Dietary and non-dietary complementary and alternative medicine use in Saudi Arabia: the differential role of associated factors.

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Learn more: PMC Disclaimer | PMC Copyright Notice BMC Complement Med Ther . 2026 Apr 17;26:201. doi: 10.1186/s12906-026-05370-x Dietary and non-dietary complementary and alternative medicine use in Saudi Arabia: the differential role of associated factors Omar B Da’ar 1, 2, 3, ✉ , Mohammad Alkaiyat 1, 2, 3 , Faisal A Alsadoun 4 , Sarah GM Alshehri 5 , Anadel H Hakeem 5 , Hend R Almazroa 11 , Manair NA Alrajhi 6 , Fatemah S Bin Saleh 5 , Abdulaziz A Almusalam 7 , Nawaf Algannas 8 , Fahad Nasser Alzaid 9 , Abdullah E Almanea 5 , Abdul Rahman Jazieh 10 Author information Article notes Copyright and License information 1 Department of Health Systems Management, College of Public Health & Health Informatics, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia 2 King Abdullah International Medical Research Center(KAIMRC), Riyadh, 11481 Saudi Arabia 3 Department of Oncology, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, P.O. Box 22490, Riyadh, 11426 Kingdom of Saudi Arabia 4 King Faisal specialist Hospital and Research Center, Riyadh, Saudi Arabia 5 Ministry of National Guard Health Affairs, King Abdulaziz Medical City, P.O. Box 22490, Riyadh, 11426 Kingdom of Saudi Arabia 6 Otorhinolaryngology Head and Neck Surgery Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia 7 Department of Family Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia 8 King Fahad Medical City, Riyadh, Saudi Arabia 9 Family Medicine Registrar at First Health Cluster, Riyadh, Saudi Arabia 10 Cincinnati Cancer Advisors, Cincinnati, OH USA 11 Department of Family Medicine, Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia ✉ Corresponding author. Received 2025 Feb 5; Accepted 2026 Mar 27; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13220418  PMID: 41998667 Abstract Introduction Complementary and alternative medicine (CAM) is widely used among cancer patients in Saudi Arabia. However, there is currently a lack of analysis of disaggregated data on CAM use. This study predicts the likelihood of CAM use, particularly dietary or non-dietary supplements, based on patients’ socioeconomic characteristics, clinical conditions, and motivations for use. A clearer understanding of these dynamics will enable healthcare providers to align evidence-based guidance with patients’ preferences and needs. Methods This cross-sectional study was conducted in oncology departments to investigate the use of CAM, both dietary and non-dietary supplements, among cancer patients. We utilized validated instruments to record specific therapies and non-mainstream practices that patients used. Descriptive statistics were applied to summarize the variables of interest, while we categorized CAM usage into dietary and non-dietary supplements. Multivariate logistic regression was performed to explore the association between CAM use, demographic, socioeconomic factors, clinical profiles, and motivations or reasons for use, while examining whether educational attainment moderates the influence of social beliefs and gender on CAM use. Results More than three-quarters (79%) of patients reported CAM use; 69% used dietary supplements, 71% used non-dietary supplements, and 62.5% used both. Patients with intermediate or secondary education were about twice as likely to use dietary and non-dietary supplements concurrently as those without formal education (OR = 2.15, 95% CI, 1.04-4.46, p = 0.04). By contrast, monthly income > $1,600 (vs. < $800) and having a hematologic malignancy were associated with lower odds of concurrently using dietary and non-dietary supplement use (OR = 0.58, 95% CI, 0.35-0.98, p = 0.04 & OR = 0.58, 95% CI, 0.35-0.98, p = 0.03). Women were twice as likely as men to use dietary supplements (OR = 2.17, 95% CI, 1.16-4.08, p = 0.02). Mood improvement was a strong motivator, where patients reporting this reason were more likely to use dietary supplements (OR = 2.67, 95% CI 1.26-5.66, p = 0.01) or non-dietary supplements (OR = 2.40, 95% CI 1.04-5.53, p = 0.04). Patients aged >50 years were less likely to use non-dietary supplements than younger patients (OR = 0.39, 95% CI, 0.17-0.90, p = 0.03). Educational attainment did not moderate the influence of social beliefs and gender on CAM use. Conclusion CAM use was highly prevalent and significantly predicted by socioeconomic factors, clinical profiles, and mood improvement as a motivation for use. There is a need for integrating proactive CAM use screening that addresses