Bridging the Gap: The Role of Family Physicians in Colorectal Cancer Care and Functional Food Integration

 

Deepak Bhattacharya¹, Kavita Chenania², Asadollah Asadi³, Chandra Sekhar Tripathy⁴, U. S. Mahadeva Rao^5*, Diba Kiani⁶

 

ABSTRACT:

Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide, with rising incidence and significant challenges, including high recurrence rates, local and distant metastasis, and severe lifestyle disruptions. Despite the availability of treatment options, including chemotherapy, the need for cold-chain-dependent drugs, and the associated toxic side effects pose substantial barriers to effective care, particularly in rural and remote areas. Family Physicians (FPs), who are well-equipped with local support teams, medical expertise, and drug storage facilities, are uniquely positioned to assist in CRC management. However, due to a widespread misconception that legal frameworks do not permit their involvement, they largely refrain from treating cancer patients. Notably, in India—the world’s largest democracy—laws do allow FPs to play a more active role in oncology care, yet this remains largely unknown and underutilized. FPs also possess deep knowledge of Functional Foods (FFs), which are abundant in tropical and equatorial regions and have demonstrated potential in mitigating chemotherapy side effects, enhancing patient recovery, and improving overall well-being. Integrating FFs into CRC management under the supervision of FPs could offer a holistic, patient-centered approach that benefits all stakeholders—patients, healthcare providers, and the pharmaceutical industry. This paper explores the potential role of FPs in CRC care, the integration of FFs in treatment regimens, and the medico-legal considerations surrounding this paradigm shift. By leveraging the expertise and accessibility of FPs, CRC management can be made more comprehensive, ensuring better patient outcomes, economic benefits, and an expanded healthcare market that prioritizes family welfare and prolonged survival.

 

 

 

INTRODUCTION:

Following the era of the British Family Doctor model, the role of the Family Physician (FP) has been revived globally across countries such as Australia, Sri Lanka, Europe, Canada, the USA, Iran, and India. These nations have established dedicated scientific bodies recognizing the importance of FPs in healthcare. A growing area of focus within this field is Functional Foods (FFs)—a concept that has evolved from an unconventional origin into a subject of serious scientific investigation. ^1-8

 

Cancer treatment has traditionally relied on critical nursing and conservative clinical management. However, the increasing global burden of Colorectal Cancer (CRC)—currently the most prevalent malignancy worldwide—necessitates innovative, multidisciplinary approaches. CRC has a strong genetic basis, with the TNIK gene being overexpressed in CRC cells, reinforcing its genetic etiology. Furthermore, CRC is linked to reduced Wnt gene expression in the midgut, highlighting a possible connection between gut health and tumor development. ^9-15

 

Given these insights, diet and nutrition emerge as significant factors in both the prevention and management of CRC. The integration of FFs into cancer care presents an opportunity for improved outcomes, particularly when combined with the expertise of FPs. The FP’s team—comprising nurses, pharmacists, and family members—can play a critical role in CRC management by ensuring continuous care, personalized dietary interventions, and better compliance with chemotherapy (CT) regimens. However, despite their expertise, FPs remain an underutilized resource in cancer care, often due to misconceptions about legal limitations. ^16-18

 

Theory: The Role of Family Physicians in CRC Management

FPs are highly trained, well-distributed across rural and remote regions, and possess the necessary skills and infrastructure to support cancer patients. Their integration into CRC care—through structured refresher courses in pharmacognosy and FFs—could lead to:

·       Improved prognosis and survival rates

·       Enhanced patient welfare and quality of life

·       Increased accessibility and affordability of cancer treatment

·       Expansion of the pharmaceutical and functional food industries

 

Medico-Legal Considerations

In India, a country with 1.5 billion people and a dynamic legal system, no laws restrict licensed medical practitioners from treating cancer patients. The Indian National Medical Commission Act (NMCA) of 2019 explicitly permits FPs to provide cancer care, including chemotherapy, under Section 31(1). Furthermore, Section 32 of the same Act recognizes Community Health Providers (CHPs) as legitimate healthcare stakeholders, extending legal support to multidisciplinary teams, including academics, nurses, and other trained professionals. ¹⁹

This regulatory framework ensures that FPs can legally engage in CRC treatment, collaborate with CHPs, and contribute to the growing pharmaceutical market. India’s inclusive and flexible healthcare laws have already resulted in a surge of licensed and labelled pharmaceutical products, bolstering the domestic healthcare economy.²⁰

