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Abstract

Introduction

Cancer patients often face challenges in managing their disease, particularly with regard to contraindications related to medications, foods, and physical activity, which can negatively affect treatment outcomes. This study aimed to evaluate cancer patients’ awareness of these contraindications and to explore the influence of sociodemographic factors, support systems, comorbidities, and medication use on their knowledge.

Methods

A cross-sectional prospective study was conducted with 125 cancer patients in Saudi Arabia between December 2022 and February 2023. Participants were selected using purposive sampling, and data were collected through a validated questionnaire. Multinomial regression analysis was employed to identify the predictors of awareness of contraindicated medications, foods, and other environmental factors.

Results

Nationality, co-morbidities, and cancer duration were significant predictors of awareness regarding contraindicated drugs. Saudi patients were more likely to be aware of contraindicated medications (P = 0.010), and those without chronic diseases were 15 times more likely to know about drug contraindications (OR = 15.076, 95% CI: 3.442-66.042). Cancer diagnosis (P = 0.033) and cancer duration (P = 0.022) were also significant for food contraindications. Over 58% were unaware of the need to regulate body temperature during treatment. Location influenced exercise awareness (P = 0.064) and complementary and alternative medicine (CAM) awareness, with rural participants showing higher CAM knowledge (P = 0.001).

Conclusion

This study emphasizes the need to improve cancer patients’ awareness of contraindications, particularly regarding medications and foods. Key factors influencing awareness include nationality, co-morbidities, and cancer duration. While family support is beneficial, it doesn’t directly enhance knowledge, highlighting the importance of targeted educational interventions to improve patient outcomes and safety.

Plain Language Summary

Awareness of Health Risks: How Cancer Patients in Saudi Arabia Understand Medication, Food, and Activity Contraindications: This study highlights the importance of improving cancer patients’ awareness of contraindications related to medications, foods, and other environmental factors that can affect treatment outcomes. Conducted with 125 cancer patients in Saudi Arabia, the study found that nationality, co-morbidities, and cancer duration significantly influenced awareness of drug and food contraindications. Saudi patients and those without chronic diseases were more likely to be aware of harmful drug interactions, while cancer type and duration were key to understanding food-related risks. The study also revealed that awareness of body temperature regulation during treatment and complementary and alternative medicine (CAM) use was limited, with rural patients showing higher CAM knowledge. These findings emphasize the need for targeted educational interventions to enhance patient safety and treatment efficacy, as family support, though beneficial, did not directly improve knowledge of contraindications.

Keywords

cancer contraindications awareness patient safety physicians patient counseling

Introduction

Advances in cancer treatment have significantly improved survival rates and life expectancy for patients. However, this extended lifespan often necessitates the management of multiple chronic conditions, complicating treatment regimens and leading to polypharmacy. Polypharmacy, defined as the use of multiple medications, is increasingly common and presents substantial challenges in managing both cancer and its associated comorbidities.^1,2 A study revealed that 35% of elderly patients diagnosed with breast, lung, colon, rectal, prostate, or ovarian cancer were taking more than 5 medications.³ Additionally, the World Health Organization (WHO) reports that over 50% of patients worldwide do not adhere to prescribed medication regimens, and more than 50% of medications are improperly prescribed, sold, or distributed.⁴ This highlights the urgent need for effective medication management and monitoring strategies.

Cancer treatments such as chemotherapy, radiation, and surgery can lead to a range of side effects affecting multiple body systems.⁵ These treatments carry individual or combined risks that can be exacerbated by pre-existing comorbidities and concurrent medication use.⁶ Interactions between anticancer therapies and other medications may increase the risk of adverse effects and complicate treatment outcomes.⁷ Understanding the extent of polypharmacy is crucial for optimizing patient care and minimizing potential risks.

Numerous studies have shown that cancer can significantly alter food preferences, with these changes influenced by the type of treatment or disease stage.^8,9 For example, patients with head and neck cancers often experience shifts in their food-related expectations, which can lead to changes in the “meaning of food” and result in various physical, emotional, and social losses.¹⁰ After curative gastrectomy, patients commonly face increased dysphagia, eating restrictions, anxiety, changes in taste, and body image issues, although these concerns generally diminish over 12 months.¹¹ Additionally, radiotherapy is well-documented to adversely affect taste perception both during and after treatment.^12,13 Chemotherapy (CT) regimens also influence taste changes and food preferences, with significant correlations observed between ageusia and dry mouth, bitter taste and appetite loss, sour taste and nausea, and anorexia and dry mouth.¹⁴ However, systematic reviews indicate that the effects of CT on food preferences have not been consistently established.^15,16 Ultimately, the extent to which these disturbances influence dietary behavior during and after treatment remains largely unknown. Consequently, there is a notable lack of information regarding the practical management of food intake, particularly concerning meal and food preferences within a cultural context among cancer patients undergoing treatment.

The use of complementary and alternative medicine (CAM) among cancer patients adds another layer of complexity. Research indicates that a significant portion of cancer patients utilize CAM therapies alongside conventional treatments. For instance, in Europe, 36% of cancer patients reported using CAM, including dietary supplements and herbal remedies.¹⁷ CAM can interact with conventional cancer therapies, potentially affecting treatment efficacy and safety. A cross-sectional study by Zeller et al found that 65% of cancer patients using CAM supplements were at risk of “likely” or “possible” interactions with their cancer treatments.¹⁸ While CAM is widely utilized among cancer patients, many struggle to discuss their CAM practices with health care providers.^19,20 This gap underscores the need to enhance patients’ understanding of CAM to facilitate better communication with health care professionals.

Physical activity (PA) is recognized for improving the quality of life, physical performance, and mental well-being of cancer patients. Evidence suggests that PA is associated with reduced mortality risk and better treatment outcomes.^21,22 However, PA may be contraindicated in certain situations, such as severe anemia, fatigue, or acute infections, which are common among cancer patients.²³ Consequently, medical professionals often exercise caution when recommending PA during treatment. Engaging in leisure-time PA at the recommended level of 7.5-15 MET hours per week is associated with a 6%-29% reduction in risk for various cancers, including colon, breast, endometrial, kidney, myeloma, liver, and non-Hodgkin lymphoma (in women). Exercising beyond this recommended level may further decrease the risk for some cancers, but not all, indicating fundamental differences in the biological mechanisms related to different cancer types.²⁴ Therefore, it is essential to develop patient- and cancer-specific protocols to enhance the well-being of cancer patients.

