The Prevalent Use of Complementary and Alternative Medicine Among Patients With Chronic Disease in the Al-Madinah Population of Saudi Arabia

BACKGROUND

Global interest in complementary and alternative medicine (CAM) has recently risen, particularly in Saudi Arabia, and the use of CAM is gaining popularity as a healthcare option.

OBJECTIVES

This study aims to assess the prevalence of CAM use among patients with chronic diseases and identify the reasons for resorting to CAM in Al-Madinah, Saudi Arabia.

METHODS

A cross-sectional study was conducted in Al-Madinah City. Data for analysis were derived from 416 participants with chronic diseases. The data were collected using a valid, structured online questionnaire that was designed to extract socio-demographic data as well as data on the predominant use of herps, hijama (cupping), acupuncture, and other specific CAM applications. The collected data were analyzed using appropriate statistical methods.

RESULTS

Of the 416 participants, 164 (39.4%) were men, and 96.9% were Saudi citizens. Approximately one-third of the studied participants had diabetes (34.1%), while 29.3%, 25.2%, 15.1%, and 12.3% had hypertension, obesity, asthma, and gastrointestinal tract disease, respectively. The prevalence of herb and natural supplement use was 89.2%. The most commonly used herbs and natural supplements were ginger (55.5%), honey and its derivatives (53.4%), cinnamon (45.4%), and frankincense (33.4%). Of the studied participants, 36.1% and 6.5% reported undergoing cupping and acupuncture, respectively. No statistically significant differences were found between the use of herbs and acupuncture or any of the studied factors. Further, the use of acupuncture exhibited no significant differences. However, the use of cupping displayed statistically significant differences in age, sex, and income among the participants.

CONCLUSION

The prevalence of CAM use among patients with chronic diseases in Al-Madinah is high. It appears to play an essential role in health care, particularly in treating patients with chronic diseases in this population. Therefore, promoting research in the field of CAM is warranted.

Immunotherapy for Urological Tumors on YouTubeTM: An Information-Quality Analysis

BACKGROUND

YouTube^TM is an open-access source for mass information. Several previous studies of YouTube^TM videos showed a high rate of misinformation in the urological field. The aim of the current study was to evaluate the quality of information on immunotherapy (IMT) for urological tumors uploaded to YouTube^TM.

METHODS

YouTube^TM videos were searched using nine keyword combinations. The PEMAT, the DISCERN tool, and the Misinformation scale were used to assess the quality of information in YouTube^TM videos about IMT for urological tumors. Descriptive statistics and Kruskal-Wallis, Chi-square, proportion, and Pearson's tests were performed.

RESULTS

According to the selection criteria, 156 YouTube^TM videos were suitable for the analysis and stratified according to topic (urothelial carcinoma vs. renal cell cancer vs. prostate cancer vs. general information on IMT). According to PEMAT A/V, the overall Understandability score was 40% (Inter-Quartile Range [IQR]: 20-61.5) and the overall Actionability score was 0% (IQR: 0-25). According to the DISCERN tool, the overall DISCERN score was 44 (IQR: 39-53.2), defined as "fair". According to the Misinformation scale, we recorded the lowest median overall score for item 4 ("IMT in multimodality approach") and item 5 ("Future perspective").

CONCLUSIONS

YouTube^TM cannot be recommended as a reliable source of information on IMT for urological malignancies. In addition, YouTube^TM videos contributed to the spread of misinformation by underestimating the role of IMT in a multimodality approach and missing the findings of published clinical trial results.

