Homeopathy in paediatric oncology in Germany

Reprint from: Evidence-Based Complementary and Alternative Medicine
Volume 2011, Article ID 867151

Authors: Alfred Längler (1), Claudia Spix (2), Friedrich Edelhäuser (3), Genn Kameda (4), Peter Kaatsch (5), Georg Seifert (6)

Study content

Homeopathy is a frequently used treatment method in complementary and alternative medicine (CAM).

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186 (45.2%) of the 367 CAM users were treated with homeopathy. The mean duration of treatment was 601 days for HUs and 282 days for NHUs. Most HUs received their prescriptions from non-medical practitioners (Heilpraktiker) (56%; 29.4% of NHUs). HUs communicated with their doctors about the use of CAM more frequently (77.7% versus 65.2%) and recommended CAM more often than NHUs (94% versus 85.6%). Homeopathy is the most commonly used CAM treatment in PO in Germany. HUs continue their therapies significantly longer than NHUs. Most families who had used homeopathy before their child was diagnosed with cancer also used homeopathy during their child's cancer treatment. Compared with other CAM treatments, patient satisfaction with homeopathy appears to be very high.

1. Introduction

Complementary and alternative therapies (CAM) are frequently used in the treatment of acute and chronic illnesses both in Germany and worldwide. This applies equally to adults and children. With 1,595 participating parents, our study is currently the largest study of this kind in the international literature. 35% of the 1,063 patients whose parents took part in the study used CAM. Prior experience with CAM, poor prognosis and higher social status influenced the likelihood of CAM use (in order of importance). Despite the controversies surrounding homeopathy, we assume a growing number of homeopathy users in paediatric oncology. Therefore, the user profiles of homeopathy users in this field are of great interest. To date, no studies on the use of homeopathy in paediatric oncology have been published. With few exceptions, homeopathic remedies in paediatric oncology have only been used as a complement to conventional medicine. Homeopathy is prescribed both by doctors and by non-medical practitioners (Heilpraktiker) and is also used as self-medication. Homeopathy plays a significant role in many highly developed countries as well as in other countries such as India.

2. Patients and methods

The postal survey of parents was carried out in 2004 in cooperation with the German Childhood Cancer Registry (GCCR). At least 95% of all childhood cancer cases in Germany are registered in the GCCR. The study population comprised all parents in Germany with a child (under 15 years old) who was diagnosed with cancer in 2001 and systematically recorded and registered by the GCCR. Exclusion criteria were death within the first 8 weeks after diagnosis and the development of a second cancer. The survey was conducted in coordination with all German hospitals that treated children with leukaemia and cancer in 2001 and the GCCR. The questionnaire included an alphabetical list of 69 possible CAM treatments and therapies, one of which was homeopathy. CAM users who named this category were designated homeopathy users (HUs) and were compared with non-homeopathy users (NHUs) (i.e. users of other alternative medical methods, but not homeopathy). All patients had received conventional therapy as well as the reported complementary treatments. The study was approved by the Ethics Committee of the University of Witten/Herdecke, Germany and was carried out in accordance with the World Medical Association Declaration of Helsinki.

3. Statistical analysis

This is not an analytical study; it therefore primarily yields descriptive statistics, i.e. percentages relating to the data collected                               

Table 1: The "most important" CAM treatment methods from the users' perspective. Only treatment methods mentioned at least 10 times by CAM users were listed (multiple responses possible).

4. Results

4.1. CAM use
Of the 1,063 families who responded, 367 (35%) reported using CAM during their child's illness. Of these 367 CAM users, 166 (45.2%) reported that their child had taken homeopathic remedies. This was the largest numerical group of CAM users. When asked which CAM therapy was the "most important" for them, 137 (37.3%) of all CAM users reported that homeopathic remedies were given priority.

The median duration of use of homeopathic remedies was 601 days. The median duration of use of all other CAM therapies was 282 days. In many cases the therapy was still ongoing at the time of the survey.
 

There was no particular concentration of homeopathy users in specific diagnostic groups. Overall, 396 (37.3%) of respondents had prior experience with CAM, most commonly with homeopathy: 127 of 166 (76.5%); 38 (22.9%) homeopathy users had no prior CAM experience. The proportion of HUs with high social status was approximately the same as in the NHU group (52% vs. 47.6%).

4.2. Circumstances accompanying CAM use

The comparison between HUs and NHUs regarding reasons for using CAM showed that the categories

- "for physical stabilisation" (77.7% versus 63.2%), (72.3% versus 61.2%)
- "to improve the immune system",
- "to improve the tolerability of conventional treatment" (58.4% versus 39.3%), and
- for detoxification (42.2% versus 19.9%) were cited significantly more often by HUs.
The only category cited more often by NHUs than by HUs was
- "for relaxation" (21.4% versus 12.7%).

