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Complementary Alternative Cancer Therapies

Cancer Patient Nutrition: The Use of Dietary Supplements/Antioxidants During Conventional Treatment

In the following section, we summarize key findings from published studies demonstrating that dietary supplements influence clinical outcomes and long-term survival, as opposed to showing only a short-term benefit:

  1. Encouraging results from a clinical study have shown that the use of antioxidants during chemotherapy treatment does not compromise the treatment. In this study of lung cancer patients, supplementation with vitamin C, vitamin E, and beta-carotene did not interfere with the effectiveness of chemotherapy (Pathak AK et al 2005). In fact, recipients of chemotherapy who took antioxidants had better response rates and overall survival than those who received chemotherapy alone; however, these differences did not reach statistical significance (Drisko JA et al 2003; Pathak AK et al 2005).
  2. In a study of non-small cell lung cancer patients over 60 years of age who had undergone surgery to remove their primary tumor(s), doctors compared survival in vitamin users to nonusers and measured blood folate levels as an indicator of folic acid intake. The average survival of nonusers was only 11 months, compared to 41 months for vitamin users; in other words, supplement users survived almost four times longer than did nonusers. Patients with higher blood folate levels also had improved long term survival (Jatoi A et al 1998). The Mayo Clinic researchers who conducted this study have conducted further studies with larger patient samples, and their results consistently show improved survival and quality of life in non-small cell lung cancer patients who use vitamin and mineral supplements (Jatoi A et al 2005a; Jatoi A et al 2005b).
  3. Another study examined a group of transitional cell bladder cancer patients. One group was given BCG (a tuberculosis vaccine) immune-augmentation therapy plus the recommended daily allowance (RDA) of vitamins. The second BCG-treated group (the mega-dose group) received the RDA plus 40,000 IU of vitamin A, 2000 mg of vitamin C, 400 IU of vitamin E, 100 mg of vitamin B6, and 90 mg of zinc. After five years, cancer recurrence rates were 91 percent in the group that received the low-potency RDA vitamins, but only 41 percent in the mega-dose group. In this study, large doses of vitamins resulted in a 55 percent reduction in cancer recurrence (Lamm DL et al 1994).
  4. Uveal melanoma is a rare form of melanoma that occurs in the iris of the eye (Tallberg T et al 2000). Nine random high-risk patients with uveal melanoma had standard conventional therapy to eradicate their primary tumors. The patients were then put on a nutritional supplement regimen consisting of folic acid, trace minerals, amino acids, and fatty acids. After 80 months of follow-up, none of the nine patients experienced recurrent disease, compared to a similar group of patients who did not receive these supplements. Given that 100 percent of these high-risk patients were free of disease after almost seven years, the results provide further evidence of the potential value of nutritional supplementation for cancer patients (Tallberg T et al 2000).
  5. Studies of breast cancer patients have shown that patients using antioxidants are less likely to suffer a recurrence or die from their cancer (Fleischauer AT et al 2003).
  6. The effectiveness of 5-fluorouracil (5-FU), a chemotherapy agent used to treat breast cancer, was improved when it was administered in combination with folic acid (Kreienberg R 1998). 5-FU is also commonly used in colon, liver, and pancreatic cancers, but has not shown a high degree of efficacy (Christopoulou A 2004). A randomized trial of patients with metastatic colorectal carcinoma compared the effects of 5-FU administered alone and in combination with folic acid. Compared to the group receiving 5-FU alone, the patients receiving 5-FU plus folic acid experienced a 76 percent overall tumor reduction. Survival in the group receiving 5-FU plus folic acid was 47 percent greater than in the group receiving 5-FU alone. The addition of folic acid to this chemotherapy drug regimen resulted in an improved therapeutic profile and significantly prolonged survival time (Loffler TM et al 1992). These results are summarized in Table 1 below.

Table 1: Effect of folic acid on the effectiveness of 5-FU chemotherapy

5-FU

Folic Acid and 5-FU

Difference

Complete or partial remission

9%

16%

7%

Arrest of tumor growth

20%

60%

40%

Progression

71%

24%

47%

  1. Advanced cancer patients exhibit a range of defects in their immune capacity that likely contribute to an increased susceptibility to infections and disease progression (Campbell MJ et al 2005). A study of 12 advanced colorectal cancer patients sought to determine whether supplementation with vitamin E could enhance immune function. The patients received a daily dose of 750 mg (<1200 IU) of vitamin E beginning two weeks prior to intervention with chemotherapy or radiation treatment. Short-term supplementation with vitamin E led to increased white blood cell (lymphocyte) counts (CD4:CD8 ratios) and enhanced the lymphocytes’ ability to produce interleukin-2 and IFN-gamma, which are required for the immune system to destroy cancer cells (Malmberg KJ et al 2002).

While all the studies mentioned above (and many others) showed the benefit of dietary supplements for cancer patients simultaneously undergoing conventional medical treatment, some studies have failed to show any benefit or have shown mixed effects from taking nutritional supplements (Lesperance ML et al 2002). In one study, high levels of folic acid supplementation were associated with greater reductions in neutrophils (a type of white blood cell); however, the same study showed that low neutrophil levels caused by chemotherapy could be improved by vitamin E supplements (Branda RF et al 2004). A preponderance of evidence supports the use of antioxidants with conventional cancer treatments (Moss RW 2006). However, cancer patients are advised to consult physicians who are experienced in both conventional cancer treatments and nutritional oncology.

Prescription Antioxidants vs. Natural Antioxidants

Proponents of dietary supplementation for cancer patients argue that the use of supplements containing multiple high-dose antioxidants before and during conventional therapy may improve treatment efficacy by increasing tumor response and decreasing normal tissue toxicity. Conventional therapy produces toxicity during treatment that can be severe enough to cause its discontinuation. Therefore, if dietary supplements can reduce the toxicity to normal cells, or increase the response of tumor cells to conventional therapy, this would represent a significant improvement over current strategies for managing cancer (Moss RW 2006).

Critics argue that antioxidant supplements should not be used with conventional free-radical-generating cancer therapies because they would protect cancer cells from death due to free-radical damage (D'Andrea GM 2005; Labriola D et al 1999). However, synthetic antioxidants available as prescription drugs reduce toxicities associated with conventional treatments. For example, amifostine, a synthetic version of the amino acid cysteine (Mehta MP 1998; Schwartz GN et al 1998), is prescribed by oncologists to reduce the toxicity of conventional treatments without compromising their effectiveness (Mehta MP 1998; Spencer A et al 2005). Mesna, another synthetic antioxidant available as a prescription drug, improves the efficacy of the anti-cancer drug ifosfamide, which would otherwise damage the urinary system (Olver I et al 2005). These prescribed, synthetic antioxidants have been investigated in many randomized, controlled clinical trials of cancer patients (Antman K et al 1993; Komaki R et al 2002).

Naturally occurring antioxidants and enzymes are often depleted in cancer patients undergoing aggressive therapies, leaving the healthy calls defenseless against free-radical damage. Therefore, it could be argued that supplementing with antioxidants does not add something foreign to the body (unless they are synthetic), but instead replaces natural substances lost as a result of treatment (Barber MD 2001; Brown TT et al 2003). Replenishing normal antioxidant levels reduces the adverse side effects associated with chemotherapy and radiation therapy (Mehta MP 1998; Olver I et al 2005), and actually improves patient outcomes (Fleischauer AT et al 2003; Malmberg KJ et al 2002; Park CH 1988; Prasad KN et al 1996). For more information on these studies, please refer to the chapters on Cancer Radiation Therapy and Cancer Chemotherapy.