 

Uniqueness of This Study

Despite the growing interest in FFs and CRC treatment, no existing research comprehensively examines the role of FPs in integrating FFs into CRC management—especially during chemotherapy cycles. This study aims to:

·       Explore how FPs can facilitate CRC care, particularly in rural and remote settings

·       Investigate the potential of FFs in reducing chemotherapy-induced side effects

·       Propose a continuum of care model involving extended hospital stays, home-based FP supervision, and multidisciplinary collaborations

·       Assess the economic and healthcare benefits of FP-led cancer management

 

Key Issues in CRC and Chemotherapy Management

1. Systemic Inflammation and Response Pathology

Malignancies such as CRC trigger chronic inflammation, cytokine storms, and catabolic stress. These biochemical changes alter immune responses, sometimes making the body perceive chemotherapy drugs as antigens, thereby reducing drug efficacy. Other complications include:

·       Downregulated erythropoiesis, leading to anemia

·       Hypotension and vascular instability

·       Increased psychological stress and metabolic imbalances

 

Steroid therapy is commonly used to manage these side effects, but prolonged use may introduce additional complications, necessitating alternative supportive strategies such as FF-based interventions. ²¹

 

2. Chemotherapy-Induced Toxicity

Chemotherapy drugs are administered intravenously, often at vein junctions (e.g., the cubital vein), for rapid systemic distribution. However, cytotoxic effects are most pronounced at malignant tissue sites, leading to:

·       Localized vessel dilation and drug stagnation

·       Blood component interactions that form unwanted conjugates, potentially reducing drug efficacy

·       Increased oxidative stress and metabolic disruptions

 

Since CRC cells exhibit high ionization and hypervibration frequencies, their response to chemotherapy is complex and often unpredictable. FPs, being in direct and continuous contact with patients, are best positioned to monitor and manage these        dynamics. ^22,23

 

3. Systemic Anemia in CRC Patients

CRC is associated with tumor-induced angiogenesis, which paradoxically suppresses red blood cell (RBC) production, resulting in systemic anemia. This condition:

·       Impairs tissue oxygenation and hinders oncological interventions

·       Requires frequent blood transfusions, which may be impractical in remote areas

·       Reduces overall treatment efficacy in advanced-stage cancer

 

Traditional Indian medicine (Ayurveda) suggests that atomized, carboxylated, and hydroxylated ferrous suspensions may effectively reverse systemic anemia, presenting a potential alternative for CRC patients. ²⁴

 

The integration of FPs and FFs into CRC treatment represents a novel, legally supported, and economically viable approach to cancer care. By leveraging their accessibility and expertise, FPs can provide continuous, personalized, and holistic support for CRC patients—enhancing survival, reducing treatment side effects, and expanding the market for pharmaceutical and functional food industries.

 

 

 

Fig-1: Image of the original palm leaf manuscript as in Ref No.25. 

 

 

Photo (exposed for author on exclusive request) by Mr. Laxmidhara Sahu, Lab Assistant, Palm Leaf Section. Odisa State Museum, Bhubaneswar –India (sole proprietor). C/o Dr Bhagya Lipee, The Superintendant.  Its major part is a redaction from the original Sanskrit and the minor part is in sync with regional agro-met and regional health issues dt. to between c.1750-1850 (alike the other manuscripts cited in this transaction).  Text and Label’s script is in Odia (regional vernacular). This museum conserves >20,000 palm leaf manuscripts – all inclusive. Digital versions of the cited manuscripts are available on application. Fig-1 merits mining.   

 

 

 

 

Nine Key Aspects in CRC (All Clinical Stages) During Chemotherapy Cycles ^26-35

In colorectal cancer (CRC), across all clinical stages, nine notable aspects require special attention during chemotherapy cycles:

1.     Collapsed Gut Lumen – A common complication impacting digestion.

2.     Lumen Constriction Due to Lymph Node Inflammation – Worsens bowel obstruction.

3.     Declining Hemoglobin Levels with Hypotension and Fatigue – Leads to systemic weakness.

4.     Resultant Hemodynamic Alterations – Affecting circulatory stability.

5.     Gastrointestinal Distress – Including nausea, mild cramps, and a persistent uneasy stomach.

6.     Opportunistic Viral Infections – Heightened susceptibility due to immunosuppression.

7.     Nutritional Support for Chemotherapy – Site-specific dietary interventions to enhance treatment efficacy.

8.     Mood Swings and Depression – Psychological impact of CRC and treatment.

9.     Addressing the Ill-Feel Factor – Transitioning from discomfort to well-being.

 

Functional Foods (FF) in CRC Management

Functional foods (FF) are not equivalent to medical diets. Instead, they are rooted in anti-malignancy research and involve a collaborative effort between nurses, patients (both under treatment and in observation phases), and family caregivers. FF interventions are nurse-mediated and remotely supervised by healthcare professionals, ensuring dietary adherence and therapeutic efficacy.

