Traditional Complementary and Alternative Medicine (TCAM) for Cancer Related Conditions: Conflicts and Consensus

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However, their side effects have led to increased interest in Traditional Complementary and Alternative Medicine (TCAM). Objectives: This study explores TCAM usage patterns among cancer patients, examining their motivations, expectations, and experiences and analyze the consensus or disagreement between patients and Palliative Health Professionals (PHP) on integrating TCAM with conventional cancer treatments. Methodology: A qualitative study design was adopted, utilizing semi-structured interviews with 21 cancer patients and 12 PHPs in Thrissur district, Kerala. Results: The study revealed diverse patterns of TCAM usage and it highlighted both positive outcomes, such as symptom relief, enhanced immunity and improved quality of life, and negative experiences, including misdiagnosis, delayed treatment and aggravated conditions which led to reverting back to modern medicine. Non-disclosure of TCAM use to oncologists was common, complicating care integration. Conclusions: The study highlights the complex landscape of TCAM utilization among cancer patients, emphasizing the need for balanced integration with conventional treatments. While TCAM offers potential benefits in enhancing patient well-being, concerns about safety, efficacy, must be addressed. Traditional Medicine Palliative care outcomes cancer Introduction According to Global Cancer Observatory (GLOBOCAN) 2022, global cancer cases reached 19.98 million in 2022 1 with India alone accounting for 1.41 million cases 2 . While chemotherapy, radiotherapy, and surgery remain standard treatments 3,4 , they often entail adverse effects and fail to address secondary health issues such as fatigue, anxiety, depression and pain 5 . This has led to a growing interest in Traditional Complementary and Alternative Medicine (TCAM) 6,7 . Globally, 25% to 80% of cancer patients seek TCAM alongside conventional treatments 8–11 , with prevalence rates varying across countries and the highest among them is United States and lowest is Italy and Netherlands 12 . Despite the high utilization, many patients do not disclose TCAM usage to their oncologists, relying instead on advice from friends and family 10,13 . Economic barriers further drive TCAM adoption, particularly in low- and middle-income countries where access to mainstream healthcare is limited 14 . The most common alternative medical systems in India are Ayurveda, Siddha, Unani, Naturopathy and Homeopathy. 11 The Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy, abbreviated as AYUSH focus attention towards provision of care for cancer apart from education and research in these fields. 15 As found in some studies in other countries, TCAM usage is found to be high among people with low socio economic status and low education 13,16,17,18 except in pediatric oncology. 19 The most common reason for its usage is advice from friends and families 13,17,20 and commonly used TCAM is Ayurveda 13,17,19,21 except in Kolkata (Homeopathy) 18 and Kerala (Home remedies). 20 By TCAM usage most cancer patients reported better results 13,20,22 . In Sub Himalayan city 85% used it as a sole treatment. 21 Similar to findings from studies in other countries, most of the Indian patients too do not disclose the usage of TCAM to their oncologists. 20,22 . Complementary treatments have a significant role in controlling symptoms of cancer and in cancer treatment as it helps in healing, recovering and improving health. 8,23 TCAM plays a pivotal role, with Ayurveda and Homeopathy being the more preferred systems 13,18,21 . Research suggests that TCAM can effectively complement conventional cancer treatments, enhancing symptom management and improving quality of life 7,24 . However, there are also a few studies that reported negative impacts of TCAM 18,25,26 . In this backdrop, it is important to undertake studies which can validate TCAM's safety and efficacy, particularly in the context of integrative oncology care 27 . Despite the growing interest in TCAM as an adjunctive therapy in cancer care, there remains a dearth of research examining the patterns of its use and effectiveness in community settings as most of the studies are focused on patients in tertiary care settings. Objectives This study aims to explore the usage patterns of TCAM among cancer patients, focusing on areas of consensus and conflicts in its utilization. It investigates patients' motivations, expectations, and experiences with TCAM, as well as healthcare providers' attitudes and practices. The study seeks to understand perceptions of TCAM's effectiveness and safety and to analyze the extent of consensus or disagreement between patients and Palliative Health Professionals (PHP) regarding the integration of TCAM with conventional cancer treatments. Methodology This study adopted a qualitative design and used semi-structured interviews to examine deeply into patients' utilization of Traditional and Complementary and Alternative Medicine (TCAM). To ensure a comprehensive exploration, a set of open-ended questions were developed based on an extensive literature review, aiming to assess TCAM usage patterns, conflicts, and consensuses from the participants' perspectives. The interview guide underwent revisions through collaborative discussions among public health experts, oncologists and palliative health professionals. A pilot study involving seven cancer patients was conducted to refine the questionnaire and adjust the interview guide accordingly. Probing questions were incorporated to encourage participants to elaborate on their experiences with TCAM and to facilitate a clearer understanding of their perspectives. Study Sample The study population was drawn from Thrissur district of Kerala at a community level. To ensure a diversity of perceptions and beliefs regarding CAM use, patients were purposively selected with the help of ASHA workers. The ASHA workers enquired about the TCAM usage among cancer patients who are registered under government Palliative care in Thrissur district of Kerala. Selection criteria included cancer patients who are registered in the Palliative care unit of all Governmental Institutions of Thrissur District of Kerala, above the age of 18 years who are TCAM users and who are able to give the consent. Patients were recruited for the study through invitations, and informed consent was obtained by providing them with a patient information sheet to read and agree upon before interviews. For those unable to read, research assistants verbally provided information in their native languages. Interviews were conducted until theoretical saturation was reached. In total, 21 cancer patients were interviewed. Additionally a guideline interview was conducted among Palliative Health Professionals (PHP) from the Government Hospitals. Interviews were carried out in Malayalam from October to December 2024 and confidentiality was upheld, and identities were protected throughout. Each interview lasted between 15 to 90 minutes, and the recorded conversations were transcribed word for word. Quality of the study was assured at all levels. The authors collectively examined and evaluated both expected themes and emerging themes to enhance the analysis. Some very salient quotes from the respondents are also included in the results section. Results In the study, 21 cancer patients and 12 Palliative Health Professionals were interviewed. Out of the 21 cancer patients who were interviewed, 7 patients used TCAM for the treatment, 8 used TCAM after modern medicine to deal with side effects of the treatment and to avoid recurrence The remaining 6 cancer patients used TCAM till the diagnosis of cancer and stopped its usage after the diagnosis. Four of them had negative experiences including misdiagnosis and aggravation of symptoms. Out of 21 participants, one used Naturopathy, 4 used Homeopathic medical system and the rest used Ayurveda. The study specifically examined the usage patterns, and the conflicts and consensus regarding TCAM usage among the patients. 