CERTIFICATE 

          This is to certify that this thesis entitled “The Effectiveness of Homoeopathic treatment in the management of Pain in Cancer” being submitted by Dr. Rithesh.B to the University of Calicut for the award of degree of Doctor of Medicine in Homoeopathy – Homoeopathic philosophy is a bonafide record of the work carried out by him.  

          The contents of this thesis have not been submitted to any other University or institution for the award of any degree or diploma. 

ACKNOWLEDGEMENT 

I would like to express my sincere thanks to my respected teacher and guide Dr.T.AbduRahiman, Principal, Govt. Homoeopathic Medical College, Kozhikode for his valuable guidance and constant encouragement given to me throughout my post-graduation course and necessary directions in the preparation of this thesis.

I am very grateful to Dr.Suresh, (Director, Pain & Palliative clinic Medical college, Kozhikode) for his favorable suggestions in the conduction of this study particularly regarding assessment criterias..

I am deeply indebted to Dr.K.L.Babu,, Reader, Dept. of Organon of medicine, Govt. Homoeopathic Medical College, Kozhikode, who admitted sufficient number of cases for the study and for his informative suggestions and guidance which helped me to complete this work..

I sincerely thank Mr.P.I.Narayanan, MSc.D.H.S, Retired Associate Professor, Department of Biostatistics, Medical College, Kozhikode for conducting the analysis of this work..

I extend my gratitude to my colleagues and to the staff of various departments of this college for their sincere co-operation.

The gratitude I owe to my wife Dr.Narda cannot be expressed in words, without her constant encouragement and co-operation this work couldn’t have been possible.

Finally I owe my unlimited indebtedness to all my patients involved in this study for their co-operation, without which this study would not have been possible.

Last but not the least I thank almighty God for giving me the strength and perseverance to fulfill the project.       

                                                                         - Dr. Rithesh.B                                               

 Introduction  

Cancer is a common and widely publicized disease, and in spite of ever increasing effort to understand it as a process, its incidence in the population is rising. The main reason for this is the close correlation of the number of cancer cases with the increasing age of the patients and the number of more aged people in the western society (and also in Kerala) at least is rising .It used to be suggested that same aspect of the ageing process increased the susceptibility to cancer, perhaps by impairing immune surveillance .However it is now generally accepted that the relationship of many cancer cases to increasing age is rather a reflection of time required to accumulate a critical number of genetic abnormalities for cancer to arise .Cancer may affect any organ or tissue ,but while some cancer are common, Eg; lung ,breast, gut, prostate, others are very rare ,those affecting the young people often being amongst the rarest .In particular ,cancer affect epithelial tissue and over a 99% of tumor are derived from this tissue .This is not surprising since many of the known cancer causing agents (carcinogens) are from natural radiation. In the air we breathe and from the food stuff we ingest, and epithelial cells are the first line of defense to the outside world, in the skin, lung, and gastrointestinal tract¹

The prevalence of acute and chronic cancer pain and the profound psychological and physical burdens engendered by this symptom oblige all treating physician to be skilled in pain management.²

Since homoeopathic treatment has found to be effective in managing cancer pain, and since a scientific study on this subject is not known to be conducted, an attempt is made to evaluate the effectiveness of homoeopathic medicines with appropriate statistical analysis. A prospective study is conducted by studying the cancer patient with pain attending the out patient and in patient department of Govt. Homoeopathic medical college, Calicut. The patients are assessed at the time of consultation using, Pain rating scale, Degree of distress score and performance status score to rate the pain and quality of life.

Even though the aim of study is palliation of pain, cases are taken according to homoeopathic philosophy giving importance to the general symptoms .The selection of medicine are also based on the homoeopathic philosophy giving more importance to the general symptoms and if case demands taking sectoral totality of pain giving importance to its modifying factors and the characteristics of pain. Miasmatic aspect of the cases are studied and given due importance in the selection of medicine.

AIM AND OBJECTIVE OF THE STUDY

          To assess the efficacy of homoeopathic treatment in the management of pain in cancer.

Review of Literature

Neoplasia literally means ‘the process of new growth’ and a new growth is called “neoplasm”. However all new growth are not neoplasms, since examples of new growth of tissues and cells also exist in the process of embryogenesis, regeneration and repair, hyperplasia and hormonal stimulation. There fore a satisfactory definition of neoplasm or tumor is “a mass of tissue formed as a result of abnormal, excessive, uncoordinated, autonomous and purposeless proliferation of cells”. ³

The branch of science dealing with the study of neoplasm is called “Oncology” (oncos –tumor, logos –study).

Neoplasm may be “benign” when they are slow growing and localized with out causing much difficulty to the host .or “Malignant” when they proliferate rapidly, spread through out the body and may eventually cause death of the host .The common term used for all malignant tumor is cancer. Hippocrates (460-377 BC) coined the term “Karkinos”for the cancer of the breast .The word cancer means “Crab” thus reflecting the prime character of cancer since it sticks to the part stubbornly like a crab⁴.

International union against cancer (IUAC) has defined cancer as a “disturbance of growth characterized primarily by excessive proliferation of cells with out apparent relation to the physiological demand of the organ involved”⁵.