 

Key Functional Foods and Their Benefits:

1.     Curd (Homemade Probiotic Yogurt):

Supports gut microbiota, countering chemotherapy-induced disturbances.

Helps restore Akkermansia muciniphila levels, often depleted during treatment.

2.     Legumes for Gut Lumen Health:

Green gram (Vigna radiata) and black gram (Vigna mungo) aid in gut biome restoration.

3.     Minor Millets:

Essential in CRC and solid cancers for overall metabolic support.

4.     Mustard Oil (Brassica juncea):

The preferred cooking medium due to its hydrophobic properties and non-counteractive nature with CRC.

5.     Renal Support with Herbal Extracts:

Tribulus terrestris, Boerhavia diffusa, and Macrotyloma uniflorum for kidney function preservation.

 

6.     Sweet and Energy-Dense Foods:

Homemade candies (peethas), mild sweet fries, soups, noodles, and gram flour-based snacks enhance appetite and caloric intake.

7.     Dairy-Based Functional Foods:

Cottage cheese, clarified butter (ghee), and milk support energy metabolism and drug vectoring.

8.     Gut-Soothing Herbs:

Asafoetida (Ferula asafoetida), sesame seeds, and warm water aid in digestion and reduce bloating.

9.     Tubers and Rhizomes:

Most are beneficial except vitamin A-rich varieties like carrots.

10. Ayurvedic Elixirs:

Dasamularishta or Panchamularishta for diabetic and non-diabetic CRC patients.

11. Minor Millets and Country Grains:

Promote anti-acidity, mild ulcer healing, and regulated bowel movements.

12. Brining and Hydration Strategies:

Bristling brine to counter drug-induced dehydration and electrolyte imbalances.

13. Iron Supplementation:

Ayurvedic Lohasava for hematopoiesis and anemia management.

14. Fruit-Based Therapies:

Pomegranate for anti-inflammatory effects and virus resistance.

Unripe sun-dried mango (ambula) as an effective CRC supplement.

15. Mental Well-Being Interventions:

Papaver somniferum for mood stabilization and REM sleep regulation.

16. Natural Pain Management:

Dried poppy carp and Ayurvedic formulations like Mritasanjibani.

17. Exercise and Sun Exposure:

Induces peripheral circulation, metabolism of therapeutic toxins, and stress relief.

18. Traditional Healing Foods:

Chyawanprash, Dasamularishta, and Mritasanjibani as general regeneratives.

19. Oral and Dental Hygiene:

Guava twigs, neem stick brushing, and natural antiseptics for gum health.

20. Anti-Parasitic Measures:

Erythrina variegata leaves and pineapple juice for post-chemotherapy pinworm infestations.

 

Functional Foods and Symptom Management

 

Contraindicated Functional Foods

Certain foods should be avoided in CRC, as they may counteract chemotherapy effects or exacerbate symptoms:

·       Iodized salt and iodine-rich foods

·       Steroids and synthetic vitamins (especially Vitamin A)

·       Crabs, fish oils, and palm/sunflower oil

·       Green plantains and tamarind

·       Mouthwashes with benzene, Dettol, or phenol

·       Wheatgrass and genetically modified (GM) foods

·       Citrates in renal stone patients

 

Heritage and Research Perspective

Ancient healthcare manuscripts, including Indian Ayurvedic, Persian, Mesopotamian, Maori, Incan, Chinese, and Nipponese traditions, reference functional foods as integral to disease management. However, none have explicitly linked them to CRC management, making this an evolving area of study.

 

Research supports functional foods as an avenue for drug discovery, integrating bottom-up methodologies for safer and cost-effective cancer care.

