Should Physicians Recommend Vitamins, Minerals and Micronutrients To Patients With Cancer?: An Analysis From The Perspective of ESPEN Guideline

Should Physicians Recommend Vitamins, Minerals and Micronutrients To Patients With Cancer?: An Analysis From The Perspective of ESPEN Guideline

Dr. Mehmet Eren Yuksel

Ankara Yıldırım Beyazıt University School of Medicine, Intensive Care Unit, Ankara, Turkey. e-mail: doctormehmeteren@yahoo.com

Dr. Hasan Dirik

Ankara City Hospital, Intensive Care Unit, Ankara, Turkey. e-mail: hsndrk_38@hotmail.com

Abstract

Background: The number of cancer patients using complementary and alternative medicine (CAM) is rapidly increasing in Turkey. However, it is a matter of debate if physicians should prescribe vitamins, minerals and micronutrients to patients with cancer.

Method: A Pubmed search, between the years 1990 and 2021, was performed to identify the prevalence of patients using CAM. Moreover, studies about vitamin C-D-E supplementation were examined according to the recommendations of European Society for Clinical Nutrition and Metabolism (ESPEN) guideline (1).

Results: Ernst et al. published the first systemic review regarding the prevalence of CAM use in cancer patients, which was 31.4%, in 1998 (2). Horneber et. al  reported in 2012 that their meta-analysis included 152 studies from 18 countries with 65.000 cancer patients and the prevalance of CAM usage was 40% (3). The CAM use was the highest in the United States (50%) and the lowest both in Italy and the Netherlands (22%). Turkey had the highest prevalence of CAM use with 48% in Europe (3). ESPEN guideline on clinical nutrition in cancer published in 2021 pointed out a few studies (1). Wang et al. reported that a total of 14,641 male physicians received 400 IU of vitamin E and 500 mg of vitamin C daily for 10 years. However, vitamin E and C supplementation had no immediate or long-term effects on the risk of total cancer and prostate cancer (4). Bolland et al. stated that vitamin D supplementation did not reduce skeletal or non-skeletal outcomes in individuals by more than 15% (5). Klein et al. revealed that dietary supplementation with vitamin E significantly increased the risk of prostate cancer (6).

Conclusion: Despite the fact that approximately 50% of all cancer patients consume CAM, ESPEN recommends that vitamins and minerals should be supplied in amounts equal to the recommended daily allowance, whereas high-dose micronutrients should be discouraged in the absence of specific deficiencies (1).

Keywords: Alternative, cancer, complementary, medicine, vitamin

References:

1. Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, et al. ESPEN practical guideline: Clinical Nutrition in cancer. Clin Nutr. 2021;40(5):2898-913.

2. Ernst E, Cassileth BR. The prevalence of complementary/alternative medicine in cancer: a systematic review. Cancer. 1998;83(4):777-82.

3. Horneber M, Bueschel G, Dennert G, Less D, Ritter E, Zwahlen M. How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis. Integr Cancer Ther. 2012;11(3):187-203.

4. Wang L, Sesso HD, Glynn RJ, Christen WG, Bubes V, Manson JE, et al. Vitamin E and C supplementation and risk of cancer in men: posttrial follow-up in the Physicians' Health Study II randomized trial. Am J Clin Nutr. 2014;100(3):915-23.

5. Bolland MJ, Grey A, Gamble GD, Reid IR. The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta-analysis. Lancet Diabetes Endocrinol. 2014;2(4):307-20.

6. Klein EA, Thompson IM, Jr., Tangen CM, Crowley JJ, Lucia MS, Goodman PJ, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). Jama. 2011;306(14):1549-56.

Conference: 2. International Cancer Days, Sivas Cumhuriyet University, 16-18 September 2021

https://kansergunleri.cumhuriyet.edu.tr/?page_id=589&lang=tr