Integrative oncology: how Ayurveda can address unmet needs in global cancer care

Integrative oncology provides a framework to research and integrate safe, effective TCIM alongside conventional cancer treatment and can help bridge healthcare gaps in delivering evidence-informed, patient-centered care. This growing field uses lifestyle modifications, mind and body therapies (e.g., acupuncture, massage, meditation, and yoga), and natural products to improve symptom management and quality of life among patients with cancer.

To develop Integrative Oncology, the following recommendations can be made:
1) educating and integrating TCIM providers into the cancer control workforce to promote risk reduction and culturally salient healthy lifestyles;
2) developing and testing TCIM interventions to address cancer symptoms or treatment-related adverse effects (e.g., pain, insomnia, fatigue); and
3) disseminating and implementing evidence-based TCIM interventions as part of comprehensive palliative and survivorship care so patients from all cultures can live with or beyond cancer with respect, dignity, and vitality. With conventional medicine and TCIM united under a cohesive framework, integrative oncology may provide citizens of the world with access to safe, effective, evidence-informed, and culturally sensitive cancer care.

Over 19 million people worldwide were diagnosed with cancer, and almost 10 million died in 2020. By 2040, new cases and deaths will reach approximately 28 million and 16 million, respectively. Cancer treatment alone costs approximately US$1.2 trillion annually—nearly 2% of the global gross domestic product in 2019.LMICs account for 80% of the global cancer burden; yet, with only 5% of the global spending to combat this disease, LMICs will continue to fall behind in efforts to provide quality cancer care to their citizens. Furthermore, these countries will not remain aligned to achieve the WHO Sustainable Development Goal Target 3.414 for the year 2030, which aims to reduce by one-third premature mortality from non-communicable diseases, including cancer, compared with rates from 2015. Countries with a low human development index (a summary measure of key dimensions affected by sustainability and equity) experience significantly higher premature mortality because of delayed diagnosis, access to therapeutic services, and limited availability of quality treatment. Furthermore, a constellation of dynamics surrounding issues, such as lack of infrastructure, health policies, adequately trained professionals to perform evidence-based screening and treatment, trust in providers, and continuity of care across services, underlies and exacerbates these global challenges in cancer care delivery. For example, premature deaths from noncommunicable diseases that could be prevented through effective policies and public health interventions have increased nearly 50% over a few decades, from 23 million deaths in 1990 to over 34 million deaths in 2017, with one-third of those being cancer-related.

LMICs face additional challenges in responding to the rise of cancer incidence and premature death caused by undesirable lifestyle trends. Cancer incidence changes when people from Asia or Africa migrate to Western countries. Immigrants experience increased obesity and a spike in Western lifestyle-associated diseases, including cancer incidence rates higher than those observed in their home countries. Several epidemiological studies found that immigrant cancer rates can match those of their newfound home as quickly as one generation for Africans and South Asians.

Systems of medicine like Ayurveda can address treatment gaps and unmet needs in cancer management. In India, people are already using Ayurveda to improve cancer management. A prevalence rate of 34.4% was found in a study that looked at how many cancer patients were using TCIM. Home remedies were the most commonly used TCIM, and the family was the most reliable and encouraging source of advice prompting TCIM use. The main reason for TCIM use is expected improvement in the general quality of life, and most patients prefer consuming such medications during active chemotherapy. The degree of non-disclosure to the treating oncologist remained high. This is the first study done in Kerala on a small sample of patients. There is a need to do studies on larger samples. Prevalence of TCIM medications' concurrent use calls for implementing pharmacovigilance, patient education, and research to identify and integrate TCIM interventions in cancer care that have beneficial effects. Preclinical studies must be initiated to urgently understand the interactions between TCAM medications and chemotherapeutic agents.

Ayurveda as add-on to conventional treatment can be thought about with two purposes in mind- To enhance the activity of conventional treatment (synergistic activity) or To enhance Quality of life (QOL), to reduce the morbidity of treatment viz. Chemotherapy-induced Neutropenia, fatigue, Chemotherapy Induced Nausea Vomiting (CINV), Chemotherapy Induced Peripheral Neuropathy (CIPN), Anxiety, Sleep disturbances, Infections, Cachexia, Lymphedema, etc.

The combined use of Ayurveda and radiation therapy can be explored to improve the therapeutic efficacy of radiation and, thereby, the survival of patients with cancer. Ayurvedic interventions may decrease normal tissue toxicity from radiation and prevent side effects like radiation-induced mucositis and xerostomia. Ayurvedic medicines may have radiosensitizing effects and enhance the efficacy of radiation. An Ayurvedic intervention and radiation therapy could produce a combined positive outcome in specific cancers. Ayurveda can also be administered as Add-on or Stand-alone therapy in palliative care for pain, nutrition, constipation, wound management, and so on in advanced disease. Ayurveda a Stand-alone for relapse and stable disease where no conventional treatment is suggested, viz. relapsed ovarian cancer, inoperable presentations of malignancy, and non-suitable cases for chemotherapy/radiotherapy.

Careful and strategic integration of Ayurveda with conventional cancer care can lay the foundation for developing a practical approach in Integrative Oncology.

References

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