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Purpose: To clarify the current use of unapproved and unproven cancer treatment (UUCT) among the bereaved families of patients with cancer who died in palliative care units, the financial burden and psychological experiences of the families, and the relationship between patients in palliative care who used UUCT and communication with their physicians’. Methods: This study was conducted as part of a cross-sectional, anonymous nationwide survey of the bereaved family members of cancer patients who died in palliative care unit in Japan. Results: Questionnaires were sent to 1,039 bereaved family members, and responses were received from 661 (64%). Of these, 558 were included in the study after excluding the 103 who did not complete the questionnaire. A total of 7.3% (41 of 558) of patients received UUCT. Of these, 34% (14 of 41) of patients were informed that the treatment was in the research phase, and 49% (20 of 41) were informed that the efficacy of the treatment was unknown. Regarding expectations for UUCT, 61% (25/41) expected to be cured, and 80% (33/41) expected it to slow disease progression. In multivariate logistic regression analysis, use of complementary and alternative medicine (CAM) was associated with receiving UUCT (p = 0.024), and patients who could discuss CAM with their doctors tended to receive UUCT (p = 0.054). Conclusion: Patients in palliative care unit who expect to cure tended to receive UUCT. These results highlight the challenge of telling patients that UUCT is ineffective and informing them of their prognosis and severe medical conditions. [ABSTRACT FROM AUTHOR]

Purpose: This cross-sectional study aimed to investigate the prevalence and characteristics of supplement usage among cancer patients and explore its potential associations with anxiety, excessive daytime sleepiness, and overall quality of life. Methods: Cancer patients receiving specific care at Hôtel Dieu de France University Hospital, Beirut, were enrolled between April and June 2023. In face-to-face interviews, participants were asked to complete a questionnaire consisting of sociodemographic information, supplement usage details, and cancer-related variables. Three validated surveys (Epworth Sleepiness Scale, GAD-7, and EORTC-QLQ-C15-PAL) were employed to assess excessive daytime sleepiness, anxiety, and overall quality of life. Statistical analyses, including chi-square tests, t-tests, and multiple regression models, were conducted to examine associations between supplement use and other variables. Results: A total of 202 participants were interviewed. Fifty-two percent reported regular use of supplements following their cancer diagnosis, with vitamin D being the most commonly used supplement. Using multivariate logistic regression, supplement use was associated with being female, having lower educational levels, having a longer duration since cancer diagnosis, and having a poor overall quality of life. The multivariate logistic regression showed no significant correlation between supplement use and excessive daytime sleepiness and anxiety. Conclusion: This study highlights a high prevalence of supplement usage among cancer patients in Lebanon, indicating a rising interest in alternative therapies aimed at enhancing quality of life. Larger prospective studies are needed to assess the relation between supplement intake and excessive daytime sleepiness and anxiety and establish clear guidelines pertaining to supplement use in cancer patients. [ABSTRACT FROM AUTHOR]

This paper examines the predictors of belief in the efficacy of complementary and alternative medicine (CAM) and its use, including cognitive factors (scientific reasoning, health literacy, locus of control), beliefs (holistic and magical health beliefs pseudoscientific beliefs, and trust in doctors), sociodemographic factors, and cancer diagnosis. The sample consisted of 177 women (41.8% with a cancer diagnosis; Mage = 38.81, SD = 11.43). Beliefs in efficacy and use of CAM were the main outcome measures; preference for CAM over conventional treatment was a secondary outcome measure. Pseudoscientific/magical beliefs and external locus of control were the strongest predictors of positive attitudes toward CAM and its higher use, as well as preference for CAM instead of conventional treatment. Cancer diagnosis predicted only higher CAM use, but not more positive attitudes to CAM, nor preference for CAM instead of conventional medicine. Women with cancer had significantly more pseudoscientific beliefs than women without cancer and had a higher external locus of control over their health. Women with pseudoscientific/magical beliefs favor CAM treatments independently of the cancer diagnosis, although the diagnosis of cancer also contributes to their higher use of CAM. In other words, it seems improbable that women would turn toward CAM treatment only after being diagnosed with cancer. [ABSTRACT FROM AUTHOR]