Comprehensive studies that address interactions between drugs and concurrent diseases, dietary factors, CAM, and physical activity are relatively scarce. This gap emphasizes the need for research that encompasses a broader spectrum of potential interactions affecting cancer patients. Recent cross-sectional studies have begun to address these issues by examining the frequency and severity of drug interactions involving anticancer medications. For example, Khorami et al.² highlighted significant drug interactions between anticancer agents and medications for chronic conditions, emphasizing the importance of careful medication management. Similarly, Patel et al.²⁵ found that interactions between CAM and conventional treatments can complicate cancer management and affect patient outcomes. Other research, such as that by Fernandez et al.,²⁶ has explored the impact of dietary factors and physical activity²⁷ on cancer treatment efficacy, noting the need for integrated management strategies.

Given these considerations, this study aims to assess the extent of contraindicated drug use, dietary preferences, use of complementary and alternative medicine (CAM), and other pertinent factors among cancer patients. By examining these areas, this research intends to contribute valuable insights to improve cancer care management within this specific demographic and to address existing gaps in the current literature.

Methods

Study Design

An observational prospective cross-sectional study was conducted in Saudi Arabia between December 2022 and February 2023. To collect data, Google Forms surveys were utilized, allowing for efficient gathering of participant responses. The study employed purposive sampling to select participants, ensuring that individuals who fulfilled the relevant inclusion requirements were included. Interviews were conducted using a structured questionnaire, administered at any of the study sites, in the Riyadh region of Saudi Arabia. The reporting of this study adheres to the STROBE guidelines, ensuring that the methodology and findings are presented in a transparent and standardized manner.²⁸ This adherence reinforces the credibility of the research and its relevance to ongoing discussions in the field. The sample size was determined using the latest report on cancer patients in the Riyadh region, which identifies a total of 4493 patients.²⁹ Based on our recent findings,³⁰ we estimated that 11% of these patients receive contraindicated medications. To ensure accuracy, we maintained a margin of error of 5% and a confidence level of 90%, utilizing the online sample size calculator Raosoft (https://www.raosoft.com/samplesize.html). The calculated sample size required for a representative analysis of the eligible population was 104. For this study, a total of 125 samples were included in the analysis, providing a robust representation of the available population at the study location.

Participants

All cancer patients willing to participate in the study and receive treatment at any of the study sites in the Riyadh region of Saudi Arabia were considered eligible for inclusion. To ensure a focused and relevant participant group, specific inclusion and exclusion criteria were established.

Inclusion Criteria:

Diagnosis of Cancer: Participants must have a confirmed diagnosis of cancer.

Current Treatment: Individuals must be actively undergoing treatment for cancer, regardless of the type of therapy (eg, chemotherapy, radiation, surgery).

Willingness to Participate: Participants must be willing to provide informed consent and engage with the study.

Exclusion Criteria:

Inability to Provide Consent: Individuals unable to understand the study’s purpose or unable to provide informed consent due to cognitive impairments or language barriers were excluded.

Non-cancer Related Conditions: Patients with non-cancerous conditions that required treatment but did not have a cancer diagnosis were not included.

Recent Participation in Other Studies: Participants who had recently been involved in other clinical trials or studies that may influence their responses were excluded to minimize bias.

Ethical Consideration

The Institutional Review Board of AlMaarefa University granted ethical approval for this study (IRB09-04122022-101). Before participation, all individuals were thoroughly informed about the study’s aims, methodology, potential outcomes, and the voluntary nature of their involvement. Participants were assured of the confidentiality of their responses and were made aware that they could choose to decline or withdraw from the study at any point without any negative repercussions. Only those who provided their informed consent were included in the study, ensuring that all participants were comfortable and willing to contribute to the research.

Study Instrument

The study instrument, a structured questionnaire, was meticulously developed with the collaboration of qualified researchers, academicians, and practitioners in the field. The research team drew upon relevant published literature to ensure the questionnaire’s comprehensiveness and relevance. To enhance the validity of the instrument, experts in oncology and health research were consulted to review the construct, content, and criteria of the questionnaire. The questionnaire demonstrated good internal consistency, with a Cronbach’s alpha of 0.706.

The questionnaire was organized into 4 distinct sections:

Sociodemographic Characteristics of the Participants

This section comprised ten items designed to capture essential demographic information. Participants were asked about their age, gender, nationality, educational level, location, income, marital status, employment status, and the nature of family and spouse support. This information is crucial for understanding the diverse backgrounds of the participants and how these factors may influence their health behaviors and perceptions.

Co-morbidities Status of the Participants

This section was further divided into 2 sub-sections:

Sub-section 1: Focused on inquiring whether participants were suffering from any chronic illnesses, allowing for the identification of additional health challenges that may affect cancer management.

Sub-section 2: Gathered detailed information about the medications participants were taking to manage their co-morbidities. This data is vital for understanding the potential impact of polypharmacy on cancer treatment and outcomes.

Details About Cancer

This section included 6 items to collect pertinent information regarding the participants’ cancer experiences. Questions in this section explored the type of cancer diagnosed, the duration of the cancer, the length of time participants had been undergoing chemotherapy, and whether they had received counseling related to their condition. This information helps to contextualize the participants' cancer journeys and the support systems in place.

Status of Food preferences, CAM use, and Physical activity

This final section comprised 5 questions aimed at assessing the participants’ awareness of contraindicated drugs related to their cancer treatment. The questions further explored several key areas including:

Contraindicated foods: Participants were asked to identify specific foods that may adversely affect their treatment or health outcomes.

Complementary and Alternative Medicines (CAM): The questionnaire sought to gauge the participants’ understanding of the potential interactions between CAM therapies and conventional cancer treatments.

Recommended Physical Activities: Questions in this section addressed the participants’ awareness of suitable physical activities (yoga, nerve gliding exercise, sensorimotor-based exercise) that are safe to engage in during cancer treatment.

Sources of Information: Participants were also asked to identify where they obtained their information about contraindications, including health care providers, literature, and personal research.

Impact of Hyperthermia: A question to assess participants’ awareness of whether elevated body temperature is contraindicated during cancer chemotherapy.

This section aims to evaluate participants’ awareness and understanding of how various factors, such as dietary choices, CAM use, and physical activity, can interact with their cancer treatments. By assessing this knowledge, the study seeks to identify gaps in understanding that could impact patient care and health outcomes.

Overall, the questionnaire was designed to provide comprehensive insights into the experiences and knowledge of cancer patients in Saudi Arabia, facilitating the study’s objectives of understanding their health behaviors and decision-making processes.

Statistical Analysis

Data from the study were entered and analyzed using SPSS, employing both descriptive and inferential analysis techniques. Participants’ awareness of contraindications to drugs, foods, CAM, exercise, and body temperature was compared against their sociodemographic traits as well as their clinical and treatment characteristics using the Pearson Chi-square test, with statistical significance set at a P-value below 0.05. Additionally, multinomial regression analysis was performed to identify factors influencing cancer patients’ awareness, with results reported as odds ratios, confidence intervals (upper and lower limits), and P-values.

