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
