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Integrating Traditional and Allopathic Medicine: An Opportunity to Improve Global Health in Cancer

Integrating Traditional and Allopathic Medicine: An Opportunity to Improve Global Health in Cancer Cancer is one of the leading causes of disease burden worldwide, with more than 14 million new cases and 8 million deaths estimated in 2012 alone. Approximately 57% of those new cancer cases and 65% of cancer deaths occurred in less developed regions of the world (1) where resources to treat cancer are scarce. All cancer patients face challenges to treatment, but many of these issues are particularly stark in low- and middle-income countries, including diagnosis at late stages when treatment is generally less effective, lack of geographic access to cancer care facilities, a need for trained medical professionals, issues of affordability of care, stigmatization of disease, and minimal access to palliative care (2). The integration of allopathic and traditional medicine may afford an opportunity to address some of the challenges in cancer control. Too often, we view traditional medicine and allopathic medicine as separate realms. We ignore the fact that cancer patients walk in both realms at the same time during their disease journey. A systematic review of studies performed in Europe, North America, Australia, and New Zealand found that the use of complementary medicines has been increasing over time, with almost half of cancer patients reporting use in the most recent time period (3). This prevalence is likely to be much higher in other parts of the world—for instance, an estimated 71% of the population in Chile and 65% of the population in rural India use traditional medicine to help meet their primary health care needs (4). We also forget that many of the interventions we prescribe routinely in allopathic medicine arose from traditional medicine and natural products, including aspirin, morphine, taxol, vinca alkaloids, artemisinin, yoga, and acupuncture. Integrative oncology has been defined as both a science and philosophy that addresses the complexity of the health of cancer patients, using complementary therapies in concert with allopathic medical treatment to enhance efficacy, improve symptom control, alleviate patient distress, and reduce suffering (5). Careful, evidence-based integration of allopathic and traditional medicine has the potential to foster earlier diagnosis of cancer, decrease toxicities associated with interactions between traditional and allopathic medicine, improve adherence to treatment recommendations, and improve health-related quality of life. As a corollary, research can inform both traditional and allopathic medicine and guide effective integration of these two disciplines to improve cancer care. In many settings, practitioners of traditional medicine are more accessible to patients than practitioners of allopathic medicine and are often the first point of patient contact. This has long been recognized by programs targeting the control of AIDS in Africa, where traditional healers have been suggested as potential partners in public health programs, as long as there is mutual respect and consistent communication to ensure program quality and adherence to current medical standards (6). Practitioners of traditional medicine are more likely to speak the same language as the patient, to reside closer to the patient, and to charge fees more affordable to the patient. In some countries, the number of traditional medicine practitioners far exceeds the number of allopathic medicine practitioners (7). Thoughtful integration of traditional practitioners into routine cancer care could thus expand the cancer workforce. For example, education of practitioners of traditional medicine about the signs and symptoms of cancer, accompanied by a pathway for timely referrals to allopathic practitioners for further evaluation, could potentially decrease time to cancer diagnosis and thus downstage many common cancers. However, such collaboration can only be fruitful if there is mutual respect and understanding between the allopathic and traditional medicine practitioner. Just as we stress the importance of close communication between the primary care physician and oncology specialists, we must stress the importance of close communication between traditional medicine practitioners, the primary care team, and the oncology team. Delays in cancer diagnosis currently occur both in the realms of traditional medicine and allopathic medicine. Both sets of practitioners need to be aware of the risk of cancer and the importance of timely diagnosis. In addition, both sets of practitioners need to be aware of the current and recommended regimens for medications and treatment for individual patients. Allopathic practitioners should routinely ask cancer patients respectfully about use of traditional medicine and ongoing relations with traditional medicine practitioners. Both sets of practitioners should also be aware of the possibility for known or as yet unknown interactions between traditional and allopathic medications and cancer treatments, as well as the limitations