Review Article

The use of traditional and complementary medicine by cancer patients in SSA: A scoping review

Ammaarah Sheik Adam, Varsha Bangalee, Frasia Oosthuizen

Received: 08 June 2024; Accepted: 09 Oct. 2024; Published: 03 Dec. 2024

Copyright: © 2024. The Author(s). Licensee: AOSIS.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: The rate of traditional and complementary medicine (T&CM) use is increasing worldwide, including among cancer patients who are often willing to try alternate therapies. Despite T&CM popularity in sub-Saharan Africa (SSA), there are limited data on its use with conventional treatments.

Aim: This scoping review aims to describe the prevalence of use, reasons for use, most common types of T&CM used, patient satisfaction with T&CM and disclosure of T&CM use to physicians among cancer patients in SSA.

Methods: A systematic literature search was conducted for articles published from 2013 to 2022 across four databases: PubMed, ScienceDirect, Google Scholar and EBSCOhost. A scoping review approach was used to map relevant literature. Forty-six articles were assessed based on their titles and abstracts. After full-text screening, 10 articles were included.

Results: Average T&CM use was calculated to be 66.7%. Reasons for T&CM use included: to improve psychological well-being, boost the body’s immunity and provide symptomatic relief. An average of 21.2% of T&CM users informed their physician. Nine articles addressed patient satisfaction with T&CM. An average of 39.1% of patients reported general T&CM satisfaction.

Conclusion: The use of T&CM is common among cancer patients. It is important for healthcare providers to expand their knowledge in order to counsel patients and avoid potential hazards when combining T&CM with conventional treatments.

Contribution: These findings highlight commonly used T&CM and provide insight on the portion of cancer patients informing their doctors about T&CM use. This information will help understand the attitude cancer patients have towards T&CM.

Keywords: complementary medicine; alternative medicine; traditional medicine; cancer patients; sub-Saharan Africa.

Introduction

As defined by the World Health Organization (WHO 2019), complementary medicine (CM) is a collection of healthcare practices that fall outside the country’s conventional medicine and are not entirely incorporated into the mainstream healthcare system. The WHO states that traditional medicine (TM) refers to the knowledge, skills and practices from indigenous theories, beliefs and experiences of different cultures being used to maintain health, as well as prevent, diagnose, improve or treat physical and mental illness (WHO 2019). The WHO further merges both terms to create traditional and complementary medicine (T&CM), which includes products, practices and practitioners (WHO 2019).

Traditional and complementary medicines are being used extensively for many illnesses such as diabetes mellitus, hypertension, human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), cancer, asthma and pain (James et al. 2018). In the African setting, specifically, it is largely made up of local herbal products or medicines and indigenous traditional healthcare practices. Several CM products and practices have also been imported, such as acupuncture and homeopathy. Sub-Saharan Africa (SSA) is one of the regions where T&CM use is popular and has become a means on which a large population rely on it to maintain health, prevent and combat diseases, as well as treat mental, physical and social disorders (James et al. 2018).

A considerable portion of South Africa’s population prefers using traditional medicine or herbal products over conventional or Western medicine as they find traditional medicine and practices more accessible, affordable and efficient while aligning with their beliefs (Monakisi 2007). According to a review done in South Africa in 2007, it was found that trade in traditional medicines in the country was worth approximately R2.9 billion per year. In South Africa alone, it is evident that the use of T&CM is vast with at least 27 million consumers (Mander, Ntuli & Diederichs 2007).

In 2010, the Allied Health Professions Council of South Africa (AHPCSA) estimated that 1% – 19% of South Africa’s population used T&CM practices, including acupuncture, aromatherapy, chiropractic, herbal medicines, homeopathy, massage therapy, naturopathy, osteopathy, therapeutic reflexology, traditional Chinese medicine and traditional Indian medicine such as Ayurveda and Unani (WHO 2019). Complementary medicine is frequently used alongside conventional treatment. Often cancer patients become depressed and have to deal with many physical and emotional aspects of the disease, leaving them open to try T&CM to aid them in their fight against cancer (Dehghan et al. 2022). This scoping review includes the following T&CM categories used in sub-Saharan Africa: acupuncture, herbal products, massage therapy, meditation, mind-body practices, prayer, reflexology, spiritual healing, supplement use (with and without dietary modifications), various traditional medicines (African, Chinese and Indian origin), vitamins/minerals and yoga.