1 Utilization of TCAM/ TCAM usage pattern by cancer patients 1.1. Utilization of TCAM for cancer treatment care It is interesting to highlight the patient-centric motivations behind the utilization of TCAM, especially Ayurveda as a complementary or alternative treatment for cancer. The various reasons for choosing Ayurveda for treating cancer include the aversion towards invasive procedures like surgery, the perceived benefits of Ayurvedic practices in enhancing immunity and reducing chemotherapy side effects, the role of Ayurveda as a viable option in cases of accessibility constraints, and the fear of adverse effects associated with conventional treatments. The opinion of Palliative Health Professional (PHP) on TCAM ranged from total disagreement to conditional acceptance depending on the patient's comfort and the stage of the disease. For instance, one of the respondents mentioned: “ Then the doctor said that, as my husband’s right arm was paralyzed, he could not do chemotherapy anymore and thence stopped the modern medicine treatment. So, we switched to Ayurvedic treatment. In January it will be one year since Ayurveda was started .” (Respondent 14) 1.2. Utilization of TCAM for post-cancer treatment care/ Integrating TCAM into Post-Cancer Treatment Care The utilization pattern encompasses the proactive use of TCAM to prevent cancer recurrence, the focus on immune system enhancement, and the mitigation of treatment-related side effects. Patients turn to TCAM modalities such as Ayurveda and Homeopathy to address holistic health needs, promote immune function, and alleviate treatment-induced adverse effects. Amid varying perspectives on TCAM usage, PHPs often advocate for integrating TCAM with conventional medicine to manage symptoms and enhance the quality of life following cancer treatment. One of the patients reported that: “ After the breast cancer treatment was completed, to not to recur the disease and to get rid of side effects of modern medicine treatment, I took Ayurvedic treatment including Panchakarma therapies for about one and half years at an interval of about 3 months.” (Respondent 3) 1.3. Utilization of TCAM before Cancer Diagnosis This subtheme elucidates the obstacles encountered by cancer patients in the utilization of TCAM before initiating conventional cancer treatment. Patients commonly discontinue TCAM by medical advice from healthcare providers, influenced by concerns about potential interactions with conventional treatments and uncertainties regarding TCAM safety and efficacy. Moreover, perceptions of TCAM lacking therapeutic value and fears of adverse effects on cancer progression contribute to the cessation of TCAM practices among cancer patients. PHPs have limited understanding of the use of TCAM before a cancer diagnosis, as the application of these treatments prior to the onset of cancer is generally considered less relevant in the context of cancer care. 2. Conflicts in the utilization of TCAM 2.1. Risks and Concerns Regarding TCAM in Cancer Treatment, The responses of the patients show various drawbacks associated with TCAM use in cancer care. Risks and concerns regarding Traditional, Complementary, and Alternative Medicine (TCAM) in cancer treatment are significant, primarily due to the potential failure of these therapies and the lack of systematic monitoring. The absence of regular follow-up can lead to inadequate tracking of patient health, increasing the risk of disease aggravation. For instance, some patients have experienced initial improvements followed by a deterioration of symptoms, highlighting the complex and variable responses to TCAM treatments. In addition, uncertainties surrounding the effectiveness of naturopathy, particularly in terminal stages of cancer, and the rising trend of exploring herbal treatments from unregistered practitioners further complicate the landscape. Negative outcomes have been noted in cases where patients, disillusioned by conventional treatments, turned to Ayurveda. A notable example involves a patient with colon cancer who, after opting for Ayurvedic treatment and experiencing worsening symptoms, eventually had to revert to modern medicine. This case exemplifies the potential risks of delaying conventional care and underscores the importance of a balanced approach to cancer treatment. PHP are concerned about patients abandoning conventional treatments for TCAM, potentially missing curative opportunities in early-stage cancers and experiencing worsened conditions. There is also growing skepticism about the reliance on unregistered practitioners, raising further concerns about the effectiveness and safety of these treatments as revealed by one of the respondents: “ When I opted for Ayurvedic treatment they even made me drink cow’s urine for a whole month. But by that time my symptoms got aggravated, felt gas problems and diarrhea. Also, Bleeding Time and Clotting Time went too high” (Respondent 16) 2.2. Misdiagnosis leading to unnecessary financial burden and late diagnosis of cancer Patients have reported challenges in diagnosing cancer-related conditions through TCAM approaches, with instances of misdiagnosis leading to delayed detection, thus hindering early intervention and effective disease management. Although palliative health professionals lack specific data on misdiagnosis, they have observed cases where reliance on TCAM has resulted in delays in cancer diagnosis and treatment. Moreover, patients have experienced temporary relief followed by disease progression, as well as unnecessary financial burdens due to ineffective or inappropriate TCAM treatments, underscoring the broader socioeconomic implications of diagnostic inaccuracies in cancer care. The experience of Respondent 17 highlights this: “ At first the disease was not known. There was only constipation, I had no diarrhea, no loss of appetite and no other discomforts. Then took some homeopathic medicine for a short period, then took some Ayurvedic medicines. After a certain period of time, the stool was bloody and went to the hospital and confirmed as third stage cancer” (Respondent 17) 2.3. Financial Barriers in TCAM Utilization for Cancer Care Financial factors also play a major problem in TCAM treatment. There are significant financial challenges that cancer patients face while accessing TCAM modalities. The findings reported critical challenges faced by cancer patients, including financial burdens due to treatment costs and limited access to diverse treatment options. It also points out disparities such as ineligibility for cancer pensions and inadequate financial aid for Above Poverty Line (APL) patients. Additionally, the lack of insurance coverage for Traditional, Complementary, and Alternative Medicine (TCAM) treatments further limits choices for patients seeking alternative therapies. These issues underscore the need for improved healthcare policies and support systems to ensure equitable access to effective cancer care regardless of financial status or treatment preferences. 