Assessment of Patient Experiences in an Academic Hospital in Saudi Arabia

Introduction Patient continuous assessment is an important component of patient-centered healthcare systems and requires the identification of the services and resources of these systems to ensure patient satisfaction. This study aimed to determine the factors that affect patient satisfaction, identify patients' unmet health care and informational needs, and suggest measures to fill these gaps in healthcare systems. Methods A cross-sectional study included 235 patients who were admitted to the medical ward of an educational tertiary healthcare center in Jeddah, Saudi Arabia, between June-September 2016. A self-administered questionnaire based on the Arabic version of the "échelle de qualité des soins en hospitalisation" or the quality of care in hospitalization scale (ESQ-H) consisting of two subscales that measured their satisfaction with the services received was offered to the study participants. We analyzed the data to identify factors associated with patient dissatisfaction using IBM SPSS® Statistics Version 21.0. Results The patients included 145 males (61.7%) and 90 females (38.3%). The Cronbach's alpha coefficient was 0.933 for the questionnaire. In the subscale associated with the quality of the medical information patients received, three independent variables were associated with higher patient satisfaction: planned patients' hospital stay (p<0.001), patients' health improvement (p<0.001), and patients' overall life satisfaction (p<0.001). In the subscale associated with patients' relationship with medical staff and the daily routine of the medical ward, four independent variables were significant: male gender (p=0.007), patients, if the hospital stay was planned (p=0.009), improvement of patients' health (p<0.001), and patients' overall life satisfaction (p=0.006). Conclusion Patients' satisfaction level was "very good" with the medical information subscale and "excellent" with the relationship subscale. We found that although patients were satisfied with some aspects of their health care, other aspects required more attention; hence, the resolution of patients' unmet health care and informational needs should be prioritized by stakeholders to improve patient satisfaction. Furthermore, the patients should be informed about what they can expect during their upcoming hospital stay, their overall life satisfaction should be considered, and patients with issues related to their life satisfaction should be appointed a social worker.

Psychosocial and Clinical Predictors of Patient Satisfaction with Cancer Care

Purpose

Patient satisfaction with healthcare was recognized as an indispensable component of healthcare quality assurance programs for decades. Limited research has explored psychosocial variables impacting patient satisfaction with cancer care. The objective of our study was to identify the level of patient satisfaction with cancer care in Riyadh, Saudi Arabia and determine the psychosocial and clinical predictors of patient satisfaction.

Methods

A cross-sectional observational study was carried out in 2018–2019 with patients with cancer at the Outpatient Oncology Clinic at King Saud University Medical City in Riyadh, Saudi Arabia. The questionnaire contained a visual analog scale (VAS) of satisfaction with cancer care, a VAS of satisfaction with social support, the Patient Health Questionnaire-9 Depression scale, and the Generalized Anxiety Disorder 7-item scale.

Results

Out of the 400 patients approached, 280 agreed to participate in the study. Of the 280 patients participating in the study, 65% were satisfied with cancer care. Higher satisfaction was associated with being non-Saudi, being employed, having fewer household residents (≤4), being satisfied with social support, not receiving radiotherapy, and receiving hormonal or biological therapy. Having anxiety or depression was also associated with lower satisfaction. After adjustment for sociodemographic and clinical characteristics, being satisfied with social support, having ≤ 4 household residents, receiving hormonal therapy, and receiving biological therapy rather than radiotherapy were all independent predictors of higher satisfaction with cancer care.

Conclusion

This study found an inadequate level of patient satisfaction with cancer care. Higher levels of satisfaction were associated with being satisfied with social support, using biological and hormonal therapy, while lower satisfaction was associated with a larger number of household residents (>4), depression, anxiety and using radiotherapy.

Awareness and Use of Complementary and Alternative Medicine in Korean Lung Cancer Patients

Background

Complementary and alternative medicine (CAM) has been used frequently, and its use continues to increase in lung cancer patients, despite insufficient scientific of its efficacy. To investigate this situation, we analyzed the current awareness and use of CAM in Korean lung-cancer patients.

Methods

This prospective survey–based study was performed at seven medical centers in South Korea between August and October 2019. The survey assessed general patient characteristics and the awareness and use of CAM. We analyzed differences in the clinical parameters of patients aware and not aware of CAM and of CAM non-users and users.

Results

Of the 434 patients included in this study, 68.8% responded that they were aware of CAM and 30.9% said they had experienced it. In univariate analysis, the patients aware of CAM were younger with poor performance status, had advanced-stage lung cancer, received more systemic therapy, and received concurrent chemoradiation therapy (CCRT). By multiple logistic regression, younger age, poor performance status, advanced stage, and prior CCRT were identified as independent risk factors for CAM awareness. There were no significant differences in the general characteristics and cancer-associated clinical parameters of CAM non-users and users.

Conclusion

Specific clinical parameters were associated with patients’ awareness of CAM, although there were no significantly different characteristics between CAM users and non-users.

Complementary and alternative medicine use among ischemic stroke survivors in Jeddah, Saudi Arabia

OBJECTIVE

To determine the prevalence and pattern of complementary and alternative medicine (CAM) use and the CAM types used by stroke patients in Jeddah, Kingdom of Saudi Arabia.

