Cancer: Getting patients to trust modern medicine
This is the second of a series of three articles on traditional medicine and the dangers of using it to treat cancer.
KUALA LUMPUR: Nur Hayati
Sahak wishes for a time machine.
If there was one, she would go to a particular moment in 2016 when she was si ing in a general surgeon’s office at a private hospital in Selangor, listening to him tell her that her test results for breast cancer were inconclusive, even though her nipple excreted bloody discharge and her mammogram showed white spots.
To be sure, the surgeon suggested that she underwent exploratory surgery.
She refused.
It was that moment, she told Bernama, when she had a choice: she knew something was wrong despite the results of the tests. But instead of ge ing a second opinion and going to a breast surgeon or an oncologist, she opted for traditional medicine to kill or at least contain the cancer growing in her breast.
The next three years would see her traveling all over Peninsular Malaysia seeking alternative and traditional treatment that would treat her cancer.
“A lot of wasted time. And wasted money. If I counted all the money I spent on traditional medicine, I would be rich,” said Nur Hayati, 44, laughing.
She estimated that she had spent about RM50,000 on alternative and traditional treatments such as the supernatural healing sessions with one ‘bomoh’ (witch doctor) in Kedah who told her that he was giving her invisible chemotherapy through ‘an invisible intravenous (IV) bag’; or the Palembang native in Perak who sold her homemade herbal poultices for which she paid RM1,000 a month.
She also spent thousands of ringgit buying herbal supplements online, with supposed cancer-fighting chemicals.
When the pain got worse and pus started coming out of a rash under her right breast, she decided to go to a different hospital, where the doctors diagnosed her with Stage IV breast cancer, which had metastasised to her bones.
Nur Hayati is not alone in her regret in choosing alternative and traditional medicine as a cancer treatment. While her case is slightly different from what usually transpires – doctors say some patients who get a positive cancer diagnosis will refuse conventional treatment and opt for alternative or traditional medicine – it does highlight the difficulties in ge ing patients to trust modern medicine, long enough for them to stick around when the process is not smooth from the get-go.
‘Bridging the enthusiasm gap’
On World Cancer Day on Feb 4, Health Minister Datuk Seri Dr Dzulkefly Ahmad announced in a press statement that the Malaysian National Cancer Registry had recorded 168,822 new cancer cases from 2017 to 2021. Breast cancer, colorectal cancer, lung cancer, lymphoma cancer and liver cancer were the Top 5 types of cancer reported during that period.
According to the Department of Statistics Malaysia, cancer is the fourth leading cause of death in Malaysia, increasing from 10.5 per cent in 2021 to 12.6 per cent in 2022. Over 60 per cent of cancers are still being detected at Stages III and IV.
Dr Dzulkefly also pledged to narrow the treatment gap and improve access to cancer specialists, treatment services and facilities, usually located in urban areas, for all.
Other than the fear of surgery and the side effects of chemotherapy, the lack of easy access is one of the reasons contributing to people’s reluctance to utilise modern medicine.
While traditional or alternative medicine practitioners may be available in small towns, a cancer treatment facility with specialists may be hundreds of miles away.
For example, Kuala Lumpur Hospital serves about 25,000 cancer cases a year, including 3,700 new ones, in the central region such as Kuala Lumpur, Pahang, Perak and part of Negri Sembilan.
Cancer Survivors Malaysia president and founder Zuraini Kamal, who was diagnosed with endometrial cancer in 2012, said it was also a communication issue. She said doctors were too fond of jargon when giving the bad news to their patients.
“When I talk to people (cancer patients), they say they know, the doctor has explained. But they don’t really understand what the doctor has explained,” she said.
There are other points to address in order to ease people’s fears and encourage them to take up conventional cancer treatment first instead of depending solely on alternative or traditional medicine.
Sunway Medical Centre Velocity consultant psychiatrist Dr Ryan Tee Chuan Keat said one way was to recognise that a positive diagnosis would usually prompt the grieving process and acknowledge it.
“They will sort of grieve. It’s an emotional response to loss. It’s not grieving someone’s death. It can also be any form of loss – loss of relationship, occupation, even health in this sense,” he said.
Dr Hariyati Sharima Abd Majid, a consultant psychologist, agreed, adding that it was important to include faith when discussing people’s treatment and recovery.
“We cannot separate faith and belief from the recovery process. And when people include that in their consultation while medical healthcare professionals do not include that in the conversations they have, the patients will feel like they are not understood,” she said.