of both systems of practice. Treatment of cancer usually involves interventions across several disciplines, including surgery, chemotherapy, and radiation therapy. These interventions have known risks for side effects that adversely affect the cancer patient’s health-related quality of life. A few studies indicate that consultation from a traditional medicine practitioner and appropriate use of certain traditional medicines or practices may help alleviate symptoms of cancer and/or cancer treatment, as well as help ensure adherence of the patient to treatment recommendations. For example, one randomized clinical trial found that a four-week yoga intervention led to a clinically significant improvement in sleep quality among cancer survivors (8). There are also anecdotal reports of herbal mouthwashes that may minimize treatment-induced mucositis in patients receiving radiotherapy for head and neck cancer. Such leads should be followed up in large multicenter studies with strong study designs, so that interventions found to be effective can be included in the arsenal of cancer physicians at various stages in the treatment process. We have made progress in the allopathic treatment of cancer through scientific methods of investigation. In the same way, through rigorous scientific evaluation, we can help build the evidence base for the role of traditional medicine in cancer treatment. One critical step is the standardization of traditional medications, which often include the combination of natural products. Isolation of the different components of traditional medicines can help lead to identification of active ingredients and active combinations. Standardized preparations of traditional medicines, or their individual components, are critical to prospective clinical trials. A second key step is the design and conduct of clinical trials to evaluate traditional medicinal products or practices for the treatment of cancer or cancer-related symptoms. Not only must the intervention be standardized, but also the metrics to evaluate the impact of the intervention should include standard oncology measures and validated patient-reported outcomes. Multicenter and international collaboration should be encouraged in order to help develop standardized protocols, evaluate reproducibility, build research capacity in this emerging area, and foster a culture of open communication. Effective integration of allopathic and traditional medicine will help cancer patients and their health care providers walk together in the same realm on the cancer journey and could be an important tool with which to address current global disparities in cancer care. In low-resource settings, thoughtful collaboration with traditional practitioners could lead to an expanded workforce, increased geographical access to care, and increased opportunities for palliative care. As we work to strengthen the evidence base for the use of traditional medicine in cancer treatment, we also may in the process be able to make the cancer journey more responsive to the needs and beliefs of cancer patients, and at the same time improve cancer outcomes and control of cancer-related symptoms. References 1 Ferlay J , Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer; 2013 . http://globocan.iarc.fr/. Accessed February 20, 2017. 2 Gelband H , Sankaranarayanan R, Gauvreau CL, et al. Costs, affordability, and feasibility of an essential package of cancer control interventions in low-income and middle-income countries: Key messages from Disease Control Priorities, 3rd edition . Lancet . 2016 ; 387 10033 : 2133 – 2144 . Google Scholar Crossref Search ADS PubMed WorldCat 3 Horneber M , Bueschel G, Dennert G, et al. How many cancer patients use complementary and alternative medicine: A systematic review and metaanalysis . Integr Cancer Ther. 2012 ; 11 3 : 187 – 203 . Google Scholar Crossref Search ADS PubMed WorldCat 4 World Health Organization . Traditional Medicine. Report by the Secretariat . Geneva : World Health Organization ; 2003 . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 5 Sagar SM. Integrative oncology in North America . J Soc Integr Oncol . 2006 ; 4 1 : 27 – 39 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 6 UNAIDS . Collaborating with traditional healers for HIV prevention and care in sub-Saharan Africa: Suggestions for programme managers and field workers. Paper presented at: Joint United Nations Programme on HIV/AIDS; June 2006; New York. 7 World Health Organization . WHO Traditional Medicine Strategy: 2014–2023 . Geneva : World Health Organization ; 2014 . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 8 Mustian KM , Sprod LK, Janelsins M, et al. Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors . J Clin Oncol . 2013 ; 31 26 : 3233 – 3241 . Google Scholar Crossref Search ADS PubMed WorldCat Published by Oxford University Press 2017. This work is written by US Government employees and is in the public domain in the US. Published by Oxford University Press 2017. This work is written by US Government employees and is in the public domain in the US. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JNCI Monographs Oxford University Press