Since 2000, the WHO has been encouraging African nations and other low- and middle-income countries to embrace the use of traditional and complementary medicines by incorporating it into their national health systems in an attempt to improve the access to affordable healthcare (WHO 2002). However, developing a national policy and legal framework dealing with T&CM is still a great challenge for several sub-Saharan African nations because of the lack of evidence regarding its effectiveness, risks and interactions.

Patients using T&CM with poor understanding or based on misleading information may present a risk to their well-being (Mwaka, Abbo & Kinengyere 2020). In the same light, healthcare providers with insufficient knowledge about the mechanism of action of T&CM, their safety profiles, side effects and possible interactions with conventional medicines would be unable to improve the health of the general population who are T&CM users (Mwaka et al. 2020).

The prevalence of cancer is increasing worldwide, especially in SSA. Additionally, most of the cancer patients from SSA are being diagnosed in advanced stages where survival rates are poor, often prompting these patients to turn to the use of T&CM (Mwaka et al. 2020). There are, however, limited data available on aspects of complementary medicine use among cancer patients in SSA, including the types of T&CM used, effectiveness and risks of such treatments and the extent to which cancer patients use or rely on T&CM (Mwaka et al. 2020).

A systematic review, conducted by James et al. (2018), found that most patients using T&CM, whether alone or in combination with mainstream medicine, do not disclose the use of T&CM to their physicians, either because their physicians do not ask about T&CM use or the patient fears retribution. When it comes to anticancer drugs, most have a very narrow therapeutic window, and the use of herbal supplements, which a cancer patient may perceive as harmless, could interact with their chemotherapy regimen reducing its efficacy or enhancing its toxic effects (Vasques et al. 2024). It is therefore of great importance that patients disclose any T&CM use to their oncologist.

This scoping review aims to collect information about the prevalence of use, reasons for use, most common types of T&CM used, level of satisfaction with T&CM and disclosure of T&CM use to physicians among cancer patients in sub-Saharan Africa. The collection and reporting of information regarding T&CM used by patients with cancer will hopefully guide other researchers on future investigations that can be done to fill knowledge gaps; encourage more research to be conducted to determine the mechanisms of action of T&CM products, their indications, effectiveness, side effects from direct use, and interactions between T&CM and conventional treatments.

Research methods and design

Study design

This scoping review is aimed at collating existing knowledge on T&CM use and identifying gaps in knowledge regarding T&CM use among adult cancer patients in SSA. This scoping review was done using the Arksey and O’Malley methodological framework (2005); the following five key steps were followed: (1) specifying the research question, (2) identifying relevant literature or studies, (3) study selection, (4) charting of data and (5) collating, summarising and reporting of results. Studies written in English, published in the last 10 years, and addressing the use of T&CM among cancer patients in SSA were reviewed.

This scoping review will focus on studies conducted in SSA. While T&CM practices may vary across different cultures, many regions tend to share similar medical practices and beliefs (James et al. 2018). Owing to the limited number of studies conducted on T&CM use among cancer patients, this study region will allow for conclusions and averages to be drawn for the area, even though most studies may emerge from a few countries. A timeframe of 10 years was chosen to ensure the review reflects the most current data available on popular T&CM being utilised by cancer patients.

Step 1: Specifying the research question

In order to collate existing knowledge and identify gaps in knowledge regarding T&CM, the aim of this scoping review is to collect evidence on the prevalence of use, reasons for use, common types of T&CM used, level of satisfaction with T&CM and disclosure of T&CM use with physicians among cancer patients in sub-Saharan Africa.