Non-medical practitioners (Heilpraktiker) played a significantly greater role for HUs than did the treating doctors. In the vast majority of cases HUs received their prescriptions from non-medical practitioners (56% versus 29.4% of NHUs). Self-medication plays a smaller role for HUs than for NHUs (13.8% versus 23.4%). The same applies to the social environment (28.9% versus 42.3%).

In most cases CAM was used concurrently with conventional treatment by the paediatric oncologist. 14% of users began CAM treatment only after the end of conventional therapy.

4.3. Communication

The proportion of families who discussed the use of CAM for their child with their doctors was particularly high among HUs (77.7%) compared with about two thirds among NHUs (65.2%).
With regard to the doctors' responses ("recommended", "noted", "discouraged" and "I don't know") there were significant differences.
7.3% of the HU group report that the hospital doctors they approached recommended the use of CAM - compared with 17.3% in the NHU group. 72.7% of the hospital doctors of HUs noted without comment that their patients were using CAM simultaneously - compared with 55.5% of the doctors of NHUs. 20% of the hospital doctors of HUs spoke out against CAM therapy - compared with 27.3% in the NHU group. For paediatricians and general practitioners there was no discernible difference in reactions between HUs and NHUs.

4.4. Hope and reality

There was no substantial difference between the two groups regarding their basic belief in the effectiveness of CAM. Before starting treatment 68% of HUs and 59.2% of NHUs were "absolutely sure" or "quite sure" that CAM would have a positive influence on their child's illness. However, the proportion of "doubters" was higher in the NHU group (31.8% versus 21.1%). In the HU group there were no substantial differences between parents' expectations and the actual effect of homeopathy on their child's illness.
The generally positive attitude of all CAM users is reflected in the willingness of parents to recommend the use of CAM to other parents in a similar situation: 89.4% of all CAM users would do so (94% of HUs, 85.6% of NHUs).

5. Discussion

The present data come from the most extensive and first population-based study on the prevalence of CAM in paediatric oncology.

An important factor influencing the likelihood of using CAM in paediatric oncology is prior family experience with CAM before the child developed cancer.
A large percentage of HUs (77.7%) discussed the use of homeopathic remedies with their doctor (GP, paediatrician, paediatric oncologist).

Our data show no association between the use of homeopathy and higher social status.
Given the generally positive expectations of CAM users, the high proportion of parents who would recommend CAM to other parents in a comparable situation is not surprising. Our data also show that HUs stay "on board" significantly longer with a homeopathic treatment than patients who use other CAM therapies. The high degree of satisfaction among HUs may also be contributed to by the fact that homeopaths devote more time and attention to their patients. A homeopathic consultation lasts about 1–2 hours.

In a qualitative comparative study of homeopaths and conventional doctors it was found that parents experience treatment by a homeopath as more holistic compared with the symptom-based approach of a conventional doctor. This also applies to the HUs in this survey, even though the prescribing therapists were mostly non-medical practitioners. The data from this survey do not allow conclusions to be drawn about treatment efficacy, the occurrence of side effects or interactions with homeopathic remedies. In a clinical double-blind study by Paris et al., patients in both groups (verum and placebo) were convinced of the effectiveness of homeopathy both before and after treatment.
Nevertheless, the analysis showed that the homeopathic treatment was as ineffective as the placebo. On the one hand, studies show that patients are convinced of the effectiveness of homeopathy from the outset. This appears to be a long-term issue and must be taken into account methodologically. On the other hand - assuming the therapy was overall successful - parents' subjective assessment indicates that they attribute a noticeable benefit to the complementary homeopathic therapy. Whether this has to do with an actual therapeutic or psychological effect, for example a "stimulus-response" or a placebo effect, is not yet known, as the methods used in this study do not allow differentiation of these effects.

6. Limitations

Because a relatively high percentage of the families surveyed use anthroposophic medicine (AM) in addition to homeopathy, the frequency of homeopathy use in paediatric oncology in Germany may be slightly overrepresented in this study. For laypeople it is often difficult to distinguish between AM and homeopathy, as both use potentised remedies.

7. Conclusion

Homeopathy is the most commonly used complementary therapy in paediatric oncology in Germany. Most homeopathy users had already given or taken homeopathic remedies before their child's cancer and would recommend homeopathy to others in similar situations.

This study was supported by a grant from the German Children’s Cancer Foundation, Bonn. Alfred Längler is supported by a research fellowship from the Software AG Foundation. The funding sources had no influence on the study design, data analysis or the publication process.

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(1) Department of Paediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany, University of Witten/Herdecke, Witten, Germany

(2) German Childhood Cancer Registry (GCCR), Institute of Medical Biometry, Epidemiology and Informatics (IMBEI), University of Mainz, Germany

(3) University of Witten/Herdecke, Witten, Germany

(4) Department of Paediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany

(5) German Childhood Cancer Registry (GCCR), Institute of Medical Biometry, Epidemiology and Informatics (IMBEI), University of Mainz, Germany

(6) Department of Paediatric Oncology and Haematology, Otto Heubner Centre for Paediatric and Adolescent Medicine, Charité–Universitätsmedizin Berlin, Germany