Exploring vitamin and mineral supplementation and purported clinical effects in patients with small cell lung cancer: results from the Mayo Clinic lung cancer cohort

Evaluation of the Concentration of Selected Elements in Patients with Cancer of the Reproductive Organs with Respect to Treatment Stage-Preliminary Study

(1) Background: The aim of this study was to assess the concentrations of selected elements in female patients with cancer of the reproductive organs, taking into account the stage of treatment. (2) Methods: The study sample consisted of 51 patients with advanced endometrial cancer and ovarian cancer, undergoing chemotherapy. The median age of the studied patients with endometrial cancer was 66.0 years (IQR: from 60.75 to 70.25), and with ovarian cancer―60.0 years (IQR: from 49.0 to 64.0). Each of the qualified women, after consent to participate in the study, had her blood drawn several times (before surgery, the first course of chemotherapy, the third course of chemotherapy, and the sixth course of chemotherapy) in order to determine serum levels of macro- and micronutrients (Na, Mg, Ca, Zn, P, Cu, Fe, Cd, Ni, and Sr). (3) Results: In the study group of patients with cancer of the reproductive tract, the concentrations of iron (<0.001), magnesium (0.038), sodium (0.014), and nickel (0.037) varied significantly over the course of the study. The analysis showed that the interaction between the stage of chemotherapy and the type of cancer had an effect on the concentrations of magnesium and cadmium (p < 0.05). (4) Conclusions: In the studied group of patients with ovarian and endometrial cancer, the applied chemotherapy significantly changed the concentrations of Fe, Na, and Ni, regardless of the type of tumor. Changes in Mg and Cd concentrations resulted from the interaction between the stage of chemotherapy and the type of cancer. The results of serum concentrations of selected elements in women with cancer of the reproductive organs may help understand the physiological changes resulting from the applied chemotherapy.

The Humanistic Burden of Small Cell Lung Cancer (SCLC): A Systematic Review of Health-Related Quality of Life (HRQoL) Literature

Background: Little is known about the humanistic burden of small cell lung cancer (SCLC), specifically the impact on health-related quality of life (HRQoL). The aim of this systematic literature review was to explore the impact of SCLC on HRQoL and the patient reported outcomes (PROs) used to capture this impact.

Methods: We conducted a systematic search of Medline®, Embase, and PsycINFO, oncology organization websites and conference proceedings within the past 10 years. Articles reporting HRQoL outcomes of SCLC patients were selected.

Results: Twenty-seven eligible publications were identified. Global or overall impact on HRQoL (n = 21) was reported most often, with considerably fewer reporting individual domains that comprise HRQoL. Results indicated that HRQoL was negatively impacted in SCLC patients in comparison to the normal population in most domains. Overall, the domains measuring physical functioning and activities of daily living were most impacted. However, results on cognitive and emotional functioning were inconclusive. The impact on HRQoL may be least in both limited disease and extensive disease (ED) SCLC patients who have responded to treatment, and greatest in ED patients who were treatment naïve. The most frequently used PROs were the EORTC QLQ-C30 core cancer instruments, the lung cancer specific module the EORTC QLQ-LC13, LCSS, and EQ-5D.

Conclusion: There exists a paucity of reporting on SCLC HRQoL outcomes. This extends to the reporting of domain level scores and by patient sub-group. Greater reporting at a granular level is recommended to allow for more robust conclusions to be made.

Micronutrients in Oncological Intervention

Nutritional supplements are widely used among patients with cancer who perceive them to be anticancer and antitoxicity agents. Depending on the type of malignancy and the gender 30%-90% of the cancer patients supplement their diets with antioxidant and immuno-stabilizing micronutrients, such as selenium, vitamin C, and vitamin D, often without the knowledge of the treating physician. From the oncological viewpoint, there are justifiable concerns that dietary supplements decrease the effectiveness of chemotherapy and radiotherapy. Recent studies, however, have provided increasing evidence that treatment is tolerated better-with an increase in patient compliance and a lower rate of treatment discontinuations-when micronutrients, such as selenium, are added as appropriate to the patient's medication. Nutritional supplementation tailored to an individual's background diet, genetics, tumor histology, and treatments may yield benefits in subsets of patients. Clinicians should have an open dialogue with patients about nutritional supplements. Supplement advice needs to be individualized and come from a credible source, and it is best communicated by the physician.