The following five sub-questions were formulated to shape the goals and outcomes of this review:

• To what extent are studies conducted assessing the prevalence of T&CM use among adult cancer patients in sub-Saharan African countries?
• To what extent are studies conducted assessing the reasons why adult cancer patients use T&CM in sub-Saharan African countries?
• To what extent are studies conducted assessing the different types of T&CM used by adult cancer patients in sub-Saharan African countries?
• To what extent are studies conducted assessing the level of satisfaction with T&CM use among adult cancer patients in sub-Saharan African countries?
• To what extent are studies conducted assessing the portion of adult cancer patients who disclose T&CM use with their physician in sub-Saharan African countries?

Step 2: Identifying relevant studies

Inclusion criteria: Studies that fulfilled the following criteria were included in the review:

• Published article or study has been peer-reviewed.
• Published between 01 January 2013 and 31 December 2022.
• Published in the English language.
• The research article focuses on the use of T&CM by adult cancer patients (above 18 years) with any type of cancer.
• Cancer patients participating in the study self-reported T&CM use while undergoing any form of conventional cancer therapy.
• Data were collected from a country (or countries) in sub-Saharan Africa.
• Study outcome included the prevalence of T&CM use and other aspects of T&CM use that are related to cancer.

Exclusion criteria: Studies were excluded if they were:

• Published before 01 January 2013 or after 31 December 2022.
• Articles or studies with data collected from patients outside of sub-Saharan Africa.

Search strategies: Available articles were gathered, reviewed and organised from the different databases: PubMed, ScienceDirect, Google Scholar and EBSCOhost from 2013 to 2022. The following keywords were used in the electronic database searches: ‘complementary medicine’, ‘alternative medicine’, ‘traditional medicine’, ‘complementary therapy’, ‘alternative therapy’, ‘traditional therapy’, ‘complementary treatment’, ‘alternative treatment’, ‘traditional treatment’, ‘African traditional medicine’, ‘herbal medicine’, ‘herbal supplements’, ‘medicinal plants’, ‘indigenous therapy’, ‘use’, ‘types’, ‘prevalence’, ‘attitude’, ‘knowledge’, ‘pattern’, ‘practice’, ‘perception’, ‘utilization’, ‘health seeking behaviour’, ‘cancer patients’, ‘sub-Saharan Africa’, ‘SSA’, ‘Angola’, ‘Benin’, ‘Botswana’, ‘Burkina Faso’, ‘Burundi’, ‘Cape Verde’, ‘Cameroon’, ‘Central African Republic’, ‘Chad’, ‘Comoros’, ‘Congo’, ‘Democratic Republic of Congo’, ‘Cote d’Ivoire’, ‘Djibouti’, ‘Equatorial Guinea’, ‘Eritrea’, ‘Ethiopia’, ‘Gabon’, ‘Gambia’, ‘Ghana’, ‘Guinea’, ‘Guinea-Bissau’, ‘Kenya’, ‘Liberia’, ‘Madagascar’, ‘Malawi’, ‘Mali’, ‘Mauritania’, ‘Mauritius’, ‘Mozambique’, ‘Namibia’, ‘Niger’, ‘Nigeria’, ‘Rwanda’, ‘Sao Tome and Principe’, ‘Senegal’, ‘Seychelles’, ‘Sierra Leone’, ‘Somalia’, ‘South Africa’, ‘South Sudan’, ‘Sudan’, ‘Swaziland’, ‘Tanzania’, ‘Togo’, ‘Uganda’, ‘Zambia’, ‘Zimbabwe’. The Boolean operators ‘and’ and ‘or’ were used when necessary to narrow or expand the search, respectively. An example of how search terms were used to conduct the search in each data base can be seen in Table 1-A1.

Step 3: Study selection

The relevant studies identified from the various databases were gathered and duplicates were removed. Thereafter, screening of titles and abstracts was performed to assess eligibility and relevance to the goals of the scoping review. Articles that passed abstract screening underwent full-text analysis. Those studies that met the necessary criteria and were considered eligible were included in the scoping review. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart (Figure 1) outlines the study selection process.

FIGURE 1: PRISMA flow diagram outlining the study selection process.