gender , age , and diagnosis specific patterns of CAM use and risks. Future studies that investigate patients’ decision-making and evaluate the safety and efficacy of commonly and locally used CAM supplements. Keywords: Complementary and alternative medicine use, Dietary supplements, Non-dietary supplements, Cancer patients , Saudi Arabia Introduction Complementary and alternative medicine (CAM) encompasses non-mainstream practices that can complement conventional medicine [ 1 ]. Its popularity is increasing alongside rising health awareness and a growing interest in self-managemen [ 2 – 7 ]. CAM use is particularly prevalent among cancer patients, yet there is little consensus on the reasons behind its use or the specific types of patients who utilize it. Many patients turn to CAM to alleviate treatment side effects from conventional treatment, enhance their overall well-being, bolster their immune system, and improve quality of life [ 8 – 10 ]. Additionally, CAM usage is associated with chronic diseases and physical activity [ 11 ]. However, CAM use also poses risks, including harmful interactions with conventional treatments or adverse events [ 12 ]. Therefore, the availability of conventional healthcare services is not a critical determining factor in seeking treatment and may have less impact on the use of CAM [ 13 ]. Socioeconomic factors play a role in CAM utilization. Evidence suggests that this use is significantly associated with place of residence, age, level of education, and occupation, rather than gender or possession of health insurance [ 13 ]. Understanding the socioeconomic and clinical characteristics of patients who use CAM can inform healthcare providers about tailoring their discussions about alternative treatments, thus addressing patient preferences while ensuring safety and efficacy [ 14 ]. CAM is widely used in Saudi Arabia [ 15 – 28 ]. Evidence from various studies highlights aggregate analyses of CAM use, revealing differences across patient age, gender, and types of disease. However, there is limited availability of disaggregated CAM data. This study aims to predict the likelihood of using dietary supplements and non-dietary supplements based on patients’ socioeconomic characteristics, clinical conditions, and reasons for their CAM use. In this study, we aimed to dissect the use of CAM by categorizing it into dietary and non-dietary components. We employed descriptive analysis to characterize the data and a multivariate analysis to predict the relationships between these components and the socioeconomic and clinical characteristics of cancer patients, allowing for a more detailed examination of this relationship. Furthermore, we investigated whether educational attainment moderates the influence of social beliefs and gender on CAM use. Understanding the impact and significance of patients’ socioeconomic factors, clinical profiles, and motivations or reasons for use on their likelihood of engaging with various forms of CAM is crucial for healthcare providers. Such discernments are crucial for physicians, as they may experience uncertainty regarding the range and effectiveness of complementary therapies in relation to conventional treatments. A clearer understanding of these dynamics will enable healthcare providers to align evidence-based guidance with patients’ preferences and needs. Methods Study design This is a cross-sectional analysis involving patients diagnosed with cancer in the Oncology Department at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Inclusion criteria Eligible patients with malignancies who consented to participate were enrolled in the study and completed the questionnaire. Tool description The study used a well-developed questionnaire that was previously used to evaluate CAM use among adult patients with cancer. The tool was developed by Jazieh, et al (2004) in English [ 29 ]. Subsequently, it was translated into Arabic, assessed for validity, and used in Saudi Arabia to determine CAM use among adult patients with cancer in Saudi Arabia [ 18 , 20 ]. The instrument is a straightforward questionnaire, designed for ease of completion. A research coordinator assisted participants to ensure most patients could complete the questionnaire without difficulty. The questionnaire recorded the type CAM used, demographics, socioeconomic characteristics, clinical profiles, motivations or reasons for use, and perceived benefits, among other information. Data collection The data for this study was collected from patients enrolled between 2016 and 2018 using a convenience sampling technique. Eligible patients attending