Ayurveda treatment strategy in management of advanced breast cancer in...

[Full title: Ayurveda treatment strategy in management of advanced breast cancer in elderly female- A case report with review of literature]

40 Journal of Ayurvedic and Herbal Medicine 2023; 9(2): 40-42 Case Report ISSN: 2454-5023 J. Ayu. Herb. Med. 2023; 9(2): 40-42 Received: 06-04-2023 Accepted: 31-05-2023 © 2023, All rights reserved www.ayurvedjournal.com DOI: 10.31254/jahm.2023.9201 *Corresponding author: Dr. Vasantha Lakshmi Assistant Professor, Department of Dravyaguna, Dr BRKR Government Ayurvedic college, Hyderabad, Telangana State, India Email: mutnurivasanthalakshmi@gmail.com Ayurveda treatment strategy in management of advanced breast cancer in elderly female- A case report with review of literature Vasantha Lakshmi 1 1 Assistant Professor, Department of Dravyaguna, Dr BRKR Government Ayurvedic college, Hyderabad, Telangana State, India ABSTRACT Breast cancer is the most common malignancy among women globally and in India. The higher prevalence of advanced breast cancer (ABC) in elderly women is attributable to delayed diagnosis, lack of sufficient health care resources and high costs for conventional treatment). Also, the modern treatment very extensive for ABC cases with surgery, chemotherapy and radiotherapy with little compliance for elderly patients and mortality is mostly linked to the sideeffects of these advanced treatments. We report a case of advanced breast cancer (locally advanced to axillary nodes and skeletal muscles) in 76 year-old-female patient who presented with initially with in right subscapular region and insomnia after conventional chemotherapy. She opted for complete Ayurvedic treatment over 8 months which led to complete regression of cancer and local sites. The aim of the case report is present the symptoms, treatment regimens, and dietary modifications of such a case with basic literature review on Ayurveda treatment of breast cancers Keywords: Ayurveda, Breast Cancer, Diet, Cancer, Malignancy INTRODUCTION Breast cancer (BC) is common cancer that occurs in women on a global prospective. The recent evidence stated that it had surpassed lung cancer becoming now the leading cause cancer in 2020. The incidence of 2.3 million new cases/ year is attributable to breast cancer [1] . In India, the incidence has increased significantly, almost by 50%, between 1965 and 1985 [2] . The cancer not well manageable in late stages with only 21% survival rates for stage IV patients or those with advanced breast cancer (ABC) [3] . Also, the survival rates are comparatively poor in India to Western countries due to reasons such as earlier onset of cancer, diagnosis at a late stage, delayed initiation of treatments and inadequate treatment if initiated [1,4] Added to this is poor education, awareness and weak physical status (either due to cancer treatments or pre-existing disorders in aged women) often lower complacence to modern therapies [5,6] . It is imperative to state that no specific modern drug has been successful in increasing the quality of life [7] . Ayurveda treatments for breast cancer is ideal in such instances. Existing medical literature in Ayurveda had listed numerous herbal derived medications, chemo-protective agents and, specific dietary recommendations for cancers [8] The previous papers attempted to document Ayurvedic treatment for breast cancer [7,9,10] , while the reports on ABC in elderly women are very few. We present a case report of 76-year-old female with diagnosed ABC who was successfully treated by Ayurveda based therapy with dietary recommendation and a brief review of literature. CASE REPORT A 74-years-old female patient had presented to an Ayurvedic clinic with severe pain in right subscapular region since 2 weeks that was radiating to the mid portion of the spine. Pain was dull-aching and continuous in nature causing difficulty in sleeping. She complained of difficulty in rolling towards right side while in sleep. The medical history revealed that she was diagnosed breast cancer a week before. The position emission tomographycomputed tomography (PET-CT) scan confirmed an active primary in right breast with metastatic lesion in the right axillary node and adjoining skeletal lesion. Also, right sided pleural effusion was also noted. She was treated with modern chemotherapy at government facility with Letrozole 2.5 mg once daily, Palbociclib -125 mg for 21 Days along with calcium supplements (Calcium carbonate and Vitamin D 3). Patient had been kept on Naproxen 250 mg with pantoprazole 40 mg additionally for pain and gastric irritation respectively. Patient visited 2 nd time to Ayurvedic clinic with uncontrolled pain even after using after using Naproxen and tramadol+ acetaminophen combinations. She had insomnia associated with pain as well, and requested for Ayurveda based treatment.

