Traditional and complementary medicine use among cancer patients in Nepal: a cross-sectional survey

Abstract

Background Traditional and complementary medicine (T&CM) is commonly used in South Asian countries such as Nepal. There are various causes and contributing factors for patients with cancer to consider using T&CM. However, little is known about the use of T&CM among the cancer population in this region. Methods The study followed a cross-sectional design using a structured survey questionnaire. Survey participants were recruited from two National hospitals in Kathmandu, Nepal. The survey instrument comprised 30 questions, including variables on demographics, use of T&CM, and perceived level of disease severity, and cancer treatment. Chi-square test and logistic regression were used for data analysis using SPSS ver. 23.0. Results Of 908 participants, 31.6% used one or more modalities of T&CM after a cancer diagnosis. The most commonly used T&CM was Ayurveda (46.5%), followed by yoga (32.4%). About 46% of T&CM users discussed their use with their doctors. The main source of information on T&CM was their family members and relatives (55.7%). Cancer type (head and neck cancer OR: 2.30, CI: 1.23–4.29; abdominal cancer OR: 2.69, CI: 1.47–4.95; lung cancer OR: 5.88, CI: 2.69–12.89), cancer stage (Stage I OR: 1.92¸CI: 1.14–3.25; Stage II OR: 1.76, CI: 1.06–2.94), and the patients’ self-rated disease severity (high perceived severity OR: 1.50, CI: 1.05–2.16) were strong predictors of T&CM use. Conclusion This study underlined that despite the widespread use of T&CM among cancer patients in Nepal, most patients obtained information on T&CM from informal sources and did not disclose their use to physicians. To ensure the safe use of T&CM modalities, physicians should integrate questions on T&CM use into routine patient assessments in order to facilitate active communication and improve the quality of care.

Traditional and complementary medicine use among cancer patients in Asian countries: A systematic review and meta-analysis

“…The majority of the studies were designed as cross-sectional studies in 14 Asian countries, including Turkey (n=12) [38][39][40][41][42][43][44][45][46][47][48] , Malaysia (n=5) [49][50][51][52][53] , Korea (n=4) [54][55][56][57] , India 58-60 , Iran 61-63 , Thailand 64-66 , China 67,68 , Lebanon 69,70 , Singapore 71,72 , Indonesia 73 , Mongolia 74 , Nepal 75 , Pakistan 76 , and Taiwan 77 . Two-thirds of the studies were published since 2011 (n = 27, 65.9%).…”

“…The prevalence estimate of T&CM use exhibited variation across different regions (p=0.001), health insurance (p < 0.000), survey year (p = 0.040). In terms of regional T&CM use, the highest pooled prevalence estimate was observed in East Asia (62.4%, 95% CI=50.5-73.7; I² = 97.6%) [54][55][56][57]67,68,74,77 , while the lowest estimate was reported in South Asia (33.5%, 95% CI=25.1-42.6; I² = 96.0%) 58-60, 75,76 . The heterogeneity between these subgroups was found to be signi cant based on the Q-test (Χ 2 =17.714, p=0.001), suggesting that the observed differences are unlikely to occur by chance alone and indicating the presence of substantial heterogeneity (see online Supplementary Figure 2).…”

“…The pooled prevalence estimates of T&CM use for different cancer types based on the regions are presented in Table 3. In East Asia, the highest prevalence estimates of T&CM use were observed for all cancer types except genitourinary 38,40,41,[43][44][45][46]50,55,66,67,74,75,77 and gastrointestinal cancer 38,40,41,[43][44][45][46]50,[55][56][57]61,[66][67][68]74,75,77 . Genitourinary cancer had the highest pooled prevalence estimate of T&CM use in South Asia, at 77.8% (95% CI = 66.9-85.8) 75 , followed by Southeast Asia at 75.5% (95% CI: 57.6-90.7) 50,66 .…”

“…Reasons for nondisclosure A total of fourteen studies investigated the factors contributing to the non-disclosure of T&CM use among cancer patients 45,[49][50][51]57,58,[66][67][68][69]72,74,75,77 . The most commonly reported reason for nondisclosure was "the lack of inquiry by the doctor regarding T&CM use," as identi ed in nine studies 50,51,58,66,68,72,74,75,77 . This emerged as the primary reason for non-disclosure in six of those studies.…”

Complementary and Alternative Therapies in Oncology

“…The use of CAM in cancer patients has been consistently increasing [1]. For example, in a nationwide survey carried out in the Nepal, 32% of cancer patients reported using alternative therapies [2]. In another study of almost 1500 cancer survivors, 67% reported ever using CAM, and 43% had used CAM in the past year [3].…”