A Whole Systems Approach to the Study of Ayurveda for Cancer Survivorship

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This is an application for a K23 award for Dr. Anand Dhruva, a medical oncologist/hematologist at the University of California, San Francisco. Dr. Dhruva is establishing himself as a young investigator in complementary and alternative medicine (CAM) and cancer symptom management. This K23 will provide Dr. Dhruva with the support necessary to accomplish the following goals: (1) to develop into an Independent clinical investigator focusing on the rigorous study and successful integration of CAM modalities into conventional oncology care; (2) to learn and apply compatible research methods for the study of whole systems of medicine, with focused expertise in the study of the application of Ayurveda to the oncology setting; and (3) to learn and apply advanced clinical research and qualitative methods in clinical studies. To achieve these goals, Dr. Dhruva has assembled a mentoring team comprised of primary mentor, Dr. Frederick Hecht, Director of Research at the Osher Center for Integrative Medicine, who conducts clinical investigations in CAM and HIV, and three co-mentors: Dr. Christine Miaskowski, an expert in the study of cancer-related symptoms and quality of life; Dr. Donald Abrams, an oncologist who focuses on integrative oncology; and Dr. Shelley Adler, an expert in qualitative research. Despite achieving remission or cure, many cancer survivors discover that the residual symptoms due to the cancer and/or the treatment of the cancer to be difficult, disabling, and impair quality of life. Whole systems approaches to health, such as Ayurveda, have potential benefits for improving quality of life and symptoms in cancer survivors. Complex, individualized interventions, such as those used in Ayurveda, are currently being studied using the technique of "manualization," in which a study manual is utilized to balance the competing concerns of reproducibility and ecological validity. Dr. Dhruva's research will focus on developing a manualized Ayurvedic approach to improve cancer survivor quality of life and symptoms (Aim 1) and then conducting a pilot randomized controlled trial to assess feasibility and obtain preliminary estimates of efficacy of a manualized Ayurvedic approach to improve quality of life and symptoms among breast cancer survivors (Aim 2). This research will form the basis for a larger randomized controlled trial of Ayurveda (using the manualized approach developed in this K award) that will investigate the efficacy of Ayurveda to improve quality of life and symptoms among breast cancer survivors, which will be proposed in a subsequent ROl grant application. RELEVANCE (See instructions): With increasing numbers of cancer survivors, improving understanding of effective and safe ways to improve quality of life and residual symptoms is important. Given the widespread use of CAM, more evidence from rigorously conducted studies is needed to guide its successful integration into modern healthcare.