2.4. Non-disclosure of TCAM Utilization to Oncologists In the context of TCAM, the disclosure of its usage to modern medicine physicians is a vital factor that affects patient-provider interactions and the overall effectiveness of treatment outcomes. One significant factor contributing to non-disclosure is the prevalent fear among patients, stemming from warnings issued by modern medicine doctors regarding potential risks associated with TCAM. Despite this fear, many patients opt for an independent pursuit of TCAM, driven by their belief in its efficacy and desire for holistic healing approaches. However, such decisions often encounter resistance from modern medicine doctors, who express skepticism or even criticize patients for seeking alternative treatments. In response, patients may advocate for TCAM, emphasizing its unique principles and perceived benefits, thereby highlighting the need for mutual understanding and respect between different medical paradigms. PHPs also believe that most patients do not disclose their TCAM use, which complicates the provision of comprehensive care and the monitoring of potential interactions. 3 Consensus in the utilization of TCAM 3. 1. Positive Outcomes and Enhancing Quality of Life with TCAM in Cancer Care: Patients have reported significant positive results with TCAM, including apparent cures from cancer following Ayurvedic treatment alone, with no side effects and confirmed absence of recurrence through PET scans. TCAM treatments have also been associated with improved patient well-being, symptomatic relief, and perceived strengthening of the immune system. Palliative health professionals support integrating TCAM with conventional treatments to enhance overall quality of life and patient comfort, recognizing its potential benefits in boosting immunity and managing cancer symptoms in line with holistic health principles. 3.2. Holistic and patient centric approach in Terminal Illness Care: Terminally ill patients often turn to TCAM, especially Ayurveda, to address emotional challenges such as fear and anxiety associated with conventional chemotherapy. This reflects a complex interplay between emotional well-being and treatment choices. PHP recognizes Ayurveda as potentially more effective and advanced compared to other traditional therapies, contributing positively to patient outcomes. TCAM practices, including yoga, are integrated into palliative care to enhance patient comfort and autonomy, particularly when conventional treatments are limited. PHPs emphasize a holistic, patient-centric approach, supporting patient choices and addressing misconceptions about TCAM, such as concerns about toxins in Ayurvedic medicines. Despite some PHPs’ personal reservations about traditional medicine, the focus remains on accommodating patient preferences and ensuring a thorough approach to terminal care. 3.3. Optimistic Outlook and Motivational Support in TCAM Utilization Patients undergoing TCAM treatments for cancer-related conditions receive both a potential for cure and motivational support from Ayurvedic doctors. The potential for cancer survival as advocated by Ayurvedic practitioners fosters hope, courage, and psychological support in patients, underscoring the significance of positive reinforcement in their treatment experiences. Additionally, compared to conventional oncologists, Ayurvedic doctors offer motivational support, encouraging patients to return to work and resume daily activities. This supportive approach fosters patients' sense of empowerment and self-efficacy, promoting active participation in their recovery and rehabilitation efforts. One patient revealed: “When my friends and relatives see me they say, ‘You are not as tired as people who usually undergo chemotherapy'. The only evidence that I had chemotherapy was my hair loss. When I asked the oncologists whether I could go to work, the doctor looked at me and told that if I have the courage I can go. But at the same time The Ayurvedic doctor had already said 'get ready to go to work'. That doctor is still good motivation. 'Be brave. Everything will be fine'.” (Respondent 4) Discussion The findings of this qualitative study provide valuable insights into the utilization patterns, perceived benefits, and challenges associated with the use of TCAM by cancer patients. It tried to provide a comprehensive understanding of the multifaceted role of TCAM in the cancer care continuum, contributing to the existing literature on integrative cancer care. One key finding is the utilization of TCAM, particularly Ayurveda, as a complementary or alternative approach to conventional cancer treatment. Patients cited reasons such as aversion to invasive procedures, perceived benefits in enhancing immunity and reducing chemotherapy side effects, accessibility constraints, and concerns about adverse effects of conventional treatments as motivations for choosing TCAM 28 , 29 . This aligns with previous research highlighting the patients' desire for a more holistic and personalized approach to cancer care 30 . The study also explored the utilization of TCAM following the completion of conventional cancer treatment. Patients reported using TCAM modalities like Ayurveda and Homeopathy to prevent cancer recurrence, to build immunity, and to alleviate treatment-related side effects is also consistent with other studies 7 , 27 . This finding underscores the potential of TCAM to address the comprehensive health needs of cancer survivors and promote their overall well-being. Notably, the study identified instances where cancer patients discontinued TCAM use before initiating conventional treatment, often due to medical advice, perceptions of TCAM ineffectiveness, and fears of exacerbating cancer. In a study conducted in Sri Lanka regarding TCAM usage among cancer patients, the main reasons for not using TCAM for cancer treatment include advice from doctors, family and friends, lack of confidence in TCAM and belief that it would disrupt the bio medical treatment 26 . This highlights the need for improved communication and collaboration between TCAM practitioners and conventional