          All tumors benign and malignant have the basic component,

1)    Parenchyma composed of proliferating tumor cell –parenchyma determines the nature and evolution of the tumor.

2)    Supportive stroma – comprised of fibrous connective tissue and blood vessels, it provides the framework on which the parenchyma tumor cell grow .³

3)    The tumor derives their nomenclature on the basis of the parenchymal component comprising them. The suffix “oma”is added to denote benign tumors, malignant tumors of epithelial origin are called “carcinomas” while malignant mesenchymal tumors are named “sarcomas” (sarcos-fleshy) however some cancers are composed of highly undifferentiated cells and are referred to as undifferentiated malignant tumors. Although the broad generalization regarding nomenclature of tumors usually holds true in majority of instances, some examples contrary to the concept are –melanoma for carcinoma of melanocytes, hepatoma for carcinoma of hepatocytes, lymphoma for malignant tumor of lymphoid tissue and seminoma for malignant tumor of testis .³

Tumors composed of a single type of parenchyma cells that differentiate towards more than one cell line are called mixed tumor. Teratomas on the other hand are made up of a number of parenchymal cell types arising from totipotent cells derived from more than one germ cell layer. Choristoma refers to ectopic rests of normal tissues. Hamartoma is a mass of disorganized but mature cells of tissue indigenous to the particular site .³

Classification of tumor ³

Table: 1

2.1. Cancer incidence:

The incidence of cancer has increased considerably over the last 50 years because of tobacco smoking and greater life expectancy. ⁶

Cancer rate could further increase by 50% (10 million new cases globally in 2000) to 15million new cases in the year 2020, according to the world cancer report, the most comprehensive global examination of the disease to date⁶.

In the year 2000 malignant tumor were responsible for 12% of the nearly 56 million death world wide from all the causes .In 2000, 5.3 million men and 4.7 million women developed a malignant tumor and all together 6.2 million women died from the disease. The report also reveals that cancer has emerged as a major public health problem in developing countries matching its effect in industrialized nation ⁷.

       In USA in 2003, 556000 deaths was from cancer alone, representing 25% of all mortality, a frequency surpassed only by death caused by cardiovascular diseases.⁴

The estimated cancer incidence by site and sex are as follows. In male thirty percentages is prostate cancer. Fourteen percentage lung and bronchus related cancer. Colon and rectum accounts for eleven percentage of total cancer; urinary bladder seven percentages, melanoma of the skin five percentage. Four percentages is Non Hodgkin’s lymphoma, three percentages each cancer of oral cavity, kidney and leukemia. Pancreatic cancers account for two percentages and all other sites nineteen percentages. In female thirty one percentages is breast cancer. The lung and bronchus related cancers and colon and rectal cancers twelve percentages each. Six percentages is uterine cancer.  Non –Hodgkin’s lymphoma, melanoma of the skin and ovarian cancer four percentages each. Pancreatic cancers, thyroid cancers and cancer of the urinary bladder two percentages each. All other sites accounts for the rest twenty percentages.⁴The estimated frequency of cancer death by site and sex are as follows, in male thirty one percentages death are due to cancer related to lung and bronchus. Prostate cancer accounts for eleven percentages, ten percentage death due to colon and rectal cancer. Pancreatic cancer and Non-Hodgkin’s lymphoma accounts for five percentages of death each. Four percentages due to leukemia, three percentages each due to carcinoma of the esophagus, liver, urinary bladder and kidney. Two percentages due to all other sites. In females twenty-five percentage deaths is due to cancer related to lung and bronchus. Breast cancer accounts for fifteen percentages of death. Eleven percentages due to cancer related to colon and rectum, six-percentages death due to cancer of pancreas and five percentages due to cancer of the ovary. Four percentages of death each due to leukemia and Non-Hodgkin’s lymphoma. Two percentages each due to cancer of the uterus, brain and multiple myeloma. Twenty-three percentages of the remaining death are due to cancer of all other sites.⁴

Over the past 50 years, the overall age adjusted cancer death rate has significantly increased in men, where as it has fallen significantly in women .The increase in men can be largely attributed to lung cancer .The improvement in women is mainly attributed to a significant decline in death rate from the cancer uterus, stomach, liver, and most notably from cancer of the cervix, one of the most common malignant neoplasia in women. Striking is the alarming increase in the death rate form the carcinoma of the lung in both sexes .In women carcinoma of the breast occur 2.5 times more frequently than those of the lung Because of the large difference in the cure rates of these two cancers, however lung cancer has become the leading cause of cancer death in woman. ⁴

2.2. Cancer incidence in India and Kerala

          The rate of cancer occurrence in Kerala and in India is much lower compared to western countries .It is now estimated that 25000 new cancer cases occur in Kerala in one year. Among the males 50% of cancers in the mouth, throat and lung are caused by tobacco and alcohol habits. Among women the incidence of tobacco related cancer is 15%.⁸

Most prevalent cancer in India ⁹

                                                                          Table: 2

          Cancer incidence in Kerala-Trivandrum

                    Male, age [0-85+] ¹⁰