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Alternative Medicine Use Worldwide

The International Union Against Cancer Survey

Barrie R. Cassileth, Ph.D.1

Simon Schraub, M.D.2
Eliezer Robinson, M.D.3
Andrew Vickers, Ph.D.1
1

Integrative Medicine Service, Memorial SloanKettering Cancer Center, New York, New York.

Comprehensive Cancer Center, Centre Paul

Strauss, Strasbourg, France.

Northern Israel Oncology Center, Haifa, Israel.

BACKGROUND. In the current study, the authors attempted to surmount the

deficiencies of previous surveys and elicit information regarding the use of alternative treatments of cancer worldwide.
METHODS. The International Union Against Cancer (UICC), an international,
nongovernment volunteer organization, E-mailed a questionnaire concerning alternative therapy use to its members.
RESULTS. A total of 83 responses from 33 countries were received. Descriptive
analyses of this dataset were conducted, indicating the existence of a large and
heterogeneous group of unproved remedies used to treat cancer in both developed
and developing countries around the world.
CONCLUSIONS. Improved public education concerning the importance of early
medical attention and the value of documented cancer therapies, the wider availability of useful cancer treatments, and public policies that are sensitive to the
patients need to play a meaningful role in his or her own care are required. Cancer
2001;91:1390 3. 2000 American Cancer Society.

KEYWORDS: cancer, alternative medicine, prevalence, International Union Against

Cancer.

Address for reprints: Barrie R. Cassileth, Ph.D.,

Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New
York, NY 10021; Fax: (212) 794-5851; E-mail:
Cassileth@mskcc.org
Received July 7, 2000; revision received December 21, 2000; accepted January 3, 2001.
2000 American Cancer Society

omplementary and alternative medicine (CAM) therapies appear

to be widely used by cancer patients in many parts of the world.
A systematic review of relevant published data1 located 26 surveys of
cancer patients conducted in 13 countries, including 5 in the U.S. The
average prevalence across all studies was 31%, indicating that nearly
one-third of cancer patients used CAM therapies. Those regimens
used most often included dietary treatments, herbs, homeopathy,
hypnotherapy, imagery/visualization, meditation, megavitamins, relaxation, and spiritual healing. Subsequent investigations reported
similar findings, with some studies finding even an higher prevalence
of CAM practices among cancer patients.27
An important shortcoming of the existing literature is that it is
confined to the relatively small number of countries in which surveys
have been conducted. Therefore, no information is available for much
of the world. Another drawback of currently available research is that
many studies failed to distinguish between alternative and complementary therapies.
Complementary therapies, such as massage or relaxation methods, are used adjunctively along with mainstream care for symptom
management and to enhance quality of life. Alternative therapies
(such as the regimen developed at the Gerson Clinic in Tijuana,
laetrile, shark cartilage, or the Di Bella therapy) are active biologically,
often invasive, and typically promoted as cancer treatment to be used
instead of mainstream therapy. Complementary therapies can be

UICC CAM Survey/Cassileth et al.

1391

helpful but alternative medicine, because it can create

direct physiologic interference or indirect harm by
keeping patients from receiving timely care, presents
serious problems to both the oncologist and the patient.
The current study describes an effort to surmount
the deficiencies that characterize previous surveys and
to obtain a broader geographic range of information
concerning the use of alternative cancer therapies.
The International Union Against Cancer (UICC) is
an independent, international, nongovernment volunteer organization with a worldwide mandate to work
for the control of cancer. The UICC E-mailed a questionnaire regarding the use of alternative therapy to its
member organizations. An accompanying message
from the President of the UICC requested a reply from
an oncologist or another senior person at each member organization. The aim was to gather data regarding the scope and specifics of alternative therapies
used to treat cancer worldwide. We hoped to broaden
current understanding by obtaining information from
countries not previously surveyed and from oncologists, whose views concerning CAM utilization rarely
are sought.
This was not a formal survey, and it was not intended to produce quantitative estimates of prevalence or attitudes.

TABLE 1
Countries Providing Survey Responses

MATERIALS AND METHODS

number of responses were returned from Israel (N

19), Australia (N 12), and the United Kingdom (N
6). Each of the remaining countries sent 5 responses, and a single reply was received from 20 countries.
An extraordinary variety of different alternative
remedies was reported (Table 2). Specific therapies
varied geographically, so that, for example, the Di
Bella therapy was mentioned in Italy and other Mediterranean countries, the use of essiac was reported in
Canada, and the use of mistletoe was reported in
central Europe. Although they are found to a limited
degree elsewhere, many therapies are used primarily
in the country of their origin, such as kamateros spring
water in Greece, antineoplastons in the U.S., the
Breuss diet in the Czech republic, and hasumi vaccines in Japan. Many therapies are associated with a
single unconventional practitioner. The treatments reported most often included dietary therapies, shark
products, vitamin therapies, and botanicals.
The majority of respondents believed that alternative medicine constituted a problem in their country, and most had discussed alternative medicine with
their patients. However, only a minority of respondents felt adequately well informed regarding alternative medicine. The majority of respondents as-

In the fall of 1999, questionnaires were drafted by the

authors and sent for review to all members of the
UICC Alternative Medicine Committee. The comments of the committee members were incorporated
and the questionnaires then were sent via E-mail to
286 UICC member organizations in 83 countries. The
questionnaires, which could be completed and returned by E-mail, were comprised of basic, factual
questions regarding the types and the prevalence of
alternative therapies used in the respondents country. Information concerning each respondents professional background also was solicited.
Completed questionnaires were collected and collated by one of the authors (S.S.) and then sent to the
Memorial Sloan-Kettering Cancer Center for analysis.
The nature of the dataset (incomplete and nonrandom) required descriptive analyses. Those analyses
are reported herein.

