Complementary Therapies in Clinical Practice
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Complementary Therapies in Clinical Practice 17 (2011) 235e240
Contents lists available at ScienceDirect
Complementary Therapies in Clinical Practice
journal homepage: www.elsevier.com/locate/ctcp
Herbal preparation use by patients suffering from cancer in Palestine
Mohammed S. Ali-Shtayeh a, b, *, Rana M. Jamous a, Rania M. Jamous a
a
Biodiversity & Environmental Research Center, BERC, Til, Nablus, Palestine
b
Department of Biology, An-Najah University, Nablus, Palestine
a b s t r a c t
Keywords: This study sought to describe type, frequency, purpose and patterns of herbal medicine used by a sample
Complementary and alternative medicine of patients with cancer in Palestine.
Herbal medicine
A cross-sectional survey of patients attending the outpatient cancer departments at the Governmental
Cancer
Palestine
Hospitals was undertaken using semi-structured questionnaires.
Results: A total of 1260 patients with cancer were interviewed. Of the participants, 60.9% (n ¼ 767)
reported using herbs primarily bought from Palestine (92.3%) frequently employed in the form of
decoctions (43%). The most common herbal product was Arum palaestinum (22.5%). Most Complemen-
tary and Alternative (CAM) users were more than 40 years of age, predominantly female, and living in
rural areas of Palestine. Family member’s recommendation was cited as the main factor prompting
participants to use CAM (43.5%).
Conclusion: This study revealed that there is an appreciable prevalence of herbal use among patients with
cancer in Palestine.
Ó 2011 Elsevier Ltd. All rights reserved.
1. Introduction patients has been reported to be up to 50%. According to two recent
systematic reviews carried out by Ben-Arye et al. (2011) and Olaku &
In Palestine (Palestinian Authority, PA), as with many devel- White (2011), traditional herbal medicine is the leading CAM
oping countries, medicinal plants play an important role in primary modality in Middle Eastern countries and USA. Put together, these
health care. They are widely used as complementary and alterna- studies indicate that, in both developed and developing countries,
tive medicine (CAM) in the Traditional Arabic Palestinian Herbal herbal remedies are believed by the general public to be safe, cause
Medicine (TAPHM), for health maintenance and to treat various less side effects, less likely to cause dependency, and patients turn to
illnesses including chronic diseases.1,2 these remedies for symptomatic relief or to overcome the side
In 2002, the World Health Organization (WHO) estimated that effects of conventional medicines.
80% of the world’s population in developing countries depended The use of herbal medicines for cancer is both widespread and
mainly upon medicinal plants and traditional medicine practi- diverse worldwide.5,15 When concurrently used with pharmaceu-
tioners to meet their primary health care needs.3 Although tical drugs, interactions may increase or decrease the pharmaceu-
modern medicine may be available in many of these countries, the tical or toxicological effects of either components.1619 A potential
popularity of Herbal medicine has persisted. This has also been the risk to human health could be the simultaneous use of multiple
case in Palestine.4 herbal medicines and conventional medicines.20
Many patients with cancer use CAM either concurrently with
conventional medicine (complementary) or on their own (alterna-
tive).5 A systematic review of 26 surveys in 13 countries estimated
2. Aims and objectives
the average prevalence of CAM use by cancer patients as 31.4% (range
7e64%).6 However, it has been suggested that the prevalence of CAM
The present study sought to evaluate the prevalence and factors
therapies across this group of patients could be as high as
related to the use of herbs by patients living with cancer, to discuss
70e80%.7e9 In Jordan,5 Israel,10 and Turkey11,12 CAM usage in cancer
the demographic details of these patients and to identify perceived
benefits from herbal therapy use. The study also aimed to identify
sources of information recommending the use of a particular herb
* Corresponding author. Tel.: þ972 9 2536 406; fax: þ972 9 253 6147. and the underlying reasons for using herbal therapy. One of the
E-mail addresses: msshtayeh@yahoo.com, shtayeh@najah.edu (M.S. Ali-Shtayeh). main objectives was to ascertain whether patients had discussed
1744-3881/$ e see front matter Ó 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ctcp.2011.06.002236 M.S. Ali-Shtayeh et al. / Complementary Therapies in Clinical Practice 17 (2011) 235e240
their use of CAM with their physicians. To date, no previous studies 3.2. Data analysis
have investigated this prevalence in Palestine.
