Supportive Care in Cancer

, Volume 20, Issue 3, pp 557–564 | Cite as

Integrative oncology research in the Middle East: weaving traditional and complementary medicine in supportive care

  • Eran Ben-Arye
  • Mohammed Saleem Ali-Shtayeh
  • Mati Nejmi
  • Elad Schiff
  • Esmat Hassan
  • Kamer Mutafoglu
  • Fatma U. Afifi
  • Rana Majed Jamous
  • Efraim Lev
  • Michael Silbermman
Original Article



Complementary and alternative medicine (CAM) has an important role in supportive cancer care in the Middle East and is often used in association with traditional medicine. This article provides a comprehensive review of published data on CAM research in supportive cancer care in the Middle East.

Methods and results

A multi-disciplinary Middle-Eastern Research Group in Integrative Oncology (MERGIO) was established in six countries. Authors independently searched Medline database for articles in Arabic, Hebrew, French, and Turkish using oncology and CAM-related keywords. Articles were recorded according to the first author’s affiliation with an academic or clinical institution in the Middle East.


We identified 143 articles on CAM and cancer care that had been published in12 Middle-Eastern countries. Eighty-five articles were directly related to cancer supportive care. The latter included studies on the prevalence of CAM use by patients with cancer, aspects related to of doctor–patient communication, ethics and regulation, psychosocial aspects of CAM, CAM safety and quality assurance, studies of CAM education for health care providers, and ethno-botanical studies and reviews. Twenty-eight articles referred to clinical research on supportive care, and the use of specific CAM modalities that included acupuncture, anthroposophic medicine, dietary and nutritional therapies herbal medicine, homeopathy, mind–body medicine, shiatsu, therapeutic touch, and yoga.


CAM-related supportive care research is prevalent in the Middle East, a fact that may serve as a basis for future multinational-multidisciplinary research work in supportive care in oncology.


Integrative medicine Complementary alternative medicine Doctor–patient communication Cancer Oncology Chemotherapy Middle East Islamic medicine 