Results

Sociodemographic Characteristics of the Participants

The study included a nearly equal distribution of male and female participants (48% male vs 52% female). Fifty-eight percent of participants were over the age of 40. The majority were from urban areas (81.6%) and a significant portion were non-Saudi participants (75.2%) (Table 1). Nearly half (46.4%) of the cancer patients in the study had a university education, and over 81% of them were married. The participants’ percentages of working and non-working were roughly equal (51.2% vs 48.4%); however, most of them (64.8%) had family incomes of between 10 000 and 30 000 Saudi Riyals (Table 1).

Table 1.

Demographic Characteristics of the Participants.

Number	Characteristics	Variables	Frequency	Percentage
1.	Gender	Female	65	52.0
1.	Gender	Male	60	48.0
2.	Age (years)	Under 20	16	12.8
		20-30	14	11.2
		30-40	21	16.8
		40-50	35	28.0
		Older 50	39	31.2
3.	Nationality	Saudi	31	24.8
3.	Nationality	Non-saudi	94	75.2
4.	Location	Urban	102	81.6
4.	Location	Rural	23	18.4
5.	Marital status	Married	102	81.6
		Separated	18	14.4
		Unmarried	5	4.0
6.	Educational level	University	58	46.4
		Low education	57	45.6
		Uneducated	10	8.0
7.	Employment status	Employed	64	51.2
7.		Unemployed	61	48.8
8.	Total family income (SAR)	Less than 10000	39	31.2
		10000-30000	81	64.8
		More than 30000	5	4.0

Clinical and Treatment Characteristics

Table 2 presents the clinical and treatment characteristics of the study participants. Regarding the duration of cancer, most patients (58.4%) had been diagnosed for less than 1 year, while 24.8% had been living with cancer for 1 to 3 years, and 16.8% for more than 3 years. In terms of chemotherapy, most participants (64.8%) had undergone treatment for less than 1 year, with 20.8% having received chemotherapy for 1 to 3 years, and 14.4% for more than 3 years.

Table 2.

Clinical and Treatment Characteristics of the Participants.

Number	Characteristics	Variables	Frequency	Percentage
1	Duration of cancer	Less than 1 year	73	58.4
		One-3 years	31	24.8
		More than 3 years	21	16.8
2	Duration of chemotherapy	Less than 1 year	81	64.8
		One-3 years	26	20.8
		More than 3 years	18	14.4
3	Support of spouse	Yes	80	64.0
3	Support of spouse	No	45	36.0
4	Support of family	Yes	100	80.0
4	Support of family	No	25	20.0
5	Co-morbidities	No chronic diseases	78	62.4
		Hypertension	27	21.60
		Diabetes mellitus	24	19.20
		Dyslipidemia	5	4.0
		Others	12	9.6
6	Use of other drugs	No drug use	75	60
		Acetaminophen	30	24
		Beta blockers	17	13.6
		Proton pump inhibitors	14	11.2
		Others	70	56
7	Type of cancer diagnosis	Breast cancer	41	32.8
		Gastrointestinal cancer	27	21.6
		Malignant lymphoma	26	20.8
		Leukemia	20	16
		Lung cancer	17	13.6
		Others	44	35.2
8	Status of counseling provided by health care professional	No counselling	115	92
		Nurse	12	9.6
		Pharmacist	8	6.4
		Physician	3	2.4

Support from spouses and family was reported by 64.0% and 80.0% of participants, respectively. Concerning co-morbidities, 62.4% of participants reported no chronic diseases, while hypertension and diabetes mellitus were the most common co-morbidities, affecting 21.6% and 19.2% of participants, respectively. Regarding the use of other medications, 60% of participants did not take any additional drugs, while 24% used acetaminophen, 13.6% used β-blockers, and 11.2% used proton pump inhibitors.

Breast cancer was the most common diagnosis, affecting 32.8% of participants, followed by gastrointestinal cancer (21.6%), malignant lymphoma (20.8%), leukemia (16.0%), and lung cancer (13.6%). Additionally, a significant majority (92.0%) of participants reported not receiving counseling from health care professionals, with a small proportion receiving counseling from a nurse (9.6%), a pharmacist (6.4%), or a physician (2.4%). These findings provide valuable insights into the clinical characteristics, treatment history, and support systems of cancer patients in the study population.

Use of CAM, Avoidance of Food and Preferred Information Source

Table 3 provides an overview of participants’ use of complementary and alternative medicine (CAM), avoidance of certain foods, and preferred sources of health-related information. Regarding CAM use, 52.8% of participants reported not using CAM or supplements. Among those who did use supplements, Vitamin D3 was the most commonly used (27.2%), followed by Vitamin B12 (20.8%), Vitamin C (12.0%), and Vitamin E (10.4%). Additionally, 25.6% of participants reported using other types of supplements.

Table 3.

Use of CAM, Avoidance of Food, and Preferred Information Source.

Number	Characteristics	Variables	Frequency	Percentage
1.	Use of CAM and other supplements	No CAM	66	52.8
		Vitamin D3	34	27.2
		Vitamin B12	26	20.8
		Vitamin C	15	12
		Vitamin E	13	10.4
		Others	32	25.6
2.	Food avoided	Nothing	80	64
		Sugar	37	29.6
		Fatty food	21	16.8
		Spicy food	8	6.4
		Fast food	3	2.4
		Others	10	8
3.	Preferred information source	Doctor	113	90.4
		Internet	14	11.2
		General search	6	4.8
		Google	4	3.2
		Others	8	6.4

Regarding food avoidance, the majority (64.0%) of participants did not avoid any specific foods. Among those who did avoid foods, sugar was the most avoided (29.6%), followed by fatty foods (16.8%), spicy foods (6.4%), and fast food (2.4%). A small group (8.0%) reported avoiding other types of food.

When it comes to the preferred source of health information, most participants (90.4%) preferred to receive information from their doctor. The internet was the second most common source (11.2%), followed by general searches (4.8%), Google (3.2%), and other sources (6.4%). These findings highlight the diverse practices and preferences regarding CAM use, dietary restrictions, and the sources from which patients seek health information.

Awareness of Contraindications

Figure 1 illustrates participants’ awareness regarding various aspects of their cancer treatment, including contraindications related to body temperature, the usefulness of exercise, food avoidance, the use of complementary and alternative medicine (CAM), vitamins, and drug use.

Figure 1.

Awareness of the use of contraindicated drugs, food, exercise, body temperature, and use of CAM.

The data shows that 58.4% of participants were aware of the contraindication related to increased body temperature, while 41.6% were not. Regarding the usefulness of exercise during chemotherapy, only 7.2% of participants believed exercise to be useful, while a substantial 92.8% did not. In terms of food avoidance, 60.0% of participants were aware of the need to avoid specific foods, while 40.0% were not. Regarding CAM and vitamin use, 53.6% of participants were aware of their potential benefits, while 46.4% were not. Finally, about drug use, 42.4% of participants were aware of the importance of avoiding certain drugs, while 57.6% were not.

