The Evaluation on The Pattern of Complementary Alternative
Treatment Used by Cancer Patients
Mochamad Djunaedi
1
, Wahyu Utami
1
and Anila Impian Sukorini
1
1
Community Department Faculty of Pharmacy Universitas Airlangga, Jl. Darmawangsa Dalam, Surabaya, Indonesia
Keywords: Complementary Alternative Medicine, Cancer, Health Professionals
Abstract: Objective: Complementary alternative treatment used among cancer patients is expected to support the
therapeutic goal achievement. This study aims to evaluate the attitudes of cancer patients in an attempting to
the treatment of cancer using the complementary alternative medicines (CAM) and to identify the CAM
used by cancer patients. Methods: A cross-sectional study was conducted in 2016 using a “semi-structured
questionnaire” in 100 respondents. Only 75 respondents were eligible and met the inclusion criteria.
Results: The recommendations for using the CAM we found from non health professionals (85%). The
used of CAM without prior assessments was 77%. Patients used CAM when the condition of the cancer had
severe (87%). Conclusion: Integration of health personnel, including pharmacists to assist the team in using
herbs, supplements or traditional medicine has not been done optimally.
1 INTRODUCTION
Cancer has high morbidity and mortality. A total of
6.25 million cancer patients are from developing
countries, including Indonesia. There are about 6%
of the population of Indonesia has cancer.
Conventional treatment of cancer includes surgery,
radio therapy and chemotherapy (chemo). However,
surgical therapy may be ineffective when cancer
cells are spread (metastasis), the process of radiation
is also non-selective, while chemotherapy is still
often found to cause side effects in normal cells [1].
Less consumption of fibrous foods, less physical
activity or immobility, smoking, alcohol
consumption is an unhealthy behaviour that has
cancer risk factors. Exposure to carcinogens
(ultraviolet/UV and ionizing radiation);
benzo(α)pyrene, formalin and aflatoxin in foods and
asbestos; viral, bacterial and parasitic infections are
also important risk factors. Interventions of cancer
risk factors should be aimed at preventing the
growth and further development of cancer [2].
In CAM, there are herbal ingredients,
supplements or traditional medicine, single dose,
extracted or combination of natural ingredients that
have antineoplastic effect, such as:
a. All parts of the plant Rice Rodent
(Typhonium flagelliforme Lodd.) Can stimulate
apoptosis, anticancer activity (breaking the DNA of
cancer cells) and as an antibacterial.
b. Tapak dara (Vinca rosea) can inhibit cell
proliferation in breast cancer.
c. Sirsat (Annona muricata, L.) can kill cancer
cells 10,000x stronger than Adriamycin.
d. White Turmeric (Kaempferiae rotunda, L.)
e. Sambiloto (Andrographis paniculata,
(Burm.) F, Nees).
f. Ceplukan (Physalis minima, L).
g. Mangosteen rind extract (Garcinia
mangostana, L) is a source of antioxidants (which
can serve as antiproliferative and apoptotic).
h. Flavonoid and polyphenol contained in
Sarang Burung functioning as antioxidants
The patient's health seeking behaviour still relies
on the direction of health practitioners. However,
they still have behaviours associated with the
customary treatment adopted and ancient habits [3].
The elderly in Palestine who suffer from cancer use
the decoction of the Arum palaestumum plant
because of its recommendation by members of his
family [4]. The CAM use in patients undergoing
palliative therapy is not influenced by the patient's
demographic characteristic [5].
Patients often seek advanced information on the
medical development and recurrence of cancer,
while protocols direction, to detect the signs of side
Djunaedi, M., Utami, W. and Sukorini, A.
The Evaluation on The Pattern of Complementary Alternative Treatment Used by Cancer Patients.
DOI: 10.5220/0009845200002406
In Proceedings of BROMO Conference (BROMO 2018) - Symposium on Natural Product and Biodiversity, page 1
ISBN: 978-989-758-347-6
Copyright
c
2022 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
1
effects, insurance and healthy lifestyle is neglected
[6].
The rate of herbal use among cancer patients was
increased sharply, despite the lack of scientific data
that supporting for the use of CAM. They used
CAM for to increase their stamina, memory and
fitness of the body or lowering blood pressure,
unfortunately the adverse drug effects might arise,
such as: stomach disorder or redness of the eyes.