the oncology clinics of King Abdulaziz Medical City hospital were invited to participate, and those who consented completed the survey. The instrument used in this study has been described in a previous publication [ 26 ]. Statistical analyses Participants’ data were entered into an Excel database, cleaned and transferred to Stata 16 statistical software (College Station, TX: StataCorp LLC). STATA was used to analyze the data. Descriptive analysis was performed to characterize the socio-economic and clinical profiles related to complementary and alternative medicine (CAM) use among cancer patients enrolled at KAMC in Riyadh. Additionally, multivariate logistic regression was employed to model the associations between cancer patients’ socioeconomic and clinical factors and their use of CAM. Odd ratios (ORs) with 95% confidence intervals (CIs) were calculated to illustrate the strength of these associations. We hypothesized an interaction between educational level and social beliefs to determine whether educational level influences CAM use based on social beliefs among cancer patients. Results A total of 952 adult cancer patients participated in the study, with a mean age of 55 years ± 16.17 (SD). Among these patients, 61% were female, 69% were married and 25.5% had higher education, while 29% were not educated. Approximately 58% of the patients were unemployed, compared to 19% who were full-time employed. Over a quarter (27%) were patients with a monthly income exceeding USD 1,600, while 44% were from households earning less than USD 800 monthly. The majority (81%) had solid tumors, while 19% had hematological malignancies (refer to Table 1 for details). Table 1. Demographics, socioeconomic and clinical characteristics of patients ( N = 952) Characteristics n (%) Age (Mean ± SD; Median, IQR 55 ± 16.17; 56 (17-98) Gender Male 367 (38.6) Female 585 (61.4) Marital status Separated 14 (1.47) Widow 139 (14.6) Divorced 28 (2.94) Married 654 (68.7) Single 117 (12.3) Education Uneducated 280 (29.4) Primary 162 (17.0) Intermediate 100 (10.5) Secondary 167 (17.5) Higher Education 243 (25.5) Work status No job 554 (58.0) Part-time 20 (2.1) Full-time 179 (18.8) Retired 198 (20.8) Unknown 1 (0.1) Monthly income (USD) < $800 421 (44.2) $800 to $1600 182 (19.1) > $1600 264 (27.7) Unknown 85 (8.9) Monthly cost of CAM (Mean ± SD) 429 ± 4133 Cancer type Solid tumor 770 (80.9) Hematological malignancy 179 (18.8) Stem Cell Transplant 3 (0.3) Open in a new tab Figure 1 shows that more than three-quarters (79%) of the 952 cancer patients used some type of CAM remedy. Dietary supplements (DS) were used by 661 (69%), while 679 (71%) use non-dietary supplements (NDS). Over three-fifth (62.5%) of the patients concomitantly used both dietary and non-dietary supplements. Fig. 1. Open in a new tab Dietary supplement (DS), non-dietary supplement (NDS, and both DS and NDS CAM use As shown in Fig. 2 , patients used a variety of dietary remedies, such as Zamzam water (57%), water that has had Quranic verses recited on it as a form of healing (47%), honey (8%), black seed (23%), olive oil (32%), and herbal mix (8%). Cancer patients also used non-dietary supplements, including recitation of the Holy Quran (62%) and supplication (64%), a form of prayer or worship, asking for guidance and blessing from God. As shown in Fig. 3 , more than half of the patients (57.6%) used CAM for cancer treatment, 9% used it for pain relief, 10% to boost the immune system, and 12% for religious reasons. Others used CAM for a variety of other reasons, such as to shrink tumors, increase strength, improve mood, and for social reasons. Finally, the data showed that about 36% of patients told their doctors about CAM use. A third (34%) used CAM before their diagnosis, while 78% used it after their diagnosis. This is consistent with the description in Fig. 3 where 71% indicated that CAM use was for cancer treatment purposes. However, only 6% reported that they had delayed their treatment because of using CAM. Table 2 presents the results of the multivariate logistic regression analysis, highlighting the association between patients’ socio-economic and clinical characteristics and their overall use of complementary and alternative medicine (CAM), encompassing both dietary and non-dietary supplements. The findings reveal significant associations with education level, gender, age, income, cancer type, and reasons for CAM use. Patients with an intermediate schooling level are twice as likely to concurrently use both dietary and non-dietary supplements compared to those with no education (OR = 2.15, 95% CI, 1.04 to 4.46, p = 