Effect of cigarette smoking on quality of life in small cell lung cancer patients

BACKGROUND

Continued cigarette smoking after small cell lung cancer (SCLC) diagnosis has been shown to shorten patients' survival, but little is known about the impact of smoking and cessation on quality of life (QOL) profile (e.g., overall QOL, pain, fatigue, cough, dyspnea, appetite change, and performance status) in SCLC survivors (who survived at least 6 months post initial diagnosis). In this study, we sought to evaluate the relationship between cigarette smoking and QOL profiles in SCLC patients.

METHODS

A total of 223 survivors were classified into five groups: never smokers, former smokers (quit more than 1 year prior to diagnosis), recent quitters (quit within 1 year surrounding diagnosis), late quitters (quit after 1 year post diagnosis) and never quitters. One hundred and sixty-eight of these survivors were matched with 334 lung-cancer-free controls on age, gender, and smoking status for comparative analysis. QOL scales were scored from 0 (worse) to 100 (best). Conditional logistic regression, linear mixed-effect models, and Wilcoxon signed rank tests were used.

RESULTS

SCLC survivors consistently showed a significant deficit in QOL profile; e.g., mean overall QOL in patients was 17.5 points worse than the controls (p<0.0001). Among all smokers, former smokers reported the best QOL profile, while late or never quitters reported the worst. The recent quitters showed an improving trend in QOL profile and lower percent of reduced appetite (an average of 43%) compared to the late or never quitters (58%).

CONCLUSIONS

Our study confirmed the negative impact of smoking on SCLC survivors' QOL and found that smoking cessation surrounding the time of diagnosis could improve overall QOL and symptoms. The findings of this study provide evidence for oncologists to recommend smoking cessation to their SCLC patients.

Socio-demographic and medical correlates of the use of biologically based complementary and alternative medicines amongst recent Australian cancer survivors

OBJECTIVE

Describe the socio-demographic/medical correlates of the use of biologically based complementary and alternative medicines (BBCAM) amongst a heterogeneous sample of recent cancer survivors.

METHOD

Cross-sectional analysis was undertaken on the baseline data of a population-based longitudinal study conducted in New South Wales and Victoria, Australia (2006-2008) of cancer survivors 6 months post diagnosis. Participants (n=1323) completed a self-report survey assessing socio-demographic/medical characteristics and use of BBCAM (dietary supplements or vitamins, herbal treatments, and special diets).

RESULTS

Twenty-seven percent of respondents (n=349) reported using at least one BBCAM to help manage their cancer and related symptoms. Nutritional supplements and vitamins were the most commonly reported BBCAM (23%). Correlates of BBCAM use included cancer type (bowel [OR=3.3; CI:1.8-5.9], breast [OR=2.4; CI:1.4-4.1], head and neck [OR=3.8; CI: 2.0-7.2], haematological [OR=2.0; CI: 1.1-3.7], prostate [OR=1.8; CI: 1.0-3.9] versus melanoma), education level (university degree [OR=1.6; CI:1.1-2.3] versus secondary school) and treatment types (chemotherapy [OR=2.0; CI:1.4-2.7] versus not, bone marrow/stem cell transplant/immunotherapy [OR=2.3; CI:1.2-4.4] versus not).

CONCLUSION

Providers should openly discuss the use of complementary and alternative therapies with all cancer patients, and given potential safety concerns, be proactive in exploring BBCAM use among the subgroups of survivors identified in this study.

