Little Appetite For Conventional Cancer Treatment Among Some Malaysians

Nur Hayati Sahak wishes for a time machine.

If there was one, she would go to a particular moment in 2016 when she was sitting 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 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 getting 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 she spent about RM50,000 on alternative and traditional treatments such as the supernatural healing sessions with one witch doctor or bomoh in Kedah who told her he was giving her invisible chemotherapy through an invisible IV (intravenous) 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.

Nur Hayati Sahak, 44, regrets turning to alternative and traditional medicine when she suspected she had cancer. --fotoBERNAMA (2024) COPYRIGHT RESERVED

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. 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 getting 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 Dzulkefly Ahmad announced in a press statement that the Malaysian National Cancer Registry recorded 168,822 new cancer cases from 2017 to 2021. Breast cancer, colorectal cancer, lung cancer, lymphoma cancer and liver cancer were the top five 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 percent in 2021 to 12.6 percent in 2022. Over 60 percent 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 is also a communication issue. She said doctors are 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 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 is to recognise that a positive diagnosis usually prompts 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. 

Zuraini Kamal, president and founder of Cancer Survivors Malaysia support group. --fotoBERNAMA (2024) COPYRIGHT RESERVED

Dr Hariyati Sharima Abd Majid, a consultant psychologist, agreed, adding that it is 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 the objective is to include patients in treatment plans and give them back some semblance of control over their lives.

COMPLICATIONS 

Convincing patients to undergo conventional treatment as soon as possible is important to increase the chances of surving but discouraging use of some traditional and alternative treatments, especially those that require ingesting herbal concoctions, is also key since they may cause complications. Traditional and alternative medicine in Malaysia ranges from mainstream practices such as acupuncture and massage and fringe supernatural healing by witch doctors to consuming herbal supplements, either sold by companies or local practitioners. 

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 percent of breast cancer patients admitting 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 United States’ Journal of the National Cancer Institute on Aug 10, 2017, found that after 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.

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. Photo taken from Facebook. --Nina Muslim/Bernama

Traditional and alternative medicine usually has herbal supplements and concoctions as part of the treatment. 

Medical experts Bernama talked to said many of the dangers are due to the unintended side effects of these medicines and treatments, some of which are unregulated and unregistered. Registered or not, most people would not know what the effect of a 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 on the market work like steroids, which will improve 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 anti-cancer properties although there is no scientific evidence to back it up. A partially man-made and more purified version of amygdalin is called laetrile. It is often 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 doctors see is daun belalai gajah or Sabah snakegrass. 

Consultant cardiothoracic surgeon Dr Anand Sachithanandan told Bernama that traditional and alternative herbal treatments can complicate treatment. And sometimes, patients forget to disclose supplements as they don’t 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 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.

HOLISTIC

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 said it is important to treat patients holistically, that is, physically as well as mentally.

Health Minister Datuk Seri Dr. Dzulkefly Ahmad giving the keynote address at the launch of Liver Cancer Awareness Day in conjunction with World Cancer Day in Cheras on Feb 4. --fotoBERNAMA (2024) COPYRIGHT RESERVED

Doctors acknowledge some traditional and complementary medicines serve a purpose by alleviating symptoms and improving the quality of life for cancer patients.

“We treat the person, rather than just the organ,” said Dr Cecilliann Veronica, an integrative and functional medicine physician at SOL Integrative Wellness Centre.

These days, Nur Hayati tries not to dwell on the past too much though it can be hard, especially when she found out her cancer had returned in December, after being cancer-free for nine months.

She told Bernama if she knew more about cancer and the importance of getting 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 left,” she said. 

Life is too short after all.

This is the second of a series of three articles on traditional medicine and the dangers of using it to treat cancer.