Responses were coded and entered into SPSS for Windows,
version 16, for statistical analysis. Multivariate analysis and 2 2
3. Methods
contingency tables were used to compare groups. Chi-square and
Fisher exact tests were used to test for significant differences
The study took the form of a cross-sectional survey of patients
between groups. An a priori level of significance was set at 0.05.
attending the outpatient departments at the Governmental
Hospitals in Nablus, Tulkarm, Ramalla, Beit-Jala, and Hebron. To
ensure a representative cross-sectional sample of the cancer out 4. Results
patients, interviews were conducted on different days and times.
The study included both males and females of different age groups. 4.1. Demographics
The method was based on the use of a semi-structured
questionnaire. Of the total 1260 patients interviewed, 662 were female (55.2%)
Prior to proceeding with the study, ethical approval was and 598 were male (44.8%) patients (Table 2). Table 2 summarizes
obtained from the Institutional Review Board (IRB) at Ministry of the demographic characteristics of participants in this study. The
Health in Nablus. Patients expressing interest in participating in the majority of the interviewees were above 40 years of age (n ¼ 888,
study were requested to sign this document. Interviews were 70.4%). As expected, a high percentage of individuals of the study
conducted by trained researchers from the Faculty of Sciences at population were married (n ¼ 890, 70.6%). About 27% of partici-
the An-Najah University, Nablus (ANU), and the Biodiversity and pants (n ¼ 339) in the study had high school degree, while 246
Environmental Research Center (BERC), Nablus. All researchers (20%) had a university degree (Table 2).
were trained in questionnaire administration and interviewing
skills. All participants were fully informed that the study was
exploring their use of herbal medicines in combination with 4.2. Pattern of herbal preparation use among participants
prescribed medications. Patients were assured that all information
was confidential and would only be used for research purposes. Regarding the use of herbal remedies among participants in our
Where patients were younger than 16 years of age or unable to study, of the 1260 participants, 60.9% (n ¼ 767) were users of plant-
interact, next of kin (NOK) were interviewed. The study took place based products. All values and percentages from here onwards refer
between August 2010 until March 2011.The vast majority of the to this group of patients. This group consisted predominantly of
questions had pre-formulated answers. The main themes females (n ¼ 422, 55%). The majority of herbal medicine users
addressed by the questionnaire are represented in Table 1. obtained their supply from Palestine (n ¼ 709, 92.3%) and preferred
the use of crude extract in the form of decoction (n ¼ 333, 43%), raw
3.1. Research sample Table 2
Socio-demographic data of study participants (n ¼ 1260) and those using herbs
To evaluate the questionnaire, a pilot study on 50 randomly (n ¼ 767).
selected patients with cancer was performed. In the present study, Variable Total frequencya Frequency using
a total of 1260 randomly selected cancer out patients participated. (%) herbs (%)
The findings from the pilot study have not been included in the Gender
analysis of data for the present study. Male 598 (47.5) 345 (45.0)
Female 662 (52.5) 422 (55.0)
Table 1 Age group
Main themes addressed by questionnaire. < 16 68 (5.4) 27 (3.5)
16e25 92 (7.3) 42 (5.5)
1 Demographic details of Gender, age group, marital status, education level, 26e40 213 (16.9) 144 (18.8)
the patient or next area of residence (city, village, refugee camp) 41e50 329 (26.1) 219 (28.5)
of kin (NOK) if the 51e60 279 (22.1) 189 (24.6)
patient is 60 279 (22.0) 145 (18.9)
of age Marital status
2 Disease details e Type of cancer: GIT (Gastro Intestinal), Breast, Single 221 (17.5) 115 (15)
(obtained from Respiratory, Hemaptopoetic/lymphomas, Brain/ Married 890 (70.6) 565 (73.6)
the patient file) neurological, Colon, Testis/prostate, Uterus/ Divorced 41 (3.3) 22 (2.9)
cervix/ovary/vagina, Bone, Kidney/bladder, Widowed 100 (7.9) 63 (8.2)
Thyroid, Other (Liver, skin, unknown type) Educational level
e Other medical problems: Hypertension, asthma, Illiterate 226 (17.9) 142 (18.5)
diabetes mellitus, others. Primary school 433 (34.3) 252 (32.8)
e Current treatment (s) of the patient: Secondary school 339 (26.9) 216 (28.1)
Chemotherapy [single, multiple; curative/ University 246 (19.5) 145 (18.9)
palliative], Radiotherapy, Surgery. Residence
3 Information about the e Plant Part used, Forms of use (Raw, Cooked, City 581 (46.1) 312 (40.6)
use of CAM (herbs or Infusion, Decoction, paste, juice), Mode of Village 593 (47.0) 405 (52.7)
herbal preparation) Preparation, Administration, Dose, period of use, Camp 80 (6.3) 48 (6.2)
e Origin of the herbs (local, imported), Chronic diseases presence
4 Source of the e Friends, family member, physician, pharmacist, No chronic Disease 695 (55.2) 411 (53.5)
information herbalist, media (TV, radio, hardcopy), other (e.g. Other chronic disease 565 (44.8) 357 (46.5)
internet, advertisements, text messages, etc) Current treatment
5 Purpose of the use of Curing disease, slow down progress of disease, Chemotherapy 515 (40.8) 293 (38.2)
CAM (herbs) relief of symptoms, reducing medication Radiation 26 (2.1) 17 (2.2)
side effects Surgery 115 (9.1) 68 (8.9)
6 Outcomes Did the patient achieve the sought effect and Combined therapy 592 (46.9) 383 (49.9)
discussed the CAM use with the physician?