  1. 1.
    Ben-Arye E, Schiff E, Golan O (2008) Ethical issues in integrative oncology. Hematol Oncol Clin North Am 22(4):737–753PubMedCrossRefGoogle Scholar
  2. 2.
    Yildirim YK, Fadiloğlu C, Uyar M (2006) Complementary therapies in palliative cancer care. Agri 18(1):26–32PubMedGoogle Scholar
  3. 3.
    Afifi FU, Wazaify M, Jabr M, Treish E (2010) The use of herbal preparations as complementary and alternative medicine (CAM) in a sample of patients with cancer in Jordan. Complement Ther Clin Pract 16(4):208–212PubMedCrossRefGoogle Scholar
  4. 4.
    Ulger O, Yağli NV (2010) Effects of yoga on the quality of life in cancer patients. Complement Ther Clin Pract 16(2):60–63PubMedCrossRefGoogle Scholar
  5. 5.
    Ben-Arye E, Bar-Sela G, Frenkel M, Kuten A, Hermoni D (2006) Is a bio-psycho-social-spiritual approach relevant to cancer treatment? A study of patients and oncology staff members on issues of complementary medicine and spirituality. Support Care Cancer 14(2):147–152PubMedCrossRefGoogle Scholar
  6. 6.
    Tarhan O, Alacacioglu A, Somali I, Sipahi H, Zencir M, Oztop I, Dirioz M, Yilmaz U (2009) Complementary-alternative medicine among cancer patients in the western region of Turkey. J BUON 14(2):265–269PubMedGoogle Scholar
  7. 7.
    Montazeri A, Sajadian A, Ebrahimi M, Haghighat S, Harirchi I (2007) Factors predicting the use of complementary and alternative therapies among cancer patients in Iran. Eur J Cancer Care (Engl) 16(2):144–149CrossRefGoogle Scholar
  8. 8.
    Rezaei M, Adib-Hajbaghery M, Seyedfatemi N, Hoseini F (2008) Prayer in Iranian cancer patients undergoing chemotherapy. Complement Ther Clin Pract 14(2):90–97PubMedCrossRefGoogle Scholar
  9. 9.
    Weyl Ben Arush M, Geva H, Ofir R, Mashiach T, Uziel R, Dashkovsky Z (2006) Prevalence and characteristics of complementary medicine used by pediatric cancer patients in a mixed Western and Middle-Eastern population. J Pediatr Hematol Oncol 28(3):141–146PubMedCrossRefGoogle Scholar
  10. 10.
    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):2439–2448PubMedGoogle Scholar
  11. 11.
    Yildirim Y (2010) Patterns of the use of complementary and alternative medicine in women with metastatic cancer. Cancer Nurs 33(3):194–200PubMedCrossRefGoogle Scholar
  12. 12.
    Genc RE, Senol S, Turgay AS, Kantar M (2009) Complementary and alternative medicine used by pediatric patients with cancer in western Turkey. Oncol Nurs Forum 36(3):E159–E164PubMedCrossRefGoogle Scholar
  13. 13.
    Yildirim Y, Tinar S, Yorgun S, Toz E, Kaya B, Sonmez S, Balsak D (2006) The use of complementary and alternative medicine (CAM) therapies by Turkish women with gynecological cancer. Eur J Gynaecol Oncol 27(1):81–85PubMedGoogle Scholar
  14. 14.
    Ben-Arye E, Steinmetz D, Ezzo J (2007) Two women and cancer—the need for addressing spiritual well-being in cancer care. Families Syst Health 25(1):1–9CrossRefGoogle Scholar
  15. 15.
    Frenkel M, Ben-Arye E, Baldwin CD, Sierpina V (2005) An approach to communicating with patients about the use of nutritional supplements in cancer care. South Med J 98(3):289–294PubMedCrossRefGoogle Scholar
  16. 16.
    Ben-Arye E, Frenkel M (2004) Doctor, patient and cancer in the encounter of complementary and conventional medicine. Isr J Fam Pract 14(114–115):11–17Google Scholar
  17. 17.
    Barak F, Lugacy G, Kreitler S (2008) Complementary medicine regulations. Patient Educ Couns 73(1):166–167PubMedCrossRefGoogle Scholar
  18. 18.
    Gilbar O, Iron G, Goren A (2001) Adjustment to illness of cancer patients treated by complementary therapy along with conventional therapy. Patient Educ Couns 44(3):243–249PubMedCrossRefGoogle Scholar
  19. 19.