Purpose: Mistletoe treatment is discussed controversial as a complementary treatment for cancer patients. Aim of this systematic analysis is to assess the concept of mistletoe treatment in the clinical studies with respect to indication, type of mistletoe preparation, treatment schedule, aim of treatment, and assessment of treatment results. Methods: In the period from August to December 2020, the following databases were systematically searched: Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL, and "Science Citation Index Expanded" (Web of Science). We assessed all studies for study types, methods, endpoints and mistletoe preparations including their ways of application, host trees and dosage schedules. Results: The search concerning mistletoe therapy revealed 3296 hits. Of these, 102 publications and at total of 19.441 patients were included. We included several study types investigating the application of mistletoe in different groups of participants (cancer patients of any type of cancer were included as well as studies conducted with healthy volunteers and pediatric patients). The most common types of cancer were breast cancer, pancreatic cancer, colorectal cancer and malignant melanoma. Randomized controlled studies, cohort studies and case reports make up most of the included studies. A huge variety was observed concerning type and composition of mistletoe extracts (differing pharmaceutical companies and host trees), ways of applications and dosage schedules. Administration varied e. g. between using mistletoe extract as sole treatment and as concomitant therapy to cancer treatment. As the analysis of all studies shows, there is no relationship between mistletoe preparation used, host tree and dosage, and cancer type. Conclusions: Our research was not able to deviate transparent rules or guidelines with respect to mistletoe treatment in cancer care. [ABSTRACT FROM AUTHOR]

Objective: The aim of this cohort study was to gain insight on influencing factors on the decision-making process in conventional medicine compared to complementary and alternative medicine (CAM). Methods: A standardized questionnaire was distributed among cancer patients who attended the counselling facility for CAM of a German university hospital in 2020. Results: Fifty patients (30.3%) returned the questionnaire. After counselling on CAM, most patients made a decision in CAM but also in conventional medicine. Thus, the focus on informed decision-making during counselling on CAM had a strong effect on the decision-making process in conventional medicine. Patients reporting good support also reported making decisions together with physicians and relatives. Moreover, after counselling on CAM, patients reported being more satisfied with their decision in both settings afterwards. Conclusion: Information on CAM which focuses on informed decision-making, supports patient's ability to understand and weigh risks and benefits of treatments, supports shared decision-making and enables patients to transfer these competences also to decisions on conventional medicine. So counselling on CAM may further decision-making competences in cancer patients. This encourages patients to engage in shared decision-making and increases patient's satisfaction with decisions. [ABSTRACT FROM AUTHOR]

Purpose: Nowadays, complementary and alternative medicine (CAM) is used by cancer patients all over the world. The aim of this study was to investigate the prevalence of CAM use in patients with cancer in Iran. Methods: This descriptive-analytical study was conducted on 320 cancer patients in Arak. For gathering information, a researcher-made questionnaire was used. This questionnaire was consisted of two parts: demographic and clinical information; and patient's attitude toward using complementary and alternative medicine treatments and their effectiveness, as well as how much they used different kinds of these treatments. The data were analyzed using SPSS software version 16. Results: Our findings showed that average age of participants was 55.11 ± 15.58. Most of them had leukemia (25.9%) and underwent chemotherapy (55%), and 141 (44.3%) of individuals were using CAM. Majority of patients (73.2%) were using CAM to improve physical conditions, 61.4% were using it simultaneously with conventional medical treatments, and 25% to reduce pain. Participants have reported visiting holy places, yoga, prayer therapy, and using medicinal plants and special diets, respectively. Conclusion: Considering the high number of patients using CAM treatments, proper planning and implementation to educate professional members of health team, especially doctors and nurses about CAM treatments is essential. The most important CAM treatments to be educated are spiritual therapies, yoga, medicinal plants, and diet therapy. Moreover, support and education about using these kinds of treatment should be considered in the supportive care program for patients with cancer. [ABSTRACT FROM AUTHOR]

