Discovering the Use of Complementary and Alternative Medicine in Oncology Patients: A Systematic Literature Review

Table 1

Studies related to using complementary and alternative medicine.

	Author, year, and location of the study	Study design	Participants	Aim of study	Type of complementary and alternative medicine	Instrument/tool	Result	Outcome measures
1	Wode, K., Henriksson, R., Sharp, L., Stoltenberg, A., and Nordberg, J.H. (2019) Sweden.	Cross-sectional.	Cancer patients.	To explore Swedish cancer patients´ patterns of CAM use, their experiences, and preferences.	Natural products including vitamins and minerals and relaxation, mind and body practices, changes in diet, anthroposophic medicine, homeopathy, energy medicine, traditional Chinese medicine.	Questionnaire.	Lifetime CAM use was reported by 34% (n = 256), and 26% (n = 198) used CAM after cancer diagnosis. Being female, younger, and having higher education predicted CAM use. Most commonly used methods were natural products. Main reasons for CAM use were improvement of physical, general, and emotional well-being and increasing the body’s ability to fight cancer. Satisfaction with CAM usage was generally high. Reported adverse effects were few and mild; 54% of users spent < 50 euros a month on CAM. One third had discussed their CAM use with cancer care providers. More than half of all participants thought that cancer care providers should be able to discuss (58%) and to consider (54%) the use of CAM modalities in cancer care.	CAM use and related experiences among Swedish patients with solid tumors in both curative and palliative stage.
2	Buckner, C.A., R M lafrenie, Dénommée, J.A., Caswell, J.M., and Want, D.A. (2018) Ontario.	A cross-sectional.	141 cancer patients.	To determine the rate of CAM use in patients receiving treatment at a Northern Ontario cancer centre.	Biologic products, vitamins, and minerals.	Anonymous questionnaire.	Patients in Northern Ontario reported significant CAM use both before and after diagnosis. However, as a function of the CAM type, CAM use was greatly enhanced after cancer diagnosis. For example, the number of patients who reported use of biologic products increased to 51.8% after a cancer diagnosis from 15.6% before a cancer diagnosis. Patients reported much smaller changes in the use of alternative medical systems or spiritual therapy after diagnosis. Vitamin use was reported by 66% of respondents, and the number of different CAMs used correlated significantly with the reported number of vitamins used.	Rate of CAM use in patients receiving treatment at a Northern Ontario cancer centre.
3	Balneaves, Wong, Porcino, Truant, Thorne, and Wong, (2018) Canada.	A sequential, multimethod research design.	Chinese-speaking cancer patients.	To explore Chinese-speaking cancer patients (CSCPs) use of complementary and alternative medicine (CAM), sources of CAM information, and decision support needs, as well as their experience of making CAM decisions.	Biologically based therapies, energy-based therapies, body-based therapies, and mind-body therapies.	Semistructured interviews.	More than 65% of CSCPs reported using CAM. CSCPs favored biologically based therapies, including traditional Chinese medicine herbs and other natural health products. Many CSCPs were using CAM without adequate culturally appropriate information and decision support. Those who made decisions spontaneously relied on peers for advice whereas deliberate decision makers sought information from multiple sources, including peers and the Internet, selecting therapies congruent with their cultural health perspectives, and previous experiences with CAM.	Use of complementary and alternative medicine (CAM) experience of making CAM decisions.
4	Gras, M., et al. (2019). France.	A prospective survey.	200 cancer patients.	To report on the nature, frequency of use, and patient-reported outcome of CAMs in a single-center study.	Osteopathic medicine, homeopathy, acupuncture, healing touch, magnetism, naturopathy, suction cups, Chinese medicine, reflexology, to hypnosis.	A questionnaire.	CAMs ranged from osteopathic medicine, homeopathy, acupuncture, healing touch, magnetism, naturopathy, suction cups, Chinese medicine, reflexology, to hypnosis. CAMs were widely used (n = 166, 83%), the first being osteopathic medicine (n = 99, 49.5%), the second homeopathy (n = 78, 39.0%), and finally acupuncture (n = 76, 38.0%). Whatever the CAM, high satisfaction rates were reported (median satisfaction: 61–81%). CAMs were mainly used to prevent/treat side effects of anticancer treatments (81.2% for healing touch), increase well-being (55.4% for naturopathy), improve the immune system (16.9% for homeopathy), and treat cancer (n = 3, 5.1% for homeopathy). Patients could easily consider using CAMs, as up to 50.8% would have accepted a consultation.	Use of CAMs and level of satisfaction.