Another reason is due to their self-treatment
to counteract dissatisfaction in undergoing
conventional therapy and economic considerations
[7]. Finding information through social media
networks is less effective for the elderly rather than
community based media [8]. In Thailand, in addition
to self-treatment, there are also treatments performed
by herbalists and religious leaders who prescribe
traditional herbs to overcome the complaints of
patients such as: pain, gastric discomfort, insomnia
and fatigue [9].
The screening to detect the early onset of cancer
can be done in the community health care facility.
Especially in East Java, the most common screening
is to detect breast cancer and cervical cancer.
Trained personnel consisting of Obstetrician
Gynecologists, Oncology Surgeons, general
practitioners, and midwives have been deployed
[10].
There are important issues that emphasize
performing this research. The lack of understanding
about the disease being suffered, such as: symptoms
(sign and symptom) and treatment, additionally
improper indication to use the CAM that may
affect the condition of the patient's health. Most
patients seek for alternative treatments when the
cancer has spread, even the CAM used does not
result in any improvement. The therapeutic
relationship between CAM users and health care
providers in an attempt to improve the patient's
condition is still irrational. The lack of publications
that support on the empowerment of health workers
related to the use of CAM by cancer patients. It also
adds that the limitations of the law that implements
therapy using traditional medicine for East Java are
only provided to some trained doctors. While
permits the practice of traditional medicine by
doctors and colleagues of professional organizations
has never been realized and still depends on the
policies of each region. Standardized the
competence of health professionals who are experts
on treatment with herbal has not been established
[11].
This research aims to evaluate the attitudes of
cancer patients in an attempting to the treatment of
cancer using herbs, supplements and traditional
medicine. To identify the herbs, supplements and
traditional remedies used by cancer patients.
2 OBJECTIVES
To evaluate the attitudes of cancer patients for
attempting the treatment of cancer using herbs,
supplements and traditional medicine. This study
also aims to identify the herbs, supplements and
traditional remedies used by patients.
3 METHOD
A cross-sectional study was selected to carry
out this research. This study emphasized to explore
data surveys from cancer patient. The data found
were the information about the benefits or
disadvantages of using herbs, supplements or
traditional medicine as a complement to alternative
treatments of cancer patients. The study was
conducted in 2016, from July to November.
3.1 Measured Variable
a. Patient's report on herbs, supplements and
traditional drugs used was collected.
b. Patient's report on their knowledge of the illness
suffered, indications and confirmation of the use
of herbs, supplements or traditional medicine to
health care professional.
c. Herbal, supplement or traditional medicine
identities: origin and dosage form
3.2 Population and Sampling Technique
The study population were cancer patient
currently using herbal, supplement or traditional
medicine who joined in any palliative-sharing group
for taking herbal, supplement or traditional as a
CAM. Patients with cancer were recruited from
groups or communities of cancer patients in
Surabaya. The group was established primary due to
similar communication topic on herbal product,
supplement or traditional medicine they were taking.
A convenient sampling technique was used. Patients
aged > 18 years old, confirmed diagnosed with
cancer by health professionals who consumed
BROMO 2018 - Bromo Conference, Symposium on Natural Products and Biodiversity
2
herbal, supplement or traditional medicine were
included. Patients with AIDS were excluded.
3.3 Instrument
The instrument used for data collection is
"semi-structured questionnaires". This instrument
was applied to investigate the prevalence of herbal
use among cancer patients. Details of this instrument
explored information about patient demographics,
the reasons using alternative, complementary
treatments and type of preparations used as CAM.
4 RESULT AND DISCUSSION
4.1 Demographic Profile of Cancer
Patients Using the CAM
Age: The average age of patients is (45 ± 11)
years old. Cancer patients younger than 40 years old
were 31%; increased sharply for those aged between
40-55 years old to 60%, while those over the age of
55 years old were 9%. The Bulletin of Data and
Information Window (2015) had committed that
women aged between 30-50 years old become the
main target for the next five years in cancer
prevention efforts. Therefore, this finding should
suggest the health providers in Primary Health care
center as basic information for them performing
monitoring and evaluation of cancer population.
The level of education pursued was Bachelor
(56%), Junior High School (20%), Postgraduate
11%, Diploma 9% and SD 4%. Those who have
married 73%, widows / widowers 15% and 12%
single.