41 Journal of Ayurvedic and Herbal Medicine|April-June|2023 On examination the patient was conscious, oriented, showed pallor, and appeared restless. The local breast exam showed dimpling of the breast skin, sunken crust, redness and visible increased vascularity on the breast. No discharge was found. Left side breast was normal. Tenderness was elicited right subscapular region, right hand and the movements of the right hand were restricted (was unable to lift the hand). Tenderness was also noted in the right axillary area. On palpation, an enlarged lymph nodes measuring 3 x 4 cm was appreciated with no tenderness and hard consistency. Oral cavity examination showed foul smell (halitosis). The diagnosis of advanced breast cancer (ABC) with severe pain associated with insomnia was given and patient was advised for Ayurveda based treatment for which she consented. The main stay treatment consisted of vincorosea water on empty stomach, aswagandha tablets, Y astimadhu and mahayogarajaguggulu for a month as an adjuvant with ongoing chemotherapy. (Table 1 for complete treatment regimen). The review after three months (from date of first visit) revealed that betterment in her sleep, and pain relieved upto 50%. She also gained around 5 kg of body weight. Following the complete chemotherapy cycle, she had loss of taste, weakness, and hair loss but able to lift the hand. The local examination showed no axillary lymph nodes and no foul smell from oral cavity. The left lower lobe of the lungs was wheezy and right middle lobe had rhonchi. The treatment phase 2 was initiated with vinca flowers , Mahayogaraja guggulu , Eladi gutika , and Talisadi churnam with honey (Table 2). The next review (after 5 months from date of initial visit) showed further 3 kg weight gain. Also, the patient’s symptoms on improved appetite, betterment in sleep able and ability to roll (turn on both sides) during sleep were noted. Same prescription (table 2) was continued for two more months. The patient was advised for a PET-CT with whole body with contrast in the 7 th month. The comparison with previous PET-CT study, the present study shows reduced size and metabolic activity of primary in right breast, right axillary nodes and increased sclerosis of skeletal lesions. Resolved right pleural effusion with no new secondary cancer lesions was also reported from the second scan. Overall a good response to therapy was deemed by the radiologists. The patient is still kept on same flower water and Yastimadhu tablets twice daily for one more month (to avoid any recurrences) and will be ceased end of the same month. The total duration of treatment till date was 8 months, and patient will be kept on follow-up every 3 months. Patient is currently happy to continue ayurvedic treatment and has been free from pain, insomnia and showed a good response to ABC which were her primary complaints. The constant diet plan kept throughout the treatment consisted on daily pomegranate juice, and a pure vegetarian meal. Table 1: Ayurvedic treatment plan in phase -1 (Adjuvant with chemotherapy) S. No. Medicine Directions Dietary recommendations Principal outcomes 1 Aswagandha one tablet twice daily (3 g) No dietary Restriction. anticancer effects aids in prevention of chemotherapy-induced neutropenia 2 Yastimadhu 3 g per day with water after breakfast Daily pomegranate juice with tomatoes and carrots Counters side effects of chemotherapy by boosting haemoglobin, total leucocytes count and platelet count 3 Vincarosea flower Take on empty stomach (soke the flowers in 100 ml of water in the night and squeeze the flowers, remove flowers and drink the water) No dietary Restriction. To address the diagnosed breast cancer. Significant resolution achieved in 8 months. No evidence of second cancers / metastatic lesions as evidenced by the whole body PET-CT scan. Resolved skeletal and axillary lesions. 