healthcare providers to address concerns and facilitate informed decision-making by patients. However, the study also identified conflicts and concerns regarding the use of TCAM in cancer care. Patients reported experiences of worsening cancer conditions, misdiagnosis leading to delayed intervention and unnecessary financial burdens, and limited information on potential side effects. This reflects the fact that even though TCAM can give a lot of opportunities in cancer patient care, if it is not used wisely, it will be harmful for the patient 25 . These findings highlight the need for comprehensive regulation, quality control, and improved communication between TCAM practitioners and oncologists to ensure patient safety and optimal treatment outcomes. The findings also revealed a consensus among patients regarding the positive outcomes associated with TCAM utilization. In this study, the patients reported cure from cancer following Ayurvedic treatment, lack of side effects, and the absence of cancer recurrence. Additionally, patients perceived improvements in immune function, symptom relief, and overall quality of life, aligning with the holistic principles of TCAM. Ayurvedic treatment focuses on restoring equilibrium, building mental and physical health and rejuvenation. 31 Shelotkar et al. suggest that through appropriate scientific evidence based ayurvedic intervention in the integrative oncology care, substantial and significant advancement can be made in the quality of life of cancer patients. 24 In the midst of this financial burden, there are some institutions which provide the provision of free-of-cost TCAM treatments which address financial barriers and ensure equitable access to essential cancer care. Conclusions This study underscores the complexities in the understanding of utilization patterns, perceived benefits, and challenges associated with TCAM use among cancer patients. The findings show the potential of TCAM to address the holistic needs of cancer patients and survivors. There is a pressing need for a careful and evidence-based integration of TCAM into mainstream cancer care, addressing both anticipated benefits and patient-raised concerns. Continued research efforts and interdisciplinary collaboration are crucial for developing holistic, patient-centered cancer management strategies that leverage the complementary aspects of conventional and TCAM treatments. Additionally, further investigation is necessary to assess the effectiveness and safety of specific TCAM modalities in cancer treatment mainly to establish guidelines for communication and collaboration between TCAM practitioners and oncologists, ensuring optimal patient care delivery. Declarations Ethical Clearance The study received ethical approval from the Institutional Ethics Committee of Ananthapuri Hospitals and Research Institute (AHRI) (AHRI/EC/162/Jan/2023). Conflict of Interest There are no conflicts of interests on our part. Relevance to the preventive medicine The study could help in developing integrated strategies for cancer care which may help in preventing misuse of TCAM especially for palliative cancer care. Implications for clinical practice The research shows that there is a need for enhancing quality of communication between patients and Palliative Health Professionals regarding the use of other systems of medicine in order to optimise the treatment modalities. References Global Cancer Observatory- Cancer Fact Sheet.pdf. https://gco.iarc.who.int/media/globocan/factsheets/cancers/39-all-cancers-fact-sheet.pdf (accessed April 13, 2024). Cancer Today. https://gco.iarc.who.int/today/ (accessed April 13, 2024). Hosseini A, Ghorbani A. 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While chemotherapy, radiotherapy, and surgery remain standard treatments\u003csup\u003e3,4\u003c/sup\u003e, they often entail adverse effects and fail to address secondary health issues such as fatigue, anxiety, depression and pain\u003csup\u003e5\u003c/sup\u003e. This has led to a growing interest in Traditional Complementary and Alternative Medicine (TCAM)\u0026nbsp;\u003csup\u003e6,7\u003c/sup\u003e. Globally, 25% to 80% of cancer patients seek TCAM alongside conventional treatments\u003csup\u003e8–11\u003c/sup\u003e, with prevalence rates varying across countries and the highest\u0026nbsp;among them is United States and lowest is Italy and Netherlands\u003csup\u003e12\u003c/sup\u003e. Despite the high utilization, many patients do not disclose TCAM usage to their oncologists, relying instead on advice from friends and family\u003csup\u003e10,13\u003c/sup\u003e. Economic barriers further drive TCAM adoption, particularly in low- and middle-income countries where access to mainstream healthcare is limited\u003csup\u003e14\u003c/sup\u003e.\u0026nbsp;The most common alternative medical systems in India are Ayurveda, Siddha, Unani, Naturopathy and Homeopathy.\u003csup\u003e11\u003c/sup\u003e The Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy, abbreviated as AYUSH focus attention towards provision of care for cancer apart from education and research in these fields.\u003csup\u003e15\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs found in some studies in other countries, TCAM usage is found to be high among people with low socio economic status and low education\u003csup\u003e13,16,17,18\u003c/sup\u003e except in pediatric oncology.\u003csup\u003e19\u003c/sup\u003e The most common reason for its usage is advice from friends and families\u003csup\u003e13,17,20\u003c/sup\u003e and commonly used TCAM is Ayurveda\u003csup\u003e13,17,19,21\u003c/sup\u003e except in Kolkata (Homeopathy)\u003csup\u003e18\u003c/sup\u003e and Kerala (Home remedies).\u003csup\u003e20\u003c/sup\u003e By TCAM usage most cancer patients reported better results\u003csup\u003e13,20,22\u003c/sup\u003e. In Sub Himalayan city 85% used it as a sole treatment.\u003csup\u003e21\u003c/sup\u003e Similar to findings from studies in other countries, most of the Indian patients too do not disclose the usage of TCAM to their oncologists.\u003csup\u003e20,22\u003c/sup\u003e. Complementary treatments have a significant role in controlling symptoms of cancer and in cancer treatment as it helps in healing, recovering and improving health.\u003csup\u003e8,23\u003c/sup\u003e \u0026nbsp;TCAM plays a pivotal role, with Ayurveda and Homeopathy being the more preferred systems\u003csup\u003e13,18,21\u003c/sup\u003e. Research suggests that TCAM can effectively complement conventional cancer treatments, enhancing symptom management and improving quality of life\u003csup\u003e7,24\u003c/sup\u003e. However, \u0026nbsp;there are also a few\u0026nbsp;studies that reported negative impacts of TCAM\u003csup\u003e18,25,26\u003c/sup\u003e. In this backdrop, it is important to undertake\u0026nbsp;studies which can validate TCAM's safety and efficacy, particularly in the context of integrative oncology care\u003csup\u003e27\u003c/sup\u003e. Despite the growing interest in TCAM as an adjunctive therapy in cancer care, there remains a dearth of research examining the patterns of its use and effectiveness in community settings as most of the studies are focused on patients in tertiary care settings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study aims to explore the usage patterns of TCAM among cancer patients, focusing on areas of consensus and conflicts in its utilization. It \u0026nbsp;investigates patients' motivations, expectations, and experiences with TCAM, as well as healthcare providers' attitudes and practices. The study seeks to understand perceptions of TCAM's effectiveness and safety and to analyze the extent of consensus or disagreement between patients and Palliative Health Professionals (PHP) regarding the integration of TCAM with conventional cancer treatments.