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Old 03-25-2013, 03:54 AM   #1
thickdescription
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Question Should I take anti-oxidants prior to, during, and post treatment?

I thought I was doing my body a favor by upping my vitamin intake, by both my oncologist and an alternative/complementary MD tell me I should cease all anti-oxidants during treatment. This is because they may support the health of the cancer cells as well as the normal cells.

Sounds like I need to stop my Vit A, Vit C, Vit E and CoQ10 supplements as well as Curcurumin/Turmeric immediately.

Can anyone point me in the direction of an authoritative source on this?

I've just started Herceptin and post-re-excision, will do six cycles of taxotere and carboplatin.

Thanks!
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Old 03-25-2013, 08:24 AM   #2
NanaJoni
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Re: Should I take anti-oxidants prior to, during, and post treatment?

This is pretty standard and I'll bet Jackie will have the research to back up your onc's position. During chemo and for a while after it's always best to stay away from any supplements unless your drs okay them. I used to work in a college of medicine research lab and we did work on Vitamin E. The differences in manufacturing standards for supplements is huge and compounds aren't regulated in the same way as prescription medicines so you can get variations in the same supplement by different manufacturers. Best to just let them go for a while.
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Old 03-27-2013, 06:00 AM   #3
TanyaRD
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Re: Should I take anti-oxidants prior to, during, and post treatment?

This topic, like many in cancer care, is controversial. Generally, it is not recommended for patients undergoing chemo/radiation to take extra antioxidants--though they are not restricted in the diet. The idea is that we can consume very high doses in supplemental form vs smaller doses in food. Some research has shown that taking high dose antioxidants decreases the effectiveness of some chemotherapies. Other research has shown a synergistic effect with antioxidants enhancing certain chemotherapy drugs. I think it is important to recognize that we use the term "chemotherapy" very broadly when in reality each drug is very different in its mechanism of action and the effect of antioxidants on each of these drugs is likely different. I continue to caution patients against using high dose supplements but do recommend a diet with plenty of fruits and vegetables.

Here are two opposing reviews.

CA Cancer J Clin. 2005 Sep-Oct;55(5):319-21.
Use of antioxidants during chemotherapy and radiotherapy should be avoided.

D'Andrea GM.
Source

Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.

Abstract

Many patients being treated for cancer use dietary supplements, particularly antioxidants, in the hope of reducing the toxicity of chemotherapy and radiotherapy. Some researchers have claimed, furthermore, that antioxidants also increase the effectiveness of cytotoxic therapy and have explicitly recommended their use. However, mechanistic considerations suggest that antioxidants might reduce the effects of conventional cytotoxic therapies. Preclinical data are currently inconclusive and a limited number of clinical studies have not found any benefit. Clinicians should advise their patients against the use of antioxidant dietary supplements during chemotherapy or radiotherapy. Such caution should be seen as the standard approach for any unproven agent that may be harmful.


PMID:16166076[PubMed - indexed for MEDLINE]
Integr Cancer Ther. 2006 Mar;5(1):63-82.
Should patients undergoing chemotherapy and radiotherapy be prescribed antioxidants?

Moss RW.
Source

Cancer Communications, Lemont, Pennsylvania 16851, USA. ralph@cancerdecisions.com

Abstract

In September 2005, CA: A Cancer Journal for Clinicians published a warning by Gabriella D'Andrea, MD, against the concurrent use of antioxidants with radiotherapy and chemotherapy. However, several deficiencies of the CA article soon became apparent, not least the selective omission of prominent studies that contradicted the author's conclusions. While acknowledging that only large-scale, randomized trials could provide a valid basis for therapeutic recommendations, the author sometimes relied on laboratory rather than clinical data to support her claim that harm resulted from the concurrent use of antioxidants and chemotherapy. She also sometimes extrapolated from chemoprevention studies rather than those on the concurrent use of antioxidants per se. The article overstated the degree to which the laboratory data diverged in regard to the safety and efficacy of antioxidant therapy: in fact, the preponderance of data suggests a synergistic or at least harmless effect with most high-dose dietary antioxidants and chemotherapy. The practical recommendations made in the article to avoid the general class of antioxidants during chemotherapy are inconsistent, in that if antioxidants were truly a threat to the efficacy of standard therapy, antioxidant-rich foods, especially fruits and vegetables, ought also be proscribed during treatment. Yet no such recommendation is made. Furthermore, the wide-scale use by both medical and radiation oncologists of synthetic antioxidants (eg, amifostine) to control the adverse effects of cytotoxic treatments is similarly overlooked. In sum, this CA article is incomplete: there is far more information available regarding antioxidant supplements as an appropriate adjunctive cancer therapy than is acknowledged. Patients would be well advised to seek the opinion of physicians who are adequately trained and experienced in the intersection of 2 complex fields, that is, chemotherapeutics and nutritional oncology. Physicians whose goal is comprehensive cancer therapy should refer their patients to qualified integrative practitioners who have such training and expertise to guide patients. A blanket rejection of the concurrent use of antioxidants with chemotherapy is not justified by the preponderance of evidence at this time and serves neither the scientific community nor cancer patients.
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Old 04-03-2013, 07:34 AM   #4
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Re: Should I take anti-oxidants prior to, during, and post treatment?