0.04). However, patients with a monthly income exceeding $1,600 exhibited 42% lower concurrent use of dietary and non-dietary supplements compared to those earning less than $800 (OR = 0.58, 95% CI, 0.35 to 0.95, p = 0.03). Similarly, patients with hematologic malignancies showed 42% lower concurrent use of dietary and non-dietary supplements use than those with solid tumors (OR = 0.58, 95% CI, 0.35 to 0.98, p = 0.04). For the disaggregated data, women were twice as likely to use dietary supplements compared to men (OR = 2.17, 95% CI, 1.16-4.08, p = 0.02). Similarly, relative to other reasons, mood improvement was a strong motivator, where patients reporting this reason were more likely to use dietary supplements (OR = 2.67, 95% CI 1.26-5.66, p = 0.01) or non-dietary supplements (OR = 2.40, 95% CI 1.04-5.53, p = 0.04). Patients older than 50 years were less likely to use CAM, especially non-dietary supplements, than younger patients (OR = 0.39, 95% CI, 0.17-0.90, p = 0.03). Compared to other cancer types, patients with hematologic malignancies showed 61% lower odds for non-dietary supplement use (OR = 0.39, 95% CI, 0.17-0.90, P = 0.03). Fig. 2. Open in a new tab Percentage (%) utilization of various dietary and non-dietary supplements Fig. 3. Open in a new tab Bar chart showing the reasons for using CAM Table 2. Association between CAM use and demographics, socioeconomic, clinical factors and reasons for use CAM Use CAM Use dietary supplement CAM Use non-dietary OR 95% CI P -Value OR 95% CI P -Value OR 95% CI P -value Age Age > 50 years 1.04 0.66:1.65 0.87 1.08 0.52:2.24 0.83 0.39 0.17:0.90 0.03* Gender Female 1.06 0.69: 1.64 0.80 2.17 1.16:4.08 0.02* 1.13 0.55:2.06 0.68 Marital status (Separated = base) Window 1.76 0.49:6.30 0.39 1.27 0.14:11.71 0.83 4.34 0.55:34.07 0.16 Divorced 2.77 0.51:15.22 0.24 2.47 0.18:33.70 0.50 1.75 0.17:17.81 0.64 Married 1.51 0.45:5.14 0.51 2.52 0.28:22.29 0.41 2.25 0.31:16.61 0.43 Single 0.94 0.25:3.58 0.92 1.24 0.12:12.77 0.85 1.44 0.18:11.76 0.73 Education (No schooling = base) Primary 0.72 0.43:1.18 0.19 1.83 0.77:4.36 0.17 0.68 0.30:1.52 -0.34 Intermediate 2.15 1.04:4.46 0.04* 1.01 0.43:2.40 0.98 0.93 0.37:2.35 0.872 Secondary 1.78 0.96:3.31 0.07** 0.89 0.39:2.04 0.79 2.57 0.86:7.69 0.09** Higher Education 1.72 0.943:3.12 0.08** 1.12 0.47:2.69 0.80 1.87 0.64:5.41 0.25 Work status (No job = base) Part-time 0.49 0.16:1.47 0.20 1.64 0.17:15.84 0.67 0.50 0.11:2.36 0.38 Full-time 0.91 0.51:1.62 0.75 1.20 0.51:2.79 0.68 0.55 0.22:2.37 0.20 Retired 0.95 0.53:1.71 0.86 0.81 0.37:1.78 0.59 1.40 0.59:3.29 0.44 Type of cancer (Tumor = base) Hematol. Malignancy 0.58 0.35:0.98 0.04* 2.35 0.93:5.96 0.07** 0.39 0.17:0.90 0.03* Stem Cell Transplant 0.20 0.01:4.42 0.31 0.08 0.01:1.26 0.07** Treatment: Surgery 0.87 0.59:1.29 0.50 0.84 0.48:1.46 0.53 0.98 0.51:1.89 0.96 Treatment: Radiation 1.41 0.98:2.03 0.06** 0.96 0.57:1.59 0.86 0.74 0.39:1.38 0.34 Treatment: chemotherapy 1.03 0.65:1.60 0.90 0.49 0.23:1.05 0.07** 1.42 0.71:2.83 0.32 Treatment: Stem cell transplant 0.88 0.47:1.62 0.67 0.49 0.19:1.31 0.16 1.43 0.46:4.43 0.54 Monthly income, USD (< 800 = base) $800 to $1600 0.93 0.57:1.53 0.78 0.97 0.49:1.95 0.94 0.95 0.39:2.32 0.90 > $1600 0.58 0.35:0.95 0.03* 0.90 0.44:1.87 0.79 0.80 0.34:1.87 -0.61 Reason for CAM use Social belief 1.06 0.30:3.75 0.926 0.92 0.32:2.68 0.89 Increase immunity 2.00 0.81:4.95 0.136 0.78 0.34:1.82 0.57 Improve mood 2.67 1.26:5.66 0.010* 2.40 .04:5530 0.04* Open in a new tab *Significant at p < 0.05; **Significant at p < 0.1 Table 3 illustrates that the interaction between education and social beliefs does not significantly impact the use of CAM, both dietary and non-dietary. Similarly, there is not statistically significant interaction between education and gender. Despite these interactions showing no effect, the overall model demonstrated a significant fit ( p < 0.001). Additionally, through overidentification and specification tests, the analysis confirmed the absence of omitted variable bias or specification error, as indicated by p-values exceeding the standard significance threshold of 0.05. Such findings suggest that while education and social beliefs are relevant individual characteristics, their interplay does not meaningfully influence CAM utilization among cancer patients. This result is essential for clinicians seeking to understand the factors affecting CAM engagement, as it highlights the need to focus on more direct influences rather than potentially confounding interactions between educational attainment and social beliefs. Table 3. Association between CAM use, demographics, socioeconomic, clinical