Integrating Traditional and Allopathic Medicine: An Opportunity to Improve Global Health in Cancer

Trimble, Edward L.; Rajaraman, Preetha
JNCI Monographs , Volume 2017 (52) – Nov 1, 2017
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Publisher
Oxford University Press
Copyright
Copyright © 2022 Oxford University Press
ISSN
1052-6773
eISSN
1745-6614
DOI
10.1093/jncimonographs/lgx011
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Abstract

Cancer is one of the leading causes of disease burden worldwide, with more than 14 million new cases and 8 million deaths estimated in 2012 alone. Approximately 57% of those new cancer cases and 65% of cancer deaths occurred in less developed regions of the world (1) where resources to treat cancer are scarce. All cancer patients face challenges to treatment, but many of these issues are particularly stark in low- and middle-income countries, including diagnosis at late stages when treatment is generally less effective, lack of geographic access to cancer care facilities, a need for trained medical professionals, issues of affordability of care, stigmatization of disease, and minimal access to palliative care (2). The integration of allopathic and traditional medicine may afford an opportunity to address some of the challenges in cancer control. Too often, we view traditional medicine and allopathic medicine as separate realms. We ignore the fact that cancer patients walk in both realms at the same time during their disease journey. A systematic review of studies performed in Europe, North America, Australia, and New Zealand found that the use of complementary medicines has been increasing over time, with almost half of cancer patients reporting use in the most recent time period (3). This prevalence is likely to be much higher in other parts of the world—for instance, an estimated 71% of the population in Chile and 65% of the population in rural India use traditional medicine to help meet their primary health care needs (4). We also forget that many of the interventions we prescribe routinely in allopathic medicine arose from traditional medicine and natural products, including aspirin, morphine, taxol, vinca alkaloids, artemisinin, yoga, and acupuncture. Integrative oncology has been defined as both a science and philosophy that addresses the complexity of the health of cancer patients, using complementary therapies in concert with allopathic medical treatment to enhance efficacy, improve symptom control, alleviate patient distress, and reduce suffering (5). Careful, evidence-based integration of allopathic and traditional medicine has the potential to foster earlier diagnosis of cancer, decrease toxicities associated with interactions between traditional and allopathic medicine, improve adherence to treatment recommendations, and improve health-related quality of life. As a corollary, research can inform both traditional and allopathic medicine and guide effective integration of these two disciplines to improve cancer care. In many settings, practitioners of traditional medicine are more accessible to patients than practitioners of allopathic medicine and are often the first point of patient contact. This has long been recognized by programs targeting the control of AIDS in Africa, where traditional healers have been suggested as potential partners in public health programs, as long as there is mutual respect and consistent communication to ensure program quality and adherence to current medical standards (6). Practitioners of traditional medicine are more likely to speak the same language as the patient, to reside closer to the patient, and to charge fees more affordable to the patient. In some countries, the number of traditional medicine practitioners far exceeds the number of allopathic medicine practitioners (7). Thoughtful integration of traditional practitioners into routine cancer care could thus expand the cancer workforce. For example, education of practitioners of traditional medicine about the signs and symptoms of cancer, accompanied by a pathway for timely referrals to allopathic practitioners for further evaluation, could potentially decrease time to cancer diagnosis and thus downstage many common cancers. However, such collaboration can only be fruitful if there is mutual respect and understanding between the allopathic and traditional medicine practitioner. Just as we stress the importance of close communication between the primary care physician and oncology specialists, we must stress the importance of close communication between traditional medicine practitioners, the primary care team, and the oncology team. Delays in cancer diagnosis currently occur both in the realms of traditional medicine and allopathic medicine. Both sets of practitioners need to be aware of the risk of cancer and the importance of timely diagnosis. In addition, both sets of practitioners need to be aware of the current and recommended regimens for medications and treatment for individual patients. Allopathic practitioners should routinely ask cancer patients respectfully about use of traditional medicine and ongoing relations with traditional medicine practitioners. Both sets of practitioners should also be aware of the possibility for known or as yet unknown interactions between traditional