Step 4: Charting of data

The charting method was used for data analysis (Levac, Colquhoun & O’Brien 2010). Data were extracted from the articles and stored in a Microsoft Word table drawn up with the headings necessary to answer the research question and record all relevant information sought by the scoping review. The template included the following headings: ‘Title of article’, ‘First author and Year of publication’, ‘Type of study design’, ‘Country’, ‘Prevalence of use among cancer patients’, ‘Reasons for use’, ‘Reported satisfaction with T&CM’, ‘Disclosure of T&CM’ and ‘Types of T&CM used’. This format made it easy to compare the outcomes of each study and identify which aspects were not covered (see Table 2-A1).

Step 5: Collating, summarising and reporting of results

The results were collated according to sub-topics in order to best meet the aim of the scoping review and answer each aspect of the research question. The eligible articles were summarised using an outcome-based descriptive analysis. Statistical analyses of the data collected from the articles were not conducted because of the heterogeneity of each study’s intent and design. Only the median and average were calculated for all aspects, and their respective ranges are reported in Table 3-A1.

Ethical considerations

An application for full ethical approval was made to the Biomedical Research Ethics Committee of University of KwaZulu-Natal, and ethics consent was received on 11 October 2023. The ethics approval number is BREC/00005784/2023. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all individual participants involved in the study.

Results

Sub-Saharan Africa consists of the 49 countries in the southern part of the African continent (Tapon 2023). Articles included in the scoping review only contained information from eight countries in sub-Saharan Africa (Ghana, Ethiopia, Nigeria, Malawi, Tanzania, Morocco, Uganda and Kenya). Conclusions were drawn based on articles analysed, thus only covering 16.3% of sub-Saharan Africa.

The use of T&CMs ranged from 14.1% to 84%. Average T&CM use is 66.7% based on the 10 articles included in the scoping review. The country with the highest T&CM use among cancer patients was Malawi (84%) and the country with the lowest T&CM use by cancer patients was Kenya (14.1%).

Reasons for traditional and complementary medicine use among cancer patients

Nine out of the 10 articles included described reasons why cancer patients opted to use T&CM. From five of the articles, it was found an average of 45.3% of cancer patients stated that the reason they are using T&CM is based on the belief that it can cure cancer. The study conducted in Kenya reported the highest percentage of cancer patients using T&CM to cure cancer (64%), while the study conducted in Morocco revealed the lowest percentage (4%) of use to cure cancer, while the other four articles did not mention patients using T&CM to cure cancer. Traditional and complementary medicine being used in order to improve psychological well-being was evaluated in four articles. The average percentage of patients using T&CM for psychological comfort is 38.1%. The use of T&CM based on the belief that it boosts the body’s immunity was covered in four articles. An average of 31.6% of T&CM users stated the reason for T&CM use was to boost immunity. From the 10 articles included, 5 articles addressed cancer patients using T&CM for symptomatic relief – on average more than a quarter of cancer patients (26.7%) used some form of T&CM to treat cancer symptoms.

An average of 66.5% of cancer patients reported using T&CM as they believed it to increase their quality of life. According to two articles, an average of 52.1% of patients used T&CM as they were willing to try anything or were simply being hopeful (Ong’udi et al. 2019; Yarney et al. 2013).

Two articles made mention that a portion of patients used T&CM as they were disappointed or dissatisfied with conventional cancer treatment. Cancer patients using T&CM for this reason were stated to be 9.4% in Ghana (Yarney et al. 2013) and 14.9% in Ethiopia (Erku 2016).

Other reasons why cancer patients used T&CM were because of lack of cancer services, fear of surgical operations, spiritual and cultural importance, conventional treatment being expensive and to reduce side effects of chemotherapy.