These findings highlight varying levels of awareness among patients about key aspects of their cancer treatment and self-care, particularly concerning contraindications, exercise, and the use of CAM and other supplements.

Comparison of the Awareness Status of the Participants with Their Sociodemographic Characteristics

Table 4 compares participants’ awareness of contraindicated drugs with various demographic and clinical characteristics. Significant differences in awareness were found based on age, nationality, location, marital status, and co-morbidities. Younger participants (under 20 years) had the highest awareness (81%), while awareness decreased with age, particularly among those over 50 years (23%) (P = 0.001). Non-Saudi participants had higher awareness (37%) compared to Saudi participants (58%) (P = 0.042), and those living in rural areas demonstrated greater awareness (61%) than urban residents (38%) (P = 0.047). Marital status was also a factor, with separated and unmarried individuals showing higher awareness (67% and 60%, respectively) compared to married individuals (37%) (P = 0.048). Furthermore, participants without chronic diseases had significantly higher awareness (65%) compared to those with conditions like hypertension or diabetes (P = 0.001). Other variables, such as gender, educational level, employment status, and cancer diagnosis, did not show significant differences in awareness. These results highlight that certain demographic and health-related factors, particularly age, nationality, and co-morbidities, influence awareness of contraindicated drugs.

Table 4.

Comparison of Awareness of Contraindicated Drugs and Food With Patients’ Characteristics.

Number	Characteristics	Variables	Drug Awareness, n (%)		P Value	Food Awareness, n (%)		P Value
Number	Characteristics	Variables	No	Yes	P Value	No	Yes	P Value
1.	Gender	Female	36 (55)	29 (45)	0.717	30 (46)	35 (54)	0.144
1.	Gender	Male	36 (60)	24 (40)	0.717	20 (33)	40 (67)	0.144
2.	Age (years)	Under 20	3 (19)	13 (81)	0.001	6 (38)	10 (62)	0.658
		20-30	6 (43)	8 (57)		4 (29)	10 (71)
		30-40	8 (38)	13 (62)		7 (33)	14 (67)
		40-50	25 (71)	10 (29)		14 (40)	21 (60)
		Older 50	30 (77)	9 (23)		19 (49)	20 (51)
3.	Nationality	Saudi	13 (42)	18 (58)	0.042	15 (48)	16 (52)	0.272
3.	Nationality	Non-saudi	59 (63)	35 (37)	0.042	35 (37)	59 (63)	0.272
4.	Location	Urban	63 (62)	39 (38)	0.047	40 (39)	62 (61)	0.706
4.	Location	Rural	9 (39)	14 (61)	0.047	10 (43)	13 (57)	0.706
5.	Marital status	Married	64 (63)	38 (37)	0.048	41 (40)	61 (60)	0.995
		Separated	6 (33)	12 (67)		7 (39)	11 (61)
		Unmarried	2 (40)	3 (60)		2 (40)	3 (60)
6.	Educational level	University	32 (55)	26 (45)	0.345	21 (36)	37 (64)	0.469
		Low education	36 (63)	21 (37)		26 (46)	31 (54)
		Uneducated	4 (40)	6 (60)		4 (40)	6 (60)
7.	Employment status	Employed	37 (58)	27 (42)	0.961	21 (33)	43 (67)	0.093
7.	Employment status	Unemployed	35 (57)	26 (43)	0.961	29 (48)	32 (52)	0.093
8.	Total family income (SAR)	Less than 10000	18 (46)	21 (54)	0.124	16 (41)	23 (59)	0.161
		10000-30000	52 (64)	29 (36)		30 (37)	51 (63)
		More than 30000	2 (40)	3 (60)		4 (80)	1 (20)
9.	Duration of cancer	Less than 1 year	39 (53)	34 (47)	0.338	25 (34)	48 (66)	0.262
		One-3 years	18(58)	13 (42)		17 (55)	14 (45)
		More than 3 years	15 (71)	6 (29)		8 (38)	13 (62)
10.	Duration of chemotherapy	Less than 1 year	45 (56)	36 (44)	0.689	29 (36)	52 (64)	0.689
		One-3 years	15 (58)	11 (42)		14 (54)	12 (46)
		More than 3 years	12 (67)	6 (33)		7 (39)	11 (61)
11.	Support of spouse	Yes	47 (59)	33 (41)	0.729	34 (43)	46 (57)	0.447
11.	Support of spouse	No	25 (56)	20 (44)	0.729	16 (36)	29 (6)	0.447
12.	Support of family	Yes	57 (57)	43 (43)	0.786	43 (43)	57 (57)	0.171
12.	Support of family	No	15 (60)	10 (40)	0.786	7 (28)	18 (72)	0.171
13.	Co-morbidities	No chronic diseases	27 (35)	51 (65)	0.001	26 (33)	52 (67)	0.337
		Hypertension	16 (94)	1 (6)		8 (47)	9 (53)
		Diabetes mellitus	16 (94)	1 (6)		10 (59)	7 (41)
		Dyslipidemia	4 (100)	0 (0)		2 (50)	2 (50)
		Others	9 (100)	0 (0)		4 (44)	5 (56)
14.	Cancer diagnosis	Breast cancer	9 (47)	10 (53)	0.369	10 (53)	9 (47)	0.609
		Gastrointestinal cancer	12 (67)	6 (33)		8 (44)	10 (56)
		Malignant lymphoma	16 (73)	6 (27)		8 (36)	14 (64)
		Leukemia	7 (41)	10 (59)		4 (23)	13 (77)
		Lung cancer	6 (54)	5 (46)		5 (46)	6 (54)
		Others	22 (58)	16 (42)		15 (40)	23 (60)

Bold indicates that they are siginificant as P value is <0.05.

Participants’ awareness of contraindicated foods was compared across various demographic and clinical characteristics, as shown in Table 4. The analysis revealed that factors such as gender, age, nationality, and marital status did not have statistically significant associations with awareness levels. For instance, although more males (67%) were aware of contraindicated foods compared to females (54%), this difference was not statistically significant (P = 0.144). Similarly, non-Saudi participants had slightly higher awareness (63%) than Saudi participants (52%) (P = 0.272), but this difference was also not significant.

Further analysis indicated no significant differences in awareness based on location, educational level, employment status, or support from family or spouse (P > 0.05). However, participants without chronic diseases demonstrated higher awareness (67%) compared to those with hypertension, diabetes, or other conditions (P = 0.337). Cancer diagnosis also did not significantly impact awareness, though those diagnosed with leukemia (77%) or malignant lymphoma (64%) showed higher awareness of contraindicated foods. These findings suggest that while there are some trends, most demographic and clinical factors did not show statistically significant differences in awareness of contraindicated foods.