METHODS

This cross-sectional study included 152 ischemic stroke survivors who visited King Fahad Hospital, Jeddah, Kingdom of Saudi Arabia, between January 2018 and December 2019. Phone-based and face-to-face surveys were conducted. Data on the patients` demographic characteristics, their use of CAM, and their pattern of CAM use were gathered.

RESULTS

Ninety (59.2%) stroke patients used CAM, mainly cauterization (29.61%) and Quran recitation by a religious sheik (28.95%). Most of the patients (72.22%) used CAM post-hospitalization and within less than one month from stroke onset (62.22%). A minority (6.67%) of the patients stopped their medication while on CAM. Some patients (25.56% to 31.11%) discussed with their physician their use of CAM. The CAM users reported a subjective improvement in their physical weakness (45.6%) and psychological wellbeing (62.2%). The patients learned about CAM mainly from their relatives and friends (96.7%), and the most common reason for their CAM use was their belief in this intervention (42.22%).

CONCLUSION

The CAM use was prevalent among our cohort of Saudi ischemic stroke patients, and cauterization and Quran recitation were the most commonly used CAM interventions. An effective communication was lacking between the medical professionals and the stroke patients as regards CAM use despite the interest of the patients in this intervention.

Spiritual and Religious Healing Practices: Some Reflections from Saudi National Center for Complementary and Alternative Medicine, Riyadh

Traditional practices constituting spiritual and religious (S/R) healing are an important component of the holistic healthcare model and are used in health, well-being, and treating a variety of diseases around the world. The main focus of this review is to summarize the Complementary and Alternative Medicine (CAM) studies that especially target S/R healing practices in Saudi Arabia (SA) and discuss the results in light of relevant international literature. From year 2013-2017, electronic searches of PubMed, OvidSP, Google Scholar, and two publishing housing Web sites (Sciencedomain.com and Dove Medical Press.com) were made using key words and Boolean operators and retrieved thousands of published papers from peer-reviewed journals. Two independent reviewers decided to include a total of 108 articles: 48 from SA and 60 from other international literature. The sociodemographic variables of the participants varied in local studies and were comparable with international data. The frequency and types of religious and spiritual practices reported in local and international zones varied in accordance with religious belief, gender, age, education, and prevalent chronic diseases. Most of professionals and practitioners showed fairly good knowledge and positive attitude toward spiritual and religious practices used in diverse clinical and non-clinical situations across the world. Furthermore, it was observed that in the international scenario, S/R researches using specific religious screening tools have been conducted on different aspects of clinical application including self-care, social cohesion, negative impact, and child development, whereas regional studies targeting varied participants mainly focused on the epidemiological trends of S/R therapies in Saudi Arabia. CAM practitioners and public tend to show great interest in prescribed and self-use of religious and spiritual therapies across the world because of multiple dynamic forces, including positive effects on health, sense of well-being and disease control, cost-effectiveness, easy access to services, and improvement in quality of life. Further studies are needed to assess the effectiveness of different types of religious and spiritual therapies and practices used in specific diseases, their role in promotion of health and well-being, and prevention of diseases nationwide and across the world. Besides integration of S/R into mainstream treatment modalities, medical education curriculum, continuous medical education, and training programs are needed for bridging the knowledge, attitude, and practice gaps concerning CAM in targeted population groups such as medical professionals, CAM practitioners, medical students, public and traditional healers, not only in SA but also around the world.

Complementary and Alternative Medicine Practice Among Saudi Patients with Chronic Kidney Disease: A Cross-Sectional Study

Objective

Complementary and alternative medicine (CAM) practice in patients with chronic kidney disease (CKD) has significantly increased. However, statistics regarding CAM practices among patients with CKD in Saudi and worldwide are limited. Hence, this study aimed to explore the prevalence and types of CAM in Saudi patients with CKD.

Methods

A cross-sectional study was conducted in 315 patients, who were divided into CKD stages 3-4, CKD stage 5-hemodialysis, and kidney transplant with functioning allografts, by using a convenience sampling technique between September and December 2018. Next, they answered a self-administered questionnaire. The study outcomes were the prevalence of CAM, CAM types, reasons for using herbs, and the source of information about CAM.