Background/Aim: Non-medical practitioners (NMPs) are an ill-defined group of professionals offering patient diagnostic and therapeutic methods mostly in the field of complementary and alternative medicine (CAM). Despite a lack of quality-assessed structured professional formation, many patients with cancer visit NMPs for advice. This study aimed to learn more on patients' motives and expectations for consulting an NMP. Patients and Methods: A standardized questionnaire was distributed to adult cancer patients addressing attitudes towards NMPs, motives and expectations for consulting an NMP. Results: A total of 279 patients took part in the survey. Of the included patients 44.8% had already visited an NMP and 16.5% planned to do so. Reasons to visit an NMP were seeking for a supplementary treatment (72.0%) or control of side-effects (68.0%). While the oncologist ranked higher than the NMP in all aspects of physician-patient interaction and patients more often trusted in the oncologist, those patients rating their oncologist rather low in any of these questions significantly more often consulted an NMP. The methods applied or recommended by the NMPs were highly heterogenous ranging from biologically-based methods to mind-body-techniques. Most often used methods were homeopathy (72.0%) vitamin D (62.7%), selenium (42.7%), acupuncture (38.7%). Conclusion: There is a high proportion of cancer patients visiting NMPs mostly for additional treatment. Biologically-based treatments may induce side-effects and interactions, especially as NMPs are not trained on medically accepted cancer treatment and medications. Offering information on CAM and improving the physician-patient relationship are important means to answer unmet needs from the side of the patient. [ABSTRACT FROM AUTHOR]

Objectives: We estimated prevalence of complementary and alternative medicine (CAM) use by reason for use (treatment, wellness, or both) among non-institutionalized adults with cancer in the United States. We also examined health-related quality of life (HRQOL) outcomes among adults with cancer who used CAM.Methods: We used data from the 2012 National Health Interview Survey (NHIS), which represents non-institutionalized adults with cancer (n = 2967 unweighted). Using a cross-sectional design with survey sampling techniques, we estimated past year prevalence of CAM use. We ran multivariable logistic regression analyses to investigate the odds of perceived benefits of CAM.Results: In the past 12 months, 35.1% of adults with cancer reported using some form of CAM. Among CAM users, 56.0% used CAM for both treatment and wellness, and 32.4% used CAM for wellness only. Only 11.6% used CAM for treatment only. Regardless of reason for use, the most commonly used CAM types in the past year were herbal therapies (56.8%), chiropractic (27.1%), and massage (24.9%). Among CAM users, those using CAM for wellness only and for a combination of treatment and wellness reported significantly higher odds of "a better sense of controlling health" and "improved overall health and feeling better" compared with treatment only users. Similar patterns were found in other HRQOL outcomes, but they were not statistically different.Conclusions: CAM is widely used among adults with cancer for wellness only or a combination of treatment and wellness. Given improved HRQOL outcomes, CAM may be a promising approach for enhancing health promotion and well-being among adults with cancer. [ABSTRACT FROM AUTHOR]

Purpose: One important goal of any cancer therapy is to improve or maintain quality of life. In this context, mistletoe treatment is discussed to be highly controversial. The aim of this systematic review is to give an extensive overview about the current state of evidence concerning mistletoe therapy of oncologic patients regarding quality of life and side effects of cancer treatments. Methods: In September and October 2017, Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL and "Science Citation Index Expanded" (Web of Science) were systematically searched. Results: The search strategy identified 3647 articles and 28 publications with 2639 patients were finally included in this review. Mistletoe was used in bladder cancer, breast cancer, other gynecological cancers (cervical cancer, corpus uteri cancer, and ovarian cancer), colorectal cancer, other gastrointestinal cancer (gastric cancer and pancreatic cancer), glioma, head and neck cancer, lung cancer, melanoma and osteosarcoma. In nearly all studies, mistletoe was added to a conventional therapy. Regarding quality of life, 17 publications reported results. Studies with better methodological quality show less or no effects on quality of life. Conclusions: With respect to quality of life or reduction of treatment-associated side effects, a thorough review of the literature does not provide any indication to prescribe mistletoe to patients with cancer. [ABSTRACT FROM AUTHOR]

