze. Switzerland, AM plays a major role in general medical practice [21], *Correspondence to: Dr. med. Alfred Langler,¨ Gemeinschaft- especially in adult cancer patients (mistletoe therapy in particular) skrankenhaus, Department of Paediatric, and Adolescent Medicine, [22,23], but also in children [24]. While AM and mistletoe therapy, Gerhard-Kienle-Weg 4, D-58313 Herdecke, Germany. along with other CAM treatments are used in clinical oncology in E-mail: [email protected] Germany, no studies of the use of AM in paediatric oncology have Received 1 June 2009; Accepted 12 February 2010 © 2010 Wiley-Liss, Inc. DOI 10.1002/pbc.22523 Published online in Wiley Online Library (wileyonlinelibrary.com). 2Langler¨ et al. PATIENTS AND METHODS TABLE I. The ‘Most Important’ CAM Treatment Methods from the Users’ Viewpoint∗ The study survey was mailed to parents of paediatric cancer patients in 2004 in collaboration with the Deutsche Kinderkrebs- CAM treatment methods Number (%) register (GCCR) (German Childhood Cancer Registry). The study Homeopathy 137 (37.3) population included all parents whose children were under the age Mistletoe therapy 53 (14.4) of 15 years and had been diagnosed in 2001 with one of the diseases Anthroposophic–homeopathic medications 46 (12.5) registered and systematically recorded by the GCCR. At least 95% (except for mistletoe therapy) of all German cases of childhood cancer are registered in the GCCR. Food supplements 43 (11.7) Exclusion criteria for the survey were death within the first 8 weeks Reiki 27 (7.4) after diagnosis and development of a second cancer. The survey Dietary changes 26 (7.1) was conducted in coordination with all German hospitals which had Laying on of hands 22 (6.0) treated children with cancer in the year 2001 and had reported to the Medicines of plant origin (phytotherapy) 21 (5.7) GCCR. The hospitals were permitted to exclude individual patients Selenium 21 (5.7) from the survey with stating reasons. The questionnaires were sent Vitamin C 21 (5.7) Massage 19 (5.2) by mail. The CAM methods were listed in the questionnaire as Other 19 (5.2) comprehensively as possible to obtain a representative sample of Spiritual healer 18 (4.9) the different methods used. The German language questionnaire for Ayurveda, e.g., H15 (incense) 16 (4.4) parents was developed on the basis of data published on this topic to High dosage vitamins 16 (4.4) date, our own clinical experience and the experience obtained from Bach flower remedies 15 (4.1) a pilot survey [25]. Acupuncture 14 (3.8) The questionnaire presented a list of 69 CAM treatments Bioresonance 13 (3.5) and therapies in alphabetic order including anthroposophic– Kinesiology 13 (3.5) homeopathic medicines [20], eurythmy therapy [19] and mistletoe Osteopathy 12 (3.3) therapy [26]. Data for general CAM use has been previously ‘Biochemistry according to Schussler’¨ 11 (3.0) ‘Energy work’ 11 (3.0) published [18]. This article reports responses from CAM-users Music therapy 11 (3.0) who employed one or more of the three anthroposophic cate- Eurythmy therapy 6 (2.0) gories (anthroposophic medicine users [AM-user]). The differences between the AM-user group and the other CAM-user group ∗The table includes treatment methods listed at least 10 times plus (i.e., non-anthroposophic, complementary or alternative medicine eurythmy therapy (n = 367 CAM-users; multiple answers possible). users only [NAM-users]), are examined with respect to CAM-use Anthroposophic treatments in bold. behaviour, associated circumstances and previous experience of CAM. CAM during the course of their child’s illness. Of these 367 CAM- All patients had received conventional treatment as well as users, 67 (18%) used anthroposophic–homeopathic medication, 59 the specified complementary treatments or therapies. Because we children (16%) received mistletoe therapy and 11 children (3%) did not collect