RESULTS
A total of 80 questionnaires were received from 33
different countries, including the United Kingdom, the
U.S., China, Australia, Zimbabwe, Brazil, Latvia, Malaysia, Tasmania, and Japan (Table 1). The majority of
respondents were oncologists. A disproportionate

Argentina
Australia
Austria
Bahrain
Bangladesh
Belgium
Brazil
Canada
China
Colombia
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Estonia
Fiji
Finland
Spain
Sudan
Sweden
Switzerland
Taiwan
Thailand

France
Germany
Greece
Guatemala
Honduras
Hungary
Iceland
India
Indonesia
Ireland
Israel
Italy
Japan
Jordan
Korea
Kuwait
Lebanon
Latvia
Lithuania
Luxembourg
Malaysia
Malta
Trinidad and Tobago
Tunisia
Turkey
United Kingdom
United Arab Emirates
United States

Mexico
Mongolia
Namibia
Nepal
Netherlands
New Zealand
Nigeria
Norway
Oman
Pakistan
Panama
Peru
Philippines
Poland
Portugal
Romania
Russia
Saudi Arabia
Singapore
Slovakia
Slovenia
South Africa
Uruguay
Venezuela
Vietnam
Yugoslavia
Zimbabwe

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CANCER April 1, 2001 / Volume 91 / Number 7

TABLE 2
Alternative Therapies by Category
Diets and
supplements

Botanicals

Unconventional agents

Traditional medicine

Energy healing and other

Shark cartilage, aleta de tiburon (shark fin)

Isoflavones (genistein, biochanin,
daidezein, and formononetin)
Laetrile

Acupuncture
Folk medicine

Magnetic fields
Bioresonance therapy

Ayurveda

Teletherapy (irradiation treatment)

Houtsmuller diet

Sun herbal compound

Royal Agaricus
mushroom
Essiac (burdock root,
sorrel, Indian rhubarb,
and slippery elm)
Mistletoe (iscador)

Ozone

Siddha and unani medicine

Macrobiotic diet
The Bristol diet
High dose vitamins
Selenium

Bitter cucumber
Traditional Chinese herbs
Aloe vera
Reishi mushroom

Curanderos
Brujos
Qi gong

Trace minerals

Rodent tuber

Wheat grass

Nerium oleander

Lassi (butter and milk)

Curcumin

Noni juice

Tulsi
Maca plant extract

Chelation
Autologous-targeted cytokines
714X (Gaston Naessens)
Hasumi vaccine (made from patients
urine)
Di Bella therapy (somatostatin,
bromocriptine, cyclophosphamide, and
multivitamins)
Maruyama vaccine (from organisms that
cause tuberculosis)
Beljanski treatment (mitotic agents that
destroy only cancer cells)
Burzynskis antineoplastons
Quantum booster (sends vibrations
through the body)
Tallberg regimen (calf brain, etc.)
Heavy metals

Tronado machine (high radio

frequencies)
Homeopathy
Naturopathy
Alevizatos treatment
Kamateros spring water

Gerson diet
Breuss diet
Moerman diet

Una de Gato
Trinivin (red clover plant)
Phytoestrogens
Hoxsey therapy

sumed that patients turn to alternative medicine

because they were failing on mainstream treatment.

DISCUSSION
Alternative medicine appears to be a feature of oncology regardless of geographic region, and it appears to
exist in great abundance. Nevertheless, the number
and variety of different alternative therapies used in
each country most likely is underestimated substantively in the current survey. This is assumed because
the oncologist responders were unlikely to have full
knowledge of patient use of CAM, because the survey
return rate was 28% of individuals and 40% of countries contacted, and because the number of different
therapies reported usually grew with the number of
replies received from that country. For example, 12
replies from Australia yielded 20 different remedies, 4
replies from India produced 10 therapies, and 1 reply
each from Germany and Ireland resulted in 1 therapy
noted for each of these countries. Thus, it is likely that
additional respondents from each country would have
produced an even longer list of alternative cancer
regimens.
Although cancer survival rates are improving,

Detoxification with diets and

enemas
Urine therapy
Hyperthermia
Immune enhancement
Wasam (scarring of skin around
swelling or pain)
Pildora de Vibora de Castabel
Blastofag

prognosis varies by specific cancer diagnosis and by

geographic location, and patients in some areas of the
globe may well seek alternative therapies because they
do not have adequate access to mainstream cancer
treatment.8 Furthermore, throughout history, people
have acted to assist themselves and their ill family
members, hence the existence of a rich folk heritage of
healing methods in all cultures. Self-care appears to be
an integral component of human instinct and preference.
Despite the weaknesses of the current study, especially the uncontrolled methodology and relatively
low return rate, data from previously unrepresented
countries were obtained
Therefore, the problem with alternative cancer
therapies appears to require three eventualities: better
education to stress the importance of seeking early
medical attention and the value of documented cancer therapies, availability of useful therapies to all
individuals, and understanding on the part of health
professionals and policy makers that patients need to
play a meaningful role in their own care. The UICC
will continue its work toward these goals.

UICC CAM Survey/Cassileth et al.

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