The Benefits and Dangers of Vitamins & Supplements for Breast Cancer Patients

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1 The Benefits and Dangers of Vitamins & Supplements for Breast Cancer Patients Richard T. Lee, MD Assistant Professor, Department of Oncology Center Medical Director, Integrative Medicine Program MD Anderson Cancer Center

2 Objectives Review clinical research on vitamins and supplements in cancer care Discuss specific benefits and dangers of vitamins and supplements Overview of the Integrative Medicine Center Clinical Model at MD Anderson Cancer Center

3 I need to work on my nutrition 3

4 Patients Are Asking How do I prevent cancer from coming back? What vitamins, minerals, and other supplements should I be taking to improve during cancer treatment? Health Blood counts Effectiveness

5 DSHEA Dietary Supplement Health and Education Act of 1994 (DSHEA) The dietary supplement or dietary ingredient manufacturer is responsible for ensuring that a dietary supplement or ingredient is safe before it is marketed

6 What Are Supplements A dietary supplement is a product taken by mouth that contains a "dietary ingredient" intended to supplement the diet. The "dietary ingredients" in these products may include: vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites.

7 What Are Vitamins Vitamins are organic substances (made by plants or animals), minerals are inorganic elements that come from the earth; soil and water and are absorbed by plants. Animals and humans absorb minerals from the plants they eat Vitamins and minerals are nutrients that your body needs to grow and develop normally

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10 Natural Products are a Common Source of Chemotherapeutic Agents Catharanthus roseus (Periwinkle) Vinblastine Taxus brevifolia (Yew Tree) Paclitaxel Camptotheca acuminata (Happy Tree) Irinotecan Podophyllum pelatum (Mayapple) Etoposide

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14 Patient Safety May promote cancer development and growth Treatment interactions Serious side effects Contamination Clouatre D., Toxic Lett. 2003; Ernst E, et al., Clin Pharm Ther 2001; Sparreboom A, et al., JCO 2004

15 Development of Methotrexate

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17 JAMA 2011 Klein

18 35,000 woman were followed for a mean of 9.5 years A 19% increase in breast cancer was found Risk seemed to be increased with those using multivitamins for over 3 years

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20 Treatment Related Risks Bleeding risk ginseng, ginger, garlic, and fish oil supplements

21 Potential Risks

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25 1,038 Stage III Colon cancer patients Study evaluated multivitamin use both during and after chemotherapy No significant differences found in recurrence, survival, or grade 3/4 side effects from chemotherapy. Fatigue was reduced by 39%

26 Vitamin D Low Vitamin D levels are associated with worse outcomes in breast, colon, melanoma, CLL, lymphoma, esophageal, and prostate cancers High dose Vitamin D supplementation was associated with no improvement in prostate cancer

27 Calcium 15 clinical trials including 8,000 patients Median follow-up 3.6 years 27% increase in myocardial infarctions Total daily intake should probably be 1200 to 1500mg

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29 The practice of medicine that reaffirms the importance of the relationship between practitioner and patient Focuses on the whole person Informed by evidence Makes use of all appropriate therapeutic approaches, providers, and disciplines to achieve optimal health and healing

30 Integrative Medicine Center Model * Supportive Care Center * Pain Center Acupuncture Massage Smoking Cessation Psychiatry Psychology Chaplaincy Exercise Rehabilitation Meditation Yoga * Tobacco Treatment Program Integrative Oncology Consultation Nutrition Optimal Health & Healing = Improved Clinical Outcomes Psycho-Spiritual Tai Chi Physical Music Therapy Chemotherapy Surgery Radiation Pharmacy Social Education Rest/Sleep * Physical & Occupational Therapy Environmental Exposures Patient Advocacy Social Work Family/Friends Support Groups * Fatigue Center * Psychiatry

31 Healthy body weight (normal BMI) Exercise regularly 150 minutes/week of moderate intensity or 75 minutes of vigorous activity Healthy diet 5 servings of fruits and vegetables per day Limit processed meat, red meat, and refined grains Limit alcohol Avoidance of tobacco exposure McCullough et al. Cancer Epidemiol Biomarkers Prev; 20(6);

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35 Nutrition & Physical Activity

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38 Vitamin and Supplements Conclusions No single vitamin or supplement has consistently shown any benefits for the prevention of cancer Some vitamins and supplements may actually increase the risk for cancer development Vitamins and supplements do not improve physical performance when added to a healthy, balanced diet

39 Summary Judicious use of any vitamin and mineral supplementation is warranted Too much of a good thing can be bad. Focus on overall physical health through: Healthy Diet Regular Exercise Normal Weight More research is needed to evaluate which patients would benefit from vitamins and supplements

40 Integrative Medicine Team

41 Integrative Medicine Team Lorenzo Cohen Richard T. Lee Gabriel Lopez Peiying Yang Alejandro Chaoul Kay Garcia Laura Fletcher Amy Spelman Deanna Cuello Jane Williams Benny Torres Julie Pauls Raquel Villarreal Penny Benzman LaShaunte Range Jerah Thomas Felicia Stephens Stephanie Maxson Meide Liu Curtiss Beinhorn Sat-Siri Sumler Judy Walker Ingrid Sevy Michael Richardson Anne Marie Alcala Edrea Cook Linda Cortez Amanda Kato Devin Bigler Amica Onyemeh-Sea And our many collaborators... Donna Capps Sarah Prinsloo Qi Wei Erin Glueckert Rosalinda Engle Robin Haddad Smitha Mallaiah Courtney Miller Sarah Nyguyen Fan Pei Koung Charlotte McBride Stehanie Gabel Zinat Taiwo Leslie Graham-Getty Waun Ki Hong Michael Fisch Wendy Austin Andrea Armstrong Cynthia Powers

42 Thank You