Thank you Tanya, for this reply!

I appreciate your sharing both sides of the issue.
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Old 04-04-2013, 11:16 AM   #5
Jackie07
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Re: Should I take anti-oxidants prior to, during, and post treatment?

There is a clinical trial on-going about the (supplement use) issue:

Breast Cancer Res Treat. 2013 Feb;137(3):903-13. doi: 10.1007/s10549-012-2400-2. Epub 2013 Jan 10.
Supplement use during an intergroup clinical trial for breast cancer (S0221).

Zirpoli GR, Brennan PM, Hong CC, McCann SE, Ciupak G, Davis W, Unger JM, Budd GT, Hershman DL, Moore HC, Stewart J, Isaacs C, Hobday T, Salim M, Hortobagyi GN, Gralow JR, Albain KS, Ambrosone CB.
Source

Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, USA.

Abstract

The use of supplements during chemotherapy is controversial, partly due to the potential effect of antioxidants on reduced efficacy of chemotherapy-related cytotoxicity. We examined supplement use among breast cancer patients registered to a clinical trial (SWOG 0221) before diagnosis and during treatment. Patients (n = 1,467) completed questionnaires regarding multivitamin and supplement use at trial registration (baseline) to capture use before diagnosis. Of these patients, 1,249 completed a 6-month followup questionnaire to capture use during treatment.

We examined the use of vitamins C, D, E, B6, B12, folic acid, and calcium at these timepoints, as well as physician recommendations regarding supplement use. The use of vitamins C, E, folic acid, and calcium decreased during treatment, while the use of vitamin B6 increased.

Five hundred seventy four patients (51 %) received no physician recommendations regarding supplement use. Among the remaining 49, 10 % were advised not to take multivitamins and/or supplements, 7 % were advised to use only multivitamins, and 32 % received recommendations to use multivitamins and/or supplements.

Among patients who took vitamin C before diagnosis, those who were advised not to take supplements were >5 times more likely not to use of vitamin C during treatment than those not advised to stop use (OR = 5.27, 95 % CI 1.13-24.6). Previous non-users who were advised to take a multivitamin were nearly 5 times more likely to use multivitamins during treatment compared to those who received no recommendation (OR = 4.66, 95 % CI 2.10-10.3).

In this clinical trial for high-risk breast cancer, supplement use generally decreased during treatment. Upon followup from the clinical trial, findings regarding supplement use and survival outcomes will better inform physician recommendations for patients on adjuvant chemotherapy.
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Exemestane 25 mg tab 102912 ~ 101016 stopped due to r. hip/l.thigh pain after long walk
DEXA 1/13
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3-11 Appendectomy - visually O.K., a lot of puss. Final path result - not cancer.
Start Vitamin D3 and Calcium supplement (600mg x2)
10-10 Stopped Exemestane due to r. hip/l.thigh pain OKed by Onco 11-08-2016
7-23-2018 9 mm groundglass nodule within the right lower lobe with indolent behavior. Due to possible adenocarcinoma, Recommend annual surveilence.
7-10-2019 CT to check lung nodule.
1-10-2020 8mm stable nodule on R Lung, two 6mm new ones on L Lung, a possible lymph node involvement in inter fissule.
"I WANT TO BE AN OUTRAGEOUS OLD WOMAN WHO NEVER GETS CALLED AN OLD LADY. I WANT TO GET SHARP EDGED & EARTH COLORED, TILL I FADE AWAY FROM PURE JOY." Irene from Tampa

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Old 04-04-2013, 11:22 AM   #6
Jackie07
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Re: Should I take anti-oxidants prior to, during, and post treatment?

Cancer. 2012 Apr 15;118(8):2048-58. doi: 10.1002/cncr.26526. Epub 2011 Sep 27.
Antioxidant supplement use after breast cancer diagnosis and mortality in the Life After Cancer Epidemiology (LACE) cohort.