a
Numbers do not add up to the total population size, as some data were missing.M.S. Ali-Shtayeh et al. / Complementary Therapies in Clinical Practice 17 (2011) 235e240 237
Table 3 c2 tests showed that the use of CAM differed significantly
Pattern of use of medicinal herbs by cancer patients (n ¼ 767). between users and non-users of CAM in relation to the following
Characteristic Number of % variables: female gender (p ¼ 0.026), older age (>40 years)
patientsa (p ¼ 0.045), and residence in rural areas (vs city or refugee camps)
In which form do you use herbs? (p < 0.0001). On the other hand, there was no statistically significant
Crude form (powder, infusion) 767 100 association between users and non-users of CAM with regard to
Pharmaceutical dosage form 18 2.3
educational level (p ¼ 0.959) or the presence of other chronic
Where do you obtain this remedy?
Palestine 709 94 diseases (p ¼ 0.135).
Abroad 24 3.2 Patients in the study were on different types of treatments (e.g.
Both 21 2.8 chemotherapy, radiotherapy, etc.). Over 38% of participants taking
Who recommended this remedy to you? CAM were concomitantly on single or multiple chemotherapy
Friend 294 38.3
Family member 334 43.5
(n ¼ 293, 38.2%), radiotherapy (n ¼ 17, 2.2%), surgery (n ¼ 68, 8.9%),
The physician and pharmacist 68 8.9 and combined therapy (n ¼ 393, 49.9%).
The herbalist 105 13.7 Breast cancer was the predominant cancer among female CAM
Media (TV, newspapers, magazines, internet) 75 9.8 users (n ¼ 188, 44.1%), whereas colon cancer was predominant one
Others 72 9.4
among male CAM users (n ¼ 62, 18%), followed by prostate cancer
Why do you take this remedy?
Cure of disease 304 39.6 (n ¼ 54, 15.7%) (Table 4).
Slow down progression of disease 311 40.5
Relieve symptoms of disease 232 30.2 4.3. Herbal use
Reduce side effect of medication 168 21.9
Did you get the sought effect?
Yes 258 33.6 Ninety seven plant taxa, belonging to 43 botanical families, were
No 486 63.4 used by cancer patients in this study with Lamiaceae (9 species),
Don’t know 23 3.0 Apiaceae (8) and Brassicaceae (8) being the most quoted families.
Did you discuss using such remedies Of these plants, 59 species (belonging to 34 Families) were cited
with the doctor?**
Yes 361 48
by 3 patients (Table 5), 38 species were mentioned by < 3
No 391 52 patients each and therefore were excluded from further discussion.
Only a few patients (n ¼ 18, 2.3%) reported using herbal mixtures in
**Numbers do not add up to the total population size, as some data were missing.
a
The total number here was more than 767, because some participants reported dosage form (e.g., garlic tablets).
