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To describe the prevalence, expectations and factors associated with the use of complementary and alternative medicine (CAM) in Asian radiotherapy patients.Overall 65 consecutive patients in an Asian oncology department were surveyed from December 2004 to January 2005, using a modified and translated instrument capturing information on patients' characteristics, CAM use, treatment refusal and satisfaction.Some basic characteristics were: 86% Chinese; median age 56 years (range: 31–87 years); 57% women; cancer types – breast 42%, lung 20%, nasopharyngeal 11%. All had received prior radiotherapy (54%), chemotherapy (51%) or surgery (45%). The median diagnosis-to-survey time was 7.1 months (range 1–168 months). Fifty-six patients (86%) used CAM for cancer treatment. The two commonest categories were spiritual practices (48%) and traditional Chinese medicine (TCM) (37%). Significant factors in TCM use were being male (P = 0.007) and having advanced disease (P = 0.045). Overall 60% of patients using herbal treatment and 97% of patients using spiritual practices expected a cure, a longer life, symptomatic relief, improved immunity or a better quality of life. Satisfaction with western treatment correlated positively with satisfaction with CAM (Spearman's rank correlation coefficient = 0.4). Forty-six patients (71%) did not discuss their CAM use with their oncologists and 64% obtained advice from their friends or families. Fourteen patients refused previous western treatments (11 feared its side effects (79%), five preferred CAM (36%)).This study highlights the prevalence of CAM practices among Asian radiotherapy patients, their high expectations of the outcome and the need for better doctor–patient communication.