Table 5 compares body temperature and exercise awareness among cancer patients based on various demographic and clinical characteristics. Significant differences were found in body temperature awareness between genders, with males showing higher awareness (70% vs 48% in females, P = 0.011). Age also played a role, particularly in exercise awareness, with younger patients (under 20) showing significantly higher awareness (P = 0.012). Patients with cancer for less than 1 year exhibited higher awareness of both body temperature (P = 0.029) and exercise (P = 0.005). Spousal and family support were associated with higher body temperature awareness (P = 0.031 and P = 0.046, respectively), although family support did not significantly affect exercise awareness. Education level, employment status, and family income did not show significant associations with either form of awareness. Additionally, cancer diagnosis type did not significantly impact awareness levels, though patients with leukemia exhibited higher body temperature awareness. These findings highlight the complex interplay of factors influencing awareness in cancer patients, with gender, age, and support systems being particularly impactful.

Table 5.

Comparison of Body Temperature and Exercise Awareness With Patients’ Characteristics.

Number	Characteristics	Variables	Body Temperature Awareness, n (%)		P Value	Exercise Awareness, n (%)		P Value
Number	Characteristics	Variables	No	Yes	P Value	No	Yes	P Value
1.	Gender	Female	34 (52)	31 (48)	0.011	58 (89)	7 (11)	0.108
1.	Gender	Male	18 (30)	42 (70)	0.011	58 (97)	2 (3)	0.108
2.	Age (years)	Under 20	5 (31)	11 (69)	0.913	16 (100)	0 (0)	0.012
		20-30	6 (43)	8 (57)		11 (77)	3 (21)
		30-40	9 (43)	12 (57)		17 (81)	4 (19)
		40-50	16 (46)	19 (54)		35 (100)	0 (0)
		Older 50	16 (41)	23 (59)		37 (95)	2 (5)
3.	Nationality	Saudi	15 (48)	16 (52)	0.377	29 (94)	2 (6)	0.853
3.	Nationality	Non-saudi	37 (39)	57 (61)	0.377	87 (93)	7 (7)	0.853
4.	Location	Urban	44 (43)	58 (57)	0.463	96 (94)	6 (6)	0.230
4.	Location	Rural	8 (35)	15 (65)	0.463	20 (87)	3 (13)	0.230
5.	Marital status	Married	45 (44)	57 (56)	0.420	96 (94)	6 (6)	0.386
		Separated	6 (33)	12 (67)		16 (89)	2 (11)
		Unmarried	1 (20)	4 (80)		4 (80)	1 (20)
6.	Educational level	University	22 (38)	36 (62)	0.437	54 (93)	4 (7)	0.938
		Low education	27 (47)	30 (52)		53 (93)	4 (7)
		Uneducated	3 (30)	7 (70)		9 (90)	1 (10)
7.	Employment status	Employed	24 (38)	40 (63)	0.341	61 (95)	3 (5)	0.266
7.	Employment status	Unemployed	28 (46)	33 (54)	0.341	55 (90)	6 (10)	0.266
8.	Total family income (SAR)	Less than 10000	17 (44)	22 (56)	0.598	37 (95)	2 (5)	0.641
		10000-30000	34 (42)	47 (58)		74 (91)	7 (9)
		More than 30000	1 (20)	4 (80)		5 (100)	0 (0)
9.	Duration of cancer	Less than 1 year	27 (37)	46 (63)	0.029	70 (96)	3 (4)	0.005
		One-3 years	19 (63)	12 (39)		30 (97)	1 (3)
		More than 3 years	6 (29)	15 (71)		16 (76)	5 (24)
10.	Duration of chemotherapy	Less than 1 year	29 (36)	52 (64)	0.005	78 (96)	3 (4)	0.023
		One-3 years	18 (69)	8 (31)		24 (92)	2 (8)
		More than 3 years	5 (28)	13 (72)		14 (78)	4 (22)
11.	Support of spouse	Yes	39 (49)	41 (51)	0.031	75 (94)	5 (6)	0.584
11.	Support of spouse	No	13 (29)	32 (71)	0.031	41 (91)	4 (9)	0.584
12.	Support of family	Yes	46 (46)	54 (54)	0.046	93 (93)	7 (7)	0.863
12.	Support of family	No	6 (24)	19 (76)	0.046	23 (92)	2 (8)	0.863
13.	Co-morbidities	No chronic diseases	29 (37)	49 (63)	0.079	72 (92)	6 (8)	0.315
		Hypertension	11 (65)	6 (35)		16 (94)	1 (6)
		Diabetes mellitus	9 (953)	8 (47)		17 (100)	0 (0)
		Dyslipidemia	0 (0)	4 (100)		4 (100)	0 (0)
		Others	3 (33)	6 (67)		7 (78)	2 (22)
14.	Cancer diagnosis	Breast cancer	11 (58)	8 (41)	0.358	19 (100)	0 (0)	0.283
		Gastrointestinal cancer	9 (50	9 (50)		17 (94)	1 (6)
		Malignant lymphoma	10 (45)	12 (55)		19 (86)	3 (14)
		Leukemia	4 (23)	13 (77)		17 (100)	0 (0)
		Lung cancer	4 (36)	7 (64)		9 (82)	2 (18)
		Others	14 (37)	24 (63)		35 (92)	3 (8)

Bold indicates that they are siginificant as P value is <0.05.

Table 6 compares the awareness of complementary and alternative medicine (CAM) use among cancer patients based on various demographic and clinical characteristics. While gender shows a trend, with males having higher awareness (62%) than females (46%), the difference is not statistically significant (P = 0.144). Age did not have a clear impact on CAM awareness, as awareness rates varied across different age groups without significant differences (P = 0.658). Nationality, location, marital status, educational level, and employment status all showed no significant associations with CAM awareness, with roughly equal distribution between those aware and unaware across these characteristics. Interestingly, rural patients had significantly higher awareness (91%) compared to urban patients (45%) (P = 0.706). Family support was linked to higher awareness of CAM use, with 64% of those without family support being aware, compared to 51% with family support (P = 0.171). Co-morbidities, cancer diagnosis type, and the duration of chemotherapy or cancer diagnosis also did not exhibit significant correlations with CAM awareness. Overall, the table indicates that while there are some trends, such as higher awareness among rural patients, the factors influencing CAM awareness in cancer patients are largely non-significant in this sample.

Table 6.

Comparison of Awareness of the Use of CAM With Patients’ Characteristics.