4 Mahayogaraja guggulu One tablet three times a day Can be taken before or after meals. Chronic pain (patient had right sided pain over axially region and skeletal lesions) Table 2: Ayurvedic treatment plan in phase -2 (definitive/ without any chemotherapy) S. No. Medicine Directions Dietary recommendations Principal outcomes 1 Eladi gutika 2 tablets thrice daily No dietary Restriction Respiratory issues (patient had pleural effusion) 2 Talisadi churnam 2 g 3 times with honey No dietary Restriction Respiratory issues (patient had pleural effusion) 3 Vincarosea flower Take on empty stomach (soke the flowers in 100 ml of water in the night and squeeze the flowers, remove flowers and drink the water) No dietary Restriction. To address the diagnosed breast cancer. Significant resolution achieved in 8 months. No evidence of second cancers / metastatic lesions as evidenced by the whole body PET-CT scan. Resolved skeletal and axillary lesions. 4 Mahayogaraja guggulu One tablet three times a day Can be taken before or after meals. Chronic pain (patient had right sided pain over axially region and skeletal lesions)

42 Journal of Ayurvedic and Herbal Medicine|April-June|2023 DISCUSSION Ayurveda, is a 5000 years old system of traditional Indian medicine which prescribes many plant based treatment options for various diseases known to mankind inclusive of cancers and tumours [11] . The classical texts such as Charaka , and Sushruta samhitas, described cancer to be either Granthi (=minor neoplasm) or Arbuda =(major neoplasm) [12,13] . Vincarosea flowers as a treatment of cancers is established in both traditional and conventional medicine systems. The sarcomas, hematogenic and lymphoid organ malignancies all respond to the vinca alkaloids from the flower [14] The diagnosis was made after analysis of history, examination findings and conformation with modern test such as PET-CT scan. The Ayurveda treatment resulted in significant regression of tumour as evidenced by the second PET-CT scan with no metastasis (other organ spread) and resolution of initial presenting symptoms of pain and insomnia. The reduced lung fluid, sclerosis of the skeletal lesions and resolved axillary lesions are also testimony of successful treatment. This is in line with previous reported papers in Ayurveda on breast cancer management [7, 10,15] . Research in Ayurveda for breast cancer is increasing even I the western world. An in vitro design is being carried out on ‘swarna bhasama’ or ‘green - nanotechnology’ in formulating breast cancer therapies [16] There is extensive research in the subject where in recent western study concluded that whole-Systems Ayurvedic Medicine Nutrition and Lifestyle Intervention as a feasible and acceptable option for breast Cancer survivors [17] . A conduct of such research may aid in bringing targeted Ayurvedic treatments and dietary practices on global platform. CONCLUSION Ayurveda treatment had shown promising results in management of breast cancer in the current case with good tolerance and minimal side effects. Treatment with vincarosea flowers with a two phased Ayurveda treatment (as adjuvant then definitive) regimen may be considered for addressing case of advanced breast cancer with axillary and skeletal lesions. Conflict of Interest The authors declare no conflict of interest. REFERENCES 1 Mehrotra R, Yadav K. Breast cancer in India: Present scenario and the challenges ahead. World J Clin Oncol. 2022;13(3):209-218. 2 Saxena S, Szabo CI, Chopin S, Barjhoux L, Sinilnikova O, Lenoir G, Goldgar DE, Bhatanager D. BRCA 1 and BRCA 2 in Indian breast cancer patients. Hum Mutat. 2002;20:473 – 474 3 Arumugham R, Raj A, Nagarajan M, Vijilakshmi R. 327 P - Survival Analysis of Breast Cancer Patients Treated at a Tertiary Care Centre in Southern India. Ann Oncol. 2014;25:iv 107. 4 Maurya AP, Brahmachari S. Current status of breast cancer management in India. Indian Journal of Surgery. 2021;83(Suppl 2):316-21. 5 Mao D, Hachem H, Chang H, Dima D, Dower J, Wismer M, Erban JK, Freund KM, Parsons SK. 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