Complimentary/Alternative Medicines during Chemo?

[Paul Edwards]

The March 2014 issue of the Asia-Pacific Journal of Clinical Oncology published an article “Why do some cancer patients receiving chemotherapy choose to take complementary and alternative medicines and what are the risks?” by authors from University of Queensland School of Pharmacy and the Sunshine Coast Cancer Care Services.

 

The research found that

• Complementary and alternative medicine (CAM) that is systemically absorbed is most likely to interfere with concurrent chemotherapy and potentially cause harm to cancer patients.
• When tested in rigorous clinical trials, no CAM cancer treatments alone have shown benefit beyond placebo.
• With the exception of ginger to treat chemotherapy-induced nausea, there is no compelling evidence overriding risk to take complementary medicines for supportive care during chemotherapy treatment.
• There is, however, established evidence to use mind–body complementary therapies for supportive care during chemotherapy treatment.

The study listed mind–body therapies where benefit over standard care had been proven and which were safe to use as adjuvants with chemotherapy:

Acupuncture

• Benefit for chemotherapy-induced acute vomiting

 

Acupressure (acupuncture points stimulated by pressure)

• Benefit for chemotherapy-induced nausea and vomiting

 

Moxibustion (acupuncture points stimulated by heat)

• Benefit for chemotherapy-induced acute vomiting

 

Mild exercise

• Reduces fatigue and enhances life satisfaction
• Yoga has been shown to be a useful practice for women recovering from breast cancer treatments to reduce stress, improve quality of life and well-being, and to reduce persistent post treatment fatigue

 

Hypnosis

• Decreased chemotherapy-induced nausea and vomiting

 

Imagery and relaxation (e.g. imagining immune cells as powerful medieval knights or big brooms dispatching cancer cells)

• Modulates immune functioning during treatment

 

Massage

• Decreased chemotherapy-induced nausea and vomiting

 

• Reflexology decreased anxiety during chemotherapy

 

Meditation

• Shown to alter immune patterns by decreasing stress

 

• Decreases anxiety and depression

 

Music

• Reduces chemotherapy-induced anxiety

 

Self-expression (includes written or verbal expression, artwork, humor and movement)

• Written emotional expression has shown a positive effect on outlook and decreased dark feelings in patients with breast cancer

 

Thanks to Alan for flagging this journal article.

[alanbarlee]

I think we should be clear about where some dietary supplements fit into the more generalised warnings about 'CAM' (complementary and alternative medicines) in the full article above.

 

Some mineral and vitamin supplements such as fully formulated calcium (citrate) and vitamin D3 are widely recommended for bone protection (osteoporosis) in the context of extended androgen deprivation (ADT). VItamin D3 appears to be most useful when the body is deprived of exposure to sunlight (e.g. older patients living in southern lattitudes, especially in winter): a serum reading of 75-80 nmol/L of 25-OH calcidiol is widely suggested as optimum, especially if loss of muscle mass is a problem.

 

A magnesium supplement is often suggested for alleviating muscle cramps, although this would be more convincing in an individual case if magnesium deficiency was supported by a blood test.

 

Vitamin B supplements seem to be of doubtful benefit, and may produce adverse effects, especially in mega-doses. Your doctor's advice should be sought on this one.

 

Good quality fIsh oil is regarded as beneficial in avoiding 'cellular inflammation' (which can be a negative for cancer) - although even this can be problematic for some people, since it 'softens' blood vessels and may risk haemorrhage if used in excessive amounts in conjunction with blood thinners and/or aspirin.

 

So-called 'immune boosters' seem to be of doubtful benefit, although certain supplements comprising extracts from specific vegetables and fruit (e.g. broccoli sprouts, tomatoes, pomegranate) have had a better (medical) press.   