Background and purpose Cannabinoids are widely used to alleviate intractable symptoms such as pain, nausea, and muscle spasticity. The purpose of this review was to ascertain the current state of the science regarding use of cannabinoids for cancer pain. Methods Four electronic databases were searched for randomized control trials of cannabinoids and cancer pain. Studies included examined the analgesic effects of cannabinoids for cancer pain. Methodological quality was assessed using the Jadad scale. Conclusions Eight randomized control trials met the inclusion criteria for review. Most trials found analgesic effects from cannabinoids when compared to placebo, although not all associations reached statistical significance. The analgesic effects of cannabinoids were also limited by dose-dependent side effects. Side effects most commonly reported were changes in cognition, sedation, and dizziness. Implications for practice There is evidence that cannabinoids are effective adjuvants for cancer pain not completely relieved by opioid therapy, but there is a dearth of high-quality studies to support a stronger conclusion. Cannabinoids appear to be safe in low and medium doses. Methodological limitations of the trials limited the ability to make sound conclusions. Further research is warranted before efficacy, safety, and utility of cannabinoids for cancer pain can be determined. [ABSTRACT FROM AUTHOR]

Complementary and alternative medicine (CAM) including Japanese Kampo is known to have anticancer potential. An increasing number of cancer survivors are using CAM for disease prevention, immune system enhancement, and symptom control. Although there have been abundant previous clinical reports regarding CAM, scientific investigations aimed at acquiring quantifiable results in clinical trials, as well as basic research regarding CAM, have only recently been undertaken. Recent studies suggest that CAM enhancement of immune function is related to cytokines. This review provides a translational aspect of CAM, particularly Hozai in Kampo from both scientific and clinical points of view for further development of CAM for cancer treatment.

Although complementary and alternative medicine (CAM) is widely used in the pediatric population, research on the use of these therapies in the pediatric oncology population is of mixed quality. In this multicenter survey, we investigated the prevalence of CAM use, possible determinants of use, and parental attitude towards communication and research on CAM therapies. The prevalence of CAM use in the past 12 months was assessed by using a questionnaire based on the European guidelines on CAM research, filled out by parents of children visiting pediatric oncology outpatient clinics of six academic hospitals in the Netherlands. The questionnaire consisted of 26 questions on the child's clinical status, CAM use, and attitude towards communication and research on CAM therapies. One hundred and twenty-two of 288 respondents (42.4 %) reported CAM use. The most frequently used categories were homeopathy (18.8 %) and dietary supplements (11.5 %). Female gender and parental CAM use were significant predictors for the use of CAM ( p < 0.001). Only one third of the parents had discussed CAM use with their pediatric oncologist. More than 80 % of the respondents identified a need for information about CAM from their pediatrician and 85.7 % was positive towards research on CAM. Half of the parents were interested in participating in future CAM trials. Conclusion, with more than 40 % of parents of Dutch pediatric oncology patients providing complementary and alternative medicine to their child and with lacking evidence on efficacy and safety of most CAM modalities, there is a clear need for high-quality research in this field. This study shows that most parents have an open attitude towards CAM research and that almost half of the parents would consider participating in future CAM trials, paving the way for research on CAM and aiming for its evidence-based use in pediatric oncology. [ABSTRACT FROM AUTHOR]

Objectives: To provide an overview of key issues and resources related to complementary and alternative medical (CAM) and integrative approaches in cancer care. Data Sources: Peer-reviewed publications and web sites of professional, federal, and academic institutions and organizations. Conclusion: The field of integrative oncology is growing and research evidence in this area is burgeoning. Many cancer patients are using and can benefit from CAM. There are many resources and educational opportunities available to oncology nurses to enhance their CAM knowledge and skills. Implications for Nursing Practice: Nurses must keep abreast of the growing evidence in integrative oncology that documents the safety and efficacy of different CAM approaches for cancer patients. It is critical that nurses be aware of reputable resources and legal implications related to use of CAM. [Copyright &y& Elsevier]

Copyright of Der Onkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: India has an eclectic health system that incorporates biomedical as well as traditional, complementary and alternative medicine (TCAM). Our understanding of the co-existence of these therapeutic modalities in this diverse, postcolonial and developing nation is extremely limited, and in the context of cancer care, to our knowledge no sociological work has been carried out. Contemporary Indian oncology represents a fascinating site for examining the interplay and articulation of forms of tradition/modernity, economic progress/structural constraint and individual beliefs/cultural norms. In a context of an increase in the prevalence and impact of cancer in an ageing Indian population, this paper reports on a qualitative investigation of a group of oncology clinicians'' accounts of ‘pluralism’ in India. The results illustrate the embeddedness of patient disease and therapeutic trajectories in vast social inequalities and, indeed, the intermingling of therapeutic pluralism and the politics of social value. We conclude that notions of pluralism, so often espoused by global health organisations, may conceal important forms of social inequality and cultural divides, and that sociologists should play a critical role in highlighting these issues. [Copyright &y& Elsevier]

