The Evaluation on The Pattern of Complementary Alternative

Treatment Used by Cancer Patients

Mochamad Djunaedi

, Wahyu Utami

and Anila Impian Sukorini

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

(Mursyidah & Santoso, 2009).

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

(Kementrian Kesehatan RI, 2015).

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

(Kementrian Kesehatan RI, 2015).

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

(Hunte & Sultana, 1992) 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 (Ali-

Shtayeh et al., 2011). The CAM use in patients

undergoing palliative therapy is not influenced by

the patient's demographic characteristic (Gray et al.,

1998).

240

Djunaedi, M., Utami, W. and Sukorini, A.

The Evaluation on The Pattern of Complementary Alternative Treatment Used by Cancer Patients.

DOI: 10.5220/0008360602400244

In Proceedings of BROMO Conference (BROMO 2018), pages 240-244

ISBN: 978-989-758-347-6

Patients often seek advanced information on the

medical development and recurrence of cancer,

while protocols direction, to detect the signs of side

effects, insurance and healthy lifestyle is neglected

(Katchmar et al., 1999).

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

(Kumar et al., 2002). Finding information through

social media networks is less effective for the

elderly rather than community based media (Curbow

et al., 2004). 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 (Poonthananiwatkul et al., 2015)

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

(KemenKes R.I., 2015)

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

(Menteri Kesehatan, R.I., 2007).

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

The Evaluation on The Pattern of Complementary Alternative Treatment Used by Cancer Patients

241

cancer by health professionals who consumed

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

Type of malignancy

Percentage

breast cancer

uterus Cancer

Craniofagioma

Hodgkin's lymphoma

colon / rectum cancer

Malignant timomas

Musicnous carcinoma

Muscle uterus

FNAC

Mouth cancer

Lymph node cancer

Tumor ductus lactiferus

lung cancer

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

Type of preparation

Simple herbal ingredients (liquid part

of concoction)

20 %

Modern preparations such as: capsules,

pills, sachets/powders, etc.

71%

Phytomedicine preparation

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

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242

herbs, supplements or traditional medicines obtained

from fellow patients, family or relatives (87%).

Table 3: Identity of products used as CAM by cancer

patients

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

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)

Loranthus sp.

Div

III

Traditional Chinese Medicine

Chinese traditional

medicine

(unidentified)

Tianchi

Lamla Herbal

G3 Lingzhi

Table 4 Advisors or information sources who

recommend using herbs, supplements or

traditional medicines

Recommender

Friends, relatives or family.

67%

Doctor, Pharmacist, Nurse,

Herbalist or other health

professional.

21%

Electronic information media

11%

belief in myths

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

Description

Number

The body becomes healthier

Increased Appetite

reduce the side effects of reduced

chemotherapy

feel safe (mood boster)

kill active cancer cells

Inhibits disease progression

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

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243

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.

BROMO 2018 - Bromo Conference, Symposium on Natural Products and Biodiversity

244