more than one choice. The most used plants were Arum palaestinum (Araceae) (173
patients), Nigella ciliaris (Ranunculaceae) (100), Matricaria aurea
(n ¼ 288, 38%), cooked (n ¼ 210, 27%), infusion (n ¼ 156, 20%), juice (Asteraceae) (75), Salvia fruticosa (Lamiaceae) (64), Zingiber offici-
(n ¼ 70, 16%), and paste (n ¼ 16, 2%). nale (Zingiberaceae) (64), Anisum vulgare (Apiaceae) (54), Allium
The main sources of recommendations for herbal products were sativum (Liliaceae) (53), Trigonella berythea (Fabaceae) (41), Cur-
family (n ¼ 334, 43.5%) and friends (n ¼ 294, 38.3%), followed by cuma longa (Zingiberaceae) (28), Majorana syriaca (Lamiaceae) (28),
herbalists (n ¼ 105, 13.7%). Herbal remedies recommended by Rosmarinus officinalis (Lamiaceae) (28), Allium cepa (Liliaceae) (27),
physicians or pharmacists were last in the list (n ¼ 68, 8.9%). Olea europaea (Oleaceae) (24), Camellia thea (Theaceae) (21), and
More than 40% of herbal medicine users (n ¼ 311, 40.5%) believed Teucrium capitatum (Lamiaceae) (21).
that these preparations would play the role of slowing down the
progression of their disease. Other reasons included curing the 5. Discussion
disease (n ¼ 304, 39.6%), relieving symptoms of the disease (n ¼ 232,
30.2%) or reducing side effects of the medication (n ¼ 168, 21.9%). CAM is widely used among cancer patients throughout the
The majority of herbal medicine users (n ¼ 486, 63.3%) claimed world.6,13,14,2127 The present study is the first attempt to identify
to have obtained the sought effect from taking these herbs, and quantify the prevalence of the use of herbal medicines as CAM
although most (n ¼ 391, 52%) did not report this fact to their in a sample of patients with cancer in Palestine.
physicians (Table 3). In 2010, the cancer incidence rate in the West Bank (PA) was
53.7 per 100,000 of the Palestinian population.28 After
Table 4
Range of cancers identified in study population.
Type of Cancer Cancer patients population CAM users % CAM users in
each cancer type
Male n (%) Female n (%) Total n (%) Male n (%) Female n (%) Total n (%)
in the study
population
Bone 32 (5.4) 17 (2.6) 49 (3.9) 11 (3.2) 11 (2.6) 22 (2.9) 44.9
Brain/neurological 42 (7.0) 16 (2.4) 58 (4.6) 20 (5.8) 7 (1.7) 27 (3.8) 46.6
Breast 2 (0.3) 278 (42.0) 280 (22.2) 2 (0.6) 186 (44.1) 188 (21.8) 67.1
Colon 96 (16.1) 64 (9.7) 160 (12.7) 62 (18.0) 45 (10.7) 107 (14.4) 66.9
GIT 44 (7.4) 40 (6.0) 84 (6.7) 24 (7.0) 24 (5.7) 48 (6.3) 57.1
Hemaptopoetic/lymphomas 101 (16.9) 64 (9.7) 165 (13.1) 50 (14.5) 28 (6.6) 78 (10.7) 47.3
Kidney/Bladder 41 (6.9) 16 (2.4) 57 (4.5) 24 (7.0) 9 (2.1) 33 (4.6) 57.9
Respiratory 74 (12.4) 20 (3.0) 94 (7.5) 50 (14.5) 13 (3.1) 63 (8.9) 67.0
Testis/prostate 81 (13.5) 0 (0.0) 81 (6.4) 54 (15.7) 0 (0.0) 54 (8.0) 66.7
Thyroid 15 (2.5) 8 (1.2) 23 (1.8) 10 (2.9) 6 (1.4) 16 (2.2) 69.6
Uterus/Cervix/Ovary/Vagina 0 (0.0) 83 (12.5) 83 (6.6) 0 (0.0) 57 (13.5) 57 (6.6) 68.7
Other 50 (8.4) 32 (4.8) 82 (6.5) 25 (7.2) 21 (5.0) 46 (6.1) 56.1
More than one cancer 20 (3.3) 24 (3.6) 44 (3.5) 13 (3.8) 15 (3.6) 28 (3.7) 63.6
Total 598(100) 662(100) 1260(100) 345(100) 422(100) 767(100) 1260238 M.S. Ali-Shtayeh et al. / Complementary Therapies in Clinical Practice 17 (2011) 235e240
Table 5
Most frequently used CAM herbal preparations in descending order by number of informants (quoted by 3 patients).