 

The article above mentioned that an antioxidant may be benefical in reducing the side effects of taxanes (e.g. Taxotere/docetaxel, carbazitaxel), although they reduce the activity  of some other chemotherapeutics. Since the preferred choice and dosage of antioxidant is not clear, this might be another item to discuss with your medical oncologist or radiologist if you're on or are about to start taxane therapy.

 

Mark Moyad's 'Beyond Hormone Therapy (2011) and Snuffy Myers' 'Beating Prostate Cancer: Hormonal Therapy and Diet (2006)' are essential references that are easy to understand and which cover the field well  - even although they don't agree on everything (e.g. Snuffy Myers' 2006 list of recommended supplements includes selenium and vitamin E, but a large Phase 3 clinical trial completed 2-3 years ago showed these supplements to be ineffective or even damaging).

 

A balanced Mediterranean diet and regular exercise are still the best complementary medicines. As always, check with your medical specialist (and your pharmacist) for potential adverse interractions of supplements with your prescription drugs!

 

Cheers,

 

Alan B

[Paul Edwards]

I agree that at all stages your medical specialists need to be aware of what supplements and alternative medications you are taking.

 

Supplements and alternative medications can interfere with chemotherapy or radiation treatment.  For example, I was told to stop taking fish oil during radiation treatment.

 

As Alan points out, supplements and alternative medications may have adverse drug interactions with your prescription drugs.

[alanbarlee]

Many of our members take Vitamin D supplement, with some basing their 'dose' on a blood test.

 

Here's some information that is useful to take on board - which does not challenge the benefit of enhancing absorbtion of supplementary calcium when used to help protect bone density during ADT (hormone treatment) - but which points out shortcomings in 'the optimum level', analytical reliability and evidence for other claimed benefits.

 

 

[alanbarlee]

 Article from THE CONVERSATION published 7 August 2013

Six things you need to know about your vitamin D levels

Authors

Robyn Lucas

Associate Professor of Epidemiology at Australian National University

 

Terry Slevin

Honorary Senior Lecturer in Public Health at Curtin University; Education & Research Director, Cancer Council WA; Chair, National Skin Cancer Committee at Cancer Council Australia

 

Vitamin D has emerged as “the vitamin of the decade”, with a long and growing list of maladies supposedly caused through its absence or prevented through its bountiful supply.

But is there adequate evidence for the wonders claimed for vitamin D or are we getting a bit carried away?

Before you answer that, here are some common misconceptions about vitamin D that you should know about.

1.              Everybody knows their vitamin D level should be above …?

It’s a fairly universal agreement that a blood concentration of 25-hydroxyvitamin D (the usual measure of vitamin D status) below 25 nanomoles/litre (nmol/L) should be considered a serious deficiency.

Anyone who is tested and returns results like that needs to talk to their doctor about proper management. But knowing what levels are sufficient is trickier.

In 2010, the Institute of Medicine in the United States concluded that bone health is the only condition for which there’s an established causal association with vitamin D. They found:

health benefits beyond bone health — benefits often reported in the media — were from studies that provided often mixed and inconclusive results and could not be considered reliable.

So there’s clearly contention about how much is enough. A level of 50nmol/L is sufficient to optimise the bone health of the majority of the population. But other groups recommend 75nmol/L, 100nmol/L or higher (note that US sites provide recommendations in nanograms per millilitre or ng/ml – multiply by 2.5 to convert to nmol/L).

2.              There’s a vitamin D deficiency epidemic in Australia.

Actually, what is most clear is that there’s an epidemic of vitamin D testing in Australia – a 94-fold increase from 2000 to 2010. Costs to Medicare have gone from $1.3 million in 2000/2001 to $140.5 million in 2012/2013.

Rather than an epidemic of deficiency, there’s currently an epidemic of vitamin D testing in Australia. Shutterstock

Some populations are clearly at risk of vitamin D deficiency. People who habitually cover their skin while in public for cultural or other reasons, for instance, and the immobile elderly who are rarely sun exposed. But the evidence of population-wide vitamin D deficiency is thin and unconvincing, at least in part because vitamin D tests are problematic and the desired level is hotly debated.