Number	Characteristics	Variables	Awareness, n (%)		P Value
Number	Characteristics	Variables	No	Yes	P Value
1.	Gender	Female	35 (54)	30 (46)	0.082
1.	Gender	Male	23 (38)	37 (62)	0.082
2.	Age (years)	Under 20	7 (44)	9 (56)	0.475
		20-30	4 (29)	10 (71)
		30-40	9 (43)	12 (57)
		40-50	16 (46)	19 (54)
		Older 50	22 (56)	17 (44)
3.	Nationality	Saudi	10 (32)	21 (68)	0.069
3.	Nationality	Non-saudi	48 (51)	46 (49)	0.069
4.	Location	Urban	56 (55)	46 (45)	0.001
4.	Location	Rural	2 (9)	21 (91)	0.001
5.	Marital status	Married	50 (49)	52 (51)	0.449
		Separated	6 (33)	12 (67)
		Unmarried	2 (40)	3 (60)
6.	Educational level	University	29 (50)	29 (50)	0.497
		Low education	26 (46)	31 (54)
		Uneducated	3 (30)	7 (70)
7.	Employment status	Employed	30 (45)	34 (53)	0.913
7.	Employment status	Unemployed	28 (46)	33 (54)	0.913
8.	Total family income (SAR)	Less than 10000	17 (44)	22 (56)	0.404
		10000-30000	40 (49)	41 (51)
		More than 30000	1 (20)	4 (80)
9.	Duration of cancer	Less than 1 year	31 (43)	42 (57)	0.578
		One-3 years	16 (52)	15 (48)
		More than 3 years	11 (52)	10 (48)
10.	Duration of chemotherapy	Less than 1 year	35 (43)	46 (57)	0.387
		One-3 years	12 (46)	14 (54)
		More than 3 years	11 (61)	7 (39)
11.	Support of spouse	Yes	42 (53)	38 (47)	0.068
11.	Support of spouse	No	16 (36)	29 (6)	0.068
12.	Support of family	Yes	49 (49)	51 (51)	0.244
12.	Support of family	No	9 (36)	16 (64)	0.244
13.	Co-morbidities	No chronic diseases	34 (44)	44 (56)	0.672
		Hypertension	9 (53)	8 (47)
		Diabetes mellitus	7 (41)	10 (59)
		Dyslipidemia	3 (75)	1 (25)
		Others	5 (56)	4 (44)
14.	Cancer diagnosis	Breast cancer	10 (53)	9 (47)	0.445
		Gastrointestinal cancer	9 (50)	9 (50)
		Malignant lymphoma	12 (55)	10 (45)
		Leukemia	5 (29)	12 (71)
		Lung cancer	3 (27)	8 (73)
		Others	19 (50)	19 (50)

Bold indicates that they are siginificant as P value is <0.05.

Multinomial Regression Analysis to Determine Factors Influencing Outcome Variables

Table 7 presents the factors influencing the awareness of contraindicated drugs and foods, as assessed through logistic regression analysis. The table reports the significance (Sig.), odds ratios (Exp(B)), and 95% confidence intervals (CI) for each factor related to the 2 outcomes: awareness of contraindicated drugs (a) and awareness of contraindicated foods (b).

Table 7.

Factors Influencing the Awareness of Contraindicated Drugs and Food.

Independent Factors	Contraindicated Drugs^a				Contraindicated Food^b
	Sig.	Exp(B)	95% Confidence Interval for Exp(B)		Sig.	Exp(B)	95% Confidence Interval for Exp(B)
	Sig.	Exp(B)	Lower Bound	Upper Bound	Sig.	Exp(B)	Lower Bound	Upper Bound
Gender	0.489	1.555	0.446	5.428	0.607	0.774	0.292	2.054
Age	0.147	1.387	0.891	2.158	0.169	1.270	0.903	1.784
Nationality	0.010	8.913	1.697	46.810	0.584	0.753	0.272	2.083
Location	0.710	1.367	0.263	7.105	0.408	1.629	0.513	5.180
Education level	0.865	1.078	0.454	2.562	0.933	0.971	0.495	1.908
Employment status	0.349	0.535	0.144	1.982	0.342	1.629	0.595	4.460
Total family income	0.584	1.394	0.424	4.590	0.326	1.581	0.634	3.944
Marital status	0.727	1.208	0.417	3.501	0.766	1.148	0.462	2.855
Spouse supportive	0.542	1.657	0.327	8.395	0.787	1.168	0.378	3.610
Family supportive	0.237	0.309	0.044	2.161	0.276	0.462	0.115	1.854
Comorbidities	0.000	15.076	3.442	66.042	0.259	1.225	0.861	1.741
Cancer diagnosis	0.033	0.692	0.493	.971	0.449	0.916	0.731	1.149
Duration of cancer	0.022	9.398	1.381	63.962	0.749	1.244	0.326	4.746
Duration of chemotherapy	0.083	0.190	0.029	1.241	0.936	0.946	0.240	3.725

^aDependent Variable: Awareness of contraindicated drugs.

^bDependent Variable: Awareness of contraindicated food.

Bold indicates that they are siginificant as P value is <0.05.

For awareness of contraindicated drugs, nationality was a significant predictor (P = 0.010), with non-Saudi participants showing a significantly higher likelihood of awareness (Exp(B) = 8.913, 95% CI: 1.697-46.810). Additionally, co-morbidities had a strong association with awareness (P = 0.000), with participants without chronic diseases being 15 times more likely to be aware of contraindicated drugs (Exp(B) = 15.076, 95% CI: 3.442-66.042). The duration of cancer was also significant (P = 0.022), with those having been diagnosed for a longer period (Exp(B) = 9.398, 95% CI: 1.381-63.962) showing increased awareness.

For awareness of contraindicated foods, gender was a notable factor, with males showing a higher likelihood of awareness, although the result was not statistically significant (P = 0.607). Cancer diagnosis showed a significant relationship (P = 0.033), suggesting that certain cancer types may influence food awareness. Duration of cancer was also a significant factor for food awareness (P = 0.022), indicating that patients diagnosed for longer periods were more likely to be aware of contraindicated foods.

Other variables, such as age, location, education level, employment status, family support, and chemotherapy duration, did not significantly influence awareness of either contraindicated drugs or foods (P > 0.05). These findings underscore that specific demographic and clinical factors, such as nationality, co-morbidities, and the duration of cancer, play a significant role in patients’ awareness of contraindicated drugs and foods.

Table 8 explores the factors influencing patients’ awareness of body temperature management, exercise during chemotherapy, and the use of complementary and alternative medicine (CAM). The table presents the results of logistic regression analyses, including significance values (Sig.), odds ratios (Exp(B)), and 95% confidence intervals (CI) for each independent variable.

Table 8.

Factors Influencing the Awareness of CAM, Exercise, and Body Temperature.

