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Communication and integration: a qualitative analysis of perspectives among Middle Eastern oncology healthcare professionals on the integration of complementary medicine in supportive cancer care


Context and objectives

The use of complementary and traditional medicine (CTM ) in Middle Eastern countries is widespread, including among patients with cancer. Perspectives of oncology healthcare professionals (HCPs) in this region regarding the integration of CTM within conventional supportive cancer care were explored.


An 11-item questionnaire with an open-ended question asking respondents to comment about the integration of CTM within supportive cancer care was sent to Middle Eastern oncology HCPs, using snowball sampling methodology. The narratives provided were examined using thematic analysis.


A total of 339 oncology HCPs completed and returned the study tool (80.3 % response rate ), of which 178 from 15 Middle Eastern countries responded to the open-ended question. The majority of respondents are in favor of the integration of CTM within supportive cancer care, though ideas on how this should be implemented varied. Thematic analysis identified multifactorial barriers to integration, which focused on HCPs’ perspectives (e.g., a lack of knowledge and training; a skeptical approach to CTM), attitudes of patients and caregivers (e.g., unrealistic expectations regarding the outcomes of CTM treatments) and HCP–patient communication. In order to overcome these barriers, respondents suggested education and training programs for oncology HCPs which would focus on improving patients’ quality-of-life-related outcomes.


Middle Eastern oncology HCPs support the integration of CTM within supportive cancer care, while recognizing the need for education and training in this field. A better understanding of CTM would provide the knowledge and skills which would promote a non-judgmental, evidence-based approach, fostering better communication with patients.

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  1. Akhu-Zaheya LM, Alkhasawneh EM (2012) Complementary alternative medicine use among a sample of Muslim Jordanian oncology patients. Complement Ther Clin Pract 18(2):121–126

  2. Ben-Arye E, Karkabi K, Karkabi S, Keshet Y, Haddad M, Frenkel M (2009) Attitudes of Arab and Jewish patients toward integration of complementary medicine in primary care clinics in Israel: a cross-cultural study. Soc Sci Med 68(1):177–182

  3. Ben-Arye E, Schiff E, Hassan E, Mutafoglu K, Lev-Ari S, Steiner M, Lavie O, Polliack A, Silbermann M, Lev E (2012a) Integrative oncology in the Middle East: from traditional herbal knowledge to contemporary cancer care. Ann Oncol 23(1):211–221

  4. Ben-Arye E, Schiff E, Shapira C, Frenkel M, Shalom T, Steiner M (2012b) Modeling an integrative oncology program within a community-centered oncology service in Israel. Patient Educ Couns 89(3):423–429

  5. Ben-Arye E, Steiner M, Karkabi K, Shalom T, Levy L, Popper-Giveon A, Schiff E (2012c) Barriers to integration of traditional and complementary medicine in supportive cancer care of arab patients in northern Israel. Evid Based Complement Alternat Med 2012:401867

  6. Ben-Arye E, Schiff E, Zollman C, Heusser P, Mountford P, Frenkel M, Bar-Sela G, Lavie O (2013) Integrating complementary medicine in supportive cancer care models across four continents. Med Oncol 30(2):511

  7. Ben-Arye E, Hamadeh AM, Schiff E, Jamous RM, Dagash J, Jamous RM, Agbarya A, Bar-Sela G, Massalha E, Silbermann M, Ali-Shtayeh M (2014a) Compared perspectives of Arab patients in Palestine and Israel on the role of complementary medicine in cancer care. J Pain Symptom Manag 49(5):878–884

  8. Ben-Arye E, Schiff E, Silbermann M, Agbarya A, Bar-Sela G (2014b) Perceptions of complementary medicine integration in supportive cancer care of Arabs and Jews in Israel: a cross-cultural study. J Pain Symptom Manag 49(5):871–877

  9. Ben-Arye E, Massalha E, Bar-Sela G, Silbermann M, Agbarya A, Saad B, Lev E, Schiff E (2014c) Stepping from traditional to integrative medicine: perspectives of Israeli–Arab patients on complementary medicine’s role in cancer care. Ann Oncol 25(2):476–480

  10. Ben-Arye E, Halabi I, Attias S, Goldstein L, Schiff E (2014d) Asking patients the right questions about herbal and dietary supplements: cross cultural perspectives. Complement Ther Med 22(2):304–310

  11. Ben-Arye E, Schiff E, Mutafoglu K, Omran S, Hajjar R, Charalambous H, Dweikat T, Ghrayeb I, Sela GB, Turker I, Hassan A, Hassan E, Popper-Giveon A, Saad B, Nimri O, Kebudi R, Dagash J, Silbermann M (2015a) Integration of complementary medicine in supportive cancer care: survey of health-care providers’ perspectives from 16 countries in the Middle East. Support Care Cancer 23(9):2605–2612