Results

Overall, 54.9% of the study participants were current CAM users, of which 88.4% were herbal consumers. Patients with CKD stages 3-4 accounted for 87.3% of the CAM users, followed by those with CKD 5-hemodialysis (7.5%) and CKD-transplant recipients (5.2%). CAM practice was associated with monthly income (P = 0.021). Meanwhile, 79% of CAM users did not report their CAM practices to their primary physicians. Nigella sativa and parsley were the most commonly consumed herbs by CAM users [94 (61.4%) and 78 (51%), respectively].

Conclusion

CAM practice and herb consumption were highly prevalent among patients with CKD. Patients inadequately inform the primary physicians about their CAM practices. Therefore, healthcare providers are encouraged to inquire about these practices.

The use of complementary and alternative medicine among women with breast cancer in Saudi Arabia

PURPOSE

The purpose of the study was to explore the frequency of use of complementary and alternative medicine (CAM) therapies among women with breast cancer in Saudi Arabia.

DESIGN

A descriptive cross-sectional study design was used with face-to-face interviews using a structured questionnaire.

SAMPLE

A convenient sample of 85 Saudi women with breast cancer who were undergoing cancer treatment was recruited from the Oncology Department of King Faisal Hospital, Jeddah, Kingdom of Saudi Arabia.

METHODS

Using structured questionnaire "Use of Complementary Therapies Survey," consisted of diet and nutritional supplements, stress-reducing therapies, and other traditional treatments.

RESULT

Participants were predominantly married (76.5%), resided in an urban area (83.5%), unemployed (62%), and about half reported no income (49.4%). The mean age was 48 years. All participants reported using at least three or more CAM therapies (mean = 21.15, SD = 8.85) since their diagnosis. There were significant correlations between other CAM use and time since diagnosis (r_s = -0.33, p < .05). The highest usage of dietary and nutritional supplements occurred with honey, olive oil, antioxidants, Fennel flower seeds, and ginger. The highest stress reducing CAM techniques included reading the Holy Qur'ãn, and praying. For other traditional CAM therapies, positive thinking and relaxation techniques were the most frequent methods reported by women. Other CAM treatments involved ZamZam water and listening to music.

CONCLUSIONS

The use of complementary therapies among Saudi women with breast cancer is highly prevalent, with a predominance of interventions of religious background, indicating the strong influence of religion on peoples' lives, especially when people are faced with a life-threatening illness. The results of this study will guide future studies examining the efficacy of CAM on symptom management in Saudi Arabian women with breast cancer and other types of cancer.

Cupping therapy in Saudi Arabia: from control to integration

Cupping therapy or Hijamah is a leading traditional practice after spiritual healings and herbal medicine in Saudi Arabia. Wet cupping is by far the most common type of cupping therapy. Hijamah in Saudi Arabia and other Muslim countries is a model of religious influences, interconnectivity, and cross-cultural influences between different civilizations. Accordingly, differentiating the cupping practiced in Saudi Arabia, and other Muslims societies from that practiced in other countries like China, by Korea only by the technique or cupping sites is an underestimation of the differences. In Saudi Arabia, the profile or characteristics of cupping therapy user is distinct from the profile of other traditional medicine users by being more educated, with higher job rank and not affected by nationality or gender. After an era of unregulated practice, cupping therapy is currently regulated and monitored by the National Center for Complementary and Alternative Medicine in the Ministry of Health (NCCAM/MOH) of Saudi Arabia. Regulations and licensing include practitioners, practice place, and cupping equipment. After regulation, cupping is mainly offered by the private sector and paid directly by the client as insurance does not cover it. In the private sector, licensed cupping service is usually provided as a parallel and not an integrated service. However, there are few models of integrated cupping clinic in universities, academic institutions, and governmental hospitals. Further health system research is needed to develop more models of integrated cupping service pending for the healthcare transformation which is going on in Saudi Arabia.

The use of complementary and alternative medicine by patients with cancer: a cross-sectional survey in Saudi Arabia

BACKGROUND

A significant proportion of cancer patients use complementary and alternative medicine (CAM) along with conventional therapies (CT), whereas a smaller proportion delay or defer CT in favor of CAM. Previous studies exploring CAM use among cancer patients in the Middle East region have shown discrepant results. This study investigates the prevalence and pattern of CAM use by Saudi cancer patients. It also discusses the possible benefits and harm related to CAM use by cancer patients, and it explores the beliefs patients hold and their transparency with health care providers regarding their CAM use.