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThis study adopted a qualitative design and used semi-structured interviews to examine deeply into patients\u0026apos; utilization of Traditional and Complementary and Alternative Medicine (TCAM). To ensure a comprehensive exploration, a set of open-ended questions were developed based on an extensive literature review, aiming to assess TCAM usage patterns, conflicts, and consensuses from the participants\u0026apos; perspectives. The interview guide underwent revisions through collaborative discussions among public health experts, oncologists and palliative health professionals. A pilot study involving seven cancer patients was conducted to refine the questionnaire and adjust the interview guide accordingly. Probing questions were incorporated to encourage participants to elaborate on their experiences with TCAM and to facilitate a clearer understanding of their perspectives.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Sample\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population was drawn from Thrissur district of Kerala at a community level. To ensure a diversity of perceptions and beliefs regarding CAM use, patients were purposively selected with the help of ASHA workers. The ASHA workers enquired about the TCAM usage among cancer patients who are registered under government Palliative care in Thrissur district of Kerala. Selection criteria included cancer patients who are registered in the Palliative care unit of all Governmental Institutions of \u0026nbsp;Thrissur District of Kerala, above the age of 18 years who are TCAM users and who are able to give the consent. Patients were recruited for the study through invitations, and informed consent was obtained by providing them with a patient information sheet to read and agree upon before interviews. For those unable to read, research assistants verbally provided information in their native languages. Interviews were conducted until theoretical saturation was reached. In total, 21 cancer patients were interviewed. Additionally a guideline interview was conducted among Palliative Health Professionals (PHP) from the Government Hospitals.\u003c/p\u003e\n\u003cp\u003eInterviews were carried out in Malayalam from October to December 2024 and confidentiality was upheld, and identities were protected throughout. Each interview lasted between 15 to 90 minutes, and the recorded conversations were transcribed word for word. Quality of the study was assured at all levels. The authors collectively examined and evaluated both expected themes and emerging themes to enhance the analysis. Some very salient quotes from the respondents are also included in the results section.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn the study, 21 cancer patients and 12 Palliative Health Professionals were interviewed. Out of the 21 cancer patients who were interviewed, 7 patients used TCAM for the treatment, 8 used TCAM after modern medicine to deal with side effects of the treatment and to avoid recurrence \u0026nbsp;The remaining 6 cancer patients used TCAM till the diagnosis of cancer and stopped its usage after the diagnosis. Four of them had negative experiences including misdiagnosis and aggravation of symptoms. Out of 21 participants, one used Naturopathy, 4 used Homeopathic medical system and the rest used Ayurveda. The study specifically examined the usage patterns, and the conflicts and consensus regarding TCAM usage among the patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1 Utilization of TCAM/ TCAM usage pattern by cancer patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.1. Utilization of TCAM for cancer treatment care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt is interesting to highlight the patient-centric motivations behind the utilization of TCAM, especially Ayurveda as a complementary or alternative treatment for cancer. The various reasons for choosing Ayurveda for treating cancer include the aversion towards invasive procedures like surgery, the perceived benefits of Ayurvedic practices in enhancing immunity and reducing chemotherapy side effects, the role of Ayurveda as a viable option in cases of accessibility constraints, and the fear of adverse effects associated with conventional treatments. The opinion of Palliative Health Professional (PHP) on TCAM ranged from total disagreement to conditional acceptance depending on the patient's comfort and the stage of the disease.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor instance, one of the respondents mentioned:\u003c/p\u003e\n\u003cp\u003e“\u003cem\u003eThen the doctor said that, as my husband’s right arm was paralyzed, he could not do chemotherapy anymore and thence stopped the modern medicine treatment. So, we switched to Ayurvedic treatment. In January it will be one year since Ayurveda was started\u003c/em\u003e.”\u0026nbsp;(Respondent 14)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2. Utilization of TCAM for post-cancer treatment care/ Integrating TCAM into Post-Cancer Treatment Care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe utilization pattern encompasses the proactive use of TCAM to prevent cancer recurrence, the focus on immune system enhancement, and the mitigation of treatment-related side effects. Patients turn to TCAM modalities such as Ayurveda and Homeopathy to address holistic health needs, promote immune function, and alleviate treatment-induced adverse effects. Amid varying perspectives on TCAM usage, PHPs often advocate for integrating TCAM with conventional medicine to manage symptoms and enhance the quality of life following cancer treatment. One of the patients reported that:\u003c/p\u003e\n\u003cp\u003e“\u003cem\u003eAfter the breast cancer treatment was completed, to not to recur the disease and to get rid of side effects of modern medicine treatment, I took Ayurvedic treatment including Panchakarma therapies for about one and half years at an interval of about 3 months.”\u0026nbsp;\u003c/em\u003e(Respondent 3)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3. Utilization of TCAM before Cancer Diagnosis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis subtheme elucidates the obstacles encountered by cancer patients in the utilization of TCAM before initiating conventional cancer treatment. Patients commonly discontinue TCAM by medical advice from healthcare providers, influenced by concerns about potential interactions with conventional treatments and uncertainties regarding TCAM safety and efficacy. Moreover, perceptions of TCAM lacking therapeutic value and fears of adverse effects on cancer progression contribute to the cessation of TCAM practices among cancer patients.