factors, reasons for use, with interaction of education and social belief Variables CAM Use dietary supplement CAM Use non-dietary supplement OR 95% CI P -value OR 95% CI P -value intercept 3.71 0.32 43.18 0.30 6.07 0.67 54.77 0.11 Age Age > 50 years 1.05 0.51 2.18 0.89 0.39 0.17 0.89 0.03* Gender Female 2.12 1.12 3.99 0.02* 1.12 0.53 2.34 0.77 Marital status (Separated = base) Window 1.22 0.13 11.23 0.86 4.88 0.72 32.90 0.10 Divorced 2.3 0.17 31.43 0.53 2.03 0.24 17.49 0.52 Married 2.5 0.28 22.13 0.41 2.54 0.43 15.06 0.30 Single 1.21 0.12 12.48 0.87 1.62 0.21 12.78 0.65 Education (No schooling = base) Primary 1.74 0.73 4.16 0.21 0.72 0.32 1.59 0.41 Intermediate 0.92 0.38 2.21 0.85 0.97 0.38 2.50 0.95 Secondary 0.84 0.36 1.93 0.67 2.52 0.82 7.74 0.11 Higher education 1.19 0.48 2.92 0.71 1.94 0.68 5.55 0.22 Work status (No job = base) Part-time 1.57 0.16 15.21 0.70 0.50 0.08 2.96 0.44 Full-time 1.17 0.50 2.74 0.72 0.57 0.22 1.51 0.26 Retired 0.8 0.36 1.77 0.59 1.40 0.53 3.72 0.50 Type of cancer (Tumor = base) Hematol. malignancy 2.34 0.92 5.93 0.08** 0.39 0.17 0.90 0.03* Stem cell transplant 0.19 0.01 4.08 0.29 0.08 0.01 1.11 0.06 Treatment-Surgery 0.85 0.49 1.49 0.57 0.99 0.52 1.89 0.97 Treatment-Radiation 0.94 0.56 1.56 0.80 0.72 0.40 1.29 0.27 Treatment chemotherapy 0.49 0.23 1.05 0.07** 1.43 0.72 2.84 0.31 Treatment Stem cell transplant 0.49 0.19 1.32 0.16 1.47 0.48 4.50 0.50 Income, USD (< 800 = base) $800 to $1,600 1.01 0.50 2.03 0.98 0.95 0.42 2.13 0.89 > $1,600 0.89 0.43 1.84 0.75 0.81 0.34 1.90 0.62 Reason - Social belief 0.39 0.07 2.26 0.29 0.60 0.06 5.99 0.66 Reason- increase immunity 1.98 0.80 4.92 0.14 0.78 0.34 1.78 0.55 Reason - improve mood 2.64 1.24 5.61 0.01* 2.45 1.03 5.85 0.04* Social belief by education No schooling × Social belief 2.06 0.13 33.34 0.61 2.90 0.11 79.95 0.53 Primary × Social belief 1.09 0.04 27.76 0.96 Intermediate × Social belief 1.11 0.04 34.50 0.95 Open in a new tab ×Denotes interaction; *Significant at p < 0.05; **Significant at p < 0.1 Discussion Our study represents one of the largest cross-sectional surveys on the use of CAM among cancer patients in Saudi Arabia, addressing both the scope and methodological shortcomings of previous research. It assesses the likelihood of cancer patients utilizing dietary and non-dietary supplements based on their demographic, socioeconomic, clinical profiles, motivations for use, and the interplay educational attainment and social beliefs. The findings revealed a significant prevalence of CAM use among cancer patients, reaching 79%. There is a notable variation in CAM prevalence reported in existing literature from Saudi Arabia, with figures ranging from 20% [ 19 ] to as high as 96% [ 27 ]. These disparities underscore the complexity of CAM use in this population and highlight the need for further investigation into the factors associated with these variations. Our findings indicate a high prevalence of CAM use among the cancer patients surveyed, aligning with international trends. Studies reports that CAM use among adults in developed countries ranges from 5% to 76% [ 4 , 27 ], while within the European Union it varies from 0.3% to 86% [ 30 ]. Among patients with irritable bowel syndrome, reported prevalence ranges from 9% to 38% [ 31 ], with a study in northern India noting a rate of approximately 38.7% [ 32 ]. A systematic review of studies from Western Europe, the United States, Australia, and China found that about 31% of cancer patients use CAM [ 3 ], and an Australian outpatient study reported a current use rate of 52.9%, with 61.5% having ever used CAM at some point [ 33 ]. Overall, international estimates for cancer patients range from 9% to 71%, reflecting substantial cross-country variation. This variability highlights the influence of cultural, socioeconomic, and health system factors on CAM utilization. Understanding these determinants is essential for developing effective integrative care strategies, particularly in contexts such as Saudi Arabia, where the prevalence of CAM use among cancer patients is high, with recent studies reporting prevalence around 71%, is high, in line with earlier Saudi studies showing substantial CAM use [ 18 , 20 ]. Our study suggests that patients with hematological malignancies had significantly lower rates of CAM use compared to those with solid tumors, a finding that contrasts with results from studies conducted in other countries. For example, research in Malaysia reported a high prevalence of CAM among patients with hematological cancers [ 34 ]. In an Australian outpatient clinic, metastatic cancer was found to be associated with CAM use [ 33 ]. However, the specific studies referenced must be confirmed to ensure they support this claim, as they may focus more broadly on CAM use in a general population without distinct comparisons by cancer type. Demographic and socioeconomic factors significantly predict the likelihood of CAM use among cancer patients. Notably, our results indicate a gender differential, with female cancer patients being considerably more likely to utilize CAM, particularly dietary supplements, compared to their male counterparts. This finding is consistent with several studies, includin some within Saudi Arabia that revealed female patients were more inclined to use CAM [ 18 , 20 ]. A 2010 review conducted in the UK supports higher CAM utilization among women compared to men [ 35 ]. Furthermore, a European research study has indicated that CAM users tend to be younger, female, and possess higher educational levels [ 36 ]. In the United States, studies reported a greater proportion of female patients using CAM for perceived benefits such as overall well-being and disease prevention [ 37 ]. While the US study also showed that male and female CAM users may differ by race/ethnicity [ 37 ], our study did not explore how gender differences in CAM use intersect with other demographic factors such as race. However, a multiracial and multicultural country study in Malaysia found no significant association between CAM use and factors such as age, gender, education, and income, although female patients were more likely to engage in multiple CAM therapies [ 34 ]. The results also suggest that patients older than 50 years were less likely to use CAM, especially non-dietary supplements than younger patients. Previous evidence shows that older patients are often associated with lower CAM uptake when non-dietary modalities are considered, echoing patterns seen in Saudi oncology cohorts and regional surveys [ 18 , 20 ]. This association may suggest cohort differences in health literacy, access, and physician disclosure, reinforcing the need for age-specific CAM discussions in oncology management [ 18 , 20 ]. Internationally, this finding corroborates a European research study, which revealed that CAM users tend to be younger, female, and possess higher educational levels [ 36 ]. Our study suggests that cancer patients with at least an intermediate school education are more likely to use CAM compared to those with no formal education. This aligns with existing evidence indicating that the profile of CAM consumers is typically younger, women, and of higher education attainment [ 36 ]. While this finding is unsupported by evidence revealing low socioeconomic status as a significant contributor to higher proportions of CAM consumers [ 38 ], it nonetheless appears intuitive. Individuals with some level of education are likely more informed about the risks and benefits of CAM or have a greater cultural and religious appreciation for its practices. Additionally, our findings reveal that middle-income patients exhibit lower CAM usage compared to those with low income. However, this finding is supported by evidence showing that low socioeconomic status contributes most to the proportions of CAM consumers [ 38 ]. Amid these mixed results, understanding these dynamics is vital for healthcare practitioners to address and support the needs of cancer patients considering CAM in their treatment choices. Our findings suggest that mood improvement was the main motivation or reason associated with CAM use among cancer patients. However, research has shown that religious practices are associated with the use of various CAM modalities, dietary supplements, herbs, and relaxation techniques or meditation [ 33 ]. In another study, recommendations from family members or friends were indeed cited as reasons for patients opting for CAM therapies [ 38 ]. This may indicate that social influences may drive CAM usage rather than individual choice. Moreover, while many patients report using CAM for symptom management, evidence supporting its efficacy is often limited, particularly in terms of improving outcomes for specific sysmtoms [ 31 ]. This highlights a crucial consideration for healthcare providers, as patients may pursue these therapies under misconceptions or pressures, necessitating informed discussions about the risks and benefits of CAM options in their treatment plans. In contrast to prior studies in Saudi Arabia, our study offers strong external validity, providing a generalized understanding of CAM usage among a significant cohort of cancer patients. We identified a mixed socioeconomic gradient effect, where