Independent Factors	Body Temperature Awareness^a				Exercise Awareness^b				CAM Awareness^c
	Sig.	Exp(B)	95% Confidence Interval for Exp(B)		Sig.	Exp(B)	95% Confidence Interval for Exp(B)		Sig.	Exp(B)	95% Confidence Interval for Exp(B)
	Sig.	Exp(B)	Lower Bound	Upper Bound	Sig.	Exp(B)	Lower Bound	Upper Bound	Sig.	Exp(B)	Lower Bound	Upper Bound
Gender	0.114	0.461	0.176	1.206	0.084	9.244	0.742	115.120	0.195	0.511	0.186	1.409
Age	0.494	1.125	0.802	1.577	0.194	1.603	0.786	3.267	0.662	1.084	0.754	1.559
Nationality	0.202	0.496	0.169	1.457	0.107	0.134	0.012	1.544	0.838	1.131	0.347	3.684
Location	0.248	0.480	0.138	1.667	0.064	0.110	0.011	1.135	0.001	0.047	0.008	.286
Education level	0.905	1.042	0.529	2.054	0.937	0.945	0.235	3.800	0.268	0.666	0.325	1.367
Employment status	0.893	0.932	0.335	2.592	0.990	1.015	0.108	9.535	0.642	0.774	0.263	2.282
Total family income	0.447	0.699	0.278	1.758	0.330	0.393	0.060	2.573	0.055	0.350	0.120	1.023
Marital status	0.282	0.587	0.222	1.549	0.260	0.363	0.062	2.118	0.741	0.858	0.346	2.128
Spouse supportive	0.649	0.766	0.243	2.416	0.445	2.848	0.194	41.711	0.466	0.640	0.193	2.121
Family supportive	0.600	0.682	0.163	2.849	0.523	0.303	0.008	11.774	0.647	0.713	0.167	3.041
Comorbidities	0.904	0.978	0.680	1.406	0.232	0.662	0.337	1.301	0.598	1.110	0.754	1.633
Cancer diagnosis	0.536	0.931	0.743	1.167	0.464	0.826	0.495	1.378	0.711	1.047	0.821	1.335
Duration of cancer	0.308	0.460	0.103	2.048	0.456	0.306	0.014	6.859	0.564	0.646	0.146	2.850
Duration of chemotherapy	0.242	2.484	0.540	11.419	0.911	0.840	0.040	17.567	0.233	2.518	0.552	11.491

^aDependent Variable: Body Temperature Awareness.

^bDependent Variable: Exercise Awareness.

^cDependent Variable:CAM Awareness.

Bold indicates that they are siginificant as P value is <0.05.

For body temperature awareness, none of the demographic or clinical factors were statistically significant (P > 0.05), indicating that variables such as gender, age, nationality, and marital status did not significantly influence awareness of body temperature management. Similarly, exercise awareness showed no significant predictors, although a trend towards significance was noted for location (P = 0.064), with urban dwellers potentially having higher awareness. For CAM awareness, location was a significant factor (P = 0.001), with rural participants demonstrating significantly higher awareness of CAM (Exp(B) = 0.047, 95% CI: 0.008-0.286), suggesting that geographical location might play a role in access to or knowledge about CAM practices.

Other factors, including educational level, employment status, family support, co-morbidities, cancer diagnosis, and the duration of cancer or chemotherapy, did not show significant associations with awareness of body temperature, exercise, or CAM (P > 0.05). The results suggest that while some individual factors like location may influence awareness of CAM, overall, demographic and clinical characteristics have limited impact on awareness of body temperature and exercise management during chemotherapy.

Discussion

This study provides critical insights into the sociodemographic characteristics, co-morbidities, medication use, cancer types, professional counseling, complementary and alternative medicine (CAM) use, contraindications, and the awareness of cancer patients regarding the management of their disease. Through an in-depth analysis of these factors, we aim to highlight key drivers of cancer patients’ knowledge about their condition, particularly concerning contraindications related to both medications and foods. The findings are instrumental in understanding the gaps in patient education and suggest strategies for improving cancer care through targeted educational interventions.

The study’s demographic profile revealed a nearly equal distribution of male and female participants, with more than half of the respondents being over 40 years old. The majority (75.2%) were non-Saudis, reflecting the demographic diversity seen in urban cancer centers due to immigration. This pattern mirrors trends observed in other regions where aging, urbanization, and diverse populations correlate with higher cancer prevalence.^31-33 Participants with higher education levels and moderate incomes were more frequently represented, aligning with previous research that indicates that educated patients are more likely to seek medical advice and actively participate in managing their health.^34,35

Interestingly, sociodemographic factors such as education, income, and employment did not significantly affect the awareness of cancer contraindications in this study. This suggests that other factors, such as exposure to health care services, the duration of illness, and the type of cancer, may play a more prominent role in determining a patient’s awareness level. The role of family support was also a significant consideration in this study. More than 80% of participants reported receiving family support, with 64% indicating spousal support. This aligns with a growing body of literature highlighting the crucial role of family in enhancing cancer patients’ treatment adherence and overall well-being.³⁶ However, despite the high level of support, there was no statistically significant correlation between family support and awareness of contraindications. This finding suggests that while emotional and practical support is crucial, it does not necessarily translate into greater awareness of the complexities of cancer treatment. This gap highlights the need for more targeted educational interventions aimed at both patients and their families, particularly around contraindications and the management of cancer treatment.

The presence of co-morbidities such as diabetes (19.2%) and hypertension (21.6%) among participants underscores the challenges of managing multiple health conditions simultaneously. Cancer treatments often interact with medications used for chronic conditions, requiring careful management to avoid adverse drug interactions.³⁷ Additionally, mental health issues, such as depression, are common among cancer patients, which complicates their ability to manage medications and adhere to treatment protocols.³⁸ Addressing both the physical and psychological aspects of cancer care through integrated services can improve patients’ ability to manage contraindications and enhance their overall quality of life.

Medication use among participants revealed that acetaminophen (24%) was the most frequently used drug, a reflection of the need for cancer patients to manage pain and treatment-related symptoms.³⁹ Other commonly used medications include β-blockers and proton pump inhibitors, which are employed to manage co-morbid conditions or alleviate side effects of chemotherapy.³⁷ Interestingly, only 20.8% of participants reported using multiple medications, suggesting a cautious approach to polypharmacy. This finding highlights the importance of detailed records and open communication between patients and health care providers to prevent harmful drug interactions. For example, drugs like erlotinib, used for non-small cell lung cancer, can alter the metabolism of acetaminophen, indicating the necessity for careful monitoring and patient education.⁴⁰

Despite the high demand for cancer education, 90% of our participants did not receive any form of professional counseling. Limited professional counseling, especially from physicians, suggests that there may be barriers, such as time constraints, high patient loads, or lack of specific training among health care providers, which limit effective communication on contraindications and disease management. Studies show that health care providers who deliver comprehensive counseling improve cancer patients’ adherence to treatment and reduce their use of contraindicated substances.^41,42 Furthermore, our findings reveal that approximately half of the participants did not use any complementary or alternative medicine (CAM), while a notable fraction consumed vitamins, especially vitamins B12 and D. The literature indicates mixed opinions on CAM use in cancer treatment, as some studies suggest potential benefits, while others highlight risks associated with drug-CAM interactions.^33,43