Scientific name (Family)a Common Arabic No. of Plant part Form of
name name informants usedb preparationc
Arum palaestinum Boiss. (Araceae) Palestinian Arum Lufe 173 AP, LE R, C, D
Nigella ciliaris DC. (Ranunculaceae) Black Cumin Qezha 100 FR, SD R, C, I, D
Matricaria aurea (L.) Sch. Bip. (Asteraceae) Golden Cotula Babounej 75 AP, LE, FL, SD R, C, I, D
Salvia fruticosa Mill. (Lamiaceae) Common Sage Mariamieh 64 AP, LE R, C, D
Zingiber officinale Rose. (Zingiberaceae) Ginger Zangabel 64 AP, LE, FL, RT, FR R, C, I, D
Anisum vulgare L. (Apiaceae) Anise Yansoon 54 AP, LE, FL, SD C, I, D
Allium sativum L. (Liliaceae) Garlic Thoum 53 RT, FR R
Trigonella berythea Boiss. & Blanche Fenugreek Seed Hilbeh 41 AP, LE, FL, FR R, C, I, P
(T. foenum- graecum L.) (Fabaceae)
Curcuma longa L. (Zingiberaceae) Turmeric Korkom 28 AP, FL, RT, SD R, C, D
Majorana syriaca (L.) Rafin. (Lamiaceae) Wild Thyme Za’tar Barri 28 AP, LE R, C, I, D
Rosmarinus officinalis L. (Lamiaceae) Rosemary Hassalban 28 AP, LE, FL C, I, D
Allium cepa L. (Liliaceae) Onions Basal 27 AP, LE, RT R, C, D, J
Olea europaea L. (Oleaceae) Olive Zaitoun 24 RT, FR R, D, P, J
Camellia thea Link. (Theaceae) Tea Shai Akhdar 21 LE I, D
Teucrium capitatum L. (T. polium L.) (Lamiaceae) Cat Thyme Jedeh Subian 21 AP, LE R, C, I, D
Triticum aestivum L. (Poaceae) Wheat Qamh 18 AP, FR, SD R, C, I
Phoenix dactylifera L. (Palmae) Date Palm Tamer 17 RT, FR R
Petroselinum sativum Hoffm. (Apiaceae) Parsley Baqdoones 15 AP, LE, FR R, C, I, D, J
Brassica oleracea L. (Brassicaceae) Cabbage Malfof 14 LE, FR R, C, I, D, J
Punica granatum L. (Punicaceae) Pomegranate Rumman 14 FR D
Mentha spicata L. (Lamiaceae) Peppermint Na’na’ 13 AP, LE R, C, I, D
Vitis vinifera L. (Vitacea) Grape Inab 13 FR R
Hordeum vulgare L. (Poaceae) Barley Shaeer 11 AP, LE, SD R, D
Malva sylvestris L. (Malvaceae) Common Mallow Khubbaizeh 11 LE R, C, D
Urtica pilulifera L. (Urticaceae) Roman Nettle Qurrais 11 AP, LE, SD R, C, I, D
Daucus carota L. (Apiaceae) Carrot Jazar 10 RT R
Syzygium aromaticum (Myrtaceae) Clove Kabsh Koronful 10 LE, FL C, D
Amygdalus communis L. (Rosaceae) Almond Louz Hilo 9 FR, SD R, C
Lepidium sativum L. (Brassicaceae) Cress Rashad 8 SD C, I, D
Foeniculum vulgare Miller (Apiaceae) Fennel Shomar 7 AP, LE, RT, FR R, C, J
Capsicum annuum L. (Solanaceae) Sweet Peppers Felfel 6 FR R
Citrus limon (L.) Burm. Fil (Rutaceae) Limon Tree Laimoon 6 RT, FR R, D, J
Cuminum cyminum L. (Apiaceae) Cumin Kammoun 6 FL, FR, SD R
Opuntia ficus-indica (L.) Mill. (Cactaceae) Prickly-Pear Sabr 6 FR, ST R
Cinnamomum zeylanicum Blume. (Lauraceae) Cinnamon Tree Qerfeh 5 LE, BA I, D
Crocus sativus L. (Iridaceae) Saffron Za’faran 5 LE, FL C, I, D
Micromeria fruticosa (L.) Druce (Lamiaceae) Thyme Za’tar Balat 5 AP, LE I, D
Musa sapientum L. (Musaceae) Banana Mose 5 LE, FR C, D
Origanum majorana L. (Lamiaceae) Sweet-Marjoram Mardaqoush 5 LE, SD R, I, D
Sinapis arvensis L. (Brassicaceae) Wild Mustard Khardal Barri 5 AP, LE R, I, J
Brassica oleracea L.var. botrytis (Brassicaceae) Broccoli Broccoli 4 AP, LE, FR R, C
Cichorium pumilum Jacq. (Asteraceae) Dwarf Chicory Hendba’ 4 LE C
Coridothymus capitatus (L.) Reichb. (Lamiaceae) Capitate Thyme Za’tar Farsi 4 LE R
Crataegus aronia (L.) Bosc. ex DC. (Rosaceae) Hawthorn Za’roor 4 LE, FR C, I, D
Eruca sativa Miller (Brassicaceae) Garden Rocket Jarjeer 4 LE R
Eucalyptus camaldulensis Dehn. (Myrtaceae) Red River Gum Kina 4 LE, FL C, I, D
Ficus carica L. (Moraceae) Fig Tree Teen 4 FR R
Quercus calliprinos L. (Fagaceae) Kermes Oak Sendian 4 RT, ST R