METHODS

A cross-sectional study was conducted in oncology wards and outpatient clinics by using face-to-face interviews with the participants.

RESULTS

A total of 156 patients with a median age of 50 years (18-84) participated in the study. The prevalence of CAM use was 69.9%; the most prominent types of CAM were those of a religious nature, such as supplication (95.4%), Quran recitation (88.1%), consuming Zamzam water (84.4%), and water upon which the Quran has been read (63.3%). Drinking camel milk was reported by 24.1% of CAM users, whereas camel urine was consumed by 15.7%. A variety of reasons were given for CAM use: 75% reported that they were using CAM to treat cancer, enhance mood (18.3%),control pain (11.9%), enhance the immune system (11%),increase physical fitness (6.4%), and improve appetite (4.6%). Thirty percent of CAM users had discussed the issue with their doctors; only 7.7% had done so with their nurses.

CONCLUSIONS

The use of CAM, including camel products, is highly prevalent among cancer patients in the Middle East, but these patients do not necessarily divulge their CAM use to their treating physicians and nurses. Although CAM use can be beneficial, some can be very harmful, especially for cancer patients. Association is known between camel products and brucellosis and Middle East respiratory syndrome coronavirus (MERS-CoV). Both can lead to tremendous morbidity in immune-compromised patients. Doctor-patient communication regarding CAM use is of paramount importance in cancer care.

Quality of life and complementary and alternative medicine use among women with breast cancer

Background

Complementary and Alternative Medication (CAM) is commonly used among women with breast cancer to improve their quality of life (QoL). However, few studies examine the prevalence of CAM and its’ relation to the patients’ QoL among women with breast cancer.

Methods

A cross-sectional study was conducted among 95 women with breast cancer at a tertiary hospital in Saudi Arabia. The outcome measure of interest was the QoL. The correlation was used to assess the association between CAM use and QoL. Bivariate and multivariate analyses were used to examine the factors that affect the use of CAM. The data was analysed using Statistical Package for the Social Sciences (SPSS) version 24.0.

Results

CAM use was reported by 81.1% of the study participants. The most commonly used CAM therapy was spiritual therapy 70.5%, followed by honey 36.8%, olive oil 24.2% and 23.2% herbal therapy. We found that those who were undergoing cancer treatment had a significantly higher percentage of CAM usage as compared to those not undergoing cancer therapy (72.6% vs. 8.4%, P=0.008). With regards to QoL, there was a statistically significant difference between CAM users and non-CAM users in global health status (73.2% vs. 64.8%, P = 0.049).

Conclusions

CAM therapy was commonly used among women in our study sample which was correlated with higher overall global QoL. As CAM is widely used, health care providers may need to discuss the use of CAM with breast cancer women and be up to date on the benefits and risk of CAM use through well-equipped training programs and workshops.

The prevalence extent of Complementary and Alternative Medicine (CAM) use among Saudis

Introduction: There is worldwide interest in the use of CAM. Studying CAM in Saudi population is important as it will reflect the influence of psychosocial, cultural and religious factors on health beliefs and behaviors. The objective of this study was to present an updated review on the use of CAM practices in Saudi Arabia including commonly used types, common conditions for which it has been used and who uses CAM. Methods: This review used data from national surveys conducted in Saudi Arabia and published between 2000 and 2015. The literature search was performed considering standards adopted such as Moose guidelines for observational studies. Two authors independently reviewed each article. The search yielded 73 articles, and a total of 36 articles were included. Further careful data extraction was carried out by two independents reviewers. Results: Most of the reviewed studies were cross-sectional in design and were published between 2014 and 2015, and mostly in Riyadh region. Substantial difference in the findings for the patterns of CAM use was revealed. The most commonly employed practice was of spiritual type such as prayer and reciting Quran alone or on water. Other types include herbs (8-76%), honey (14-73%) and dietary products (6-82%). Cupping (Alhijamah) was least used (4-45%). Acupuncture was more practiced among professionals. Conclusion: The utilization of CAM is widely practiced in Saudi Arabia. There is need for efforts to promote research in the field of CAM to address each practice individually. Population surveys should be encouraged supported by mass media to raise knowledge and awareness about the practice of different CAM modalities. The national center of CAM should play a major role in these efforts.

