Integrative oncology: Addressing the global challenges of cancer prevention and treatment.

The increase in cancer incidence and mortality is challenging current cancer care delivery globally, disproportionally affecting low- and middle-income countries (LMICs) when it comes to receiving evidence-based cancer prevention, treatment, and palliative and survivorship care. Patients in LMICs often rely on traditional, complementary, and integrative medicine (TCIM) that is more familiar, less costly, and widely available. However, spheres of influence and tensions between conventional medicine and TCIM can further disrupt efforts in evidence-based cancer care. Integrative oncology provides a framework to research and integrate safe, effective TCIM alongside conventional cancer treatment and can help bridge health care gaps in delivering evidence-informed, patient-centered care. This growing field uses lifestyle modifications, mind and body therapies (eg, acupuncture, massage, meditation, and yoga), and natural products to improve symptom management and quality of life among patients with cancer. On the basis of this review of the global challenges of cancer control and the current status of integrative oncology, the authors recommend: 1) educating and integrating TCIM providers into the cancer control workforce to promote risk reduction and culturally salient healthy life styles; 2) developing and testing TCIM interventions to address cancer symptoms or treatment-related adverse effects (eg, 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.

Ayurvedic management of a refractory skin disease clinically diagnosed as Cutaneous Lichen Planus-A case report.

This study reports the successful management of a recurrent, refractory skin disease diagnosed clinically as Cutaneous Lichen Planus (CLP) in a female patient with Ayurvedic treatment. A 42-year-old home maker from Coimbatore presented with blackish-red pigmented skin rashes and white streaks. Though mucous membranes were not affected, she did not respond to homoeopathic and biomedical treatment. The lesions were spread all over the body except for the face, scalp, axillary and genital region. In addition, she complained of dry skin, pain, and itching. The condition was treated as Kapha-Pitta dominant Tridoshaja Kushta based on Ayurvedic clinical assessment. The patient recovered after one year of conservative Ayurvedic intervention. After six years, there was a relapse, and the patient was admitted for a full course of Ayurvedic treatment and recovered within six months. Ayurvedic interventions should be considered an option in refractory skin diseases like Cutaneous Lichen Planus.

A scoping review of Ayurvedic rasayana adaptogens in oncology.

INTRODUCTION: Rasayanas are Ayurvedic natural products that have adaptogenic effects. The extensive research on rasayanas in oncology is not currently well summarized. The aim of this review is to investigate the range and nature of the current body of research, identify gaps in knowledge, and to summarize the existing literature as it relates to Ayurvedic rasayanas and oncology. MATERIALS AND METHODS: A comprehensive literature search of fifteen Ayurvedic adaptogen rasayanas was conducted using three main concepts: Ayurvedic herbal terms, neoplasm terms, and oncological pathways. After screening was performed, key variables were extracted (tagged) including type of adaptogen, cancer type, type of study design, constituent type, and mechanisms of action (MOA). The results were synthesized and summarized using descriptive statistics and narrative summaries. RESULTS: Five hundred and eighty-four articles were reviewed and tagged. The two most tagged adaptogens were Glycyrrhiza glabra (Yashthimadhu/licorice) (n = 166 (28.4 %)) and Withania somnifera (Ashwagandha) (n = 151 (25.9 %)). The most frequently tagged cancer diagnostic categories were gastrointestinal (n = 175 (30 %)), and breast (n = 126 (21 %)). Most of the articles focused on in vitro studies (n = 470 (80.3 %)). Of the 12 MOA tags, the most frequently tagged was apoptosis (n = 298 (29.2 %)). CONCLUSION: A large body of pre-clinical literature exists on adaptogen rasayanas in oncology, indicating this field of research is still in its early phase. Comparatively few studies focused on the effects on the immune system. Given the growing interest in immuno-oncology therapeutics and the potential impact of adaptogen rasayanas on the immune system, future research may focus more in this area, along with work that is more directly linked to future clinical studies.

