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Ebrahimi H, Battle D, Salgia NJ, Zengin ZB, Dizman N, Meza L, Bergerot CD, Barragan-Carrillo R, Hsu J, Castro D, Mercier B, Chawla N, Li X, Tripathi A, Liu ST, Chehrazi-Raffle A, Vaishampayan U, Staehler MD, Pal SK. Prevalence of Dietary Modification and Supplement Use in Patients with Metastatic Renal Cell Carcinoma Receiving Systemic Therapy. Nutrients 2024; 16:1630. [PMID: 38892563 PMCID: PMC11174627 DOI: 10.3390/nu16111630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/12/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Many patients diagnosed with cancer adopt dietary changes and supplement use, and a growing body of evidence suggests that such modifications can affect outcomes to cancer therapy. We sought to assess the prevalence of these practices and the surrounding physician-patient dialogue among patients with metastatic renal cell carcinoma. An online survey was administered by Kidney Cancer Research Alliance (KCCure), interrogating dietary modification patterns, supplement usage, out-of-pocket expenditure related to supplements, and patients' views toward alternative medicine practices. Patients with metastatic renal cell carcinoma receiving combination therapy were actively solicited. In total, 289 unique responses were collected. The most common first-line treatments were nivolumab/ipilimumab (32.4%) and axitinib/pembrolizumab (13.1%). Within the cohort, 147 (50.9%) started using supplements following diagnosis of renal cell carcinoma; the most utilized supplements were probiotics, cannabidiol (CBD) oil/marijuana, and Vitamin C, reported by 70 (47.6%), 61 (41.4%), and 54 (36.7%), respectively. Dietary modifications following cancer diagnosis were reported by 101 (34.9%) respondents, of which 19.8% followed the Mediterranean diet and 18.8% adopted a ketogenic diet. Most respondents (71.3%) noted that they consistently report supplement usage to their physicians. A substantial proportion of patients with metastatic renal cell carcinoma utilize dietary modification and supplements as an adjunct to antineoplastic therapy. Considering the widespread adoption of these practices and the reported effects on cancer treatment, it is crucial for healthcare providers to engage in discussions with patients regarding supplement use.
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Affiliation(s)
- Hedyeh Ebrahimi
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (H.E.); (Z.B.Z.); (L.M.); (R.B.-C.); (J.H.); (D.C.); (B.M.); (N.C.); (X.L.); (A.T.); (A.C.-R.)
| | - Dena Battle
- Kidney Cancer Research Alliance (KCCure), Alexandria, VA 22314, USA;
| | - Nicholas J. Salgia
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA;
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
| | - Zeynep B. Zengin
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (H.E.); (Z.B.Z.); (L.M.); (R.B.-C.); (J.H.); (D.C.); (B.M.); (N.C.); (X.L.); (A.T.); (A.C.-R.)
| | - Nazli Dizman
- Department of Internal Medicine, MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Luis Meza
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (H.E.); (Z.B.Z.); (L.M.); (R.B.-C.); (J.H.); (D.C.); (B.M.); (N.C.); (X.L.); (A.T.); (A.C.-R.)
| | - Cristiane D. Bergerot
- Oncoclinicas&Co—Medica Scientia Innovation Research (MEDSIR), Sao Paulo 04543906, Brazil;
| | - Regina Barragan-Carrillo
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (H.E.); (Z.B.Z.); (L.M.); (R.B.-C.); (J.H.); (D.C.); (B.M.); (N.C.); (X.L.); (A.T.); (A.C.-R.)
| | - JoAnn Hsu
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (H.E.); (Z.B.Z.); (L.M.); (R.B.-C.); (J.H.); (D.C.); (B.M.); (N.C.); (X.L.); (A.T.); (A.C.-R.)
| | - Daniela Castro
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (H.E.); (Z.B.Z.); (L.M.); (R.B.-C.); (J.H.); (D.C.); (B.M.); (N.C.); (X.L.); (A.T.); (A.C.-R.)
| | - Benjamin Mercier
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (H.E.); (Z.B.Z.); (L.M.); (R.B.-C.); (J.H.); (D.C.); (B.M.); (N.C.); (X.L.); (A.T.); (A.C.-R.)
| | - Neal Chawla
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (H.E.); (Z.B.Z.); (L.M.); (R.B.-C.); (J.H.); (D.C.); (B.M.); (N.C.); (X.L.); (A.T.); (A.C.-R.)