    Bogusz MJ, al Tufail M, Hassan H (2002) How natural are ‘natural herbal remedies’? A Saudi perspective. Adverse Drug React Toxicol Rev 21(4):219–229PubMedGoogle Scholar
  20. 20.
    Ben-Arye E, Frenkel M, Bar-Sela G, Stashefsky Margalit R, Hermoni D, Kuten A (2008) Teaching complementary medicine at an academic oncology department. J Cancer Educ 23(1):46–50PubMedCrossRefGoogle Scholar
  21. 21.
    Said O, Khalil K, Fulder S, Azaizeh H (2002) Ethnopharmacological survey of medicinal herbs in Israel, the Golan Heights and the West Bank region. J Ethnopharmacol 83(3):251–265PubMedCrossRefGoogle Scholar
  22. 22.
    Ben-Arye E, Attias S, Tadmor T, Schiff E (2010) Herbs in hemato-oncological care: an evidence-based review of data on efficacy, safety, and drug interactions. Leuk Lymphoma 51(8):1414–1423PubMedCrossRefGoogle Scholar
  23. 23.
    Zaid H, Rayan A, Said O, Saad B (2010) Cancer treatment by Greco-Arab and Islamic herbal medicine. The Open Nutraceuticals Journal 3Google Scholar
  24. 24.
    Ali-Shtayeh MS, Jamous RM (2006) Ethnobotany of Palestinian herbal medicine in the Northern West Bank and Gaza Strip: review and a comprehensive field study. Biodivers Environ Sci Stud Ser 4(1):1–122Google Scholar
  25. 25.
    Samuels N (2002) Acupuncture for cancer patients: why not? Harefuah 141(7):608–610, 666PubMedGoogle Scholar
  26. 26.
    Bar-Sela G, Atid L, Danos S, Gabay N, Epelbaum R (2007) Art therapy improved depression and influenced fatigue levels in cancer patients on chemotherapy. Psychooncology 16(11):980–984PubMedCrossRefGoogle Scholar
  27. 27.
    Alsawaf MA, Jatoi A (2007) Shopping for nutrition-based complementary and alternative medicine on the Internet: how much money might cancer patients be spending online? J Cancer Educ 22(3):174–176PubMedCrossRefGoogle Scholar
  28. 28.
    Walfisch S, Walfisch Y, Kirilov E, Linde N, Mnitentag H, Agbaria R, Sharoni Y, Levy J (2007) Tomato lycopene extract supplementation decreases insulin-like growth factor-I levels in colon cancer patients. Eur J Cancer Prev 16(4):298–303PubMedCrossRefGoogle Scholar
  29. 29.
    Can G, Topuz E, Derin D, Durna Z, Aydiner A (2009) Effect of kefir on the quality of life of patients being treated for colorectal cancer. Oncol Nurs Forum 36(6):E335–E342PubMedCrossRefGoogle Scholar
  30. 30.
    Rashad UM, Al-Gezawy SM, El-Gezawy E, Azzaz AN (2008) Honey as topical prophylaxis against radiochemotherapy-induced mucositis in head and neck cancer. J Laryngol Otol 19:1–6Google Scholar
  31. 31.
    Mabed M, El-Helw L, Shamaa S (2004) Phase II study of viscum fraxini-2 in patients with advanced hepatocellular carcinoma. Br J Cancer 90(1):65–69PubMedCrossRefGoogle Scholar
  32. 32.
    Motallebnejad M, Akram S, Moghadamnia A, Moulana Z, Omidi S (2008) The effect of topical application of pure honey on radiation-induced mucositis: a randomized clinical trial. J Contemp Dent Pract 9(3):40–47PubMedGoogle Scholar
  33. 33.
    Ahmadi A, Mohagheghi M, Karimi M, Golestanha SA, Naseri M, Faghihzadeh S, Habibi G (2010) Therapeutic effects of HESA-A in patients with end-stage metastatic cancers. Integr Cancer Ther 9(1):32–35PubMedCrossRefGoogle Scholar
  34. 34.
    Bani Hani MN, Al Manasra AR (2009) Spontaneous regression in alveolar soft part sarcoma: case report and literature review. World J Surg Oncol 10(7):53CrossRefGoogle Scholar
  35. 35.
    Bar-Sela G, Tsalic M, Fried G, Goldberg H (2007) Wheat grass juice may improve hematological toxicity related to chemotherapy in breast cancer patients: a pilot study. Nutr Cancer 58(1):43–48PubMedCrossRefGoogle Scholar
  36. 36.
