Morbidity Profile of Patients Attended Siddha Cancer Special OPD of Arignar Anna Government Hospital of Indian Medicine, Chennai: A Cross-Sectional Study

India is witnessing a rapidly increasing burden of Non-Communicable Diseases (NCDs) such as diabetes, cardiovascular diseases, and cancer, which account for approximately 60% of all deaths (Nethanet al., 2017). Among these, cancer ranks as one of the most feared illnesses, second only to cardiovascular diseases. Between 2012 and 2017, there was a noticeable upward trend in cancer incidence (World Health Organization, 2023). According to data from the Global Cancer Observatory, in 2022, ten types of cancer accounted for approximately two-thirds of all new cases and deaths worldwide. Lung cancer is the most frequent cancer globally, accounting for 2.5 million new cases (12.4% of all new cases) and it is also the primary cause of cancer-related deaths (World Health Organization, 2024). After lung cancer, female breast cancer (2.3 million cases, 11.6%) was noted to have a higher incidence. Out of 185 nations, 157 had breast cancer as the most frequent cancer among women in 2022, and worldwide 670,000 lives were lost due to this (World Health Organization, 2023a). Colon cancer is the second largest cause of cancer-related deaths globally and the third most prevalent malignancy overall, making up around 10% of all cancer cases. A sedentary lifestyle, obesity, smoking, excessive alcohol use, a high intake of processed meats and a poor intake of fruits and vegetables are some of the lifestyle factors that contribute to the development of colorectal cancer (Sathishkumaret al., 2022).

Due to lifestyle changes, there is an increased incidence of chronic deadly diseases. As the greater number of patients with these chronic diseases are approaching culturally acceptable, locally available, and affordable traditional and complementary medicine (T&CM) as it offers simpler remedies when compared with conventional systems, T&CM should be mainstreamed to manage and prevent the chronic lifestyle diseases as recommended by the WHO (Duraisamyet al., 2018). Systems like AYUSH, which encompasses Ayurveda, Unani, Siddha, Sowa-Rigpa, and Homeopathy, represent such traditional practices. Among them, the Siddha system of medicine holds a unique position as the native medical system of Tamil Nadu, India.

The Siddha system includes 4,448 distinct ailments. In this classification, terms such as Kaṭṭi, Kiranti, Puṟṟu, Vippuruti, and Tuṉmārkkisam are used to describe various types of growths. ‘P’ is the code in the National Siddha Morbidity Code (NSMC) for Puṟṟu Nōykal, which is a Tamil term meaning “termite mound” (Vikaspedia Domains, 2017). This metaphorically represents the invasive spread of diseases like cancer, with metastatic growth likened to the way a termite mound expands through underground tunnels. This analogy illustrates the abnormal, uncontrolled, and indestructible nature of cancer, which derives its name from the Greek word “karkinos” meaning crab. The Siddha medical literature such as Agathiyar Vallathi 600, Agathiyar Vaidhya Kaaviyam 1500, Agathiyar Vaithiya Rathina Surukkam 360, Agathiyar Pallu 200, Agathiyar Paripooranam 400, Theraiyar Vaithiyam 1001, Theraiyar Vaithiya Kaaviyam 1500, Pulipaani 500, and Boghar Saptha Kaandam 7000, provide detailed references to medicines indicated for various types of Puṟṟu Nōykal (cancer-related diseases). Based on these ancient texts, medicines are prepared and used to manage cancer symptoms at the Arignar Anna Government Hospital of Indian Medicine and Homoeopathy (AAGHIM), Chennai, which operates under the Department of Indian Medicine and Homoeopathy. Such medicines were Rasa Gandhi Mezhugu, Nandhi Mezhugu, Anna Pavala Chenthooram, Rasa Chenthooram, Paadigalinga Chenthooram, Serankottai Nei, Vippuruthi Ennai, Chithra Moola Kuligai, Linga Chenthooram, Karuppu Vishnu Chakkara Mathirai, Gowri Chinthamaani, Kowsigar Kuzhambu, Maha Vallathy Legiyum, etc., In response to the rising incidence of cancer, the demand for Siddha treatment has also increased. To meet this growing need, a dedicated Siddha Cancer Special Outpatient Department (SCS-OPD) was established in April 2023 and operates every Wednesday.