Types of traditional and complementary medicine used

When analysing the common types of T&CM used by cancer patients, all 10 articles mentioned the use of herbs and herbal medication. The use of herbal products ranged from a minimum of 22% in Uganda to a maximum of 91% among Kenyan cancer patients who were T&CM users. The second most common type of T&CM reported by patients, and covered in six articles, was prayer and spiritual/faith/traditional-based practices. Cancer patients who reported using prayer ranged from 8.5% to 80.3% and those using spiritual/faith/traditional healing ranged from 8.2% to 64%. Seven articles addressed dietary changes and supplement use; an average of 20.3% of T&CM users made diet modifications such as an increase in vegetables, or fruits, or fish and/or meat, or milk or a decrease in sugar and began taking supplements. Each of the following categories was mentioned in four different articles with the average use in brackets: vitamins/minerals (37%), massage (32.7%) and Chinese medicine (20.1%). Each of the following categories were covered in two different articles with the average use in brackets: spiritual sacrifice (11.4%), acupuncture (2.8%), mind-body practices (2.5%), yoga (9.3%) and meditation (15.3%). Reflexology (3.8%), Indian medicine (5%) and scarification (10%) were also only covered once.

Reported satisfaction with traditional and complementary medicine

Patient satisfaction with T&CM was described in different ways in the articles. Nine of the 10 articles addressed patient satisfaction with T&CM in some way or another. Some articles described the believed benefits of T&CM according to the cancer patients using them, while other articles described which types of T&CM they found beneficial, or simply stated the percentage of users who were satisfied with complementary therapy. From the nine articles, the following benefits were mentioned, and the portion of T&CM users who saw these benefits is stated in brackets: fought cancer (40.6%), reduced the severity of cancer (23.2%), improved sleep (17.4%), improved emotional and physical well-being (14.5%), reduced nausea and vomiting (11.9%), improved appetite (10.1%) and reduced pain (6.9%). From the study done in Malawi, 88% of cancer patients who made dietary changes saw improvements and were satisfied. From those who used faith-based healing, 50% satisfaction was reported. An average of 72% reported contentment with vitamin/mineral supplements and 16% with herbal medicine. Four articles stated the percentage of cancer patient T&CM users who were satisfied with complementary therapy use in general; satisfaction ranged from 22% to 54.5%.

Disclosure of traditional and complementary medicine to physician

Seven out of the 10 articles reported the percentage of T&CM users that informed their physicians regarding their use of complementary treatment. An average of 21.2% of cancer patients disclosed T&CM use to their medical doctor. The portion of patients who told their physicians about T&CM use ranged from 5% in Morocco to 55% in Kenya. Some of the reasons why cancer patients did not tell their physicians about T&CM use include the following: assuming doctors have a negative response to T&CM, patients think it is not important for doctors to know about T&CM use, physicians do not ask about T&CM, patients refuse to tell their doctors, and patients are afraid that oncologists might discourage T&CM use.

Discussion

It is evident that the use of T&CM is common among those diagnosed with cancer in SSA, and the varying prevalence of T&CM use in different countries can be associated with each region’s accessibility to conventional medicine, sociocultural backgrounds and the importance placed on T&CM by the general population. Additionally, increased use of T&CM over the years is evidenced in two studies conducted in Enugu, Nigeria, among gynaecologic cancer patients. The study by Nwankwo et al. published in 2019 found that over a 2-year period (June 2014 to June 2016), 64.3% of gynaecologic cancer patients were T&CM users (Nwankwo et al. 2019), and the study conducted by Ajah et al. published in 2021 found 71.5% of participants made use of T&CM (Ajah et al. 2021).

The study conducted in Ethiopia by Erku (2016) found that the most common source of T&CM information was family members and friends, and the least common source used to seek information about T&CM was medical practitioners. The study done in Nigeria and Ghana reported similar findings in which most of the participants got information about T&CM from friends and family or mass media (Yarney et al. 2019). The study done in Tanzania found that more than half of respondents used herbal medicine for their current cancer disease; however, only a quarter consulted a traditional healer or herbalist (Henke, Bruchhausen & Massawe 2022). In the study done in Nigeria by Nwankwo et al. (2019), it was also revealed that most of the T&CM being used were self-administered and no professional herbalists were consulted; the products being used were mainly recommended by family and friends. A large population of T&CM users sourced products informed by friends, family or the media and do not seek help from herbalists or physicians. This presents a great challenge as herbal agents are prone to abuse among T&CM users as they are not counselled about how to use them; furthermore, it could be a potentially toxic compound when combined with anticancer treatment (Nwankwo et al. 2019).

