She then underwent subsequent TACE, resulting in remission of her primary hepatocellular carcinoma [ ]. Further studies are needed on the efficacy and safety of high-dose vitamin C. The PDQ cancer information summary for health professionals can help to provide comprehensive, peer-reviewed, evidence-based information about the use of high-dose vitamin C in the treatment of people with cancer.
Scientific Evaluation of Dietary Factors in Cancer
It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions. Reported complications of intravenous ascorbate are unusual, but include rare cases of hemolysis in patients with glucosephosphate dehydrogenase G6PD deficiency and oxalate nephropathy.
Adverse effects may also occur in patients with iron overload and renal failure. Before a vitamin C infusion G6PD should always be assessed therefore by laboratory testing. Oral supplements or parenteral administration of vitamin C could be considered in cancer patients with poor nutritional condition, with delayed postoperative wound healing, fatigue or cachexia.
Clinicians should have an open dialogue with patients about vitamin C supplements and vitamin C treatment. The advice for a vitamin C treatment needs to be individualized and come from a credible source, and it is best communicated by the physician. The authors of this peer-review received no funds for covering the costs to publish in open access. National Center for Biotechnology Information , U.
Journal List Nutrients v. Published online Mar Adamietz 6. Michael F. Author information Article notes Copyright and License information Disclaimer. Received Nov 23; Accepted Feb This article has been cited by other articles in PMC. Abstract Nutritional supplements are widely used among patients with cancer who perceive them to be anticancer and antitoxicity agents.
Keywords: Micronutrients, antioxidants, vitamin D, selenium, l -carnitine, vitamin C, cancer, treatment related side effects, chemotherapy, radiotherapy.
Prevention and Healthy Living
Malnutrition: The Overlooked Link to Micronutrient Deficiency The success of treatment and healing processes in people with cancer are greatly influenced by the nutritional status of the patient. Table 1 Incidence of malnutrition in dependence of the tumor [ 16 , 18 ]. Open in a separate window. Figure 1. Table 2 Specific chemotherapy-induced micronutrient imbalance selection [ 4 ].
Cytostatic Agent Micro-nutrient Mechanism Possible Consequences Cisplatin l -carnitine Increased renal excretion of l -carnitine Cisplatin-induced carnitine insufficiency, increased risk of complications e. Micronutrient Status in Patients with Cancer Even at the time of diagnosis and before there are any clinically-relevant changes in the nutritional status, but certainly after the start of treatment, the supply of various vitamins e. Vitamin D 5.
Vitamin D: Sunlight and Cancer Ecological studies provide the strongest evidence for reduced mortality rates with respect to solar UV-B, with vitamin D production the likely reason. Vitamin D Deficiency in Patients with Cancer Vitamin D deficiency is common in cancer patients and correlates with disease progression. Vitamin D and Cancer Therapy In breast cancer patients under polychemotherapy with anthracycline and taxane, a significant drop in 25 OH D levels was observed [ ].
Recommendation for clinical practice: Vitamin D status should be monitored in all cancer patients and treated by adequate vitamin D supplementation e.
Selenium 6. Selenium and the Risk of Cancer Selenium is an essential micronutrient for human health whose biological activities and anti-carcinogenic properties likely result from its incorporation as the 21st proteinogenic amino acid selenocysteine in selenoproteins encoded by 25 separate human genes with roles in cell protection from oxidative stress, redox control, and the inflammatory response. Use of High-Dose Selenium during Chemo- or Radiotherapy Five randomized trials have looked at the question of whether the concomitant use of high-dose selenium reduces the toxicity of chemo- or radiotherapy without impairing the main effects of oncological treatment.
Table 3 Studies on the use of high-dose selenium during chemo- or radiotherapy. Author Design Outcomes Hu et al. CHOP: cyclophosphamide, doxorubicin, vincristine, prednisone. Many causes of l -carnitine deficiency are already known in patients with cancer: Nutritive l -carnitine deficiency with an inadequate diet e. Figure 2. Table 4 Studies on the use of l -carnitine and acetyl- l -carnitine in cancer. Author Design Outcomes Iwase et al. Kraft et al. BMI increased, nutritional status increased, quality of life increased, cancer related fatigue unchanged.
Cruciani et al. Cancer-related fatigue unchanged, pain unchanged, depression unchanged Cruciani et al. Cancer-related fatigue decreased, depression decreased, and quality of life increased. Bianchi et al. High-Dose l -Carnitine Supplements in Patients with Cancer A deficiency of l -carnitine has been proposed to be an underlying cause of cancer cachexia and tumor associated fatigue [ 33 , , ].
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Recommendations for clinical practice: There is weak evidence from some randomized controlled trials that l -carnitine has a positive influence on cancer anorexia-cachexia syndrome CACS. Vitamin C 8. Vitamin C Deficiency In addition to selenium, vitamin C is the antioxidant micronutrient most frequently used in complementary oncology. Preclinical Data: Combination with Chemotherapy and Radiotherapy In vitro studies have shown that vitamin C increases the cytotoxic effects of cisplatin, dacarbazine, doxorubicin, paclitaxel, tamoxifen, and fluorouracil [ , , ].
Vitamin C: Effect on Cancer Cells in Vitro Further in vitro and animal studies have shown that the administration of high-dose vitamin C alone can kill selective cancer cells ovarian cancer, pancreatic cancer, and glioblastoma by inducing free radicals, without harming healthy cells [ ]. Figure 3. Vitamin C and Radiotherapy According to a recent in vitro study, cells from glioblastoma multiform brain tumors seem to be considerably more sensitive to radiotherapy when high doses of vitamin C are given shortly before treatment sessions.
Vitamin C in Cancer Therapy Effects on the efficacy of cancer therapy. Recommendation for clinical practice: Further studies are needed on the efficacy and safety of high-dose vitamin C. Acknowledgments The authors of this peer-review received no funds for covering the costs to publish in open access.
Author Contributions All authors contributed writing of this review and approved the text. Conflicts of Interest The authors declare no conflict of interest. References 1. Bray F. Global cancer transitions according to the Human Development Index — : A population-based study. Lancet Oncol. American Cancer Society. Global Cancer: Facts and Figures. Holzhauer P. Hippokrates Verlag; Stuttgart, Germany: Der Onkol.
Vitamins and Cancer
Micke O. Predictive factors for the use of complementary and alternative medicine CAM in radiation oncology. Zirpoli G. Supplement use during an intergroup clinical trial for breast cancer S Breast. Cancer Res. Use of antioxidants during chemotherapy and radiotherapy should be avoided. CA Cancer J. Block K. Re: Should supplemental antioxidant administration be avoided during chemotherapy and radiation therapy? Cancer Inst. Yasueda A. Efficacy and interaction of antioxidant supplements as adjuvant therapy in cancer treatment: A systematic review.
Cancer Ther. Impact of antioxidant supplementation on chemotherapeutic toxicity: A systematic review of the evidence from randomized controlled trials. Nechuta S. Vitamin supplement use during breast cancer treatment and survival: A prospective cohort study. Cancer Epidemiol. Vitamin D in oncology: Update Fearon K. Definition of cancer cachexia: Effect of weight loss, reduced food intake and systemic inflammation on functional status and prognosis. Tong H. The prevalence of nutrition impact symptoms and their relationship to quality of life and clinical outcomes in medical oncology patients.
Support Care Cancer. Laviano A. Nutritional issues in cancer management. Bozzetti F.
Nutrition in oncology: The case of micronutrients review Oncol. Vitamine, Spurenelemente und Mineralstoffe. Thieme; Stuttgart, Germany: G; Pirlich M. The German hospital malnutrition study. Dewys W.