Anacardium occidentalis L. (Anacardiaceae) Caju, Cashew Cashew 3 SD R
Cupressus sempervirens L. (Cupressaceae) Cypress Sarw’ 3 RT, SD R
Cyclamen persicum Miller (Primulaceae) Cyclamen Za’matoot 3 AP, LE R, D
Lactuca sativa L. (Asteraceae) Lettuce Khus 3 LE R, C
Linum pubescens Banks & Sol. (Linaceae) Pink Flax Kittan 3 FR, SD R, C, D
Portulaca oleracea L. (Portulaceae) Purslane Baqleh 3 LE R, C
Psidium guajava L. (Myrtaceae) Guava Guava 3 LE D
Pyrus malus L. (Rosaceae) Apple Toffah 3 FR R
Raphanus sativum L. (Brassicaceae) Radish Fijel 3 LE R
Ricinus communis L. (Euphorbiaceae) Castor Beans Kharwa’ 3 SD R
Sesamum indicum L. (Pedaliaceae) Sesame Semsem 3 SD R, J
a
Total number of plant species reported ¼ 97, of which 59 (presented in this Table) were reported by 3 or more patients; 38 were referred to by 1e2 informants.
b
AP, aerial parts; BA, bark; LE, leaves; FL, flowers; FR, fruits; SD, seeds; ST, stem; RT, roots.
c
C, cooked; D, decoction; I, infusion; J, juice; P, paste; R, raw.
cardiovascular diseases (25.4%), and cerebrovascular diseases colon cancer. In females, breast cancer was the most common
(12.1%), cancer (10.8%) was the third most frequent cause of death diagnosis followed the colon cancer.
in the PA (West Bank) in 2010. In the same year, 1350 new cancer In the current study, of the 1260 interviewees, 280 (22.2%)
cases were registered (53.3% females and 46.7% males). Of these, patients had breast cancer, of which 188 (44.1%) were CAM users.
the most common cancer diagnoses were breast (18.8%), lung In the PA, a vast majority of the population still use herbal
(10.8%), colon (10.7%), brain (5.6%), bladder (5.6%), and prostate medicines, indicating a deep rooted belief in the healing potential
(5.3%).28 In males, lung cancer was the most common followed by of plants.2,4 Several population-based studies, have demonstratedM.S. Ali-Shtayeh et al. / Complementary Therapies in Clinical Practice 17 (2011) 235e240 239
widespread use of herbal medicine as the most preferred CAM were satisfied with the outcomes of herbal therapy, it is evident
modality.12,22,23,26,29 Herbs most commonly used include A. palae- that the majority lacked appropriate awareness of the potential
stinum (173 patients), N. ciliaris (100), and M. aurea (75). Interest- risks of combining herbal and conventional treatments when
ingly, herbal therapies appear to be the most commonly used CAM attempting to manage their cancer.
therapy in many countries including Jordan,5 Israel, Egypt,13 and
Turkey.12 Conflict of interest statement
Herbal medicine use amongst Palestinians occurs for the treat- The authors have no conflict of interest.
ment of a large number of ailments and diseases. It was not
therefore surprising that a high percentage of participants (about
61%) used herbal medicines. Accessibility, lower cost and accept- Acknowledgments
ability of medicinal herbal use in Palestine as well as traditional use
of herbs, encourage patients to believe in their healing effects.2,4 The authors would like to thank Hanadi Khalil, Bahia Motawi’,
In this study, 30.2% of participants reported using herbal Ali Shanaa’, Ola Muthqal, Manal Ibrahim, Razan Abueisheh, Nibal
medicines to relieve disease related symptoms. 21.9% claimed to Khdaish, and Kifah Taleeb for their help in data collection.
use herbal preparations to reduce the side effects of prescribed
medications or to slow down disease progression (40.5%). Inter-
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