Abstract
Introduction
C
State of Ayurveda in Cancer Care in India
Ayurveda is the most commonly used CAM in India by cancer patients as a stand-alone or add-on to conventional cancer care. 3 The need for cooperation between Ayurveda and modern physicians with mutual trust in the management of cancer along with standard treatment protocols was very well recognized in various meetings, 4 and integrative oncology programs have been initiated in a few institutes across India. However, there is paucity of evidence of the specific benefits for patients. Moreover, few reports of Ayurveda as add-on or stand-alone intervention in cancer management and cancer treatment-induced morbidity are published. 5 The lack of rigorous studies and high-quality publications continues to keep decision-makers and the mainstream medical doctors skeptical about the safety and efficacy of Ayurvedic treatments.
Scope for Integrative Ayurveda Oncology
Cancer screening and prevention program
Primary prevention: Promotion of healthy lifestyles based on the principles of Ayurveda may be augmented with National Cancer Control Programme. People at high risk for cancer, having strong family history of cancer, those with habits of alcohol, tobacco, and other carcinogens may be subjected to the Ayurveda Cancer Prevention Program (ACPP). Precancerous conditions, namely oral submucous fibrosis and cervical low-grade squamous epithelial lesions may be treated using the whole system approach.
Secondary prevention: Cancer patients who have completed conventional treatment may be treated with the whole system approach of Ayurveda for enhancing immunity and preventing recurrence.
Management of cancer
Ayurveda can be administered as an add-on to conventional treatment, keeping two objectives in mind:
To enhance activity of conventional treatment, namely chemotherapy and radiation therapy, where synergism has been established by research studies.
To enhance QOL and to reduce morbidity of treatment, namely radiation-induced mucositis and xerostomia, chemotherapy-induced nausea/vomiting, neutropenia, fatigue, peripheral neuropathy, and other complications such as hepatotoxicity, sleep disturbances, cachexia, and lymphedema.
Ayurveda as an add-on or stand-alone therapy in palliative care such as pain, constipation, wounds, and for improving nutrition in advanced stages of the disease.
Ayurveda as a stand-alone therapy for relapse and stable cancer where no active conventional treatment is suggested, inoperable presentations of malignancy, and unsuitable cases for chemotherapy/radiotherapy.
Challenges and suggested approaches
Generating evidence of the benefits of Ayurvedic interventions through rigorous clinical documentation and well-conducted studies, especially targeting independent practitioners, researchers, and institutions engaged in integrative oncology service and research.
Publishing systematic reviews of prior research studies exploring the safety and efficacy of Ayurveda in the management of cancer.
Ensuring comprehensive clinical documentation of cancer patients using Ayurveda treatment as a standalone or add-on therapy based on categorization of patients. 6 Setting up a clinical case registry for practitioners to report the clinical outcomes in treatment of cancer would be an important step to learn from the experiences of physicians who practice across the country.
Conducting well-planned clinical trials that enable evaluation of the whole system approach in Ayurveda to understand the efficacy of the complete Ayurvedic intervention rather than individual components. 7
Conducting herb–drug interaction and chemosensitivity studies based on both laboratory research and real-time clinical observations.
Establishing a database of medicinal plants and natural compounds showing promise in the management of cancer can facilitate in silico studies through bioinformatics tools.
Creating a transdisciplinary team of experts from the different healthcare systems who will collectively facilitate informed decision-making at the point of care. The focus of the transdisciplinary team will be to achieve the goal of better treatment outcomes and QOL for the patients.
Addressing the medicolegal and ethical issues involved in integrative medicine and integrative Ayurveda oncology and developing guidelines for clinical practice and research.
Making available insurance coverage for integrative oncology care, keeping in mind the goal of universal health coverage.
Establishment of a scientific body like “Society of Integrative Oncology” to bring together a multidisciplinary team of professionals to develop strategic policy/guidelines for integrative Ayurveda oncology in India.
Networking with global research and clinical community to integrate Ayurveda in the development of integrative oncology in the world.
India is much in need of integrative approaches for prevention and management of cancer. India has a pluralistic healthcare set up and the National Health Policy, 2017, highlighted on prevention through lifestyle advocacy, healthcare delivery through integration, colocation, and medical pluralism. 8,9 National Program for Prevention and Control of Cancer, Diabetes, CVD and Stroke, an initiative of Government of India, emphasizes on mainstreaming and integrating AYUSH in healthcare. Through appropriate collaborations with conventional medicine, Ayurveda can make substantial contributions for the development of integrative oncology that can address the specific health challenges of the Indian population even as it can bring new paradigms and open up new avenues for the development of integrative Ayurveda oncology in the world.
Footnotes
Author Disclosure Statement
No competing financial interests exist.