    Bar-Sela G, Goldberg H, Beck D, Amit A, Kuten A (2006) Reducing malignant ascites accumulation by repeated intraperitoneal administrations of a Viscum album extract. Anticancer Res 26(1B):709–713PubMedGoogle Scholar
  37. 37.
    Bar-Sela G, Haim N (2004) Abnoba-viscum (mistletoe extract) in metastatic colorectal carcinoma resistant to 5-fluorouracil and leucovorin-based chemotherapy. Med Oncol 21(3):251–254PubMedCrossRefGoogle Scholar
  38. 38.
    Yucel I, Guzin G (2008) Topical henna for capecitabine induced hand-foot syndrome. Invest New Drugs 26(2):189–192PubMedCrossRefGoogle Scholar
  39. 39.
    Oberbaum M, Yaniv I, Ben-Gal Y, Stein J, Ben-Zvi N, Freedman LS, Branski D (2001) A randomized, controlled clinical trial of the homeopathic medication TRAUMEEL S in the treatment of chemotherapy-induced stomatitis in children undergoing stem cell transplantation. Cancer 92(3):684–690PubMedCrossRefGoogle Scholar
  40. 40.
    Schiff E, Mogilner GJ, Sella E, Doweck I, Hershko O, Ben-Arye E, Yarom N (2009) Hypnosis for post-radiation xerostomia in head and neck cancer patients: a pilot study. J Pain Symptom Manage 37(6):1086–1092PubMedCrossRefGoogle Scholar
  41. 41.
    Ben-Arye E, Schiff E, Pasternak S, Levi M, Halperin O (2010) Patients between dryness and dampness: guided imagery metaphors in the treatment of patients with post-radiation xerostomia. J Pediatr Hematol Oncol 32(1):47–51Google Scholar
  42. 42.
    Lev-Ari S, Maimon Y, Yaal-Hahoshen N (2006) Long-term survival of a patient with widespread metastases from epithelial ovarian carcinoma receiving mind-body therapies: case report and review of the literature. Integr Cancer Ther 5(4):395–399PubMedCrossRefGoogle Scholar
  43. 43.
    Baider L, Peretz T, Hadani PE, Koch U (2001) Psychological intervention in cancer patients: a randomized study. Gen Hosp Psychiatr 23(5):272–277CrossRefGoogle Scholar
  44. 44.
    Argash O, Caspi O (2008) Touching cancer: shiatsu as complementary treatment to support cancer patients. Harefuah 147(8–9):707–711, 750, 749PubMedGoogle Scholar
  45. 45.
    Aghabati N, Mohammadi E, Pour Esmaiel Z (2011) The effect of therapeutic touch on pain and fatigue of cancer patients undergoing chemotherapy. Evid Based Complement Alternat Med. (in press)Google Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Eran Ben-Arye
    • 1
    • 2
  • Mohammed Saleem Ali-Shtayeh
    • 3
  • Mati Nejmi
    • 4
  • Elad Schiff
    • 5
    • 6
  • Esmat Hassan
    • 7
  • Kamer Mutafoglu
    • 8
  • Fatma U. Afifi
    • 9
  • Rana Majed Jamous
    • 3
  • Efraim Lev
    • 10
  • Michael Silbermman
    • 11
  1. 1.Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health ServicesHaifa and Western Galilee DistrictHaifaIsrael
  2. 2.Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of MedicineTechnion-Israel Institute of TechnologyHaifaIsrael
  3. 3.Biodiversity and Biotechnology Research UnitBiodiversity and Environmental Research Center, BERC, TilNablusPalestinian
  4. 4.Centre National des Soins Palliatifs-Douleur, Directeur de Programme de Recherche “Douleurs Sans Frontières” au Maroc, I.N.ORabatMorocco
  5. 5.Department of Internal MedicineBnai-Zion HospitalHaifaIsrael
  6. 6.Department for Complementary/Integrative Medicine, Law and Ethics, The International Center for Health, Law and EthicsHaifa UniversityHaifaIsrael
  7. 7.Botany DepartmentNational Research CentreGizaEgypt
  8. 8.Department of Pediatric OncologyDokuz Eylul University, Institute of OncologyIzmirTurkey
  9. 9.Department of Pharmaceutical SciencesFaculty of Pharmacy, University of JordanAmmanJordan
  10. 10.Department of Eretz Israel StudiesUniversity of HaifaHaifaIsrael
  11. 11.Middle-East Cancer ConsortiumHaifaIsrael

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