Background: Pediatric patients with hematologic and oncologic diagnoses are at high risk of disease- and/or treatment-related symptoms, and families often seek complementary services alongside disease-directed therapy. Integrative medicine (IM) services can be effective holistic tools for symptom management and support, and are included in multiple NCCN supportive care guidelines. Despite recommendations that IM be included in comprehensive cancer care, availability and access remain variable across cancer centers, and the utilization of IM services—specifically for children—remains largely unknown. To address this knowledge gap, we conducted a retrospective review of 18 months of clinical metrics for a newly formed pediatric IM service at St. Jude Children’s Research Hospital (St. Jude) to assess referral trends and patterns of IM utilization in a pediatric cancer center. Methods: A retrospective medical record review was conducted for IM patients from December 2020 to June 2022. Descriptive analysis of the data and tests for significance of association were performed using R version 4.3.0. Results: Of 174 patients referred for IM consultation, 155 were seen (10.9% no-show rate). Among patients who received an IM consultation, 57.4% (n=89) were receiving primary anticancer therapy. The demographics of IM patients ranged in age from 4 months to 25 years, with 52.9% identifying as female and 67.7% as White. Compared with new patients at St. Jude during the study period, those referred to IM services differed only by having older average age (12.9 vs 9.2 years; P<.001). Neuro-oncology diagnoses were most common among IM-referred patients (31.6%). Following the initial consultation, most patients returned for at least 1 massage or acupoint visit (56.1% and 50.3%, respectively); the mean number of IM encounters per patient was 9.2 (median, 5 [range, 1–84]). The primary reasons for referral were refractory symptoms (49.7%) and interest in complementary therapies (6.5%–20.6%). Conclusions: During the first 18 months of pediatric IM availability, we observed increasing referrals and repeated utilization of services. Future work will investigate longitudinal trends in IM service utilization and the symptom-related impact of IM within a comprehensive cancer center.

Background/Objectives: Children with cancer suffer due to the underlying disease and prescribed cancer-directed therapies, and non-pharmacologic modalities may offer improved symptom control without additional medications. We sought to elicit knowledge, attitudes, and beliefs of Pediatric Hematology Oncology (PHO) providers surrounding the incorporation of acupuncture for symptom management for their patients. Methods: A cross-sectional survey instrument was created, formatted, and delivered to physicians and advanced practice providers (APPs) at a single US pediatric cancer center. Survey responses were summarized by descriptive statistics. Results: A total of 78 PHO clinicians participated (response rate 29%). Most participants were interested in learning more about acupuncture (n = 42, 56.0%), yet rarely (n = 17, 22.7%) or never (n = 46, 61.3%) recommend acupuncture to patients. Most (n = 51, 73.9%) noted that they would support institutional development of an acupuncture program. Over half (n = 37, 52.2%) indicated their threshold for minimum hematologic indices for acupuncture includes a platelet count greater than 20,000 and absolute neutrophil count (ANC) greater than 500 (n = 37, 54.4%). Approximately two-thirds (n = 52, 66.7%) of participants noted that acupuncture could improve their patient’s quality of life, and most (n = 46, 67.6%) were not worried about harm. Conclusions: Acupuncture for symptom management is an evidenced-based, guideline-concordant recommendation for adults with cancer, but robust data in the pediatric oncology population are lacking. PHO providers do not routinely recommend acupuncture for patients but note that it may improve quality of life. Given their high symptom burden, rigorous studies of non-pharmacologic strategies for pediatric symptom management are vital. Acupuncture should be examined as a potential beneficial adjunct.