She added that the objective was to include patients in treatment plans and give them back some semblance of control over their lives.
Complications
Traditional and alternative medicine in Malaysia ranges from mainstream practices such as acupuncture and massage to fringe supernatural healing by witch doctors and consuming herbal supplements, either sold by companies or agents.
Bernama contacted several alternative and traditional medicine practitioners, selling services ranging from ‘unseen’ spiritual treatment to herbal supplements and concoctions, for more information on their services and products but did not receive a response.
Traditional medicine is very popular in this country with up to 88.3 per cent of breast cancer patients admi ing to using it, according to a study titled ‘Complementary and Alternative Medicine Use and Delays in Presentation and Diagnosis of Breast Cancer Patients in Public Hospitals in Malaysia’ by Noor Mastura Mohd Nujar et al, published in April 2017 on an online science and medical journal, PLOS ONE.
This is despite evidence that alternative or traditional medicine, if taken as the first or only option in treating cancer, does not work.
Another report, ‘Forgoing Conventional Cancer Treatments for Alternative Medicine Increases Risk of Death’ published in the US Journal of the National Cancer Institute on Aug 10, 2017, found that a er about five years, patients with breast or colorectal cancer who used an alternative therapy as their initial treatment were nearly five times more likely to die than if they had received conventional treatment.
Traditional and alternative medicine usually has herbal supplements and concoctions as part of the treatment.
Medical experts whom Bernama talked to said many of the dangers were due to the unintended side effects of these medicines and treatments, some of which were unregulated and unregistered. .
Registered or not, most people would not know what the effect of an herb would have on a person, let alone a physically vulnerable person like a cancer patient.
Dr Ruthresh Rao from the National Cancer Society Malaysia said many herbal supplements in the market worked ‘like steroids’, which would address symptoms in the short-term.
“When the short-term improvement happens, patients are convinced they work so they take more and more. It damages your liver and kidneys and within a short span of six months to one year, they find out they have acute kidney failure or acute liver failure,” he said.
Oncologists have reported this complication in treating their patients. For example, a popular herbal supplement featuring apricot seed containing amygdalin is said to have anticancer properties although there is no scientific evidence to back it up. A partially manmade and more purified version of amygdalin is called laetrile. It is o en marketed as B17 even though it is not a vitamin.
When amygdalin or laetrile breaks down in the body, it produces cyanide, a deadly poison if taken in sufficient enough quantities. The US Federal Drug Administration does not recognise it as safe and has banned interstate sales of it.
Another common supplement that the doctors see is ‘daun belalai gajah’ or ‘Sabah snakegrass’.
Consultant cardiothoracic surgeon Dr Anand Sachithanandan told Bernama that traditional and alternative herbal treatments could complicate treatment, and sometimes, patients might forget to disclose the supplements as they did not consider them medicine.
“A lot of these traditional therapies have a blood thinning effect, anticoagulant effect. So, that can increase the risk and time of the operation, especially the risk of bleeding. And that is potentially life-threatening,” he said.
“Also, for those patients who do have surgery but get chemotherapy and all the treatments, these traditional therapies can interact with the drugs that the oncologists are giving.”
When this happens, doctors usually pause treatment to allow the chemicals to clear from the system and allow the liver or kidney function to improve. However, this takes time and depending on the type of cancer, the delay may prove costly.
This is not to say that all alternative and traditional medicine treatments for cancer patients are bad and should be avoided at all costs – it is just the unsanctioned ones and those taken without the guidance of a medical professional, or claiming to cure cancer.
Speaking at a Liver Cancer Awareness Day event here on Feb 4, Dr Dzulkefly also highlighted the importance of treating the patients holistically – meaning, physically as well as mentally.
Dr Cecilliann Veronica, an integrative and functional medicine physician at SOL Integrative Wellness Centre, said: “Doctors should acknowledge that some traditional and complementary medicines could serve a purpose by alleviating symptoms and improving the quality of life for cancer patients.
“We treat the person, rather than just the organ.”
These days, Nur Hayati tries not to dwell on the past too much though it can be hard, especially a er finding out that her cancer had returned in December, a er being cancer-free for nine months.
She told Bernama that if she knew more about cancer and the importance of ge ing a second opinion three years ago, she would have found a cancer specialist to check out her symptoms when they were still manageable.
“Sometimes I feel like giving up but never mind, I will just enjoy whatever time I’ve le ,” she said.
“Life is too short a er all.” — Bernama