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Background: Worldwide surveys suggest that the use of CAM is becoming increasingly popular among the general population as well as among cancer patients. Aim: We determined the patterns of complementary and alternative medicine (CAM) use in cancer patients, and the associated factors in a multiethnic Asian setting. Methods: Through the Asean CosTs In ONcology (ACTION) prospective cohort study, 1662 newly diagnosed cancer patients were recruited from 12 public and 2 private hospitals in Malaysia. In the current study, we only included 1328 patients who were alive and completed one-year of follow-up. Using questionnaires and cost diaries, patients' sociodemographic factors and disease related factors were measured at baseline, whereas details on CAM use were measured at 12 months. Results: Median age at cancer diagnosis was 53 years. Patients comprised those with breast cancer (33%), gastrointestinal cancers (27%), hematologic malignancies (22%), female reproductive cancers (6%), respiratory cancers (5%), and other types. At one-year, 175 patients reported using CAM (14%), of which 53 comprised patients reporting inability to make necessary household payments (economic hardship) at initial diagnosis. Most CAM users took food or nutritional supplements (75%), spending between RM150 to RM7500 in a year, followed by traditional local medicine (43%), where expenditures ranged between RM50 to RM20,000. A minority practiced homeopathy, and mind-body practices. Fifty-one patients used more than one type of therapy. In CAM users with economic hardship at baseline, median expenditure on CAM was RM1500, with some spending as much as RM10,000. Compared with other cancer types, patients with hematologic malignancies and women with breast cancer were most likely to use CAM. In a multivariable analysis, baseline factors that were associated with CAM use were economic hardship, higher anxiety scores, having female reproductive cancers, or hematologic malignancies, receipt of surgery, and nonreceipt of radiotherapy. Sex, education status, marital status, health insurance status, cancer stage, and systemic cancer therapy do not appear to be associated with CAM use. Conclusion: While the proportion of patients reporting CAM use following a cancer diagnosis appear low in this study, the finding that patients with initial economic hardship were independently more likely to use CAM, warrants attention. [ABSTRACT FROM AUTHOR]