5	Amirmoezi, F., et al. (2017). Iran.	A cross-sectional study.	36 cancer patients.	To determine the use of CAM and associated factors among Iranian cancer patients, reasons behind this use, satisfaction, and information about complementary and alternative therapy.	Minerals and vitamins, herbals, and miscellaneous health practice.	A questionnaire.	A total number of 36 cancer patients participated in this study. The majority of respondents (94.4%) used or were using at least one CAM product or practice till the study date. Altogether, the most common type of CAM used among cancer patients was praying (86.1%). The most popular herbs in herbals subgroup were mint and garlic with 41.7%. Multivitamins and vitamin C were more favored than other vitamins and minerals (33.3%). No major side effects were reported regarding CAM use. The most reliable source of information about complementary medicine was reported to be physicians.
6	Abdelmoaty, A.M., et al. (2018). Egypt.	A cross-sectional study.	331 cancer patients.	Assessing the pattern of use, motives, and possible predictors of complementary cancer therapy among a sample of Egyptian oncology patients.	Honey and herbal medicine were the most commonly used CM.	Reviewing of the patient medical records, and personal interviews.	Of the included patients, 76 out of 331 (about 23%) used CM during their cancer treatment course; none of them used any alternative cancer therapies. Being a female patient with low educational attainment (secondary or less) was significantly associated with the use of CM (OR = 1.78, and OR = 2.90, , resp.). The dominated reason for using CM therapy was to increase their body's ability to fight cancer (31.6%). Dissatisfaction with therapy was a significant positive predictor for CM usage (OR = 2.10, ). Honey and herbal medicine were the most commonly used CM. More than 60% of the patients who used CM (48/76) did not inform their treating physicians about CM usage and almost 23% of (11/48) responded that the physician would disapprove it.	Use, motives, and possible predictors of complementary cancer therapy among Egyptian oncology patients.
7	Labidi, S., Ennouri, S., Rachdi, H., El Benna, H., Mejri, N., Daoud, N., Berrazaga, Y., and Boussen, H. (2020). Tunisia.	A cross-sectional survey.	120 adult patients.	To explore the use of complementary and alternative medicine (CAM) and to identify their side effects, when used in cancer patients.	Wild herbs, Ephedra foeminea (Alanda).	An anonymous questionnaire to assess complementary and alternative medicine use.	One hundred twenty patients participated in the survey; among them, 102 used CAM (85%). A majority of users were female patients (n = 72, 70.6%), and mean age was 52.4 years ± 11.6. Patients had breast cancer in 48% of cases. Wild herbs were the most commonly used alternative therapy (67.7%), particularly Ephedra foeminea (Alanda) in 52% of cases. Patients' families incited them to use CAM in 64.7% of cases. Internet and social network (Facebook) were the major sources of information on CAM (79.4%), followed by family and friends (72.5%). Fourteen patients (13.7%) reported nausea and vomiting secondary to CAM use. We reported disruption of liver function in 9.8% of cases and renal failure in 1.96%, with fatal issue in one patient using Ephedra. Nineteen patients (18.6%) informed their oncologist about the alternative therapy they received.	Use of complementary and alternative medicine (CAM) and to identify their side effects, when used in cancer patients.
8	Chotipanich, A., sooksrisawat, C., and jittiworapan, B. (2019).	A cross-sectional study design.	426 patients with various cancers.	To investigate the patterns of complementary and alternative medicine use and its association with time to conventional treatment.	Unlabeled fresh and processed herbal products, porcupine flower, lingzhi mushroom, commercial fruit and vegetable extract beverage, Aloe vera juice, and fish oil.	A semistructured interview protocol.	The results indicated that 192 of the 426 patients (45.1%) reported using complementary and alternative medicines; herbal products were the most common type. Approximately 34.3% of these medicines involved unlabeled herbal products with unidentifiable components. The rates of complementary and alternative medicine use were significantly elevated for men and patients with stage IV cancer. The multivariable linear regression analysis of the relationship between factors and the time until conventional treatment was received revealed that the regression coefficient of the use of complementary and alternative medicine was 56.3 (95% confidence interval [27.9–84.6]). This coefficient reflected an additional 56.3 days of time until conventional treatment, relative to patients who did not use complementary and alternative medicine.	Rate of complementary and alternative medicine use.