Among sick persons, 15% are seeking remedies from traditional medical systems (Yadavet al., 2007). The patients who seek care from Siddha system should be identified and properly documented for developing Standard Protocols. Very few literatures on morbidity profiles is available and that too from research institutes that report the general morbidity profile. This is the first study to report the morbidity profile of Cancer patients approaching Siddha OPD. This study was planned to evaluate and report the morbidity profile of patients who attended the SCS-OPD at AAGHIM, Chennai, from January to April 2024. It operates under the hypothesis that Siddha services should be improved to meet the public needs in managing Cancer and providing palliative care in a traditional medical setting by formulating standard treatment protocols.

This retrospective, descriptive cross-sectional study examined the records of patients from the Siddha Cancer Special Outpatient Department (SCS-OPD) at the Arignar Anna Government Hospital of Indian Medicine and Homoeopathy (AAGHIM), Chennai, from January to April 2024. The study population consisted of patients who sought consultation as new registration at the SCS-OPD during this period. This study type provided a “snapshot” of the morbidity patterns within the cancer patient population.

The SCS-OPD at AAGHIM operates every Wednesday from 7:30 a.m. to 12:00 p.m.

On average, 30 to 45 patients visit the SCS-OPD each day for consultation regarding cancer management, palliative care, and transient care. Only new cases from January to April 2024 were included in the study, with detailed analysis focused on new cases, presented in terms of frequencies and proportions.

Ethical approval for the study was obtained from the Institutional Ethics Committee of Government Siddha Medical College, Chennai (Approval No. GSMC-CH-1243/ME-II/097/2024, Date: 26/04/2024).

The study collected socio-demographic details such as age, gender, educational qualification, occupation, and BMI. Information on personal habits, including diet, smoking, alcohol intake, and tobacco use, was also gathered, alongside data on co-morbidities, family history of cancer, existing morbidities (categorized based on known diagnoses), history of present illness, past treatments, and the expectations of cancer patients from the Siddha system. All data were sourced from patient case records or registers.

Data were entered into both a physical register and a spreadsheet. Frequencies and proportions were used to summarize the morbidity profile of the patient population.

The total number of cases of the year, 2023 was 910. From January to April 2024, the total number of cases attended SCS-OPD was 504 which comprises 105 new cases and 399 re-visiting cases. The data of newly registered cases during the study period i.e., 105 cases were collected from medical registers and case sheets, analyzed, and presented in terms of frequencies and proportions.

The mean age of male and female patients was 62.24 and 55.17 years respectively. Patient population is primarily composed of individuals aged 50 to 69, making up more than half of the cases. Specifically, 28.57% are aged 60-69, while 27.61% fall in the 50-59 age groups. Younger individuals aged 10 to 29 represent a very small portion, with only 1.09% in the 10-19 age group and less than 1% in the 20-29 age range. Male patients dominate slightly in the 60-69 age groups, accounting for 12.3% of cases compared to 16.19% of females (Table 1). A significant majority of patients, 58.09%, have not completed high school (Table 1). The occupational data show that 40.9% of the female patients are housewives. Among males, the majority are salaried employees (20%), followed by self-employed individuals (8.57%) and those engaged in business (6.67%) (Table 1). 93.3%, report following a mixed diet, which includes both vegetarian and non-vegetarian foods. Only 6.67% of the patients are vegetarian, and most of these are female (5.71%) (Table 1). 11.42% of the male patients engage in both smoking and alcohol consumption, additionally, 5.71% of the total population uses only tobacco, with a higher representation among women in this category. Smoking alone is reported in 4.76% of cases, predominantly by males (Table 1). Co-morbidities are common among this patient population, with 29.52% suffering from diabetes mellitus, and 19.04% having systemic hypertension. Thyroid dysfunction is predominantly seen in female patients, making up 8.57% of the total population (Table 1).