Un-met supportive care needs of Iranian breast cancer patients

BACKGROUND

Assessment of supportive needs is the requirement to plan any supportive care program for cancer patients. There is no evidence about supportive care needs of Iranian breast cancer patients. So, the aims of present study were to investigate this question and s predictive factors.

MATERIALS AND METHODS

A descriptive- correlational study was conducted, followed by logistic regression analyses. The Supportive Care Needs Survey was completed by 136 breast cancer patients residing in Iran following their initial treatment. This assessed needs in five domains: psychological, health system and information, physical and daily living, patient care and support, and sexuality.

RESULTS

Patient perceived needs were highest in the health systems and information (71%), and physical and daily living (68%) domains. Logistic regression modeling revealed that younger participants have more un-met needs in all domains and those with more children reported fewer un-met needs in patient care and support domains. In addition, married women had more un-met supportive care needs related to sexuality.

CONCLUSIONS

The high rate of un-met supportive care needs in all domains suggests that supportive care services are desperately required for breast cancer patients in Iran. Moreover, services that address informational needs and physical and daily living needs ought to be the priority, with particular attention paid to younger women. Further research is clearly needed to fully understand supportive care needs in this cultural context.

Complementary alternative medicine use amongst breast cancer patients in the Northern region of peninsular Malaysia

BACKGROUND

Breast cancer is a common cancer affecting women in Malaysia and the use of complementary/ alternative medicine (CAM) has been associated with delays in getting treatment. The aim of the study was to explore the use of CAM and the influencing factors in the Northern region of Peninsular Malaysia.

MATERIALS AND METHODS

This was a cross-sectional descriptive study on a convenience sample of 100 Malaysian breast cancer survivors.

FINDINGS

The reported use of CAM among the breast cancer survivors was lower than in other studies but the types of CAM used had a similar pattern with nutrition supplements/vitamins being the most common. The factors that positively influenced the use of complimentary/traditional therapy were income and getting information from television or radio. Survivors with access to internet/blogs appear to have lower odds of using complimentary/traditional therapy compared to the respondents who reported no such access.

CONCLUSIONS

Information transmitted via television and radio appears to have a positive influence on CAM use by breast cancer patients compared to other information sources and it is important to ensure that such information is accurate and impartial.

Effect of Relaxation With Guided Imagery on The Physical and Psychological Symptoms of Breast Cancer Patients Undergoing Chemotherapy

Background:

Breast cancer patients frequently experience psychological distress during the chemotherapy period.

Objectives:

This study aimed to evaluate the effect of relaxation with guided imagery on patients with breast cancer.

Patients and Methods:

A two-group, pretest-posttest, quasi-experimental design with a randomized controlled trial was conducted. Sixty-five breast cancer patients from one medical center in Taiwan were enrolled in the study. These patients were randomly assigned to the experimental group (n = 32) or to the control group (n = 33). Both groups received chemotherapy self-care education, but the experimental group also received relaxation with guided imagery training. The training on relaxation with guided imagery was conducted before chemotherapy, and the patients were supplied with a compact disc detailing the performance of relaxation with guided imagery for 20 minutes daily at home for 7 days after chemotherapy.

Results:

The experimental group showed significant decreases in insomnia (-0.34 ± 0.83, P < 0.05), pain (-0.28 ± 0.58, P < 0.05), anxiety (-3.56 ± 2.94, P < 0.00), and depression (-2.38 ± 2.70, P < 0.00) between the pretest and the posttest. Comparing the two groups, statistically significant differences were found in the overall symptom distress (B = 0.11, P < 0.05), insomnia (B = 0.50, P <0.05), depression (B = 0.38, P < 0.05), and numbness in physical symptoms (B = 0.38, P < 0.05), as well as in anxiety (B = 3.08, P < 0.00) and depression (B = 1.86, P < 0.00) in psychological distress. One week of relaxation with guided imagery can significantly improve the overall symptoms of distress, insomnia, depression, physical symptoms, and anxiety, and can decrease psychological distress.

Conclusions:

Relaxation with guided imagery had a positive effect on mediating anxiety and depression in breast cancer patients.