Nutrition aspects of lung cancer

Lung cancer is the most common type of cancer, excluding nonmelanoma skin cancer, and is the leading cause of cancer death in the United States. Notable carcinogens involved in the development of lung cancer include smoking, secondhand smoke, and radon. Lung cancer is divided into 2 major types: non-small-cell lung cancer, the most prevalent, and small-cell lung cancer. Treatment includes surgery, chemotherapy, radiation, or a combination of the same. Medical nutrition therapy is often required for nutrition-related side effects of cancer treatment, which include but are not limited to anorexia, nausea and vomiting, and esophagitis. The best protection against lung cancer is avoidance of airborne carcinogens and increased consumption of fruits and vegetables. Studies have shown that smokers taking large amounts of beta-carotene and vitamin A supplements had increased lung cancer incidence and mortality. However, ingestion of beta-carotene from foods, along with a diet rich in fruits and vegetables, has a protective role against lung disease. The use of complementary and alternative medicine by lung cancer patients is prevalent; therefore, clinicians should investigate whether complementary and alternative therapies are used by patients and advise them on the use of these therapies to avoid any potential side effects and interactions with conventional therapies. The article concludes with a case study of a patient with non-small-cell lung cancer and illustrates the use of medical nutrition therapy in relation to cancer treatment side effects.

Nutrition and Orthomolecular Supplementation in Lung Cancer Patients

This article reviews updates and provides some data related to nutritional and orthomolecular supplementation in oncology patients with an emphasis on lung cancer, a commonly diagnosed tumor with significant nutritional disturbances. Cancer and its treatment play a significant role in nutritional imbalance which likely has negative impact on the patient both in terms of quality and quantity of life. Nutritional supplementation may correct these imbalances with significant clinical benefit both physiologically and psychologically. This review will help assist in providing clinically useful data to assess the cancer patient’s nutritional status and to guide nutritional intervention to assist these patients’ recovery.

Cod liver oil, other dietary supplements and survival among cancer patients with solid tumours

The effect of various dietary supplements on chronic diseases and mortality has been widely studied, but few convincing results have emerged from studies in well-nourished populations. In Norway, both cod liver oil and other dietary supplements are frequently used. In the Norwegian Women and Cancer cohort study, we explored if supplement use before diagnosis affected survival of cancer patients with solid tumours. We performed Cox proportional hazards analyses, adjusting for age at diagnosis, smoking and stage. Cod liver oil was the most frequently used dietary supplement, followed by multivitamins and minerals. Whole year daily use of cod liver oil was associated with lower risk of death in patients with solid tumours [RR = 0.77 (95% CI 0.61-0.97)] and in lung cancer patients [RR=0.56 (95% CI 0.34-0.92)]. Also daily and occasional use of other dietary supplements decreased the risk of death among lung cancer patients [RR = 0.70 (95% CI 0.49-0.99) and 0.55 (95% CI 0.31-0.97)]. More research is needed to clarify the association; meanwhile adjustment for dietary supplement use should be performed in survival analyses of lung cancer patients.

Voodoo dolls and the cancer patient: patients do trust their doctors

OBJECTIVES

To determine oncology patients' pattern and rationale of complementary and alternative medicine (CAM) use, and canvass their views on the relative merits of allopathic and alternative medicine.

DESIGN

Observational study of opinions from a cohort of patients using self-completion questionnaires.

SETTING

Oncology departments of two UK teaching hospitals.

PARTICIPANTS

Voluntary participation of 200 oncology patients attending clinic.

MAIN FINDINGS

Twenty-two percent of patients used CAM, with a preponderance towards younger, female patients. The commonest reasons for CAM use is to make the patient feel better and to help with their cancer. However, patients seldom believe there is more evidence for CAM or that CAM will cure them, indeed often noticing no benefits from the treatment. CAM users do not resort to complementary medicine due to dissatisfaction with their doctor but instead have considerable trust in their physicians. Only a minority believes their doctor knows about their CAM use.

