{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:13:13Z","timestamp":1788502393976,"version":"build-2803163510"},"reference-count":33,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T00:00:00Z","timestamp":1753142400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"American Lebanese Syrian Associated charities (ALSAC)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>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\u2019s 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.<\/jats:p>","DOI":"10.3390\/children12080961","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T09:47:06Z","timestamp":1753177626000},"page":"961","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pediatric Hematology\u2013Oncology Provider Attitudes and Beliefs About the Use of Acupuncture for Their Patients"],"prefix":"10.3390","volume":"12","author":[{"given":"Holly L.","family":"Spraker-Perlman","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Divisions of Pediatric Hematology-Oncology & Pediatric Palliative Care, University of Utah, Primary Children\u2019s Hospital, Salt Lake City, UT 84113, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1199-0081","authenticated-orcid":false,"given":"Kenneth M.","family":"Busby","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Stanford University, Palo Alto, CA 94304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Ly","sequence":"additional","affiliation":[{"name":"Department of Pediatric Medicine, Division of Pediatric Neurology, St. Jude Children\u2019s Research Hospital, Memphis, TN 38105, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maggi","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, St. Jude Children\u2019s Research Hospital, Memphis, TN 38105, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin N.","family":"Baker","sequence":"additional","affiliation":[{"name":"Division of Quality of Life and Pediatric Palliative Care, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3206-5648","authenticated-orcid":false,"given":"Deena R.","family":"Levine","sequence":"additional","affiliation":[{"name":"Department of Oncology, Division of Quality of Life and Palliative Care, St. Jude Children\u2019s Research Hospital, Memphis, TN 38105, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,22]]},"reference":[{"key":"ref_1","unstructured":"PDQ Integrative Alternative, and Complementary Therapies Editorial Board (2002). Acupuncture (PDQ\u00ae): Health Professional Version. PDQ Cancer Information Summaries."},{"key":"ref_2","unstructured":"National Comprehensive Cancer Center (2025, July 12). National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology-Survivorship-Physician Guidelines 2025. Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/survivorship.pdf."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3998","DOI":"10.1200\/JCO.22.01357","article-title":"Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline","volume":"40","author":"Mao","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e2070","DOI":"10.1002\/onco.13933","article-title":"Health-Related Quality of Life in Cancer Survivors with Chemotherapy-Induced Peripheral Neuropathy: A Randomized Clinical Trial","volume":"26","author":"Bao","year":"2021","journal-title":"Oncologist"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"7188","DOI":"10.1200\/JCO.2005.06.028","article-title":"Acupuncture-point stimulation for chemotherapy-induced nausea and vomiting","volume":"23","author":"Ezzo","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3219","DOI":"10.1002\/cncr.35374","article-title":"Acupuncture for hot flashes in hormone receptor-positive breast cancer: A pooled analysis of individual patient data from parallel randomized trials","volume":"130","author":"Lu","year":"2024","journal-title":"Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1200\/JCO.2015.63.2893","article-title":"Acupuncture as an integrative approach for the treatment of hot flashes in women with breast cancer: A prospective multicenter randomized controlled trial (acclimat)","volume":"34","author":"Lesi","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez Garc\u00eda, E., Nishishinya Aquino, M.B., Cruz Mart\u00ednez, O., Ren, Y., Xia, R., Fei, Y., and Fern\u00e1ndez-Jan\u00e9, C. (2024). Efficacy and Safety of Acupuncture and Related Techniques in the Management of Oncological Children and Adolescent Patients: A Systematic Review. Cancers, 16.","DOI":"10.3390\/cancers16183197"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Mora, D.C., Overv\u00e5g, G., Jong, M.C., Kristoffersen, A.E., Stavleu, D.C., Liu, J., and Stub, T. (2022). Complementary and alternative medicine modalities used to treat adverse effects of anti-cancer treatment among children and young adults: A systematic review and meta-analysis of randomized controlled trials. BMC Complement. Med. Ther., 22.","DOI":"10.1186\/s12906-022-03537-w"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1016\/j.urology.2010.03.033","article-title":"Acupuncture for hot flashes in patients with prostate cancer","volume":"76","author":"Beer","year":"2010","journal-title":"Urology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1089\/act.2015.29022.ajo","article-title":"The Use of Acupuncture for Pain Management in Pediatric Patients: A Single-Arm Feasibility Study","volume":"21","author":"Johnson","year":"2015","journal-title":"Altern. Complement. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.jtcme.2019.08.004","article-title":"Acupuncture for pediatric pain: The trend of evidence-based research","volume":"10","author":"Lin","year":"2020","journal-title":"J. Tradit. Complement. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1089\/acm.2006.12.317","article-title":"Adolescent endometriosis-related pelvic pain treated with acupuncture: Two case reports","volume":"12","author":"Highfield","year":"2006","journal-title":"J. Altern. Complement. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1111\/aas.13288","article-title":"Randomized trial of acupuncture with antiemetics for reducing postoperative nausea in children","volume":"63","author":"Martin","year":"2019","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e26424","DOI":"10.1002\/pbc.26424","article-title":"Predictors of acupuncture use among children and adolescents with cancer","volume":"64","author":"Chokshi","year":"2017","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1097\/MPH.0b013e3181984f5a","article-title":"Pediatric oncologists\u2019 views toward the use of complementary and alternative medicine in children with cancer","volume":"31","author":"Roth","year":"2009","journal-title":"J. Pediatr. Hematol. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Schneider, C.D., Meek, P.M., and Bell, I.R. (2003). Development and validation of IMAQ: Integrative Medicine Attitude Questionnaire. BMC Med. Educ., 3.","DOI":"10.1186\/1472-6920-3-5"},{"key":"ref_18","first-page":"e257021","article-title":"If you build it, will they come? pediatric integrative medicine service utilization in a comprehensive cancer center","volume":"23","author":"Heidelberg","year":"2025","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5","DOI":"10.21926\/obm.icm.2101005","article-title":"Development of a pediatric integrative oncology program: Pearls, barriers, and future directions","volume":"6","author":"Ast","year":"2021","journal-title":"OBM Integr. Complement. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.ctim.2018.05.001","article-title":"A cross-sectional review of the prevalence of integrative medicine in pediatric pain clinics across the United States","volume":"38","author":"Bodner","year":"2018","journal-title":"Complement. Ther. Med."},{"key":"ref_21","first-page":"229","article-title":"Acupuncture in cancer care: Recommendations for safe practice (peer-reviewed expert opinion)","volume":"32","author":"Young","year":"2024","journal-title":"Support. Care Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1136\/aim.24.4.172","article-title":"Guidelines for providing acupuncture treatment for cancer patients--a peer-reviewed sample policy document","volume":"24","author":"Filshie","year":"2006","journal-title":"Acupunct. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"lgx005","DOI":"10.1093\/jncimonographs\/lgx005","article-title":"The national cancer institute\u2019s conference on acupuncture for symptom management in oncology: State of the science, evidence, and research gaps","volume":"2017","author":"Zia","year":"2017","journal-title":"J. Natl. Cancer. Inst. Monographs"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s11864-010-0126-0","article-title":"Recent advances in oncology acupuncture and safety considerations in practice","volume":"11","author":"Lu","year":"2010","journal-title":"Curr. Treat. Options Oncol."},{"key":"ref_25","unstructured":"Metcalf, R.A., Nahirniak, S., Guyatt, G., Bathla, A., White, S.K., Al-Riyami, A.Z., Jug, R.C., La Rocca, U., Callum, J.L., and Cohn, C.S. (JAMA, 2025). Platelet transfusion: 2025 AABB and ICTMG international clinical practice guidelines, JAMA, new online."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1089\/jicm.2022.0710","article-title":"Bleeding Risk of Acupuncture for Patients with Hematological Malignancies Accompanying Thrombocytopenia: A Retrospective Chart Review","volume":"30","author":"Kayo","year":"2024","journal-title":"J. Integr. Complement. Med."},{"key":"ref_27","first-page":"1487","article-title":"The safety of acupuncture in children and adolescents with cancer therapy-related thrombocytopenia","volume":"18","author":"Ladas","year":"2010","journal-title":"Support. Care Cancer"},{"key":"ref_28","first-page":"91","article-title":"Safety of acupuncture: Results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form","volume":"16","author":"Witt","year":"2009","journal-title":"Forsch. Komplementmed."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1542\/peds.105.S3.941","article-title":"On pins and needles? Pediatric pain patients\u2019 experience with acupuncture","volume":"105","author":"Kemper","year":"2000","journal-title":"Pediatrics"},{"key":"ref_30","first-page":"61","article-title":"Ethics meet complementary and alternative medicine: New light on old principles","volume":"21","author":"Kemper","year":"2004","journal-title":"Contemp. Pediatr."},{"key":"ref_31","first-page":"2545","article-title":"NIH issues consensus statement on acupuncture","volume":"57","author":"Morey","year":"1998","journal-title":"Am. Fam. Physician"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1177\/01632787211019445","article-title":"Remind Me Again: Physician Response to Web Surveys: The Effect of Email Reminders Across 11 Opinion Survey Efforts at the American Board of Internal Medicine from 2017 to 2019","volume":"44","author":"Barnhart","year":"2021","journal-title":"Eval. Health. Prof."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Murphy, C.C., Lee, S.J.C., Geiger, A.M., Cox, J.V., Ahn, C., Nair, R., Gerber, D.E., Halm, E.A., McCallister, K., and Skinner, C.S. (2020). A randomized trial of mail and email recruitment strategies for a physician survey on clinical trial accrual. BMC Med. Res. Methodol., 20.","DOI":"10.1186\/s12874-020-01014-x"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/8\/961\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:13:39Z","timestamp":1760033619000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/8\/961"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,22]]},"references-count":33,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["children12080961"],"URL":"https:\/\/doi.org\/10.3390\/children12080961","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,22]]}}}