 

CRC is an enduring challenge, but rather than eliminating it entirely, the goal is to manage and coexist with the condition through nature-mimicking interventions. The approach emphasizes leveraging dietary, herbal, and lifestyle modifications to enhance patient quality of life.^36-56

 

DISCUSSION:

Functional foods (FFs) have played a role in drug discovery, offering a bottom-up research model that is both economical and ensures unprecedented safety. As a rapidly evolving field, FFs provide a diverse nutritional approach that varies based on malignancy type and individual needs. However, this discussion is not exhaustive but rather an exploration of the subject, which remains highly relevant today. The selection of FFs depends on agro-meteorological factors, and our current presentation is in its early stages—thus, no definitive conclusions are drawn, only discussions.

FFs are natural reservoirs of bioactive compounds, yet they also contain internal inhibitors—elements nature has inherently placed within them. Functional practitioners (FPs) have developed expertise in enhancing the beneficial compounds, mitigating inhibitory effects, and optimizing their in vivo efficacy. This approach lays the foundation for evidence-based, resource-rich research in drug discovery, advancing a bottom-up methodology.

 

In developing economies, where extended family structures remain prevalent, many individuals informally contribute to FF-based cancer management. These efforts—ranging from sourcing, procuring, and preparing FFs under FP guidance—are largely voluntary, cost-effective, and free from taxation or government subsidies. Success stories spread rapidly, and when such grassroots efforts receive official scientific validation, all stakeholders benefit: the scientific community, commercial enterprises, and society at large.

 

Human physiology is inherently complex and pleiotropic⁵⁶. Cancer, often referred to as "the emperor of all maladies"⁵⁷, remains a persistent global challenge, with colorectal cancer (CRC) standing as one of the most dominant malignancies worldwide. These are natural biological processes—malignancy and CRC cannot be eradicated but must be managed. Hence, the core philosophy of this discussion is that individuals can coexist with cancer while leading a normal life. Mimicking nature’s mechanisms—how it initiates, regulates, and terminates biological processes—is essential.

 

Disease and drug research are largely market-driven, often influenced by hidden commercial agendas rather than pure scientific necessity. The legal and jurisprudential fields, characterized by sedentary lifestyles and high cognitive demands, present an increased risk for CRC. This underscores a global call for proactive health measures. Establishing a legal framework that recognizes the value of FFs in cancer management is imperative.

 

FFs are vast reservoirs of bioactive moieties that can be harnessed for the benefit of all stakeholders, including farmers and forest-dependent communities. Functional practitioners possess the knowledge to optimize these natural resources without imposing a financial burden on public healthcare systems. However, rather than being integrated into mainstream cancer management, FPs have been sidelined, and FFs are often dismissed as unscientific. The prevailing belief that chemotherapy is the only viable treatment while FFs remain outside the scope of medical practice is misleading. A holistic approach is not only valid but also scientifically warranted.

 

This discussion challenges the existing narrative, advocating for a paradigm shift where functional practitioners and FFs are recognized as critical components in the fight against cancer.

 

CONCLUSION:

Colorectal cancer (CRC) presents a growing global health challenge, particularly due to its high recurrence rates, metastatic potential, and the logistical constraints associated with conventional treatments. While chemotherapy remains a cornerstone of CRC management, its reliance on cold-chain logistics and its significant toxic side effects create substantial barriers, especially in resource-limited settings. Family Physicians (FPs), with their accessibility, expertise, and deep-rooted community presence, offer an untapped potential in bridging these gaps. However, misconceptions regarding legal restrictions have largely prevented their active participation in oncology care, despite existing provisions—such as those in India—allowing for their involvement.

 

The integration of Functional Foods (FFs) into CRC management, guided by FPs, represents a promising, patient-centered approach that complements standard treatments. FFs, widely available in tropical and equatorial regions, have demonstrated the potential to alleviate chemotherapy side effects, support recovery, and enhance overall well-being. By acknowledging and formalizing the role of FPs in CRC care, healthcare systems can become more inclusive, efficient, and accessible, particularly in underserved regions.

 

This paradigm shift—leveraging FPs' expertise and incorporating FFs into cancer care—has the potential to improve patient outcomes, reduce healthcare disparities, and create economic opportunities within the medical and agricultural sectors. Recognizing FPs as key stakeholders in CRC management not only enhances treatment accessibility but also fosters a more holistic and sustainable approach to cancer care.

 

CONFLICT OF INTEREST:

There is no conflict of interest between authors.

 

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Received on 10.08.2024      Revised on 22.10.2024 Accepted on 24.12.2024      Published on 28.01.2025 Available online from February 27, 2025 Research J. Pharmacy and Technology. 2025;18(2):949-954. DOI: 10.52711/0974-360X.2025.00139 © RJPT All right reserved
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