\u0026nbsp;PHPs have limited understanding of the use of TCAM before a cancer diagnosis, as the application of these treatments prior to the onset of cancer is generally considered less relevant in the context of cancer care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. \u0026nbsp;Conflicts in the utilization of TCAM\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1. \u0026nbsp;Risks and Concerns Regarding TCAM in Cancer Treatment,\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe responses of the patients show various drawbacks associated with TCAM use in cancer care. Risks and concerns regarding Traditional, Complementary, and Alternative Medicine (TCAM) in cancer treatment are significant, primarily due to the potential failure of these therapies and the lack of systematic monitoring. The absence of regular follow-up can lead to inadequate tracking of patient health, increasing the risk of disease aggravation. For instance, some patients have experienced initial improvements followed by a deterioration of symptoms, highlighting the complex and variable responses to TCAM treatments. In addition, uncertainties surrounding the effectiveness of naturopathy, particularly in terminal stages of cancer, and the rising trend of exploring herbal treatments from unregistered practitioners further complicate the landscape. Negative outcomes have been noted in cases where patients, disillusioned by conventional treatments, turned to Ayurveda. A notable example involves a patient with colon cancer who, after opting for Ayurvedic treatment and experiencing worsening symptoms, eventually had to revert to modern medicine. This case exemplifies the potential risks of delaying conventional care and underscores the importance of a balanced approach to cancer treatment. PHP are concerned about patients abandoning conventional treatments for TCAM, potentially missing curative opportunities in early-stage cancers and experiencing worsened conditions. There is also growing skepticism about the reliance on unregistered practitioners, raising further concerns about the effectiveness and safety of these treatments as revealed by one of the respondents:\u003c/p\u003e\n\u003cp\u003e“\u003cem\u003eWhen I opted for Ayurvedic treatment they even made me drink cow’s urine for a whole month. But by that time my symptoms got aggravated, felt gas problems and diarrhea. \u0026nbsp; Also, Bleeding Time and Clotting Time went too high”\u0026nbsp;\u003c/em\u003e(Respondent 16)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. Misdiagnosis leading to unnecessary financial burden and late diagnosis of cancer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients have reported challenges in diagnosing cancer-related conditions through TCAM approaches, with instances of misdiagnosis leading to delayed detection, thus hindering early intervention and effective disease management. Although palliative health professionals lack specific data on misdiagnosis, they have observed cases where reliance on TCAM has resulted in delays in cancer diagnosis and treatment. Moreover, patients have experienced temporary relief followed by disease progression, as well as unnecessary financial burdens due to ineffective or inappropriate TCAM treatments, underscoring the broader socioeconomic implications of diagnostic inaccuracies in cancer care. The experience of Respondent 17 highlights this:\u003c/p\u003e\n\u003cp\u003e“\u003cem\u003eAt first the disease was not known. There was only constipation, I had no diarrhea, no loss of appetite and no other discomforts. Then took some homeopathic medicine for a short period, then took some Ayurvedic medicines. After a certain period of time, the stool was bloody and went to the hospital and confirmed as third stage cancer”\u0026nbsp;\u003c/em\u003e(Respondent 17)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Financial Barriers in TCAM Utilization for Cancer Care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFinancial factors also play a major problem in TCAM treatment. There are significant financial challenges that cancer patients face while accessing TCAM modalities. The findings reported critical challenges faced by cancer patients, including financial burdens due to treatment costs and limited access to diverse treatment options. It also points out disparities such as ineligibility for cancer pensions and inadequate financial aid for Above Poverty Line (APL) patients. Additionally, the lack of insurance coverage for Traditional, Complementary, and Alternative Medicine (TCAM) treatments further limits choices for patients seeking alternative therapies. These issues underscore the need for improved healthcare policies and support systems to ensure equitable access to effective cancer care regardless of financial status or treatment preferences.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4. \u0026nbsp;Non-disclosure of TCAM Utilization to Oncologists\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the context of TCAM, the disclosure of its usage to modern medicine physicians is a vital factor that affects patient-provider interactions and the overall effectiveness of treatment outcomes. One significant factor contributing to non-disclosure is the\u0026nbsp;prevalent fear among patients, stemming from warnings issued by modern medicine doctors\u0026nbsp;regarding potential risks associated with TCAM. Despite this fear, many patients opt for an\u0026nbsp;independent pursuit of TCAM, driven by their belief in its efficacy and desire for holistic healing\u0026nbsp;approaches. However, such decisions often encounter resistance from modern medicine doctors,\u0026nbsp;who express skepticism or even criticize patients for seeking alternative treatments. In\u0026nbsp;response, patients may advocate for TCAM, emphasizing its unique principles and perceived\u0026nbsp;benefits, thereby highlighting the need for mutual understanding and respect between different\u0026nbsp;medical\u0026nbsp;paradigms. PHPs also believe that most patients do not disclose their TCAM use, which complicates the provision of comprehensive care and the monitoring of potential interactions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3 Consensus in the utilization of TCAM\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.\u003c/strong\u003e\u003cstrong\u003e1.