9	Shetty, N., Rai, P.R., and Shetty, A. (2019). India.	Observational study.	407 patients.	To determine the prevalence of the use of traditional, complementary, and alternative medicine (CAM) by cancer patients visiting a cancer care centre. This study laid an emphasis on the predictors of the use of CAM.	Traditional medicine, allopathic medicine.	A questionnaire.	The prevalence of traditional medicine and CAM was found to be 23.5% (96 patients). The mean duration of CAM use was 4.8 months (0.25 months–48 months). About 77% of the users had an education level below the upper primary level, of which 30.02% were illiterate. About 62.5% of the users were below poverty line. Nearly, 41.7% of the patients had not received any allopathic treatment before starting traditional medicine and CAM and did so for a mean duration of 4 months. About 53% of the patients who received some form of traditional medicine and CAM claim to have experienced some symptomatic benefits from its use. Nearly, 68.75% of the users were simultaneously receiving conventional anticancer therapy. Traditional medicine and CAM use was disclosed to the treating physician by 55% of the patients.	Prevalence of the use of traditional medicine, complementary and alternative medicine (CAM) by cancer patients visiting a cancer care centre. This study laid an emphasis on the predictors of the use of CAM.
10	Shin. J., Kim S., Park, B., Park, J., Choi, J. Seo, H.G. (2012). Korea.	A cross-sectional study design.	2,661 cancer patients.	To explore factors predicting CAM use among a nationally representative sample of cancer patients.	-	Administered questionnaires.	Overall, 25.5% reported that they had used or were using CAM. Higher income, presence of metastasis, longer time since diagnosis, less trust in hospitals, lower overall satisfaction, and higher degree of informational need were significantly associated with CAM use.	Factors predicting CAM use among a nationally representative sample of cancer patients.
11	Ricardo, E.D., Oishi, D.,   Dos Santos, M.O., and D'Alpino, R.D. (2020). Brazil.	A cross-sectional survey.	156 patients.	To define CAM use by cancer patients and investigate factors that might influence it.	-	A questionnaire.	Most cancer types were breast (17.4%), colorectal (16.7%), and lung (16.1%) cancer. More than 90% of the participants were on any active treatment. The prevalence of current CAM use was 29.6%. 58.7% of the patients did not believe CAM has anticancer properties, including 32.6% of patients who reported CAM use. Two-thirds of the participants have never discussed CAM with their oncologists. Only 5.1% of the respondents would abandon conventional cancer treatment in order to use just CAM. Among CAM users, 55% referred multiple therapies use. Of those therapies, spiritual surgery was the most prevalent one. There was a significant higher proportion of females reporting CAM use () as well as a higher proportion of CAM use among younger patients ().	Factors that might influence it.
12	Abuelgasim, K.A., Alsharhan, Y., Alenzi, T., Alhazzani, A., Ali, Y.Z., and Jazieh,A. (2018). Saudi Arabia.	A cross-sectional study.	156 patients.	To investigate the prevalence and pattern of CAM use by Saudi cancer patients. It also discusses the possible benefits and harm related to CAM use by cancer patients, and it explores the beliefs patients hold and their transparency with health care providers regarding their CAM use.	Supplication, Quran recitation, Zamzam water, water read upon Quran, olive oil, black seed (Nigella sativa), garlic, camel milk, honey, camel urine, known herbal remedies, multivitamins, and unknown herbal mixture.	Questionnaire.	The prevalence of CAM use was 69.9%; the most prominent types of CAM were those of a religious nature, such as supplication (95.4%), Quran recitation (88.1%), consuming Zamzam water (84.4%), and water upon which the Quran has been read (63.3%). Drinking camel milk was reported by 24.1% of CAM users, whereas camel urine was consumed by 15.7%. A variety of reasons were given for CAM use: 75% reported that they were using CAM to treat cancer, enhance mood (18.3%), control pain (11.9%), enhance the immune system (11%), increase physical fitness (6.4%), and improve appetite (4.6%). 30% of CAM users had discussed the issue with their doctors; only 7.7% had done so with their nurses.	Prevalence and pattern of CAM use by Saudi cancer patients. It also discusses the possible benefits and harm related to CAM use by cancer patients, and it explores the beliefs patients hold and their transparency with health care providers regarding their CAM use.