In recent years, the term integrative medicine has gained acceptance in medical academia. The Consortium of Academic Health Centers for Integrative Medicine defines this term as "the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing." Integrative oncology has been specifically described as both a science and a philosophy that focuses on the complex health of people with cancer and proposes an array of approaches to accompany the conventional therapies of surgery, chemotherapy, molecular therapeutics, and radiotherapy to facilitate health. The SIO and its Medline-indexed journal (Journal of the Society of Integrative Oncology), founded by leading oncologists and oncology professionals from major cancer centers and organizations, promote quality research and appropriate application of useful, adjunctive complementary modalities (). The SIO assembled a panel of experts in oncology and integrative medicine to evaluate the current level of evidence regarding complementary therapies in the care of cancer patients. To help health care professionals make evidence-based treatment decisions in integrative oncology, the panel made specific recommendations based on the strength of the evidence and the risks/benefits ratio. These practice guidelines, developed by the authors and endorsed by the Executive Committee of the SIO, address principles for clinical encounters, followed by individual classes of treatment modalities. There is an essential difference between "complementary" and "alternative" therapies. "Alternative" therapies are typically promoted as a substitute for mainstream care. By definition, alternative therapies have not been scientifically proven, often have no scientific foundation, and have sometimes even been disproved. However, complementary medicine makes use of unconventional treatment modalities and approaches that are nonsurgical and nonpharmaceutical but that have known efficacy. When combined with mainstream care, these modalities can enhance effectiveness and reduce adverse symptoms. The use of complementary and alternative therapies by cancer patients is common, and given that complementary therapies can be helpful in symptom control, but the substitution of therapies with no evidence of safety and/or efficacy can delay or impede treatment, we strongly recommend that medical professionals routinely inquire as to the use of such therapies during the initial evaluation of cancer patients. The extensive use of complementary and alternative therapies can also challenge and frustrate both health care professionals and patients, leading to a gap in communication that negatively affects the patient-provider relationship. This communication gap may also arise from the patient's perception that health care professionals are indifferent to or object to the use of unconventional therapies, a perception that can lead to a loss of trust within the therapeutic bond. Health care professionals, who remain open to inquiries and aware of subtle, nonverbal messages from patients, can create an environment where patients feel free to openly discuss all choices in their care. Evidence suggests that patients supported in this manner are less likely to pursue potentially dangerous alternative therapies and are more likely to adhere to conventional, evidence-based treatment programs. We strongly recommend that qualified professionals provide guidance in an open, evidence-based, and patient-centric manner with those who use or are interested in pursuing complementary or alternative medicine so that they can approach these therapies appropriately.… [ABSTRACT FROM PUBLISHER]

Copyright of Der Onkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: High levels of use of complementary and alternative medicine (CAM) have been consistently reported amongst cancer patients over recent years. This is occurring in the context of an apparent increase in sources of information on therapeutic alternatives and a growth in the range of those claiming professional expertise in the field. To date there has been little research on patient experience of discussions about CAM with biomedical cancer specialists in this increasingly complex social environment. This paper addresses three issues: patient experience with cancer specialists; the significance of that experience for patient engagement with CAM; and the nature and significance of inter-professional dynamics. It draws on the results of a qualitative study with cancer patients in the UK. In-depth interviews with 80 purposively sampled patients, incorporating a range of disease types and stages, were conducted. Patients reported three main types of approach by oncologists: explicit or implicit negativity; supportive ambivalence; and, pragmatic acceptance. Crucially, patients’ accounts suggest that the type of approach adopted influences (though does not determine) patient action. Specialist cancer nurses emerged as potentially powerful mediators between oncologists and patients. Despite the apparent potential for influence from multiple information sources and ‘experts’, on the basis of this study we would argue that oncologists remain crucial to patient engagement with CAM. However, this is not to argue that the influence is a simplistic one. Where patient and medical perspectives diverge, strategic alignment with specialist nurses may help patients make choices which conflict with perceived advice. [Copyright &y& Elsevier]