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePositive Outcomes and Enhancing Quality of Life with TCAM in Cancer Care:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients have reported significant positive results with TCAM, including apparent cures from cancer following Ayurvedic treatment alone, with no side effects and confirmed absence of recurrence through PET scans. TCAM treatments have also been associated with improved patient well-being, symptomatic relief, and perceived strengthening of the immune system. Palliative health professionals support integrating TCAM with conventional treatments to enhance overall quality of life and patient comfort, recognizing its potential benefits in boosting immunity and managing cancer symptoms in line with holistic health principles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eHolistic and patient centric approach in Terminal Illness Care:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTerminally ill patients often turn to TCAM, especially Ayurveda, to address emotional challenges such as fear and anxiety associated with conventional chemotherapy. This reflects a complex interplay between emotional well-being and treatment choices. PHP recognizes Ayurveda as potentially more effective and advanced compared to other traditional therapies, contributing positively to patient outcomes. TCAM practices, including yoga, are integrated into palliative care to enhance patient comfort and autonomy, particularly when conventional treatments are limited. PHPs emphasize a holistic, patient-centric approach, supporting patient choices and addressing misconceptions about TCAM, such as concerns about toxins in Ayurvedic medicines. Despite some PHPs’ personal reservations about traditional medicine, the focus remains on accommodating patient preferences and ensuring a thorough approach to terminal care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3. \u0026nbsp;Optimistic Outlook and Motivational Support in TCAM Utilization\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients undergoing TCAM treatments for cancer-related conditions receive both a potential for cure and motivational support from Ayurvedic doctors. The potential for cancer survival as advocated by Ayurvedic practitioners fosters hope, courage, and psychological support in patients, underscoring the significance of positive reinforcement in their treatment experiences. Additionally, compared to conventional oncologists, Ayurvedic doctors offer motivational support, encouraging patients to return to work and resume daily activities. This supportive approach fosters patients' sense of empowerment and self-efficacy, promoting active participation in their recovery and rehabilitation efforts. One patient revealed:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“When my friends and relatives see me they say, ‘You are not as tired as people who usually undergo chemotherapy'. The only evidence that I had chemotherapy was my hair loss. When I asked the oncologists whether I could go to work, the doctor looked at me and told that if I have the courage I can go. But at the same time The Ayurvedic doctor had already said 'get ready to go to work'. That doctor is still good motivation. 'Be brave. Everything will be fine'.”\u0026nbsp;\u003c/em\u003e(Respondent 4)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this qualitative study provide valuable insights into the utilization patterns, perceived benefits, and challenges associated with the use of TCAM by cancer patients. It tried to provide a comprehensive understanding of the multifaceted role of TCAM in the cancer care continuum, contributing to the existing literature on integrative cancer care.\u003c/p\u003e \u003cp\u003eOne key finding is the utilization of TCAM, particularly Ayurveda, as a complementary or alternative approach to conventional cancer treatment. Patients cited reasons such as aversion to invasive procedures, perceived benefits in enhancing immunity and reducing chemotherapy side effects, accessibility constraints, and concerns about adverse effects of conventional treatments as motivations for choosing TCAM\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. This aligns with previous research highlighting the patients' desire for a more holistic and personalized approach to cancer care\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe study also explored the utilization of TCAM following the completion of conventional cancer treatment. Patients reported using TCAM modalities like Ayurveda and Homeopathy to prevent cancer recurrence, to build immunity, and to alleviate treatment-related side effects is also consistent with other studies\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. This finding underscores the potential of TCAM to address the comprehensive health needs of cancer survivors and promote their overall well-being.\u003c/p\u003e \u003cp\u003eNotably, the study identified instances where cancer patients discontinued TCAM use before initiating conventional treatment, often due to medical advice, perceptions of TCAM ineffectiveness, and fears of exacerbating cancer. In a study conducted in Sri Lanka regarding TCAM usage among cancer patients, the main reasons for not using TCAM for cancer treatment include advice from doctors, family and friends, lack of confidence in TCAM and belief that it would disrupt the bio medical treatment\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. This highlights the need for improved communication and collaboration between TCAM practitioners and conventional healthcare providers to address concerns and facilitate informed decision-making by patients.\u003c/p\u003e \u003cp\u003eHowever, the study also identified conflicts and concerns regarding the use of TCAM in cancer care. Patients reported experiences of worsening cancer conditions, misdiagnosis leading to delayed intervention and unnecessary financial burdens, and limited information on potential side effects. This reflects the fact that even though TCAM can give a lot of opportunities in cancer patient care, if it is not used wisely, it will be harmful for the patient\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. These findings highlight the need for comprehensive regulation, quality control, and improved communication between TCAM practitioners and oncologists to ensure patient safety and optimal treatment outcomes.\u003c/p\u003e \u003cp\u003eThe findings also revealed a consensus among patients regarding the positive outcomes associated with TCAM utilization. In this study, the patients reported cure from cancer following Ayurvedic treatment, lack of side effects, and the absence of cancer recurrence. Additionally, patients perceived improvements in immune function, symptom relief, and overall quality of life, aligning with the holistic principles of TCAM. Ayurvedic treatment focuses on restoring equilibrium, building mental and physical health and rejuvenation.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e Shelotkar et al. suggest that through appropriate scientific evidence based ayurvedic intervention in the integrative oncology care, substantial and significant advancement can be made in the quality of life of cancer patients.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e In the midst of this financial burden, there are some institutions which provide the provision of free-of-cost TCAM treatments which address financial barriers and ensure equitable access to essential cancer care.