Greenlee H, Kwan ML, Kushi LH, Song J, Castillo A, Weltzien E, Quesenberry CP Jr, Caan BJ.
Source

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA. hg2120@columbia.edu

Abstract

BACKGROUND:

There is concern that antioxidant supplement use during chemotherapy and radiation therapy may decrease treatment effects, yet the effects of such supplements on recurrence and survival are largely unknown.
METHODS:

The authors prospectively examined the associations between antioxidant use after breast cancer (BC) diagnosis and BC outcomes in 2264 women in the Life After Cancer Epidemiology (LACE) cohort. The cohort included women who were diagnosed with early stage, primary BC from 1997 to 2000 who enrolled, on average, 2 years postdiagnosis. Baseline data were collected on antioxidant supplement use since diagnosis and other factors. BC recurrence and mortality were ascertained, and hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using delayed entry Cox proportional hazards models. All tests of statistical significance were 2-sided.
RESULTS:

Antioxidant supplement use after diagnosis was reported by 81% of women. Among antioxidant users, frequent use of vitamin C and vitamin E was associated with a decreased risk of BC recurrence (vitamin C: HR, 0.73; 95% CI, 0.55-0.97; vitamin E: HR, 0.71; 95% CI, 0.54-0.94); and vitamin E use was associated with a decreased risk of all-cause mortality (HR, 0.76; 95% CI, 0.58-1.00). Conversely, frequent use of combination carotenoids was associated with increased risk of death from BC (HR, 2.07; 95% CI, 1.21-3.56) and all-cause mortality (HR, 1.75; 95% CI, 1.13-2.71).
CONCLUSIONS:

Frequent use of vitamin C and vitamin E in the period after BC diagnosis was associated with a decreased likelihood of recurrence, whereas frequent use of combination carotenoids was associated with increased mortality. The effects of antioxidant supplement use after diagnosis likely differ by type of antioxidant.
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http://www.kevinmd.com/blog/2011/06/doctors-letter-patient-newly-diagnosed-cancer.html
http://www.asco.org/ASCOv2/MultiMedi...=114&trackID=2

NICU 4.4 LB
Erythema Nodosum 85
Life-long Central Neurocytoma 4x5x6.5 cm 23 hrs 62090 semi-coma 10 d PT OT ST 30 d
3 Infertility tmts 99 > 3 u. fibroids > Pills
CN 3 GKRS 52301
IDC 1.2 cm Her2 +++ ER 5% R. Lmptmy SLNB+1 71703 6 FEC 33 R Tamoxifen
Recc IIB 2.5 cm Bi-L Mast 61407 2/9 nds PET
6 TCH Cellulitis - Lymphedema - compression sleeve & glove
H w x 4 MUGA 51 D, J 49 M
Diastasis recti
Tamoxifen B. scan
Irrtbl bowel 1'09
Colonoscopy 313
BRCA1 V1247I
hptc hemangioma
Vertigo
GI - > yogurt
hysterectomy/oophorectomy 011410
Exemestane 25 mg tab 102912 ~ 101016 stopped due to r. hip/l.thigh pain after long walk
DEXA 1/13
1-2016 lesions in liver largest 9mm & 1.3 cm onco. says not cancer.
3-11 Appendectomy - visually O.K., a lot of puss. Final path result - not cancer.
Start Vitamin D3 and Calcium supplement (600mg x2)
10-10 Stopped Exemestane due to r. hip/l.thigh pain OKed by Onco 11-08-2016
7-23-2018 9 mm groundglass nodule within the right lower lobe with indolent behavior. Due to possible adenocarcinoma, Recommend annual surveilence.
7-10-2019 CT to check lung nodule.
1-10-2020 8mm stable nodule on R Lung, two 6mm new ones on L Lung, a possible lymph node involvement in inter fissule.
"I WANT TO BE AN OUTRAGEOUS OLD WOMAN WHO NEVER GETS CALLED AN OLD LADY. I WANT TO GET SHARP EDGED & EARTH COLORED, TILL I FADE AWAY FROM PURE JOY." Irene from Tampa

Advocacy is a passion .. not a pastime - Joe
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Old 04-04-2013, 11:33 AM   #7
Jackie07
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Re: Should I take anti-oxidants prior to, during, and post treatment?

Breast. 2011 Oct;20 Suppl 3:S36-41. doi: 10.1016/S0960-9776(11)70292-2.
The science behind vitamins and natural compounds for breast cancer prevention. Getting the most prevention out of it.

Lazzeroni M, Gandini S, Puntoni M, Bonanni B, Gennari A, DeCensi A.
Source

Division of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy.