on one hand, CAM use increases as educational levels rise, while on the other hand, it decreases with income. Additionally, we found no evidence supporting the interplay between interaction between education and social beliefs on one hand, and education and gender on the other regarding their impact on dietary and non-dietary CAM use, thus contributing valuable insights to the regional literature. However, we acknowledge potential internal validity issues due to sample differences; those who reported CAM use may differ significantly from non-users, possibly demonstrating heightened health consciousness and a greater interest in integrative medicine as a treatment option. This raises concerns about selection bias, as patient recruitment at a cancer center may have excluded individuals who use CAM exclusively without seeking conventional medical advice [ 18 , 20 ]. We also recognize that our quantitative methods may constrain the full appreciation of the complex realities of patient experiences with complementary and alternative medicine. While valuable, our study could have better benefitted from the rich context of qualitative approaches provide for understanding lived experiences and motivations behind cancer patients’ use of CAM. This limitation underscores the need for future research that incorporates qualitative methodologies to better understand the factors influencing CAM utilization. Finally, the data were collected between 2016 and 2018. Since that period, the country has undergone tremendous social, economic, and health changes. These shifts may considerably impact the study's findings, potentially altering patient attitudes toward CAM use and reducing the current relevance of the study. We emphasize the need for ongoing research to assess how these transformations influence current CAM practices among cancer patients. Consideration of these changes are important for improving clinical guidelines and ensuring that findings remain applicable to modern healthcare environments. Conclusion CAM use was highly prevalent and significantly predicted by socioeconomic factors, clinical profile, and motivations. Patients with intermediate or secondary education and women were significantly more likely to use both dietary and non dietary supplements, while those with higher income and hematologic malignancies were less likely to do so. Mood improvement emerged as a key driver of dietary supplement use, and older adults were less inclined to use non dietary supplements than younger patients. Educational attainment did not modify the impact of social beliefs or gender on CAM use behavior. These findings reinforce the need for integrating proactive CAM screening into oncology care to provide personalized counseling, addressing gender, age, and diagnosis specific patterns of use, risks, and interactions. Future studies need to investigate patients’ decision-making, evaluate the safety and efficacy of commonly and locally used CAM, and develop integrative oncology interventions that align evidence-based guidance with patients’ preferences. Acknowledgements We thank the patients for their time and effort in participating in the study. Abbreviations CAM Complementary and Alternative Medicine OR Odds Ratio SD Standard Deviation DS Dietary Supplements NDS Non-Dietary Supplements CI Confidence Interval Authors’ contributions AJ, OBD, and MK conceptualized the idea. FS, SS, AH, HM, MR, FB, AM, NG, FZ, and AM conducted data collection. M K data management and project administration. OBD performed statistical analysis. All authors contributed to writing and approving the manuscript. Funding This study was not funded. Data availability The dataset for the study is available from the corresponding author upon request. Declarations Ethics approval and consent to participate Ethical approval for this study was granted by the King Abdullah International Medical Research Center (KAIMRC) Institutional Review Board under protocol RC16/165/R. All participants gave written informed consent before participating in the study. The study was conducted in complete accordance with the Declaration of Helsinki and the Good Clinical Practice (GCP) standards. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Footnotes Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. Complementary NIH. alternative, or integrative health: what’s in a name. Natl Cent Complement Integr Health. 2021. 2. Alschuler L, Benjamin SA, Duke JA, D’Epiro NW. Herbal medicine: what works, what’s safe. Patient Care. 1997;31(16):49–61. [ Google Scholar ] 3. Ernst E. 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