The distribution of cancer cases among patients reveals a wide array of cancer types, with significant gender disparities observed in certain categories. Among the female patients, there were higher number of breast cancer patients followed by tongue, mouth, lung, ovary, cervix, uterus, leukaemia, stomach and other type of cancers were reported in lower number. Whereas in male patients, there were higher number of lung and mouth cancers followed by tongue, rectum, lip, colon, bladder, lymphoma, brain and CNS carcinoma and other types of cancer were reported lower in number. Notably, breast cancer emerges as the most prevalent form, accounting for 21.9% of all cases. This condition is exclusively reported among female patients, underscoring its impact on women’s health in the studied population. Similarly, cervical cancer, comprising 5.71% of cases, is another significant concern for female patients, highlighting the gender-specific burden of these cancers. In contrast, cancers affecting sites like the lip, tongue, mouth, and lungs are more evenly distributed across genders, though there is a slight male predominance. For instance, lung cancer represents 9.52% of the total cases, with 5.71% of those affected being male and 3.80% female. Cancers of the mouth and tongue, accounting for 9.52% and 8.57% respectively, also show a similar pattern, further emphasizing the role of behavioural risk factors in these cancers. Lastly, a small proportion of cases (9.52%) are classified under “Others, unspecified,” more common in females, comprising 5.71% of the total cases, compared to 3.8% in males (Table 2).

The treatment history of cancer patients shows a wide range of therapeutic approaches, with a significant 43.81% of patients having no prior treatment history. Surgery alone was the most common treatment among those receiving therapy, accounting for 10.47% of cases, indicating its effectiveness for early-stage cancers. Many patients required multimodal treatments, such as surgery combined with chemotherapy and/or radiotherapy, which was seen in 9.52% of cases, reflecting the need for aggressive treatment in advanced cancers. Chemotherapy alone was used in 9.52% of patients, while radiotherapy alone was less common (0.95%). Hormonal therapy (5.71%) and targeted therapy (2.85%) were employed in specific cases, particularly for cancers responsive to these methods (Figure 1).

Figure 1:
Past treatment for Cancer before attending SCS-OPD.

The analysis of cancer patients attending the Siddha Cancer Special Outpatient Department (SCS-OPD) shows varied purposes for seeking treatment. Nearly half (49.52%) sought Siddha medicine for cancer management, either as a standalone treatment or following conventional therapies, including 18.09% after metastasis. Integrative care, combining Siddha with conventional treatments like chemotherapy and radiotherapy, was pursued by 12.3% of patients, reflecting the growing trend of complementary approaches. Palliative care, sought by 24.7% of patients, highlights Siddha’s role in improving quality of life post-surgery or conventional treatments. Preventive care was also significant, with 9.52% of patients using Siddha to prevent recurrence or manage benign conditions. Additionally, 3.8% opted for transient care, using Siddha between conventional therapies. Overall, the data illustrates Siddha’s versatile role in cancer care, from management and integration to palliative and preventive treatment (Table 3).

The analysis of cancer patients attending the Siddha Cancer Special Outpatient Department (SCS-OPD) from January to April 2024 provides several key insights into the demographics, treatment history, and purposes for seeking Siddha care. 105 new cases were analyzed, revealing that the patient population is predominantly older, with over 77% of cases occurring in individuals aged 50 years and above. Specifically, the largest proportion of patients falls within the 60-69 age group, highlighting a higher prevalence of cancer among older adults. This aligns with existing research indicating that cancer incidence increases with age, while younger individuals, particularly those aged 10-29, represent a minimal portion of the patient population. However, a study by Selvaraj K et al reported that 28% of all outpatients were elderly people whereas only 10-15% of elderly people attended allopathy OPDs, this may be due to the preference of elderly people towards Traditional medicines for chronic ailments (Chinnakali et al., 2016).

