Introduction

Complementary and alternative medicine (CAM) is defined as a group of medical and health care systems involving practices and products that are not considered part of conventional medicine. It can be classified into mind-body therapies, energy therapies, alternative medical systems, and biologically based therapies (1).

The use of CAM has increased among cancer patients, who justify its use by the perceived improvement in quality of life and reduction of side effects from conventional treatments (2). Globally, between 9.8% and 76% of cancer patients report using CAM (3); meanwhile, in Colombia, the range is between 51.7% and 73.5% (4,5). Most of these differences are attributable to the course of the disease, the appearance of side effects, and patients' cultural backgrounds (6).

The main reasons patients use CAM include its "natural" character and perceived safety (2). However, certain foods can interact with medications used in conventional treatment. For example, St. John's wort and garlic may reduce the effectiveness of some chemotherapeutics (7,8), while turmeric improves antitumor activity (9), and agraz (Vaccinium meridionale) has shown potent antioxidant and cytotoxic effects on breast cancer cells (10).

As their primary source of information about CAM, patients often refer to individuals outside the healthcare team and avoid communicating its use to their treating physicians (11,12). Moreover, it has been found that patients who use CAM perceive a greater risk of death or recurrence (13), making CAM a common practice in their treatment regimens. Notably, the city of Neiva, located in the department of Huila (Colombia), reported 2,035 new cases of cancer (excluding non-melanoma skin cancer) by 2016, with an incidence rate similar to that of the rest of the country (14). Additionally, in this city, 76.29% of cancer cases were reported to be in advanced stages in 2011 (15), which is higher than the national average up until 2022 (16).

Given the above, this study aimed to determine the frequency of CAM use and to characterize CAM practices among cancer patients in Neiva.

Methodology

A descriptive study was conducted. The methodology follows that described in Murillo et al. (5), and the specific results for the city of Neiva are presented in this article. The study was approved by the Ethics Committees of San Ignacio Hospital/Pontificia Universidad Javeriana (Bogotá) and the Surcolombian Oncology Unit (Neiva). All participants provided informed consent. A survey was administered, consisting of sociodemographic data, clinical characteristics, frequency, and reasons for CAM use.

The sample size was defined as 525 subjects (although one more was collected, totaling 526 patients), based on an expected prevalence of CAM use of 70%, with a 95% confidence interval, a precision of 5%, and a design effect of 2 (17). Patients were randomly selected from September 2021 to March 2023 at the Surcolombian Oncology Unit in Neiva. Inclusion criteria included adults over 18 years of age with a histopathological diagnosis of cancer, undergoing active treatment, or having received radiotherapy or surgery within the last 4 months, in any clinical stage, and with any type of cancer. Patients unable to complete the survey due to physical or mental condition were excluded. Data were recorded on the RedCap platform (18).

Data were analyzed using absolute and relative frequencies with Python® and R® statistical packages (19,20). Frequency of use was reported as a percentage, and sociodemographic and clinical characteristics between CAM users and non-users were compared using the chi-square test (χ²), with a significance level of 0.05. Significant variables were included in a logistic regression model, where the outcome variable was CAM use.

Results

A total of 526 patients were surveyed, of whom 57.2% (301) reported using CAM. The median age was 60 years. Most participants were women, individuals of low socioeconomic status, and patients diagnosed with localized solid tumors. Significant associations were found between CAM use and variables such as age, sex, religion, occupation, education level, and cancer stage (Table 1).

The use of CAM substantially increased after diagnosis, rising from 17% to 57% (Figure 1).

Most patients used CAM based on herbs (n = 191), followed by vitamins (n = 164), and natural-origin special foods (n = 145). The most frequent combinations were CAM based on vitamins and herbs (65%) and CAM based on herbs and special foods (51%) (Figure 2).

Regarding the reasons for using CAM, most patients reported using this type of medicine for both curative purposes (to cure the disease and avoid future complications) and palliative purposes (improving mood and alleviating treatment side effects). Many patients expressed the desire to try all possible options (Figure 3).

The most commonly used CAM products included anamu, snake-based products (meat, soups, or capsules), and soursop (leaves or fruit). Figure 4 shows the distribution of responses on this topic.

