Integrative medicine is essentially having a cross-talk between the traditional medicine and the usual care that we give with what we call allopathic medicine. Until now there is a clear divide – one does not see the value of the other. Then we think they have a very complementary role. So, just to give you an example, in cancer prevention we know that obesity is a risk factor for cancer and is probably associated with 5-8% of all cancers but then there is a lot of inequity in terms of people having access to services like doing exercise, having physical activities to avoid obesity. In fact, there is evidence to say that men and women with less education tend to be overweight, tend to have more obesity.
So how do we address this challenge? We think the traditional and complementary medicines have wonderful opportunities like yoga, there are other mind and body exercises that are proved to reduce obesity. There are certainly even studies that have shown that they have value in other ways like improving quality of life of cancer patients also. So how do we integrate this kind of traditional medicine into the routine cancer prevention activities? That is one example of prevention.
Similarly, in terms of improving the quality of life of cancer patients, it’s quite well known that cancer patients when they are undergoing treatment, or even after treatment, they have psychological issues like depression, they have loss of sleep. So, all these things have an impact on their care, as well as on their final outcome of cancer treatment. On the other hand, we have quite good evidence to say that traditional and complementary medicine, there are several things: there is massage therapy, there is yoga, acupuncture, that can take care of many such problems that cancer patients have. So how do we integrate these two things? That is going to be my focus of the talk today.
Essentially what I will argue is that instead of having this kind of divide which is there in many countries, even the Ministry of Health is divided across the lines, two lines, that has to be an integration starting from the policy level, starting from the governance level. Then the trust-building is very, very important between the two segments of practitioners of traditional medicine and the routine allopathic medicine.
How is integrative oncology an effective tool to enhance cancer prevention and treatment in LMICs?
There has been quite a lot of research in terms of understanding the value of traditional medicine or the approaches in improving cancer care. But then these studies are either very small scale studies or there are methodological issues. We also understand the fact that you cannot evaluate the traditional medicinal practices the way we evaluate, for example, a new anti-cancer drug. There has to be thinking out of the box to see how we can generate the evidence, so, for example, from generating evidence from routine practice. In Europe it is known that more than 30% of the cancer patients also go for traditional medicine. So we have some evidence there but the data has to be collected and then analysed to understand the impact of these kinds of practices, integrated practices, on cancer care.
So, yes, research has to be focussed but then maybe we have to think in a different way. Then there is also the importance of doing implementation research in this because there are many issues here. So, for example, when somebody is choosing one type of treatment they may be neglecting the other type. What is the compliance of the patients when they go for traditional medicine – does it go down? There is even evidence that if they are appropriately advised and they are really guided to traditional and complementary medicine, their acceptance of the regular anti-cancer treatment improves. So all these implementation issues need to be also looked at when we are thinking of integrating the traditional and complementary medicine with regular cancer care.
What are some of the challenges to integrative oncology in LMICs?
If we look at the cancer centres in the US or in many of the European countries they have already started departments of integrative medicine or alternative medicine within the cancer centre. That acceptance of traditional medicine as part and parcel of cancer care has not been there yet in the low- and middle-income countries. It is essentially because, as I said, the trust factor is missing; so one sees the other as the opponent of their concepts or their thoughts. This gap has to be bridged.
Obviously there have to be different approaches in different countries. In some countries the ministry may take the initiative but in many countries the oncologists themselves have come together in understanding the value of traditional medicine and then trying to integrate these two approaches.
What opportunities will be available in the future for LMICs?
We are seeing a transition. Obviously we have, as I said, the oncology centres in high-income countries that have adopted the policies and then also started the services for access to traditional medicine. The same thing now we are seeing now in India, in China, in Brazil, these countries which are transitioning in their economic state, they are also now integrating this. So we are quite hopeful that gradually this will be a routine practice. Now, as people understand that this traditional complementary medicine has advantages, number one, it is affordable, it is accessible and it is highly accepted by the community. So all these benefits need to be translated into the improved cancer care. Then the US NCI also has a special programme to support traditional medicine, especially the integrative medicine. So all these things, I’m sure, will be helpful in improving practice.