Integrative and Complementary Interventions Result in Significant Positive Effect Sizes in Quality of Life and Symptom Burden among Patients with Pediatric Cancer and Other Serious Illness.
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PURPOSE: Children with cancer report intractable symptoms and endorse using complementary and integrative health interventions (CHI) without strong published evidence. We conducted a prospective study of CHI in 100 participants at two children's hospitals. The secondary aim was to estimate outcome effect sizes. Here we report preliminary effect size estimates of CHI on quality of life (QOL) and symptom burden in pediatric participants with cancer and other serious illness. METHODS: We used standardized patient reported outcome (PRO) measures in response to CHI sessions. Data were collected at baseline, pre/post CHI, and monthly up to 6 months. Outcomes were QOL and symptom burden. RESULTS: Participants (n=100) were aged 2-29 years (M=13.5, SD=5.6), 65% identified as female, 23% were from underrepresented populations, 52% were receiving treatment for cancer versus other serious illness. Participants completed 191 CHI sessions with 811 PRO assessments. CHI included acupuncture (39%), aromatherapy (35%), creative arts (20%), massage therapy (5%), and hypnosis (1%). Mixed-effects models controlling for cancer diagnosis revealed improvement in anxiety, fatigue, pain, sadness, and mood (Cohen's d effect sizes 0.20-1.45; all p<0.05). Creative arts were associated with improvement in all symptoms except for nausea (0.31-1.45; all p<0.03). QOL improved over time (b = 0.21; p<0.05) and was clinically significant compared to standard clinical cut offs. CONCLUSION: Patients (or proxy) reported improvement in QOL and symptom burden with CHI. The positive effect size estimates support for the need for additional efficacy studies of targeted CHI among children with serious illnesses including cancer, especially creative arts interventions.