  12. Ben-Arye E, Samuels N, Goldstein LH, Mutafoglu K, Omran S, Schiff E, Charalambous H, Dweikat T, Ghrayeb I, Bar-Sela G, Turker I, Hassan A, Hassan E, Saad B, Nimri O, Kebudi R, Silbermann M (2015b) Potential risks associated with traditional herbal medicine use in cancer care: A study of Middle Eastern oncology health care professionals. Cancer. doi:10.1002/cncr.29796

  13. Brahmi SA, El M’rabet FZ, Benbrahim Z, Akesbi Y, Amine B, Nejjari C, El Mesbahi O (2011) Complementary medicine use among Moroccan patients with cancer: a descriptive study. Pan Afr Med J 10:36

  14. Davis EL, Oh B, Butow PN, Mullan BA, Clarke S (2012) Cancer patient disclosure and patient-doctor communication of complementary and alternative medicine use: a systematic review. Oncologist 17(11):1475–1481

  15. Hsieh HF, Shannon SE (2005) Three approaches to qualitative content analysis. Qual Health Res 15(9):1277–1288

  16. http://onlinelibrary.wiley.com/doi/10.1002/cncr.29796/suppinfo link to supporting information: cncr29796-sup-0001-suppinfo.doc. Accessed 31 Dec 2015

  17. Jazieh AR, Al Sudairy R, Abulkhair O, Alaskar A, Al Safi F, Sheblaq N, Young S, Issa M, Tamim H (2012) Use of complementary and alternative medicine by patients with cancer in Saudi Arabia. J Altern Complement Med 18(11):1045–1049

  18. Lee RT, Barbo A, Lopez G, Melhem-Bertrandt A, Lin H, Olopade OI, Curlin FA (2014) National survey of US oncologists’ knowledge, attitudes, and practice patterns regarding herb and supplement use by patients with cancer. J Clin Oncol 32(36):4095–4101

  19. Paltiel O, Avitzour M, Peretz T, Cherny N, Kaduri L, Pfeffer RM, Wagner N, Soskolne V (2001) Determinants of the use of complementary therapies by patients with cancer. J Clin Oncol 19(9):2439–2448

  20. Popper-Giveon A, Schiff E, Ben-Arye E (2013) We and they in the house of healing: debate among Arab complementary medicine practitioners on an integrative versus alternative approach to supportive cancer care. Integr Cancer Ther 12(6):488–495

  21. Silbermann M, Arnaout M, Daher M, Nestoros S, Pitsillides B, Charalambous H, Gultekin M, Fahmi R, Mostafa KA, Khleif AD, Manasrah N, Oberman A (2012) Palliative cancer care in Middle Eastern countries: accomplishments and challenges. Ann Oncol 23(Suppl 3):15–28

  22. Trimborn A, Senf B, Muenstedt K, Buentzel J, Micke O, Muecke R, Prott FJ, Wicker S, Huebner J, Working Group Prevention and Integrative Oncology of the German Cancer Society (2013) Attitude of employees of a university clinic to complementary and alternative medicine in oncology. Ann Oncol 24(10):2641–2645

  23. Yildiz I, Ozguroglu M, Toptas T, Turna H, Sen F, Yildiz M (2013) Patterns of complementary and alternative medicine use among Turkish cancer patients. J Palliat Med 16(4):383–390

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We would like to thank Dr. Jamal Dagash for his contribution in study design. We would also like to thank the following for their contribution in the monitoring of data acquisition: Dr. Orit Gressel-Raz, Ms. Ronit Leibowitz, Ms. Shimrit Roni, Mr. Shmuel Attias and Ms. Sarah Ben Shlush. This study was supported in part by the Middle East Cancer Consortium.

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Correspondence to Eran Ben-Arye.

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All authors declare no financial and personal relationships with other people or organizations that could inappropriately influence our work.

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Ben-Arye, E., Popper-Giveon, A., Samuels, N. et al. Communication and integration: a qualitative analysis of perspectives among Middle Eastern oncology healthcare professionals on the integration of complementary medicine in supportive cancer care. J Cancer Res Clin Oncol 142, 1117–1126 (2016). https://doi.org/10.1007/s00432-016-2120-9

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  • Integrative medicine
  • Complementary medicine
  • Doctor–patient communication
  • Traditional medicine
  • Palliative care
  • Supportive cancer care