If an unreliable test is used and the “sufficient” bar is set too high and more people are tested, then vitamin D “deficiency” will seem more common.

3.              A vitamin D test gives a simple answer and is accurate and reliable.

This is definitely not so.

If you take blood from one person and split it up into several samples and test these, you can get very different results between the samples. And it’s not just a little bit different.

A recent Australian study assessing the consistency and accuracy of vitamin D tests found that between one-in-five and one-in-three participants were misclassified as “deficient”. The vitamin D test results for a single blood sample returned enormously different results depending on which type of test was used and where the sample was analysed.

Four samples (out of approximately 800) differed by more than 100nmol/L (that’s double the usual “sufficient” level of 50nmol/L) across two different tests, and 10% of the results differed by more than 50nmol/L. These are different measurements of the same sample!

Fortunately work is underway to improve this abysmal situation. A group of international agencies are developing a reference measurement procedure and laboratories will be able to assess the performance of their test against this new standard.

4.              Vitamin D is the elixir of life, which is sometimes presented as vitamin D deficiency will kill us all.

Given the challenges of accurately measuring levels of this vitamin and the disagreement on where the goalposts are, doing good consistent research to determine the benefits and detriments of high or low vitamin D is pretty difficult.

There’s no doubt that severe vitamin D deficiency causes rickets in children, and an equivalent condition known as osteomalacia in adults. Old pictures of children with bowed legs or knock knees were often of children with rickets.

And there’s pretty good evidence that supplementation with vitamin D and calcium, in combination with weight-bearing exercise, can decrease the risks of fractures in the elderly. Particularly in people who have low levels of vitamain D or calcium (or both) before starting supplementation.

But most evidence for the other reported benefits of vitamin D comes from weak studies, and there’s little support from better studies.

There’s good evidence that supplementation with vitamin D and calcium, in combination with weight-bearing exercise, can decrease the risks of fractures in the elderly. Shutterstock

5.              Given it is such good stuff, the higher my vitamin D level, the better.

Vitamin D has traditionally been thought to be safe, requiring very high levels (greater than 400nmol/L) to reach toxicity. This toxicity cannot occur through sun exposure, but can through excessive supplementation.

But as we delve more into the vitamin D story, studies are reporting risks to health at even modestly high levels, such as 80-100nmol/L.

The evidence is not yet strong (much like the evidence of vitamin D’s benefits) but this type of association is typical of many vitamins and nutrients, where both too little and too much are bad for you .

6.              Sunscreen stops vitamin D production.

The majority of vitamin D your body needs comes through exposure to the sun, specifically from shorter wavelength UVB radiation that is also the main cause of skin cancers. It may seem logical that if sunscreen stops the damaging UVB reaching sensitive skin cells, it will also stop vitamin D production by those same cells.

But even if sunscreen is applied very thickly, vitamin D production is reduced but not stopped. And, of course, who puts it on that thickly?

Most of us apply sunscreen because we are going to be in the sun. We put on a thin layer that is not too icky. Under these conditions, sunscreen actually doesn’t seem to make a lot of difference to vitamin D production.

There’s a lot we don’t know about vitamin D. But we do know that Australia has the highest skin cancer incidence in the world: hundreds of thousands of skin cancers are removed each year at a cost of more than $700 million and there are over 2,000 deaths from it.

Excessive sun exposure is the main cause of that problem. Getting the balance between vitamin D levels and sun protection right is an important health goal.

More research is needed and it should be Australian research because our circumstances are different to those in the United States and Europe. We can’t just take results from there and use them here.

While a simple solution would be nice, an evidence-based one is preferable and worth pursuing. Stories about our epidemic of vitamin D deficiency drive excessive testing at high cost and unknown value. And they probably just end up selling more vitamin supplements.

But they also create confusion and diminish people’s confidence and resolve to reduce excessive UV exposure.