1. Moiz Munir Fulbright Student Researcher Malaysia
Use and opinions of complementary and alternative medicine to supplement conventional care among cancer patients in Kuala Lumpur: a qualitative study
Moiz Munir
Fulbright Student Researcher Malaysia

2. Background
CAM is as a group of healthcare approaches outside of conventional medicine
Used together with (complementary) or in place of (alternative) conventional treatment
Malaysia has higher CAM usage rates than the world average with over 69% of Malaysians using CAM in their lifetime [1, 2]

3. Natural products (including antioxidant pills, herbal remedies, medicinal tea, fish oil, multivitamins, topical therapies, etc.)
Mind-body therapies (including faith healing, zam zam water, mediation, yoga, support groups, aromatherapy, Tai Chi, etc.)
Alternative medical systems (including traditional Chinese medicine, homeopathy, Ayurveda medicine, etc.)
Energy therapies (including acupuncture, electric stimulation therapy, magnetic therapy, Qi gong, Reiki therapy, etc.)
Manipulative and body-based methods (including massage, chiropractic manipulation, reflexology, etc.)

4. CAM use linked to late presentation, nonadherence and interactions with conventional therapies [2, 3, 4]
Cancer is the second greatest cause of premature mortality and one of the fastest growing major disease groups in Malaysia [5]
Increased acceptance of CAM among medical and policy establishment

5. Design
Aim: Assess opinions of cancer patients on supplementing conventional care with CAM
Hospital Kuala Lumpur oncology clinic, October – November 2017
20 semi-structured qualitative interviews (saturation reached)
Conducted in either English, Malay, or Chinese
Recorded, transcribed/translated, and analyzed

7. Results Mean age: 56 years old
Ethnicity: 10 Malay, 8 Chinese, 2 Indian
Gender: 9 male, 11 female
Most common cancers: breast, colorectal
16 used CAM
Herbal therapies most commonly used

8. The most common reason for delaying presentation was not realizing the symptoms were due to cancer
“it wasn’t painful, it was just there the lump” 64 yo, Breast
Many patients used CAM based on advice from family and friends
“Listening to everybody and started to go along…they recommended some herbal” 64 yo, Breast
Some patients avoided discussing CAM with doctor because of a fear of a negative response
“It was a secret…I think can talk to doctor provided the doctor accepts what we say…if the doctor is always negative, no cannot, there is no talking to the doctor” 59 yo, Breast
“you want him to scold me? Haha” 64 yo, Breast

9. Opinions on supplementing conventional treatment with CAM
Theme
Quote
Fear combining CAM and conventional treatment after speaking to doctor
“If anything later the doctor say I myself take responsibility” 28 yo, Breast
“The doctor say not good” 27 yo, Mediastinal GCT
Should stick to one at a time
I think if you are doing herbal you should just stick to herbal. I don’t think you should mix” 51 yo, Colorectal
“Can. Like hospital is hospital, yourself is yourself…if at the same time, cannot” 31 yo, Glioma
Can use CAM to supplement
“The supplement is only that…I eat doctor’s medicine too” 72 yo, Tonsil

10. Opinion on bringing CAM into medical setting
Themes
Quotes
CAM would be more effective in hospital setting
“They [traditional doctor] don’t have the actual things to know what are you having…so when you combine then more effective” 40 yo, Nasopharyngeal
“Better from hospital…better the doctor in charge” 41 yo, Breast
CAM provides support and supplemental benefit with less negative effects
“so have to give advice, things to give them positive thinking” 52 yo, Breast
“Rather than [painkillers], acupuncture is less negative effective” 40 yo, Nasopharyngeal
Convenience
“It is better to get it together so easier for the patient who wants this kind of treatment can go there” 59 yo, Breast
“Because outside, sometimes we don’t know whether the medicine is right or not” 52 yo, Breast

11. Conclusion
Most patients welcome incorporating CAM services into hospitals
expansion of integrative services could increase patient confidence, improve communication, and prevent patients from seeking outside therapies
Physicians must be careful that some patients do not start to view CAM as only an alternative rather than a complement

12. Current work Cross-sectional survey
Questionnaire will be administered to 351 participants in HKL clinic and wards
Pretest complete and administering questionnaire currently
Gathering CAM usage, patient opinions, and clinical data

13. Collaborators
Kong Yek Ching (Research Assistant, National Clinical Research Centre, Ministry of Health, Malaysia), Vaishnavi Jeyasingam (Clinical Oncologist, Department of Radiotherapy and Oncology, Kuala Lumpur General Hospital, Malaysia), Nirmala Bhoo-Pathy (Cancer Epidemiologist, Department of Social and Preventive Medicine, University of Malaya, Malaysia)
Fulbright Funding: Malaysian-American Commission on Educational Exchange and Bureau of Education & Cultural Affairs of the United States Department of State

14. References
Harris, P. E., Cooper, K. L., Relton, C. and Thomas, K. J. (2012), Prevalence of complementary and alternative medicine (CAM) use by the general population: a systematic review and update. International Journal of Clinical Practice, 66: 924–939. doi: /j x
Siti ZM, Tahir A, Ida Farah A, Ami Fazlin SM, Sondi S, Azman AH, Maimunah AH, Haniza MA, Siti Haslinda MD, Zulkarnain AK, Zakiah I, Wan Zaleha WC. Use of traditional and complementary medicine in Malaysia: A baseline study. Complementary Therapies in Medicine. 2009; 17, pp
Han E, Johnson N, DelaMelena T, et al. Alternative therapy used as primary treatment for breast cancer negatively impacts outcomes. Ann Surg Oncol. 2011;18:
Gerber B, Scholz C, Reimer T, Briese V, Janni W. Complementary and alternative therapeutic approaches in patients with early breast cancer: a systematic review. Breast Cancer Res Treat. 2006;95:199–209.
Institute for Health Metrics and Evaluation (IHME). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, Available from: accessed on 12 May 2017.