All Patients (100%) stated that they were
suffering from cancer. They are able to know
because: getting information about the signs of
cancer growth from other cancer patients (2%);
knowing that a sign on the body part is malignancy
(6%) and confirmed by health professionals (92%).
Table 1: Type of cancer suffered by patients
No T
yp
e of mali
g
nanc
y
Percenta
g
e
1
2
3
4
5
6
7
8
9
breast cancer
uterus Cancer
Craniofagioma
Hodgkin's lymphoma
colon / rectum cancer
Malignant timomas
Musicnous carcinoma
Muscle uterus
FNAC
41
13
9
9
7
5
4
4
4
10
11
12
13
Mouth cancer
Lymph node cancer
Tumor ductus lactiferus
lun
g
cance
r
1
1
1
1
Total 100
The table shows that of 13 types of cancer, breast
cancer ranked highest.
Historically, after the patient knew the cancer
had been suffered, some of them decided to change
their mind to:
- regulate the lifestyle. No information was found
that their lifestyles were changed except for the
consumed diet (19%).
- try using herbs, supplements or traditional
medicine (35%).
- using alternative treatment therapies (11%)
- follow the directions of physicians and other health
personnel (81%).
- ignoring her health condition (1%)
The dosage forms found to be used by patients
vary widely, ranging from simple traditional
ingredients to processed or modern packaging such
as: capsules, pills, drops etc. and the extract and
fitomedicine as well.
Table 2: Preparation of herbal, supplements or traditional
medicines used by patients
No Type of preparation %
1. Simple herbal ingredients (liquid part
of concoction)
20 %
2. Modern preparations such as: capsules,
p
ills, sachets/
p
owders, etc.
71%
3. Phytomedicine preparation 9%
Some cancer patients consume traditional herbs,
supplements or traditional medicine in single or
multi dose, but most patients (65%) use more than
one dose. The preparation is used for treatment by
the patient after knowing that the cancer has been
developed (87%), which means not for prevention
purposes.
The types of herbs, supplements or traditional
medicine used by peasant cancer originated from
Surabaya and the cities in East Java province is
76%, other provincial cities, such as Jakarta,
Yogyakarta, Bandung, Tangerang, Jombang, Kediri,
Bogor and Papua and Papua by 19%, and those from
overseas (China, Saudi Arabia and Japan) are
5%.Information sources recommending the use of
herbs, supplements or traditional medicines obtained
from fellow patients, family or relatives (87%).
The Evaluation on The Pattern of Complementary Alternative Treatment Used by Cancer Patients
3
Table 3: Identity of products used as CAM by cancer
patients
I
Fitomedicine (supplements)
Meditea/green tea/teh
hijau
Habtussaudah
Acemax's
Pine pollen
Lifepak
Cell food
Biojannah
Marine omega
Youth span
Propolis
S-lutena
TF (Trans Factor)
TXF
VCO (vcobagoes)
HPAI
Tahesta (apple cider
vinegar)
Xantonin
K link
II
Herbs
Curcuma zedoaria
Daun sirsak
Curcuma zathorrhiza
Kulit manggis
Sarang semut
Daun bintang tujuh
Keladi tikus
(Typhonium
flagelliforme)
Olive oil
Green Apel
Moringa oleifera
Betel leaf
Guava
jaw shark
Green chiretta
Daun kenikir
(artemisinin)
Bawang dayak
(Eleutherine bulbosa
(Mill.) Urb)
L
oranthus sp. Div
III
Traditional Chinese Medicine
Chinese traditional
medicine (unidentified)
Tianchi
Lamla Herbal
G3 Lin
zhi
Table 4: Advisors or information sources who
recommend using herbs, supplements or traditional
medicines
No Recommender %
1. Friends, relatives or family. 67%
2. Doctor, Pharmacist, Nurse, Herbalist
or other health
p
rofessional.
21%
3. Electronic information media 11%
4. belief in myths 1%
The perceived benefits of using herbs,
supplements or traditional medicines by the patient
include several aspects: changes in the condition of
the body become more refreshed, increased appetite
and can reduce the side effects of chemotherapy. In
addition to other reasons: the preparations will be
able to kill cancer cells and inhibit the development
of cancer cells.
Table 5: The patient's description of the benefits of using
herbs, supplements or traditional medicines
No
.
