Pediatr Blood Cancer 2014;61:687–692 Use of Traditional and Complementary/Alternative Medicine (TCAM) in Children With Cancer in Guatemala Elena J. Ladas, PhD, RD, 1 * Silvia Rivas, MD, 2 Deborah Ndao, MPH, 1 Doree Damoulakis, BA, 1 Yuan Yuan Bao, MS, 3 Bin Cheng, PhD, 4 Kara M. Kelly, MD, 1 and Federico Antillon, MD 2 INTRODUCTION The prevalence and factors associated with the use of traditional complementary/alternative medicine (TCAM) have become an important focus of pediatric oncology research, largely due to evidence documenting the high prevalence of use among children undergoing treatment for cancer in developed countries [1]. Children with cancer are three times more likely to enlist support with TCAM compared to children with other medical conditions [2]. Most often, TCAM is used for supportive care indications rather than a replacement for conventional medical care [3]. In the developing world, approximately 70–80% of the population rely on TCAM to support their primary healthcare needs [4]. Within this context, concerns about TCAM and the potential for its use to limit access to conventional medical care are exacerbated. However, an adequate understanding of the role of TCAM in conjunction with conventional care is hampered by the paucity of representative data for most developing countries [4]. Published findings on this topic are primarily from Asia, where data show a high prevalence of TCAM use in Malaysia (84.5%), Sri Lanka (67.4%), Taiwan (73%), and Singapore (67%) among the general population [5–8]. To date, there have not been published surveys exploring the use of TCAM in children residing in Central or South America. In Mexico, the use of TCAM was reported by 70% of pediatric cancer patients [9]. The use of TCAM may adversely impact the achievements obtained with conventional care possibly by reducing the effectiveness of conventional anticancer treatments, or leading to a delay or discontinuation of biomedical treatment owing to the convenience, low cost, ease of use, or expectations of cure associated with the use of TCAM. In a retrospective review conducted between 2000 and 2004 at the Unidad Nacional de Oncologı ´a Pedia´trica (UNOP) in Guatemala City, 20% of children with leukemia or lymphoma abandoned treatment. Guatemala is a low-income, developing country with a strong cultural attachment to traditional and folk medicine. Despite government-led reforms committed to more equitable access to healthcare for rural populations, including efforts to integrate Mayan medicine into conventional care practices, usage of biomedical facilities remains low. Evidence of the relationship between TCAM use, patterns of presentation, and the treatment preferences of pediatric cancer patients in Guatemala has been extrapolated from prior research that is largely limited to samples taken from single villages, and is specific to diarrhea and other common pediatric conditions [10–12]. This prior research includes findings from a health services utilization survey conducted in rural Guatemalan villages, which revealed that mothers used traditional medicines as the first line of treatment for 63–83% of diseases in children [10]. More recent survey data indicates that the vast majority of childhood illnesses are treated according to recom- mendations from family and friends [11]. A number of sociocultural factors have been associated with this treatment-seeking behavior, including: household income, social ties, illness characteristics, previous experience, gender, parent’s level of education, ethnicity, and language [11]. Background. International surveys have demonstrated that use of traditional and complementary/alternative medicine (TCAM) is highly prevalent among children with cancer; however, little is known about its use among children with cancer in Latin America. As part of a regional initiative, we present the results of the first survey exploring use of TCAM among children with cancer residing in Latin America. Procedure. A cross-sectional sample of 100 parents whose children received treatment in Guatemala City were interviewed from May 2008 to February 2010. Upon consent, an in-person interview was performed during a routine clinical visit. Information on the form, duration, cost, and satisfaction of TCAM was collected. Approval from the institutional review board was obtained. Results. The median age of patients was 9.2 years with 63% undergoing treatment. Use of TCAM was reported by 90% of parents. Most often, more than one type of therapy was utilized. Most patients (67%) relied on TCAM for supportive care indications; however, a significant percentage (34%) used TCAM for curative purposes. The most commonly reported form was the use of oral supplements with the majority perceiving TCAM as effective for the intended purpose. Conclusions. Use of TCAM was highly prevalent among children with cancer residing in Guatemala. Most importantly, TCAM was used alongside conventional therapy for supportive care indications. These findings underscoring the need for open lines of communication between clinicians and families. Future research may consider exploring the role of TCAM within the scope of supportive care and its effect on existing supportive care inter- ventions. Pediatr Blood Cancer 2014;61:687–692. # 2013 Wiley Periodicals, Inc. Key words: alternative medicine; nutrition; pediatric oncology; supportive care 1 Division of Pediatric Hematology, Oncology, Stem Cell Transplant, Columbia University, New York, New York; 2 Unidad Nacional de Oncologia Pediatrica, Hemato-Oncology Service, Guatemala City, Guatemala; 3 Division of Epidemiology, New York State Psychiatric Institute, New York, New York; 4 Division of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York Grant sponsor: Tamarind Foundation Conflict of interest: Nothing to report.  Correspondence to: Elena J. Ladas, Director, Center for Comprehen- sive Wellness, Division of Pediatric Hematology, Oncology, Stem Cell Transplant, Columbia University, 161 Ft Washington, 7th Floor, New York, NY 10032. E-mail: ejd14@columbia.edu Received 16 June 2013; Accepted 2 September 2013 C 2013 Wiley Periodicals, Inc. DOI 10.1002/pbc.24791 Published online 21 September 2013 in Wiley Online Library (wileyonlinelibrary.com).