HERBAL MEDICINE IN PEDIATRIC ONCOLOGY
Introduction: Complementary and alternative medicine (CAM) is increasing in the pediatric population with cancer. This diagnosis leaves families devastated and they feel a tremendous responsibility to ensure the best therapies for their children. Integrative medicine approach is often chosen to child’s care and the use of herbal products are raising and may interfere with chemotherapy and radiation therapy. 
Objective: The aim of this article is to synthesize the most recent evidence on the available and prevalence of herbal products use, side effects and herbal-drug interactions in the pediatric oncology population. 
Material and methods: A comprehensive review of the Medline, Embase and Cochrane databases was conducted and the search was defined by the terms “herbal”, “prevalence”, “herbal-drug interaction” and “pediatric oncology”. Inclusion criteria were primary studies involving children younger than the age of 18 years with cancer, using herbal drugs as an integrative approach. Exclusion criteria included no pediatric oncology outcomes.
Results: No data are available in Portugal for herbal products use by children. Prevalence of CAM use by children in Europe was 52%. Induction of drug-metabolizing enzymes can be one of the mechanisms behind CAM–anticancer drug interactions. Kava-kava, vitamin E, quercetin, ginseng, garlic, β-carotene and echinacea interact with anti-cancer drugs.
Conclusion: Chemotherapeutic drugs have a narrow therapeutic window which increases the risk of clinically relevant herb-drug interactions with unexpected toxicities and possible undertreatment seen in cancer children. It is important that pediatricians be aware of this fact and encourage open communication with patients and their parents. More scientific evidence on the subject are imperative to prevent therapeutic failure and toxicity.

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