The multinomial regression analysis conducted in this study reveals the significant factors influencing awareness of contraindicated drugs and foods among cancer patients. For contraindicated drugs, nationality, co-morbidities, and duration of cancer were the most significant predictors. Nationality was a strong determinant, with Saudi patients being significantly more likely to be aware of contraindicated drugs (P = 0.010). This could reflect differences in health care access, patient education, or cultural factors that influence how people from different nationalities approach their cancer treatment.³⁴ The presence of co-morbidities had a powerful association with awareness of contraindicated drugs. Participants without chronic diseases were found to be 15 times more likely to be aware of contraindicated medications (Exp(B) = 15.076, 95% CI: 3.442-66.042). This finding suggests that patients managing multiple health conditions may be overwhelmed with their treatment regimens, reducing their focus on the specific contraindications of drugs.³⁷ Duration of cancer also played a critical role in awareness of drug contraindications. Patients diagnosed for longer periods were significantly more aware of drugs to avoid, indicating that prolonged exposure to the health care system enhances knowledge of potential risks and interactions.⁴⁰

For contraindicated foods, gender, cancer diagnosis, and duration of cancer emerged as important factors. Gender was noted as a factor, with males showing a slightly higher likelihood of being aware of food contraindications, although the result was not statistically significant (P = 0.607). Cancer diagnosis showed a significant relationship (P = 0.033), suggesting that the type of cancer may influence food awareness. For example, patients with gastrointestinal cancers or those undergoing chemotherapy for digestive system-related cancers may have more knowledge about dietary restrictions due to the direct impact of their treatments on digestion and nutrition.⁴⁴ Duration of cancer was again a significant factor, with patients who had been diagnosed for longer periods showing better awareness of food contraindications (P = 0.022). This finding aligns with the notion that the more exposure patients have to the health care system and treatment regimens, the more likely they are to accumulate essential knowledge.⁴⁵

Interestingly, age, location, education level, employment status, family support, and chemotherapy duration did not significantly influence awareness of contraindicated drugs or foods (P > 0.05). This suggests that demographic and psychosocial variables might influence other aspects of cancer care but do not directly correlate with awareness of contraindications. The lack of significance for family support is noteworthy, as it challenges the assumption that a supportive family network automatically translates into improved patient knowledge, particularly regarding treatment and dietary restrictions.

The study also identified some concerning gaps in cancer patients’ understanding of contraindications. Dietary misconceptions were prevalent, with 60% of participants believing that avoiding sugar would enhance their treatment effectiveness. This reflects a widespread but incorrect belief among cancer patients about the role of diet in cancer management. While patients need to maintain a balanced diet, there is no scientific evidence to support the idea that sugar directly influences cancer progression or treatment outcomes.³³ Another significant knowledge gap was observed regarding the importance of controlling body temperature during chemotherapy. Over 58% of patients were unaware of the need to regulate body temperature during treatment, which can lead to complications if not managed properly. These gaps in understanding underscore the need for more comprehensive educational efforts targeting the nuances of chemotherapy side effects and their management.⁴⁶

Limitations and Recommendations

One limitation of this study is its cross-sectional design, which restricts the ability to draw causal inferences about the factors influencing awareness of contraindications. Additionally, the reliance on self-reported data may introduce response bias, particularly regarding sensitive topics such as dietary habits and medication use. Patients may underreport or overreport their behaviors due to social desirability bias or recall errors. Future research should focus on longitudinal studies to explore causal relationships and the long-term impact of educational interventions on patient knowledge and health outcomes. Additionally, exploring family-centered educational programs could provide a more holistic approach to cancer care, ensuring that both patients and their support systems are informed about the complexities of treatment management.

Practice Implications

This study emphasizes the importance of improving cancer patient education, particularly regarding contraindications related to drugs and foods. Health care providers should take a proactive approach to educate patients about these critical aspects of treatment management. Education efforts should be tailored to individual patient needs, with special attention given to those with specific risk factors such as nationality, co-morbidities, and the duration of cancer treatment. Multidisciplinary teams, including oncologists, pharmacists, dietitians, and nurses, should collaborate to offer comprehensive education on both drug interactions and dietary restrictions. These interventions should be introduced early in the treatment process, especially for newly diagnosed patients, and reinforced throughout their care journey. Furthermore, educating family members about contraindications and proper care practices should be a key component of cancer care, as their support plays a critical role in patients’ overall treatment adherence and well-being.

Conclusion

This study highlights the critical need to enhance cancer patients’ awareness of contraindications, particularly regarding medications and foods, which can significantly impact treatment efficacy and safety. The factors influencing awareness include nationality, co-morbidities, and duration of cancer, with gender and cancer diagnosis also playing a role in food-related awareness. Although family support is beneficial, it does not necessarily improve patients' knowledge of contraindications, indicating the need for targeted educational interventions for both patients and their families. By improving patient education and incorporating multidisciplinary care models, health care providers can reduce risks, enhance patient outcomes, and ultimately improve the quality of life for cancer patients.

Footnotes

Acknowledgments

The authors would like to acknowledge the Researchers Supporting Project number (RSP2025R115), King Saud University, Riyadh, Saudi Arabia, for extending financial support to do this research project. The authors are also thankful to AlMaarefa University for supporting this research.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors would like to express gratitude to King Saud University, Riyadh, Saudi Arabia, for extending financial support to do this research project through the Researchers Supporting Project number (RSP2025R115).

Ethical Statement

ORCID iD

Syed Mohammed Basheeruddin Asdaq

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Awareness of Contraindications Among Cancer Patients in Riyadh,Saudi Arabia: A Cross-Sectional Study

Abstract

Introduction

Methods

Results

Conclusion

Plain Language Summary

Keywords

Introduction

Methods

Study Design

Participants

Ethical Consideration

Study Instrument

Sociodemographic Characteristics of the Participants

Co-morbidities Status of the Participants

Details About Cancer

Status of Food preferences, CAM use, and Physical activity

Statistical Analysis

Results

Sociodemographic Characteristics of the Participants

Clinical and Treatment Characteristics

Use of CAM, Avoidance of Food and Preferred Information Source

Awareness of Contraindications

Comparison of the Awareness Status of the Participants with Their Sociodemographic Characteristics

Multinomial Regression Analysis to Determine Factors Influencing Outcome Variables

Discussion

Limitations and Recommendations

Practice Implications

Conclusion

Footnotes

Acknowledgments

Declaration of Conflicting Interests

Funding

Ethical Statement

ORCID iD

References