Learnings from a veteran oncologist's long-standing efforts in integrative oncology.

Kerala's first medical oncologist, the erstwhile Dr. CP Mathew, has left a rich legacy in cancer patients' case diaries and medical records. These documents contain valuable information about his attempts to integrate Siddha and Ayurveda treatments to manage cancer. A preliminary examination of these documents compiled over more than four decades gives us a glimpse of his contributions relevant to the development of Integrative Oncology in India. Patients who received treatment from Dr. CP Mathew presented with different types of cancer in varying stages of progression. In his clinical practice, he developed treatment approaches that integrated Ayurveda and Siddha with the standard of care for specific types and presentations of cancer. At Cherian Ashram in Kottayam, where he treated cancer patients, a team of medical doctors, including a senior Ayurveda physician and a Naturopathy and Yoga expert, worked together to offer integrative care. Based on his experience, he emphasized that the public should be made aware of the available options for alternative treatments even in advanced stages of cancer. While Ayurveda and Siddha could bolster the patient's immunity and improve clinical outcomes, he pointed out that such interventions could also improve tolerance to chemotherapy and radiation. In the wake of the growing global interest in Integrative Oncology, the work of Dr. CP Mathew preserved in the medical records of his cancer patients deserves to be studied with an open mind.

Ayurveda research: Emerging trends and mapping to sustainable development goals.

Ayurveda is India's prominent traditional medical system. The World Health Organization has stated the need for more evidence and data from conventional medicine methods to inform policymakers, regulatory bodies, healthcare stakeholders, and the public about its safe, effective, and equitable use. This study aims to provide a comprehensive analysis of the emerging trends in Ayurveda research, mapping research to the UN Sustainable Development Goals (SDG) and examining the impact of COVID-19. Using bibliometric methods, the researchers analyzed a total of 11,773 publications between 1993 and 2022 to understand the temporal evolution of publications, open-access publications, patterns of author collaboration, top-performing countries, and co-citation networks. The keyword co-occurrence analysis identifies networks of concentrated studies on Ayurveda research themes relating to the four clusters, Alternative and Traditional Medicine, Bioactive Compounds and Biological Activities, Analytical Techniques and Herbal Standardization, and Herbal Medicines and Immunomodulation, reflecting the diverse research areas within Ayurveda. The last cluster included research related to the SARS-CoV-2 virus, suggesting research on herbal approaches to immune modulation in the context of COVID-19. The most prominent SDG among these research themes was Good Health and Well-being (SDG 3), emphasizing the potential of natural products and traditional medicine in promoting holistic health and combating antibiotic resistance.

Outcomes of Ayurvedic care in a COVID-19 patient with hypoxia - A case report.

This paper reports for the first time, the outcomes of Ayurvedic intervention in a COVID-19 patient with hypoxia requiring supportive oxygen therapy. Patient developed fever, severe cough, loss of smell, loss of taste, nasal block, anorexia, headache, body ache, chills, and fatigue and was hospitalised when she developed severe breathing difficulty. Later, she tested positive for COVID-19 by RT-PCR. The patient sought Ayurvedic treatment voluntarily when her SPO2 remained at 80% even after being given oxygen support. The patient was administered Ayurvedic medicines while undergoing oxygen therapy at the hospital. The patient refused to take Fabiflu recommended by the treating physician and discontinued other Allopathic drugs except for Vitamin C. The patient showed clinical improvement within a day of administration of Ayurvedic medicines and was able to talk, eat, and sit on the bed without breathing difficulty and her SPO2 became stable between 95 and 98%. In the next two days, she was asymptomatic without oxygen support and was discharged from the hospital in the following week. Since obesity and high plasma C-Reactive Protein (CRP) levels indicated high risk for progression to severe disease, the favourable outcomes with Ayurvedic treatment in this patient is significant and warrants further studies. Ayurvedic care may be considered as a first-line cost-effective alternative for COVID-19 patients presenting with symptomatic hypoxia in an integrative setup.