and allopathic medications and cancer treatments, as well as the limitations of both systems of practice. Treatment of cancer usually involves interventions across several disciplines, including surgery, chemotherapy, and radiation therapy. These interventions have known risks for side effects that adversely affect the cancer patient’s health-related quality of life. A few studies indicate that consultation from a traditional medicine practitioner and appropriate use of certain traditional medicines or practices may help alleviate symptoms of cancer and/or cancer treatment, as well as help ensure adherence of the patient to treatment recommendations. For example, one randomized clinical trial found that a four-week yoga intervention led to a clinically significant improvement in sleep quality among cancer survivors (8). There are also anecdotal reports of herbal mouthwashes that may minimize treatment-induced mucositis in patients receiving radiotherapy for head and neck cancer. Such leads should be followed up in large multicenter studies with strong study designs, so that interventions found to be effective can be included in the arsenal of cancer physicians at various stages in the treatment process. We have made progress in the allopathic treatment of cancer through scientific methods of investigation. In the same way, through rigorous scientific evaluation, we can help build the evidence base for the role of traditional medicine in cancer treatment. One critical step is the standardization of traditional medications, which often include the combination of natural products. Isolation of the different components of traditional medicines can help lead to identification of active ingredients and active combinations. Standardized preparations of traditional medicines, or their individual components, are critical to prospective clinical trials. A second key step is the design and conduct of clinical trials to evaluate traditional medicinal products or practices for the treatment of cancer or cancer-related symptoms. Not only must the intervention be standardized, but also the metrics to evaluate the impact of the intervention should include standard oncology measures and validated patient-reported outcomes. Multicenter and international collaboration should be encouraged in order to help develop standardized protocols, evaluate reproducibility, build research capacity in this emerging area, and foster a culture of open communication. Effective integration of allopathic and traditional medicine will help cancer patients and their health care providers walk together in the same realm on the cancer journey and could be an important tool with which to address current global disparities in cancer care. In low-resource settings, thoughtful collaboration with traditional practitioners could lead to an expanded workforce, increased geographical access to care, and increased opportunities for palliative care. As we work to strengthen the evidence base for the use of traditional medicine in cancer treatment, we also may in the process be able to make the cancer journey more responsive to the needs and beliefs of cancer patients, and at the same time improve cancer outcomes and control of cancer-related symptoms. References 1 Ferlay J , Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer; 2013 . http://globocan.iarc.fr/. Accessed February 20, 2017. 2 Gelband H , Sankaranarayanan R, Gauvreau CL, et al. Costs, affordability, and feasibility of an essential package of cancer control interventions in low-income and middle-income countries: Key messages from Disease Control Priorities, 3rd edition . Lancet . 2016 ; 387 10033 : 2133 – 2144 . Google Scholar Crossref Search ADS PubMed WorldCat 3 Horneber M , Bueschel G, Dennert G, et al. How many cancer patients use complementary and alternative medicine: A systematic review and metaanalysis . Integr Cancer Ther. 2012 ; 11 3 : 187 – 203 . Google Scholar Crossref Search ADS PubMed WorldCat 4 World Health Organization . Traditional Medicine. Report by the Secretariat . Geneva : World Health Organization ; 2003 . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 5 Sagar SM. Integrative oncology in North America . J Soc Integr Oncol . 2006 ; 4 1 : 27 – 39 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 6 UNAIDS . Collaborating with traditional healers for HIV prevention and care in sub-Saharan Africa: Suggestions for programme managers and field workers. Paper presented at: Joint United Nations Programme on HIV/AIDS; June 2006; New York. 7 World Health Organization . WHO Traditional Medicine Strategy: 2014–2023 . Geneva : World Health Organization ; 2014 . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 8 Mustian KM , Sprod LK, Janelsins M, et al. Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors . J Clin Oncol . 2013 ; 31 26 : 3233 – 3241 . Google Scholar Crossref Search ADS PubMed WorldCat Published by Oxford University Press 2017. This work is written by US Government employees and is in the public domain in the US. Published by Oxford University Press 2017. This work is written by US Government employees and is in the public domain in the US.

Journal

JNCI Monographs – Oxford University Press

Published: Nov 1, 2017

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