Dietary supplement use in cancer patients: is there a link to psychosocial wellbeing?

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1 Dietary supplement use in cancer patients: is there a link to psychosocial wellbeing? Kathryn Taylor Clinical Psychologist St George s Cancer Care Centre

2 St George s Cancer Care Centre

3 Dietary supplements Used NZ Adult Nutrition Survey 2008/09 definition and categories: Dietary supplements were products the participant considered or intended as a supplement to their diet. This included both prescribed and self-selected supplements in a variety of forms, such as tablets, capsules, powders and liquid preparations. Supplements included, individually or in combination: vitamins, minerals, herbal and botanical preparations, oils such as fish oil, and products providing glucosamine and/or chondroitin. University of Otago and Ministry of Health A Focus on Nutrition: Key findings of the 2008/09 New Zealand Adult Nutrition Survey. Wellington: Ministry of Health. p205

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5 CAM Complementary and Alternative Medicine Includes dietary supplements but also: o Massage o Chiropractic o Acupuncture o Energy healing o Homeopathy o Folk remedies o Spiritual healing o Hypnosis o Reflexology o Kinesiology o Plus many others..

6 Beliefs associated with use of CAM Bishop et al., (2007) Journal of Health Psychology, 12, Systematic Review (94 articles) Users want to participate in decision-making Have active coping styles Believe they can control their health Value non-toxic, holistic approaches Different types of CAM users: (Furnham & Kirkaldy, 1996) o The Principalists o The Frustrated o The Opportunist shop around Note that different illness groups may differ in their reasons for CAM use

7 Dietary supplement use in cancer patients Dietary supplements are the most commonly used form of CAM in cancer patients o Gundgaard et al., (2013)

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9 Social Norms Patients more likely to use CAM if recommended by family and friends (Mao 2012)

10 Why is DS use in cancer patients worth thinking about? DS use is common o? higher in cancer survivors than in general population Prostate Cancer: 10% higher than non-cancer population. Westerlund et al. (2011) Most patients don t tell DS may be contra-indicated It might be useful clinical information

11 Pros and Cons Potential Benefits: Immune modulation Stomatitis/Mucositis (glutamine) Intestinal toxicity Neuropathy Nausea Radiation-induced dermatitis Cachexia Lymphoedema Fatigue Vasomotor symptoms Potential harm: Contaminated or adulterated supplements Liver toxicity (Chinese herbs) Herb-drug interactions especially chemotherapy (St John s Wort) Potential hormone-activity Antioxidants, Q10 High dose vitamin C, Concerns are mainly theoretical Hardy (2008), HematolOncolClinN Am, 22

12 CAM and mental health Cancer survivors with unmet needs were more likely to use CAM (Mao et al., 2008) Use of CAM among breast cancer patients associated with depression (Montazeri et al., 2005) CAM associated with increased perception of breast cancer recurrence and fear of cancerrelated death (Rakovitch et al., 2005) Higher mental distress in patients using CAM (Risberg & Jacobsen, 2003)

13 Dietary supplement use in patients at St George s Cancer Care Centre 177 patients undergoing treatment Radiation or chemo-radiation Dietary Supplement Questionnaire Distress Thermometers (5) Hospital Anxiety and Depression Scale (HADS)

14 Demographics Age: Mean years (range 24 84) Sex: 50.8% Female Ethnicity: o 90% Pakeha/NZ European, (77.4% 2006 Census data for Canterbury) o 4% Maori, (7.2% 2006 Census data for Canterbury) 82% Married/Defacto (49.4% 2006 Census)

15 Demographics Cancer Site: Breast 46.4% Prostate 37.2% Rectum 6% Stomach 1.6% Head/Neck 2.7% Other 6%

16 Results 49% took dietary supplements No difference in DS use between men and women (df=175,t=0.69, p=0.5) Male Female Mean no. supplements No difference in age of users compared to nonusers (df=175, t=0.32, p=0.75)

17 Supplements Taken Results This Study n=177 Oils 38% 16.4% Botanicals 31% 8.5% Single Mineral 27% 5.8% Single Vitamin 25% 8.6% Multivitamin + Mineral 15% 14.8% Glucosamine/Chondroitin 15% 6.2% Herbal + Vit/Min 5% 10.1% Multi-vitamin 2% 6.4% Multi-mineral 2% 1.5% Bee Product 2% 0.7% NNS 2008/09

18 Results The sample was divided into 3 groups according to supplement use: 1. None n=90, (51%) 2. Low between 1 and 3 supplements, n= 74 (42%) 3. High 4 or more supplements, n=13 (7%)

19 Distress Thermometer Scores for No, Low and High Supplement Use None Low High DT Score p=0.05* p=0.03* 0 Distress Anxiety Depression Anger Need Help DT Thermometer * Kruskal-Wallis Test

20 HADS Scores for No, Low and High Supplement Use None Low High HADS A HADS D HADS Total

21 In conclusion: DS use is widespread - 50% of patients were using DS Similar rates in men and women Different pattern DS compared to the NNS 7% had high use and this group had higher mean scores for distress and anger. There does appear to be a link between psychosocial wellbeing and high use of dietary supplements DS use is clinically useful information that we should be talking about with our patients

22 Further questions to ask: What are cancer patients beliefs about DS in the NZ setting? How do Maori cultural beliefs affect DS use? What about other cultures? e.g. strong traditions in Asian culture How does DS use change over the cancer journey? What are health professionals beliefs about DS? What more can we learn about how DS is associated with psychosocial wellbeing?

23 Any questions?

24 Dietary supplement use in older men in NZ Bacon et al., (2011) NZ Medical Journal 124, men aged 40 and above who were participants on a randomised trial of calcium supplements. 47% took at least one supplement, 30% took more than two Median monthly expenditure $20 Most common vitamins or minerals (49%), oils (22%) and glucosamine/chondroitin (13%) Reasons for taking: o Non-specific health benefit/maintenance (58%) o Symptom alleviation from health condition (21%)