Journal of Palliative Care & Medicine
Open Access

About 3500 Filipino children develop cancer each year, and only about one-third are diagnosed and treated in medical facilities. Of those who do seek consult, abandonment of treatment remains high. There are certain reasons for abandonment of treatment that are not surprising from a third world country like the Philippines. Families will often opt not to undergo treatment due to financial constraints or lack of resources. Another reason is they are unable to continue follow-up care since travel and transportation is difficult, given that the Philippines is an archipelago of 7,100 islands and rural areas are isolated.

Yet another reason is very common but overlooked: use of herbal medicine. Many families resort to the use of herbal medicines for cancer since it is readily available and affordable. Moreover, there are many anecdotal reports of how herbal medicine has improved symptoms or even ‘cured’ other illnesses. It is often used by people living in poor areas where it offers the only affordable remedy. Even in areas where modern medicine is available, the interest in herbal medicines and its utilization have been increasing in recent years.

Even though herbal supplements are commonly used among adult cancer patients, parents and guardians do not realize the inappropriateness and danger of its use in paediatric cancer as sole treatment. Because of delays in proper treatment and management, children with cancer often progress to severe disease or even succumb to their cancer before even starting chemotherapy or undergoing surgical intervention.

The mother of my two years old patient who is diagnosed as standard-risk leukaemia opted not to start treatment until she talked it over with her family members. After over a month of waiting for her consent to start treatment, I was not surprised that she came back to the emergency room with the child in active seizure. She finally decided to pursue treatment and explained that they did not come back immediately since her relatives discouraged her to pursue chemotherapy due to its side effects. She said that the grandmother advised her ‘baka hindi kakayanin ng katawan nya’ (her body might not be strong enough to handle the effects), and she feared that her child would die because of the chemotherapy. Her husband and his side of the family had similar sentiments. After the child’s seizure episode, the family decided to pursue the recommended treatment protocol. It was during the second month of treatment when the child was in remission that the mother revealed that they had initially ‘tried’ herbal medicine which was recommended by her grandmother’s sister who lives in Leyte. The extract (10mL) of native sambong and malunggay leaves would be given to the patient three times a day. It was at this time that she shared her gratitude for her child’s ‘second chance’ in the fight against cancer.

Another one of my patients, an 18-year-old who is diagnosed with sarcoma, also resorted to herbal medicine as a substitution for proper treatment. Unlike the previously mentioned family, this case is different since it is the adolescent patient herself who was the one who refused chemotherapy. She did not allow her parents, older siblings, nor her husband to bring her back to the hospital. She was already a mother of an infant, so her family considered her to be ‘old enough’ to decide for herself. Unfortunately, due to severe respiratory distress and weakness, she was brought to the Emergency Room and subsequently admitted to the intensive care unit. It was then that her father revealed that in his desperation to help her, he had consulted with an ‘albularyo’ (also known as a “witch doctor” or folk healer commonly found in rural areas in the Philippines, who heals people using herbs or traditional practices such as ‘hilot’ or massage). The albularyo gave her a mixture of some herbal medicines to take daily. Sadly, because of rapidly deteriorating condition, she did not have the ‘second chance’ like my other patient who came back for treatment.

These incidents happened just this year. They are examples of many patients whose parents and guardians opted to diverge from recognized accepted treatments and resort to ‘natural’ medicines which they perceive as more tolerable and ‘safer’ for kids. The question is: who is responsible for their obviously erroneous perception?

It is important to note that herbal medicines are valuable in a low-resource country like the Philippines. However, its lack of strict regulation in its sale and public use is resulting in the untimely and often avoidable deaths of paediatric cancer patients. The children’s chance for cure is simply taken away from them when their parents or guardians deprive them from standard treatments.

To address this issue, the government should improve its regulation and emphasize appropriate use. Manufacturers and distributors of herbal medicines should also be held accountable for public awareness of its indications. Labels should be clear and complete, highlighting its precaution for children. A more aggressive approach by the government is to require a prescription for its sale to discourage its use for paediatric cancer.

Furthermore, herbal medicines are not necessarily safe simply because they are derived from plants and are considered ‘natural’. Some may result in adverse reactions or have long-term effects such as carcinogenicity and hepatotoxicity. In this regard, it should not be sold for use in children unless recommended by a physician. Since herbal medicines do not require a prescription, sellers should take the initiative to educate parents and guardians not to give it to their children without the advice from a physician. Furthermore, upon diagnosis, pediatric hematologist/oncologists should immediately discourage parents and guardians of its use as a substitution for standard of care.

Perhaps if there were more extensive social media campaigns and advertisements against the use of herbal medicines in pediatric cancer, there would be a decrease in the rate of abandonment since standard treatment would be the only option. A more proactive mechanism should also be made to address inappropriate use of herbal medicines in children, including penalties and / or imprisonment.