| | - Xiaochen Li
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (H.E.); (Z.B.Z.); (L.M.); (R.B.-C.); (J.H.); (D.C.); (B.M.); (N.C.); (X.L.); (A.T.); (A.C.-R.)
| | - Abhishek Tripathi
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (H.E.); (Z.B.Z.); (L.M.); (R.B.-C.); (J.H.); (D.C.); (B.M.); (N.C.); (X.L.); (A.T.); (A.C.-R.)
| | - Sandy T. Liu
- City of Hope Orange County Lennar Foundation Cancer Center, Irvine, CA 92618, USA;
| | - Alex Chehrazi-Raffle
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (H.E.); (Z.B.Z.); (L.M.); (R.B.-C.); (J.H.); (D.C.); (B.M.); (N.C.); (X.L.); (A.T.); (A.C.-R.)
| | - Ulka Vaishampayan
- Department of Medicine/Oncology, Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Michael D. Staehler
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig-Maximilian University, 80539 Munich, Germany;
| | - Sumanta K. Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (H.E.); (Z.B.Z.); (L.M.); (R.B.-C.); (J.H.); (D.C.); (B.M.); (N.C.); (X.L.); (A.T.); (A.C.-R.)
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Zhang M, Wang J, Li X, Zhang L, Zhang Y, Wen Z, Zhang J, Fan Y, Qiu Z. Association between dietary supplement use and mortality in cancer survivors with different body mass index and frailty status: a cohort study. Front Nutr 2024; 11:1395362. [PMID: 38751742 PMCID: PMC11094810 DOI: 10.3389/fnut.2024.1395362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Background The association between Body Mass Index (BMI), frailty index (FI), and dietary supplement in cancer survivors has been a subject of growing interest. This study investigates the relationship of BMI and FI with mortality in American cancer survivors and explores the impact of dietary supplement usage on different BMI and FI groups. Methods Three thousand nine hundred and thirty-two cancer patients from the National Health and Nutrition Examination Survey (NHANES) database were included in the analyses. BMI, FI, and supplement usage were obtained through the NHANES structured survey and the 49-item FI tool. Weighted logistic and Cox proportional hazards models, Kaplan-Meier survival analyses, and propensity score matching (PSM) were used to elucidate the relationships between BMI, FI, dietary supplement, and mortality outcomes. Results The study found significant associations between higher BMI and increased frailty (Odds ratio [OR] = 1.04, 95% confidence interval [95% CI], 1.02-1.06). BMI < 25 kg/m2 and FI > 0.2 are associated with an increased mortality rate. Dietary supplement use can reduce all-cause and cancer mortality in cancer patients with BMI < 25 kg/m2 (Hazard ratio [HR] = 0.63, 95% CI, 0.47-0.84; HR = 0.48, 95% CI, 0.29-0.80) or FI ≤ 0.2 (HR = 0.77, 95% CI, 0.60-0.99; HR = 0.59, 95% CI, 0.39-0.89). In cancer patients with BMI < 25 kg/m2 and FI ≤ 0.2, dietary supplement users had lower all-cause and cancer mortality (HR = 0.49, 95% CI, 0.30-0.79; HR = 0.25, 95% CI, 0.10-0.60). Conclusion The study revealed a negative correlation between BMI and the FI among the cancer patient cohort as well as their complex impact on mortality and highlighted the role of dietary supplement in cancer prognosis, indicating benefits for non-frail patients with BMI < 25 kg/m2.
