Guest Contributor Dr. Roberto Campos Jeldres is a medical doctor with a specialty in pediatrics and subspecialty in hematology and pediatric oncology. He is a graduate of the APIM 2022 Academy Scholar cohort.
He is currently head of the Conventional and Integrative Oncology Unit at Sanatorio Aleman Hospital in Chile and Hospital las Higueras Talcahunao Chile.
Dr. Campos has created a bridge between conventional and integrative care, Chile’s first Pediatric Integrative Oncology Unit is paving the way for a more holistic model of cancer treatment, centered on the concept of healing the “whole child” and enhancing the overall experience for patients and families.
The recent establishment of Chile’s first Pediatric Integrative Oncology Unit marks a groundbreaking shift in the approach to childhood cancer care. This unit represents a comprehensive model that bridges conventional treatments with evidence-based integrative therapies, aiming to address both the physical and emotional needs of pediatric cancer patients. By integrating modalities such as nutrition, mind-body therapies, acupuncture, and physical activity, this unit seeks to enhance quality of life, manage side effects, and provide holistic support throughout the treatment journey.
The World Health Organization (WHO) describes chronic pain in children as a significant public health concern, with prevalence estimated to be 20–35% globally.
Pediatric chronic pain is complex and can include nociceptive, neuropathic, affective, sociocultural, behavioral, and cognitive components and therefore requires multimodal management. It has been shown to be a dynamic integration of biological processes, and psychological and socio-cultural factors considered within the child’s developmental trajectory.
A systematic review on the epidemiology of chronic pain in children and adolescents found a range of prevalence rates, for example: 8–83% for headaches, 4–53% for abdominal pain, 14–24% for back pain, 4–40% for musculoskeletal pain, 4–49% for multiple pains, and 5–88% for other pains.
Early recognition of chronic pain and thoughtful use of non-pharmacological management options may help minimize overprescribing and long-term reliance on dependence-forming-drugs. Improving quality of life is a basic premise and keeping children pain-free is even more challenging. In countries like Latin America, we have the habit of using pharmacological drugs to mitigate pain. We have improved technically, but have forgotten humanized care, which is a non-pharmacological treatment.
Why is it important to talk about non-pharmacological treatment for pain and palliative care? In my opinion, talking about non-pharmacological treatments is crucial because approaches such as those used in integrative medicine allow us to deliver safe, personalized, evidence-based care for patients.
Pediatric integrative medicine (PIM) still has barriers like minimal access, gaps in scientific studies and health system insurance coverage, ignorance of the meaning of integrative and lack of educational training in the area.
Despite these gaps, the use of PIM is estimated to be between 50% and 90% in Latin America. The prevalence of integrative medicine use in other international palliative care settings ranges from: 29% in Canada, 43% in Germany, and 63% in Hong-Kong. Studies from Brazil show a prevalence range of up to 50%.
In Chile, we have seen that 51% of our cancer pediatric patients use PIM, importantly, 50% of the patients do not tell the oncology team about using it, and 90% report obtaining the information from unregulated sources (internet or a friend).
What about pain? In continuing care and at the end of life, many patients struggle with uncontrollable pain, (end of life: 50% suffered moderate to severe pain).
Neuropathic pain can be treated with traditional conventional therapies, such as neuroleptic drugs, antidepressants and opioids, which have variable success and frequent reported unwanted side effects.
A systematic review showed that progressive muscle relaxation and guided imagery results in a significant reduction in non-musculoskeletal pain in 11 of 15 trials. Acupuncture demonstrated efficacy as a treatment for pain associated with migraines, headaches, neck pain, arthritis and low back pain, and decreased analgesic use by 62% in the pediatric population. Aromatherapy has also been used for pain relief, especially when combined with therapeutic massage and can also improve sleep, reduce fatigue, lesson depression and improve overall quality of life.
In our experience, I remember a patient diagnosed with a brain tumor. After undergoing every possible treatment, he arrived with a poor quality of life, malnutrition, and on a lot of pain medications. We began this journey with teamwork based on improving his nutrition, using supplements and an anti-inflammatory diet. For pain and muscle spasms, we began acupuncture treatment at home. He improved every day, even decreasing the pain killer drugs. We also used aromatherapy in conjunction with massages to reduce pain, muscle spasms, and improve his sleeping problems. At the end of the journey, the patient reached the end of life, but his quality of life and that of his parents improved considerably with teamwork and integrative medicine.
We can help our patients in so many ways. We need to encourage our patients and their families to learn more about evidence-based integrative therapies.