Description Number
1
2
3
4
5
6
The body becomes healthier
Increased Appetite
reduce the side effects of reduce
d
chemotherapy
feel safe (mood boster)
kill active cancer cells
Inhibits disease
p
ro
g
ression
52
23
9
6
1
1
The table above shows the elements of
experience and the perception of the patient in using
herbs, supplements and traditional medicine.
Recognition of his experience is greater portion
(52%) such as: feel the body becomes more fit,
increase appetite and reduce side effect. While a
detailed review needs to be done on the patient's
perception of the mechanism of action of anti-cancer
from herbs.
Percentage of patients who consulted the use of
herbs, supplements or traditional medicine to health
workers (64%). The rest did not confirm with health
professionals. This figure is a warning to health
professionals to be more intensive in handling the
use of CAM among cancer patients.
5 CONCLUSIONS
The irrationality of using herbs, supplements or
traditional medicine should be avoided by involving
health professionals to have a positive impact on
cancer patients. The integration of health workers
(including pharmacists) to play a role in the team
still need to be optimized.
STUDY LIMITATION
Limitations in this study is that the impact of the
CAM use were identified without clinical or
laboratory investigations. So the evaluation of the
benefits of herbs, supplements or traditional drugs
and clinical risks of its use by cancer patients to be
very minimal. Similarly, estimate the quality of life
of CAM user did not represent a real as a patient
condition were reported
BROMO 2018 - Bromo Conference, Symposium on Natural Products and Biodiversity
4
ACKNOWLEDGEMENTS
Great Thank you is dedicated to The Dean,
Faculty of Pharmacy, Airlangga University,
Surabaya, Indonesia and also to the Research
Committee for Approval and Funding the Research
Grant 2016.
REFERENCES
Mursyidah, Y. & Santoso, M. (2009). Sintesis dan
Sitotoksisitas 5-Bromo-3-hidroksi-3-(1H-indol-
3-il)indolin-2-on dan 3-Hidroksi-5-kloro-1-
metil-3-(1H-indol-3-il) indolin-2-on terhadap Sel
Kanker Serviks HeLadan Sel Kanker Kolon
WiDr. Prosiding Skripsi Semester Genap
2009/2010.
Kementrian Kesehatan, RI. (2015). Situasi Penyakit
Kanker. Buletin Jendela, Semester 1(Pusat Data
dan Informasi), 44.
Hunte, Pamela G. & Sultana, Farhat. (1992). Health
seeking behavior and the meaning of
medications in Baluchistan Pakistan. Social
Science Medicine, 34 (12), 12.
Ali-Shtayeh, M.S., Jamous, Rana M. & Jamous,
Rania M. (2011). Herbal Preparation Use by
patients suffering from cancer in Palestine.
Complementary Therapies in Clinical Practice,
17, 6. doi: 10.1016/j.ctcp.2011.06.002
Gray, Ross E., Fitch, Margaret, Greenberg, Marlene,
et al. (1998). The information needs of well
longer term survivors of breast cancer. Patient
Education and Counseling, 33, 11.
Katchmar, T.B., Bilynsky, B.T. & Shparyk, J.V.
(1999). Use of alternative medicine by cancer
patient attending conventional treatment in
chemotherapy department. Epidemiology and
communication.
Kumar, Prem, Dixit, Santosh, Siddiqui, Farhan, et
al. (2002). The benefits adverse effects and cost
of herbal supplements in a clinic population.
Journal of Allergy and Clinical Immunology.
Curbow, Barbara, Bowie, Janice, Garza, Mary A., et
al. (2004). Community based cancer-screening-
programs in older populations making progress
but can we do better. Preventive Medicine 676–
693, 38, 18. doi: 10.1016/j.ypmed.2004.01.015
Poonthananiwatkul, B., Lim, Rosemary H.M,
Howard, Rachel L, et al. (2015). Traditional
Medicine Use by Cancer Patients in Thailand.
Journal of Ethnopharmaco logy, 168, 8. doi:
10.1016/j.jep.2015.03.057
KeMenKes, R.I., Situasi Penyakit Kanker, Pusat
Data dan Informasi, Buletin Jendela data dan
Informasi, 2015.
Menteri Kesehatan, R.I., Penyelenggaraan
Pengobatan Komplementer-Alternatif Di fasilitas
Pelayanan Kesehatan, 2007.
The Evaluation on The Pattern of Complementary Alternative Treatment Used by Cancer Patients
5