For the logistic regression model, variables such as age (categorized), sex, religion, education level, occupation, and cancer stage were included. After removing non-significant variables, the final model is presented in Table 2. The model had a good fit, as indicated by the Hosmer-Lemeshow test (χ² = 3.59; p = 0.61). No outliers or influential observations were identified, and residuals followed an approximately normal distribution.

Discussion

This study is the first to report on the frequency of CAM use in the city of Neiva. A prevalence of 57.2% was found, which is higher than that documented for the rest of Colombia (51.7%) (5) and higher than that found in other Latin American (21-23) and European countries (24,25). However, a study conducted in Bogotá with a predominantly subsidized population reported a higher prevalence (4).

One of the main findings of this study was the increase in CAM use after the cancer diagnosis, which aligns with previous studies (13,26). This result may be related to patients' perceptions of CAM, as there is a widespread belief that this type of medicine can cure the disease, prevent its progression, and offer better control over treatment (13,27).

In agreement with previous reports, women and younger patients were more likely to use CAM, which was also significant in the multivariate model (24,28-30). This could be explained by a more favorable attitude towards CAM in this population. On the other hand, a significant association with occupation was found, which could be related to patients' beliefs about existing barriers to accessing formal healthcare (31), as patients may prefer CAM that is more easily accessible rather than seeking formal healthcare services.

Contrary to other studies, most CAM users were patients with low educational and socioeconomic status (13,24,29,32). This result may be associated with the high consumption of herbal products and natural foods, which are economically accessible. This finding partially differs from national data, where herbal products are the most common type of CAM used by cancer patients, but other types such as special diets and vitamins are used with similar frequency (5).

Additionally, frequent consumption of snake-based products (meat, venom, and capsules) was observed, which differs from previous reports in the country (5). These products are more commonly accepted and used in Asian countries (33) and represent a cultural specificity in Neiva.

The antineoplastic activity of various herbal products and snake-derived products has been the subject of multiple studies, finding cytotoxic biological activity in vitro (34). However, only a limited number of products have progressed to clinical trials. No studies were found analyzing the potential interaction of these products with conventional oncological treatments.

Most patients reported using CAM for palliative purposes, although a significant proportion of cancer patients explore all possible options, as seen in previous studies (24,29). Consequently, patients generally do not use CAM as a replacement for conventional treatment, but its combined use warrants careful monitoring and constant communication with the healthcare team.

Conclusions

This study had several limitations. Conducting the study in a single institution limits the external validity of the results; however, the oncology center where the study was conducted attends to a significant proportion of cancer cases in the city of Neiva and the department of Huila. Therefore, the results should be understood in the context of the study population's characteristics, particularly regarding educational level and socioeconomic status. Additionally, the guided survey may have influenced the results differently than if it had been self-reported (35). Beyond the described limitations, the study highlights the need for more research on CAM, particularly the development of clinical studies that support the therapeutic potential or drug interactions of the most commonly used products by patients in this region.

The high frequency of CAM use indicates the need to strengthen integrative medicine services. We believe that the study's contribution is relevant to this objective. It is also crucial to inform patients about the potential side effects of CAM.

Funding

This work was funded by the Pontificia Universidad Javeriana, the Ministry of Science, Technology, and Innovation, the Ministry of National Education, the Ministry of Industry, Commerce, and Tourism, and Icetex through the 2nd Scientific Ecosystem-Colombian Scientific Call 792-2017, Program "Generation of Therapeutic Alternatives in Cancer from Plants through Translational Research and Development Processes Articulated in Sustainable Environmental and Economically Viable Value Systems" (Contract FP44842-221-2018).

Conflicts of interest

The authors declare no conflicts of interest.

Acknowledgments

We thank the Pontificia Universidad Javeriana, the Ministry of Science, Technology, and Innovation, the Ministry of National Education, the Ministry of Industry, Commerce, and Tourism, and Icetex for their support through the 2nd Scientific Ecosystem-Colombian Scientific Call 792-2017, Program "Generation of Therapeutic Alternatives in Cancer from Plants through Translational Research and Development Processes Articulated in Sustainable Environmental and Economically Viable Value Systems" (Contract FP44842-221-2018).

References

Author notes

^a Corresponding author: martineznicolas@javeriana.edu.co

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