Abstract

This review highlights the role of vitamins and natural compounds in breast cancer prevention, with a particular focus on Vitamin D.

In the last decades, both encouraging and discouraging results about the association between antioxidant supplementation and cancer have been reported to public and scientific community. Their safe and favorable toxicity profile makes them suitable to be investigated in a preventive setting.

However, a recent large meta-analysis showed that treatment with beta carotene, vitamin A, and vitamin E may increase mortality, whereas the potential roles of vitamin C and selenium on mortality need further study.

Likewise, folate levels were not associated with reduced breast cancer risk in a recent meta-analysis.

Several studies have shown that a high proportion of women at-risk for breast cancer or affected by the disease have deficient vitamin D levels, i.e., 250 H-D <20 ng/ml or 50 nmol/L. While the association between Vitamin D levels and breast cancer risk/prognosis is still controversial, the U-shaped relationship between 250 H-D levels observed in different studies suggests the need to avoid both deficient and too high levels. Further trials using an optimal dose range are needed to assess the preventive and therapeutic effect of vitamin D.

Finally, Fenretinide, a pro-apoptotic and pro-oxidant vitamin A derivative, has shown promise in several trials and its preventive potential is being assessed in young women at very high risk for breast cancer.
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http://www.kevinmd.com/blog/2011/06/doctors-letter-patient-newly-diagnosed-cancer.html
http://www.asco.org/ASCOv2/MultiMedi...=114&trackID=2

NICU 4.4 LB
Erythema Nodosum 85
Life-long Central Neurocytoma 4x5x6.5 cm 23 hrs 62090 semi-coma 10 d PT OT ST 30 d
3 Infertility tmts 99 > 3 u. fibroids > Pills
CN 3 GKRS 52301
IDC 1.2 cm Her2 +++ ER 5% R. Lmptmy SLNB+1 71703 6 FEC 33 R Tamoxifen
Recc IIB 2.5 cm Bi-L Mast 61407 2/9 nds PET
6 TCH Cellulitis - Lymphedema - compression sleeve & glove
H w x 4 MUGA 51 D, J 49 M
Diastasis recti
Tamoxifen B. scan
Irrtbl bowel 1'09
Colonoscopy 313
BRCA1 V1247I
hptc hemangioma
Vertigo
GI - > yogurt
hysterectomy/oophorectomy 011410
Exemestane 25 mg tab 102912 ~ 101016 stopped due to r. hip/l.thigh pain after long walk
DEXA 1/13
1-2016 lesions in liver largest 9mm & 1.3 cm onco. says not cancer.
3-11 Appendectomy - visually O.K., a lot of puss. Final path result - not cancer.
Start Vitamin D3 and Calcium supplement (600mg x2)
10-10 Stopped Exemestane due to r. hip/l.thigh pain OKed by Onco 11-08-2016
7-23-2018 9 mm groundglass nodule within the right lower lobe with indolent behavior. Due to possible adenocarcinoma, Recommend annual surveilence.
7-10-2019 CT to check lung nodule.
1-10-2020 8mm stable nodule on R Lung, two 6mm new ones on L Lung, a possible lymph node involvement in inter fissule.
"I WANT TO BE AN OUTRAGEOUS OLD WOMAN WHO NEVER GETS CALLED AN OLD LADY. I WANT TO GET SHARP EDGED & EARTH COLORED, TILL I FADE AWAY FROM PURE JOY." Irene from Tampa

Advocacy is a passion .. not a pastime - Joe
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Old 05-15-2013, 07:12 AM   #8
6Cats
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Re: Should I take anti-oxidants prior to, during, and post treatment?

Thank you all for researching and posting all these studies. I too was a supplement taker prior to chemo. My MO nixes all supplements except for calcium and Vitamin D (she allows me to continue fiber and acidophilus). She also said if I couldn't stand being supplement-free, I could take plain-old, everyday, Centrum Silver (not the female version).

This is a huge challenge for me, but I'm following orders. Someone once said that when a woman is pregnant she is often anemic, but how often does she crave liver? I am trying to listen seriously to my food cravings, and hopefully get what I need through normal foods.
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Old 06-10-2013, 12:25 PM   #9
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Re: Should I take anti-oxidants prior to, during, and post treatment?

My oncologist also pooh-poohed anti-oxidants; however, my naturopathic doctor gave them a thumbs-up. It is indeed a divided issue; if you look through naturopathic journals, you'll see research avidly supporting anti-oxidants, while oncological journals often do not.
I opted to eat as many anti-oxidant-rich foods as my body craved.
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