CONCLUSION

CAM use by oncology patients in the UK is less common than that reported elsewhere. Although patients try CAM in the hope that it will help with their treatment, they are realistic about its likely benefits. It uptake is not as an indication of lack of faith in doctors, yet physicians are frequently unaware of use. Therefore, the medical profession should not feel threatened by patients resorting to CAM but instead focus on understanding the reasons behind it.

Epidemiology of lung cancer prognosis: quantity and quality of life

Primary lung cancer is very heterogeneous in its clinical presentation, histopathology, and treatment response; and like other diseases, the prognosis consists of two essential facets: survival and quality of life (QOL). Lung cancer survival is mostly determined by disease stage and treatment modality, and the 5-Year survival rate has been in a plateau of 15% for three decades. QOL is focused on life aspects that are affected by health conditions and medical interventions; the balance of physical functioning and suffering from treatment side effects has long been a concern of care providers as well as patients. Obviously needed are easily measurable biologic markers to stratify patients before treatment for optimal results in survival and QOL and to monitor treatment responses and toxicities. Targeted therapies toward the mechanisms of tumor development, growth, and metastasis are promising and actively translated into clinical practice. Long-term lung cancer (LTLC) survivors are people who are alive 5 Years after the diagnosis. Knowledge about the health and QOL in LTLC survivors is limited because outcome research in lung cancer has been focused mainly on short-term survival. The independent or combined effects of lung cancer treatment, aging, smoking and drinking, comorbid conditions, and psychosocial factors likely cause late effects, including organ malfunction, chronic fatigue, pain, or premature death among lung cancer survivors. New knowledge to be gained should help lung cancer survivors, their healthcare providers, and their caregivers by providing evidence for establishing clinical recommendations to enhance their long-term survival and health-related QOL.

Vitamin and mineral supplement use among US adults after cancer diagnosis: a systematic review

Vitamin and mineral supplement use is thought to be common among the 10 million adults in the United States who have been diagnosed with cancer; however, well-conducted studies of this topic are sparse. Moreover, the biologic effects of supplement use among cancer survivors are not well established and not necessarily beneficial. We present a systematic summary of studies published between 1999 and 2006, 32 in total, addressing vitamin and mineral supplement use among US adult cancer patients and survivors. Supplement use is widespread among cancer patients and longer-term survivors. In studies combining different cancer sites, 64% to 81% of survivors reported using any vitamin or mineral supplements and 26% to 77% reported using any multivitamins. In contrast, approximately 50% of US adults use dietary supplements and 33% use multivitamin/multimineral supplements. Between 14% and 32% of survivors initiate supplement use after diagnosis, and use differs by cancer site. Breast cancer survivors reported the highest use, whereas prostate cancer survivors reported the least. Higher level of education and female sex emerged as factors most consistently associated with supplement use. Up to 68% of physicians are unaware of supplement use among their cancer patients. These results highlight the need for further studies of the association between dietary supplement use and cancer treatment toxicity, recurrence, survival, and quality of life to support evidence-based clinical guidelines for dietary supplement use among cancer patients and longer-term survivors.

Modulation of response to cancer chemotherapeutic agents by diet constituents – Is the available evidence sufficiently robust for rational advice for patients?

BACKGROUND

Patients who are diagnosed with cancer want advice on how they may alter their diet or which diet supplements they should take to augment chemotherapy.

METHODS

We conducted a review of the literature mostly from the last 15 years on the interaction between dietary constituents and antineoplastic therapy in preclinical rodent models and in clinical trials.

RESULTS

Studies have explored the effect of predominantly antioxidant vitamins and folate on efficacy or toxicity mediated by cisplatin and anthracyclins. Cisplatin toxicity in rodents was ameliorated by vitamin E. The design of clinical studies of dietary agents in combination with cytotoxic agents has been very heterogeneous and results have been inconclusive.

CONCLUSIONS

Whilst preclinical experiments hint at a potential benefit of certain dietary agents, the evidence emanating from clinical studies does not allow firm conclusions to be made. Future studies should explore physiological doses of dietary agent and include pharmacokinetic and pharmacodynamic measurements.