Changing attitudes on non-proven therapies
WE strongly support the statement made by Deputy Prime Minister Datuk Seri Dr Wan Azizah Wan Ismail, warning cancer patients against seeking unscientific alternative treatments, “Cancer victims seeking alternative treatment a worrying trend” ( The Star, July 26).
Firstly, we need to fully understand the “why” to enable us to tackle this issue effectively. This is a complex issue and the intervention would likely be complex as well. It certainly isn’t simply about raising knowledge and awareness on the dangers and often fatal consequences of non-proven therapies for cancer.
Studies have shown several factors that are strongly associated with using alternative therapies in cancer, including:
1. Emotional impact of cancer diagnosis;
2. Fear of side-effects of conventional treatment;
3. (Perceived) limitations of conventional treatment;
4. Lack of clear communication with doctors and healthcare professionals (leading to dissatisfaction with the healthcare provider); and
5. Need to be in control of the cancer (personal control over the disease).
In addition, in a multi-ethnic and multi-cultural population such as Malaysia, individuals may choose alternative treatments because of the perceived match between its practices and their own set of health-related beliefs and values.
Studies in Malaysia have shown, specifically for breast cancer, that non-proven therapies have resulted in delay in treatment. An estimated 25% of cancer-related deaths in women in Malaysia can be attributed to breast cancer.
Although patients may be diagnosed at an early stage of their cancer due to screening, they may refuse further follow-up in lieu of non-proven therapies as the primary treatment. They then go back to healthcare providers at a more advanced stage of breast cancer with low survival rates.
Patients who are on non-proven therapies are also unwilling to discuss or disclose this information to their doctors. This implies that they know their doctors will not approve of these non-proven therapies.
Despite the many advances in breast cancer treatment, many women in Malaysia continue to seek non-proven therapies as the primary treatment. These include educated Malaysian professionals, who believe anecdotal claims that the non-proven therapies have helped others.
We firmly believe that more research is required, using frameworks such as health-belief models and socio-behavioural models. These would require the expertise of sociologists and behavioural scientists to dive in-depth in understanding the behaviours of Malaysians towards unproven therapies in general, and for cancer specifically, before we can mount effective interventions to address this very important issue.
We need to move beyond doing large-scale awareness and education programmes. This is a complex issue requiring complex solutions.
DR FEISUL IDZWAN MUSTAPHA DR NOR SALEHA IBRAHIM TAMIN DR ARUNAH CHANDRAN Public Health Physicians Ministry of Health Malaysia