Most patients (58.09%) have not completed high school, with females overrepresented in the lower educational categories, reflecting gender-based disparities. The underrepresentation of patients with higher educational qualifications may reflect socio-economic barriers that affect knowledge about early cancer symptoms and access to preventive care. In terms of occupation, 40.9% of female patients are housewives, while most males are salaried employees, highlighting socio-economic and gender differences. Geographically, 80.95% of patients reside in Chennai, indicating an urban focus in Siddha-based cancer care. Generally, cancer incidence is higher in urban than rural areas in Tamil Nadu (Mathuret al., 2020, Swaminathan et al., 2009b). The report of Tamil Nadu Cancer Registry Project 2012-2016 also says that a greater number of new cases were recorded from Chennai city followed by Kanchipuram and Thiruvallur (Sathishkumaret al., 2022). This geographic concentration highlights the need for broader regional outreach to ensure that patients from less accessible areas can also benefit from Siddha-based cancer treatments. A majority (93.3%) follow a mixed diet, with only 6.67% being vegetarian, mostly women. Regarding personal habits, 11.42% of males engage in both smoking and alcohol consumption, while tobacco use is more common among women. Co-morbidities are prevalent, with 29.52% having diabetes, 19.04% having hypertension, and 33.33% reporting no co-morbidities. Thyroid dysfunction is common among women, while cardiovascular issues are more frequent in men. Diabetes mellitus and systemic hypertension are the most common conditions reported. Interestingly, a significant proportion of patients reported no co-morbidities, suggesting that for some, cancer is an isolated issue, while others face multiple health challenges. This variability highlights the importance of integrated care approaches that address both cancer and co-existing health conditions.

The distribution of cancer sites shows that breast cancer is the most common among female patients, while oral cavity cancers are the most prevalent among males. This pattern aligns with other cancer registries and emphasizes the need for targeted preventive strategies and treatments based on cancer type and gender. The high incidence of breast cancer among women and oral cavity cancers among men underscores the importance of gender-specific interventions. Regarding past treatment history, 56.19% of patients had previously undergone conventional therapies before seeking Siddha care, indicating a reliance on standard treatments and highlighting the role of Siddha medicine as either complementary or alternative care. The high percentage of patients with no prior treatment suggests potential gaps in early detection or access to conventional therapies. Patients who are in need of palliative care may get benefited from Siddha medicine. More studies have to be carried out to confirm the effectiveness of Siddha formulations which are indicated for Cancer in literatures. The clinical experience in the field of palliative care Siddha interventions has shown substantial improvements in the quality of life. In a few numbers of cases, PET scan results show a decrease in size of the metabolically active lesions and also increases the survival rates of patients after recurrence and metastasis.

The strength of this study are as follows; this is the first study to report the morbidity profile of Cancer patients attending Siddha OPD. The standard disease classification by using ICD-10 codes and National Siddha morbidity codes together. This article also explains the expectations of cancer patients from Siddha medicine like whether they need treatment, or support to withstand conventional therapies or pain management or palliative care. This study was conducted only in Arignar Anna Government Hospital of Indian Medicine and Homoeopathy, Chennai and so it lacks external validity.

The scope of this study is as follows: Since more cancer patients are seeking Siddha physicians, cancer management and palliative care should be emphasized in the curriculum. Separate Siddha cancer palliative care clinics can be initiated. This morbidity profile will help to format the standard protocol for site-specific treatments, stage-specific management and symptomatic palliative care or therapies. And also, for planning manpower recruitment, training the professionals, curating medications, and drug procurement. Moreover, this study indicates that there is a huge expectation from the public to get the desirable treatment options for Cancer from Traditional Siddha Medicine.

Overall, the study provides valuable insights into the cancer patient population at SCS-OPD, emphasizing demographic patterns, educational and occupational backgrounds, geographic distribution, dietary habits, personal behaviours, and co-morbidities. These findings suggest the need for targeted interventions, improved early detection, expanded geographic outreach, and continued exploration of Siddha treatments in comprehensive cancer care strategies.

We sincerely acknowledge Tmt. Mythili Rajendiran, I.A.S., former Commissioner of Indian Medicine and Homoeopathy, Chennai, for her unwavering dedication and significant contributions towards developing the Cancer OPD infrastructure. We are equally grateful to Tmt. M. Vijayalakshmi, I.A.S., the current Commissioner, for her continuous support in ensuring the effective functioning of the Cancer OPD. Our heartfelt thanks are extended to Dr. M. Rathika, B.A.M.S., Hospital Superintendent of AAGHIM, and Dr. N. Nappinai, B.S.M.S., Residential Medical Officer of AAGHIM, for their constant support and facilitation of this research. We extend our sincere gratitude to Dr. K. Samraj, M.D(S)., Research Officer in charge at the Siddha Clinical Research Unit (SCRU) in Tirupati, operating under the Central Council for Research in Siddha (CCRS), Ministry of AYUSH, for his valuable guidance and support during the preparation and publication of this article.