Integrative approach combining Ayurveda, counselling, Yoga and meditation with conventional management of Ankylosing Spondylitis - A case report.

Lifelong medications are required for symptomatic relief in Ankylosing Spondylitis (AS). We report the potential of an integrative approach in reducing dependence on steroids and pain medications in chronic AS. A 59-year-old HLA-B27 positive male patient suffering from AS for 40 years sought Ayurvedic treatment for relapse of pain, stiffness, fatigue, intermittent constipation and disturbed sleep. Ayurvedic diagnosis was Amavata (a clinical condition characterised by joint inflammation) The patient was managed as outpatient for eleven days and hospitalised for thirty three days. Internal medicines and external therapies with diet modification, lifestyle adjustments, counselling, Yoga and IAM Technique (Integrated Amrita Meditation Technique ) were administered during the hospital stay. At yearly follow up, C-Reactive Protein was reduced to 15.7 mg/L from the baseline value of 37.5 mg/L, and ESR from 103 mm/h to 8 mm/h indicating reduction in inflammation. The dose of NSAID and DMARD (Disease Modifying Antirheumatic Drug) could be reduced from once in twenty-four hours to once in eighty-four hours and steroids from twice daily to once in a week. There was significant reduction in pain and stiffness. Integration of Ayurveda and Yoga with conventional treatment can reduce drug dependence and improve quality of life in AS.

Ayurvedic management of persistent hypoxia in a diabetic and hypertensive COVID-19 patient in the post-hospitalization period-A case report.

COVID-19 patients may require supplemental oxygen therapy at home after recovery from COVID-19. We report benefits of add on Ayurvedic intervention in a 75-year-old gentleman who was oxygen dependent post hospitalisation. He was earlier treated for COVID-19 related bilateral pneumonitis, Acute Respiratory Distress Syndrome and Acute Renal Failure. Patient reported breathing difficulty, generalized weakness, reduced appetite and severe constipation. The Pulse Oximetry readings with oxygen support fluctuated between 80 and 85 %, Blood Pressure was 150/100 mm Hg, LDH raised at 463 IU/L and HbA1c at 8.7%. The patient was administered micro-doses of Rasasindura sublingually every 10 min for one day followed by administration of Indukanta Ghrita and Suvarnamalinivasanta Rasa. The oxygen saturation improved to 95 % in 12 hrs of initiating treatment, oxygen support was weaned off on the third day of starting the Ayurvedic treatment, three weeks earlier than prescribed at the time of discharge. The patient is ambulant and maintaining oxygen saturation between 95 and 98 %. This case report highlights the potential of Ayurvedic intervention to manage patients with persistent hypoxia in post hospitalization phase. Well-designed studies are warranted to confirm the benefits of integrating such interventions with standard of care in COVID-19.

Ayurvedic clinical profile of COVID-19 - A preliminary report.

