Cancer is a deadly disease that affects millions of people around the world. In the United States, one in four deaths is thought to be due to cancer (Siegel et al., 2013). According to statistics from the Palestinian Ministry of Health, the incidence of cancer in the West Bank in 2010 was approximately 53.7 per 100,000 Palestinian population (MoH, 2011). Of these cases, 18.8% were breast cancer (MoH, 2011).
To meet their health care needs, cancer patients often seek treatments within as well as outside the allopathic treatment paradigm (Bauml et al., 2015). The term complementary and alternative medicine (CAM) has evolved to include a variety of behavioral techniques and clinical approaches, including the use of herbal medicines (Burstein et al., 1999). As in many other countries, herbal medicines are widely used as CAM in cancer treatment in Palestine (Ali-Shtayeh et al., 2011). Recent surveys have shown that approximately two-thirds of cancer survivors use CAM (Bauml et al., 2015, Mao et al., 2007, Mao et al., 2011). Previous studies have reported that the rate of CAM use among breast cancer patients is even higher, ranging from 67% to 83% (Boon et al., 2000, Richardson et al., 2000). Patients may use CAM in addition to (complementary) allopathic medications or instead of (alternative) allopathic medications ( Ali-Shtayeh et al., 2011 ).
CAM modalities are largely based on centuries-old traditions. Unfortunately, the safety and efficacy of many of these treatments is not supported by scientific evidence (Bauml et al., 2015). However, recent studies have shown evidence of safety and efficacy for some of these treatments (Mao et al., 2014a, Mao et al., 2014b). Major academic cancer centers are now setting standards to ensure that clinical trials using his CAM are conducted in a scientifically rigorous manner (Bauml et al., 2015).
Studies have shown that around 3000 plant species are used as anti-cancer agents by different traditions around the world ( Cragg and Newman, 2005 , Khazir et al., 2014 ). Therefore, many nutritional supplements and herbal extracts have been shown to have some degree of anticancer activity. in vitroThese anticancer effects include induction of apoptosis, inhibition of proliferation, inhibition of invasive behavior, induction of cell cycle arrest, and suppression of tumor angiogenesis (Cai et al., 2004, Deepa et al., 2012, Engel et al., 2011, Fang et al., 2013, Gaudet et al., 2004, Mohankumar et al., 2014, Sahpazidou et al., 2014, Shukla and Mehta, 2015, Soares et al., 2011) . Perhaps the presence of phenols and polyphenols in plants was the main reason for the activity against cancer cells. Other compounds with potential anticancer properties include flavonoids, tannins, stilbenes, diarylheptanoids, coumarins, phenolic acids, quinones, and lignans (Cai et al., 2004, Deepa et al., 2012, Engel et al., 2011, Fang et al., 2013, Gaudet et al., 2004, Mohankumar et al., 2014, Sahpazidou et al., 2014, Shukla and Mehta, 2015, Soares et al., 2011).
Patterns of CAM usage vary from country to country and culture to culture. Previous studies have demonstrated that several clinical and sociodemographic factors, such as gender, education level, age, and socio-economic status, are predictors of CAM use (Fouladbakhsh et al., 2005 , Schernhammer et al., 2009). In Palestine, little is known about the use of CAM by cancer patients, especially women with breast cancer. This study was conducted to assess patterns of CAM use among Palestinian women living with breast cancer, explore clinical and sociodemographic predictors of CAM use, and identify perceived benefits from CAM use. Ta.
This study also aims to identify the sources of information and underlying reasons for CAM use. To our knowledge, no previously published studies have investigated patterns of CAM use among Palestinian women living with breast cancer.