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study underscores the complexities in the understanding of utilization patterns, perceived benefits, and challenges associated with TCAM use among cancer patients. The findings show the potential of TCAM to address the holistic needs of cancer patients and survivors. \u0026nbsp; There is a pressing need for a careful and evidence-based integration of TCAM into mainstream cancer care, addressing both anticipated benefits and patient-raised concerns. Continued research efforts and interdisciplinary collaboration are crucial for developing holistic, patient-centered cancer management strategies that leverage the complementary aspects of conventional and TCAM treatments. Additionally, further investigation is necessary to assess the effectiveness and safety of specific TCAM modalities in cancer treatment mainly to establish guidelines for communication and collaboration between TCAM practitioners and oncologists, ensuring optimal patient care delivery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Clearance\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received ethical approval from the Institutional Ethics Committee of Ananthapuri Hospitals and Research Institute (AHRI) (AHRI/EC/162/Jan/2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are no conflicts of interests on our part.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelevance to the preventive medicine\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study could help in developing integrated strategies for cancer care which may help in preventing misuse of TCAM especially for palliative cancer care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for clinical practice\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research shows that there is a need for enhancing quality of communication between patients and Palliative Health Professionals regarding the use of other systems of medicine in order to optimise the treatment modalities.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGlobal Cancer Observatory- Cancer Fact Sheet.pdf. https://gco.iarc.who.int/media/globocan/factsheets/cancers/39-all-cancers-fact-sheet.pdf (accessed April 13, 2024).\u003c/li\u003e\n\u003cli\u003eCancer Today. https://gco.iarc.who.int/today/ (accessed April 13, 2024).\u003c/li\u003e\n\u003cli\u003eHosseini A, Ghorbani A. 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Public Information Systems and Alternative Therapeutic Approaches for Cancer in India. \u003cem\u003eJournal of Multidisciplinary Research in Healthcare\u003c/em\u003e 2020; \u003cstrong\u003e7\u003c/strong\u003e: 13\u0026ndash;31.\u003c/li\u003e\n\u003cli\u003eBroom A, Wijewardena K, Sibbritt D, Adams J, Nayar KR. The use of traditional, complementary and alternative medicine in Sri Lankan cancer care: Results from a survey of 500 cancer patients. \u003cem\u003ePublic Health\u003c/em\u003e 2010; \u003cstrong\u003e124\u003c/strong\u003e: 232\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eArnold JT. Integrating ayurvedic medicine into cancer research programs part 2: Ayurvedic herbs and research opportunities. \u003cem\u003eJournal of Ayurveda and Integrative Medicine\u003c/em\u003e 2023; \u003cstrong\u003e14\u003c/strong\u003e: 100677.\u003c/li\u003e\n\u003cli\u003eFrenkel M, Cohen L, Peterson N, Palmer JL, Swint K, Bruera E. Integrative medicine consultation service in a comprehensive cancer center: findings and outcomes. \u003cem\u003eIntegr Cancer Ther\u003c/em\u003e 2010; \u003cstrong\u003e9\u003c/strong\u003e: 276\u0026ndash;83.\u003c/li\u003e\n\u003cli\u003eWode K, Henriksson R, Sharp L, Stoltenberg A, H\u0026ouml;k Nordberg J. Cancer patients\u0026rsquo; use of complementary and alternative medicine in Sweden: a cross-sectional study. \u003cem\u003eBMC Complement Altern Med\u003c/em\u003e 2019; \u003cstrong\u003e19\u003c/strong\u003e: 62.\u003c/li\u003e\n\u003cli\u003eKim W (Sunny), James D, Millstine DM. Integrative medicine therapeutic approaches to cancer care: patient preferences from focus groups. \u003cem\u003eSupport Care Cancer\u003c/em\u003e 2019; \u003cstrong\u003e27\u003c/strong\u003e: 2949\u0026ndash;55.\u003c/li\u003e\n\u003cli\u003eDhruva A, Hecht F, Weaver J, Kaptchuk T, Lad V, Adler S. P05.45. A whole systems approach to the study of Ayurveda for cancer survivorship: results from a qualitative investigation. \u003cem\u003eBMC Complement Altern Med\u003c/em\u003e 2012; \u003cstrong\u003e12\u003c/strong\u003e: P405, 1472-6882-12-S1-P405.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Global Institute of Public Health","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Traditional Medicine, Palliative care, outcomes, cancer","lastPublishedDoi":"10.21203/rs.3.rs-5939341/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5939341/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003eIndia accounts for 1.41 million cancer cases and conventional treatments remain standard. However, their side effects have led to increased interest in Traditional Complementary and Alternative Medicine (TCAM).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives: \u003c/strong\u003eThis study explores TCAM usage patterns among cancer patients, examining their motivations, expectations, and experiences and analyze the consensus or disagreement between patients and Palliative Health Professionals (PHP) on integrating TCAM with conventional cancer treatments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e A qualitative study design was adopted, utilizing semi-structured interviews with 21 cancer patients and 12 PHPs in Thrissur district, Kerala.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe study revealed diverse patterns of TCAM usage and it highlighted both positive outcomes, such as symptom relief, enhanced immunity and improved quality of life, and negative experiences, including misdiagnosis, delayed treatment and aggravated conditions which led to reverting back to modern medicine. Non-disclosure of TCAM use to oncologists was common, complicating care integration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The study highlights the complex landscape of TCAM utilization among cancer patients, emphasizing the need for balanced integration with conventional treatments. While TCAM offers potential benefits in enhancing patient well-being, concerns about safety, efficacy, must be addressed.\u003c/p\u003e","manuscriptTitle":"Traditional Complementary and Alternative Medicine (TCAM) for Cancer Related Conditions: Conflicts and Consensus","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-04 04:29:20","doi":"10.21203/rs.3.rs-5939341/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ff7b8028-82b9-4f9a-bd84-e6020d2da255","owner":[],"postedDate":"February 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-04T04:29:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-04 04:29:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5939341","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5939341","identity":"rs-5939341","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}