BACKGROUND: Ayurvedic clinical profiling of COVID-19 is a pre-requisite to develop standalone and integrative treatment approaches. At present, Ayurvedic clinicians do not have access to COVID-19 patients in clinical settings. In these circumstances, a preliminary clinical profiling of COVID-19 based on review of modern medical and classical Ayurvedic literature with inputs from Allopathic clinicians treating COVID-19 patients assumes significance. OBJECTIVES: This paper aims to develop an Ayurvedic clinical profile of COVID-19 by literature review supported by analysis of clinical data of a cohort of COVID-19 patients. METHODS: The typical clinical presentation of COVID-19 was categorized based on a cluster of symptoms with reference to "Interim Clinical Guidance for Management of Patients with confirmed corona virus disease (COVID-19)" released by the US CDC. As the clinical presentation is found to vary widely, research papers reporting clinical symptoms of patient samples from different parts of the world were also reviewed to identify outliers and atypical presentations. Case records of fourteen COVID-19 patients treated at Medanta Hospital, Gurgaon were analyzed to compare symptomatology with data obtained from published literature. Further, a careful correlation was done with the data collected from selected Ayurvedic classical texts and expert views of clinical practitioners to arrive at a preliminary Ayurvedic clinical profile of COVID-19. RESULTS: COVID-19 can be understood from the Ayurvedic perspective as vatakapha dominant sannipatajvara of agantu origin with pittanubandha. The asymptomatic, presymptomatic, mild, moderate, severe and critical stages of COVID-19 with varying clinical presentations have been analysed on the basis of nidana, dosa, dusya, nidanapañcaka and satkriyakala to present a preliminary clinical profile of the disease. CONCLUSION: In this paper, we have demonstrated that a preliminary clinical profiling of COVID-19 from the Ayurvedic perspective is possible through literature review supported by discussions with Allopathic clinicians as well as examination of patient case records. The provisional diagnosis proposed can be further developed with continued review of literature, wider cooperation and teamwork with Allopathic physicians and access to clinical data as well as direct clinical assessment of COVID-19 patients.

Prevalence of the use of traditional complementary and alternative medicine amongst cancer patients in a tertiary care center in Kerala, India.

BACKGROUND: Unmet needs of cancer patients prompt them to seek care from Traditional, Complementary and Alternative Medicine (TCAM) practitioners. OBJECTIVE: To investigate the prevalence of TCAM use in a multi-specialty tertiary cancer center in South India. MATERIALS AND METHODS: A cross-sectional survey of cancer patients who used TCAM during the study period. The patients were recruited based on covenience sampling method. RESULT: 320 cancer patients were approached, out of which 279 (87.2%) patients responded, and the prevalence of TCAM use was 34.4%. Home remedies (36%) figure prominently, with family advice (40%) being the primary influence for the TCAM use. The key expectation was an improvement in the quality of life (49%). TCAM use was pronounced during the chemotherapy phase (50%). Most patients (76%) using TCAM reported satisfaction with the treatment. Majority of the patients did not disclose concomitant use of TCAM to their treating physicians (71%). CONCLUSION: TCAM use by cancer patients is prevalent in Kerala. The study results point towards a need for large scale surveys, implementation of pharmacovigilance, patient education and research to identify and integrate TCAM interventions in cancer care that are safe and have beneficial effects.

A phytochemical-based medication search for the SARS-CoV-2 infection by molecular docking models towards spike glycoproteins and main proteases.

Identifying best bioactive phytochemicals from different medicinal plants using molecular docking techniques demonstrates a potential pre-clinical compound discovery against SARS-CoV-2 viral infection. The in silico screening of bioactive phytochemicals with the two druggable targets of SARS-CoV-2 by simple precision/extra precision molecular docking methods was used to compute binding affinity at its active sites. phyllaemblicin and cinnamtannin class of phytocompounds showed a better binding affinity range (-9.0 to -8.0 kcal mol-1) towards both these SARS-CoV-2 targets; the corresponding active site residues in the spike protein were predicted as: Y453, Q496, Q498, N501, Y449, Q493, G496, T500, Y505, L455, Q493, and K417; and Mpro: Q189, H164, H163, P168, H41, L167, Q192, M165, C145, Y54, M49, and Q189. Molecular dynamics simulation further established the structural and energetic stability of protein-phytocompound complexes and their interactions with their key residues supporting the molecular docking analysis. Protein-protein docking using ZDOCK and Prodigy server predicted the binding pose and affinity (-13.8 kcal mol-1) of the spike glycoprotein towards the human ACE2 enzyme and also showed significant structural variations in the ACE2 recognition site upon the binding of phyllaemblicin C compound at their binding interface. The phyllaemblicin and cinnamtannin class of phytochemicals can be potential inhibitors of both the spike and Mpro proteins of SARS-CoV-2; furthermore, its pharmacology and clinical optimization would lead towards novel COVID-19 small-molecule therapy.