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Affiliation(s)
- Mengqi Zhang
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jia Wang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiaoxuan Li
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Lihua Zhang
- Department of Medicine, Qingdao University, Qingdao, China
| | - Yixuan Zhang
- Department of Medicine, Qingdao University, Qingdao, China
| | - Zengjin Wen
- Department of Medicine, Qingdao University, Qingdao, China
| | - Jiaqi Zhang
- Department of Medicine, Qingdao University, Qingdao, China
| | - Yuchen Fan
- Department of Medicine, Qingdao University, Qingdao, China
| | - Zhenkang Qiu
- Interventional Medical Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Lam CS, Hua R, Au-Doung PLW, Wu YK, Koon HK, Zhou KR, Loong HHF, Chung VCH, Cheung YT. Association between potential supplement-drug interactions and liver diseases in patients with cancer: A large prospective cohort study. Clin Nutr ESPEN 2023; 58:152-159. [PMID: 38057000 DOI: 10.1016/j.clnesp.2023.09.919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND & AIMS The concurrent use of herbal and dietary supplements and conventional drugs can lead to interactions in patients with cancer, of which hepatotoxicity is one of the most concerning sequelae. This study examined the potential supplement-drug interactions involving the hepatic system, and their associations with documented liver diseases, among patients with cancer in a large population-based cohort in the UK Biobank. METHODS Participants diagnosed with cancer and had completed supplement-use assessment after diagnosis were included. Potentially interacting supplement-drug combinations that involved CYP enzymes or increased the risk of hepatotoxicity were identified from four tertiary databases. Liver diseases were identified using ICD-codes K70-77. Log-binomial regression was used to investigate the associations between potentially-interacting supplement-drug combinations and liver diseases documented (1) at any time, and (2) confined to only after the time of supplement-use assessment, adjusting for age, sex and pre-existing comorbidities. RESULTS This analysis included 30,239 participants (mean age = 60.0 years; 61.9% female). Over half (n = 17,698, 58.5%) reported the use of supplements after cancer diagnoses. Among supplements users, 36.9% (n = 6537/17,698) were on supplement-drug combinations with interacting potential involving the hepatic system. Patients taking supplements and drugs who had hepatic comorbidities were more likely to take potentially interacting pairs (adjusted risk ratio = 1.14, 95% CI = 1.06-1.23, p < 0.001). However, no significant association was observed between the use of these combinations and subsequent liver diseases (all p > 0.05). CONCLUSION Approximately one-third of the participants who had cancer and were supplement users had a risk of potential supplement-drug interactions that contribute to adverse liver effect. Healthcare professionals should communicate with patients with cancer, especially those with pre-existing liver diseases, about supplement use and proactively assess the clinical significance of potential interactions.
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Affiliation(s)
- Chun Sing Lam
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Rong Hua
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Yu Kang Wu
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ho Kee Koon
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Keary Rui Zhou
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Herbert Ho-Fung Loong
- Department of Clinical Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Chi-Ho Chung
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China.
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Télessy IG, Buttar HS, Wilson DW, Okpala COR. Dietary supplements could prevent cardiometabolic syndrome: Are they safe and reliable enough for disease prevention and health promotion? Front Cardiovasc Med 2023; 10:1091327. [PMID: 37034351 PMCID: PMC10073544 DOI: 10.3389/fcvm.2023.1091327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Dietary supplements (DS) and their purchase is often based on a consumer's personal choice and advertisements. The associated DS regulations, particularly in manufacturing and marketing, are far more flexible and permissive than that of the well-regulated prescription pharmaceuticals. However, the adverse health effects associated with the inadvertent use of mega-doses of DS are not well understood. The demand for DS, nutraceuticals, and herbal remedies has experienced an upswing during the past two to three decades, and global product sales have thrived. More so, the prevention of cardiometabolic syndrome (CMS) and related disorders like diabetes mellitus, obesity, hypertension, and serum lipid abnormalities, as well as of other noncommunicable diseases (NCDs), is of highest health care priority globally, since these disorders impose very high economic burdens on health care systems and society. In this review, we argue why DS could prevent cardiometabolic syndrome, by providing the potential benefits and risks associated with them, especially self-medication considering their intake by the public at large. Good manufacturing practices and quality control are absolutely necessary for the manufacture of DS products, and proper labeling is needed regarding the optimal dose schedules of various DS and bioactive ingredients. Specific examples are used to underscore the indications and dosage recommendations made for the marketing and promotion of fish oil, coenzyme Q10, and Mg-containing products for the prevention of cardiometabolic syndrome.
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Affiliation(s)
- Istvan G. Télessy
- Faculty of Pharmacy, Department of Pharmaceutics, University of Pécs, Pécs, Hungary
- Correspondence: Istvan G. Télessy
| | - Harpal S. Buttar
- Department of Pathology & Laboratory Medicine, School of Medicine, University of Ottawa, Ottawa, Canada
| | - Douglas W. Wilson
- Formerly, School of Medicine Pharmacy and Health, Durham University, Durham, UK
- Centre for Ageing and Dementia Research, Swansea University, Swansea, United Kingdom
| | - Charles Odilichukwu R. