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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 lowand middleincome 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 healthrelated 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