Several cancer patients stated the reason they were using T&CM was to cure cancer. Owing to the important role traditional healers have held in the region and the large population who still have strong belief in traditional healers, it is important for healers and physicians to work together in order to deliver the best possible care to patients. Many cancer patients believe that traditional medicine has the ability to cure cancer; it is therefore crucial that physicians remind patients that traditional healing does not replace conventional anticancer treatment and all forms of T&CM need to be used with caution.

Anticancer agents are generally toxic with several side effects. Some cancer patients tend to combine herbal products with their conventional cancer treatment in an attempt to enhance well-being and manage the side effects associated with chemotherapy. However, the potential risk of interactions from herbal use may outweigh any benefit (Alnaim 2007). For example, a case report by Bilgi et al. (2010) reported that a patient taking imatinib for 7 years began displaying symptoms of hepatotoxicity upon starting to consume ginseng. Once ginseng was discontinued, the hepatotoxicity resolved. According to the study conducted by Cox et al. (2006), garlic was found to decrease the clearance of docetaxel. Despite the decrease being non-statistically significant, there is a possibility of increased adverse effects resulting from docetaxel accumulation. The pharmacokinetic study by Goey et al. (2014) concluded that St John’s wort caused a remarkable decrease in the plasma concentration of docetaxel.

In a Nigerian study, more than a third of the participants stated they used T&CM with the belief it would complement the conventional medicine and improve the outcome of treatment. A quarter of respondents also stated that they used T&CM because it was readily available and one fifth found it more affordable. This can be expected as a large portion of the African population rely on T&CM to meet their primary medical needs (Aliyu et al. 2017).

The study conducted among cancer patients in Uganda found that those patients who are dissatisfied with conventional treatment are more likely to use T&CM (Kiwanuka 2018). Respondents also stated that they turned to T&CM use in order to fulfil unmet needs by conventional therapy (Kiwanuka 2018). The growing use of traditional and herbal-based medicinal therapies may be because of the perception that they are natural and therefore do not cause any detrimental or unfavourable effects despite the lack of scientific evidence (Erku 2016).

A study conducted in Ghana found that approximately one-third of cancer participants used T&CM because they were willing to try anything. In the developing world (including Ghana), a large portion of cancer patients are diagnosed at a late stage, where many conventional treatments often fail to cure the individual (Yarney et al. 2019). The late diagnosis leads to reduced chances of cure; thus, many patients lose hope in the effectiveness of conventional treatment and turn to using or relying on traditional, complementary and alternative medicines (Yarney et al. 2019).

More than half of the cancer patients who participated in the study in Malawi used herbal medicines, even though the percentage of patients who consulted with herbalists was lower. The following herbs were commonly being reported: Terasi or Teras Juice, mvunguti (Kigelia africana), ginger (Zingiber officinale), moringa (Moringa oleifera), garlic (Allium sativum), aloe vera, avocado leaves (Persea americana) and soursop (Annona muricata). Herbal products are particularly important when looking into the impact T&CM has on cancer treatment (potential herb–drug interactions, patients delaying conventional therapies, toxic herbal products). Another problem is that a significant proportion of herbal product users state that they are often unaware of which herbs they are consuming. It was also found that many herbalists do not disclose the herbs that they supply in order to maintain proprietary rights to their herbal formulations and prevent patients from self-administering herbal products (Hill et al. 2022).

From the articles included, it was noticed that many participants reported adverse effects such as nausea, vomiting, frequent urination, diarrhoea, headache, upset stomach, skin rashes and itching.

The study conducted in Malawi by Hill et al. published in 2022 revealed relatively low satisfaction with herbal products and traditional healers. Several participants conveyed dissatisfaction because of the inability to formally diagnose cancer, control their symptoms or cure the cancer. It is common for patients to first go to traditional healers when they experience symptoms and only turn towards mainstream healthcare after traditional methods were unable to produce desired results. This may contribute to the dissatisfaction with traditional methods upon receiving a pathological cancer diagnosis (Hill et al. 2022).