Background: In recent years the demand and use of complementary and alternative medicine (CAM) in malignant diseases has increased noticeably. Since the general knowledge about CAM use is scant and CAM could potentially interact with standard therapies the German Working group ‘Trace Elements and Electrolytes in Oncology’ performed a multi-centric study to comprehensively evaluate the use of CAM therapies in cancer patients treated with radiotherapy. Methods: 1,013 patients receiving consecutively radiotherapy for malignant diseases were interviewed using a standardized questionnaire including clinical and pathological tumor parameters as well as the type of CAM and reasons for CAM use. A self-assessment of patients' personal conditions was performed in order to evaluate the subjective impact of CAM on quality of life. Results: A total of 59% of patients reported using CAM therapies. CAM use was more common in female patients, generally higher in advanced stages of disease and most common in breast cancer patients. Most frequently reported CAM therapies were vitamins (18%), mistletoe extracts (15%), selenium (10%), and other trace element preparations (7%). Multivariate logistic regression showed age, gender, tumor type and stage, and smoking behavior to be significant predictors for CAM use. A subjective improvement in quality of life due to the use of CAM was accounted for in 30% of patients. Conclusions: More than half of patients undergoing RT for cancer are using CAM therapies. Therefore, radiation oncologists should be asking for respective obtaining information about CAM use in order to avoid harmful interactions with conventional therapies. The value and potential hazards of such combined treatments have yet to be tested in further clinical studies. [ABSTRACT FROM AUTHOR]

Interest in complementary and alternative medicine (CAM) continues to grow at an exponential rate despite the advances made by conventional medicine. Complementary and alternative medicine use is increasingly manifest across a wide range of health care settings, and is particularly prevalent in cancer and palliative care. In these arenas, patient groups and self-help organizations play a significant supportive role. There is evidence that they are a key informative and pragmatic resource in the provision of CAM services to patients. However, there is a significant paucity of research dealing with the functional aspects of these groups and the way in which they advocate, promote and supply CAM. In this paper we provide a critical review of the literature pertaining to themes around CAM provision and cancer care, and suggest that for a more complete picture of the field, the impact of group mediation of CAM needs to be addressed, and attention focused on the social and interactional dynamics that underpin these groups and organizations. [ABSTRACT FROM AUTHOR]

Most cancer therapeutics, such as tubulin-targeting chemotherapy drugs, cause cytotoxic, non-selective effects. These harmful side-effects drastically reduce the cancer patient's quality of life. Recently, researchers have focused their efforts on studying natural health products (NHP's) which have demonstrated the ability to selectively target cancer cells in cellular and animal models. However, the major hurdle of clinical validation remains. NHP's warrant further clinical investigation as a therapeutic option since they exhibit low toxicity, while retaining a selective effect. Additionally, they can sensitize cancerous cells to chemotherapy, which enhances the efficacy of chemotherapeutic drugs, indicating that they can be utilized as supplemental therapy. An additional area for further research is the investigation of drug–drug interactions between NHP's and chemotherapeutics. The objectives of this review are to report the most recent results from the field of anticancer NHP research, and to highlight the most recent advancements in possible supplemental therapeutic options. [ABSTRACT FROM AUTHOR]

Background: The number of people with cancer using complementary and alternative medicine (CAM) is increasing. However, CAM may have interactions with conventional cancer therapies. In addition, alternative medicine procedures may result in significant health risks. Because of the Internet, regional CAM methods easily spread globally. This study aims at evaluating CAM procedures offered on Spanish-speaking South American websites and assessing the quality of these websites.Methods: An Internet search was carried out in nine Spanish-speaking countries in South America. Websites were analysed using a standardized tool.Results: In total, 85 websites, with a wide range of 158 different CAM procedures were evaluated. The vast majority of websites had poor content and formal quality. Overall, no website was rated as very good and only two websites could be rated as good. Among the most commonly mentioned South American methods were an Aloe- mixture called "Fray Romano", graviola, uncaria tomentosa (Cat's claw), the "Método HANSI" and components of the lapacho tree.Conclusions: There is an urgent need for quality-assured, easy-to-find sites with high quality for Spanish speaking persons in South America. Several of the methods have already spread to Europe as graviola or uncaria. [ABSTRACT FROM AUTHOR]