Less than a quarter of cancer patients disclosed T&CM use with their medical doctor. The main reason why participants did not inform their physician about T&CM use was because their doctor did not ask. Some of the additional reasons why patients do not disclose T&CM use to their physicians are because cancer patients believe their physicians would not understand T&CM usage, disapprove of their use of T&CM or force them to discontinue T&CM treatment. The fact that a large portion of cancer patients would not disclose that they are using T&CM until they are asked makes it important for every oncologist to ask their patients whether they are using T&CM, what products they use, how frequently they use them, and the manner in which they use them. The large portion of cancer patients who believe their physicians will have a negative attitude towards their T&CAM use also highlights the need for T&CM use sensitivity training so the topic can be addressed in a safe and comfortable way with patients.

It is important for T&CM users to remember that some of the information they receive about T&CM are often based on opinions and personal experiences, not based on objective research studies. The use of natural products is commonly associated with being safer than conventional treatment; however, this is not essentially correct. Guidance from nurses and healthcare professionals is key to help patients distinguish between possible deceit and evidence-based natural products. Patients who solely believe traditional healers can cure their cancer often delay or stop standard treatment, resulting in the reduced chances of remission or cure. It is of vital importance for healthcare providers to familiarise themselves with the most commonly used T&CM treatments among cancer patients so they will be equipped to answer questions about T&CM and advise patients in the best manner possible, warning them about over-stated benefits and potential harms of a particular therapy (Mwaka et al. 2020).

Limitations

This scoping review may have omitted relevant studies that could have been in another language or to which full access was not available. The presence of methodological flaws in the research design of included studies would reduce the accuracy of reported results. All studies included in the review are cross-sectional studies; however, they vary in the manner T&CM was addressed and categorised, thus potentially affecting the reporting of results.

Conclusion

From the review, the authors can conclude that many cancer patients in SSA use at least one form of T&CM during their cancer diagnosis. Reasons for using T&CM vary among patients but the most common reasons include to improve physical and psychological well-being, to cure cancer or treat symptoms, to boost immunity, to improve quality of life and because they believe in its benefits. It was found that many patients used various T&CM products concurrently with conventional anticancer treatment; additionally, very few patients disclosed the use of complementary medicine to their physician. This non-disclosure of T&CM use exposes cancer patients to potentially dangerous side effects from interactions between drugs and T&CM products. Healthcare providers need to start having more open discussions on T&CM use with their patients in order to prevent abuse of T&CM products and provide them with factual information on T&CM safety and efficacy.

There is a need for more scientific research to be conducted in order to understand pharmacodynamics and pharmacokinetics of T&CM products to successfully determine their therapeutic indications, safety and risk profiles. This will also assist policymakers who are working on integrating T&CM and conventional biomedical treatments. The inclusion of T&CM in the medical school curricula can improve the knowledge and attitudes of healthcare workers regarding T&CM use by their patients.

Acknowledgements

This article is partially based on the author’s thesis entitled ‘The use of traditional and complementary medicine among cancer patients in Kwa-Zulu Natal, South Africa’ towards the degree of Master’s in Pharmacy in the Department of Pharmacy, College of Health Sciences, University of Kwa-Zulu Natal, South Africa on 29 November 2024, with supervisors Prof. Frasia Oosthuizen and Prof. Varsha Bangalee.

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

A.S.A., V.B. and F.O. contributed to the conception, study design, review and editing. A.S.A. is responsible for data collection, summary, analysis and reporting of results. A.S.A., V.B. and F.O. gave final approval to the version being published and agreed to be accountable for all aspects of the work reported.

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

The data that support the findings of this article are openly available and can be requested from the corresponding author, A.S.A. A list of all articles used for the scoping can be found in the article.

The views and opinions expressed in this article are those of the authors and are the product of professional research. The article does not necessarily reflect the official policy or position of any affiliated institution, funder, agency or that of the publisher. The authors are responsible for this article’s results, findings and content.

References

Appendix 1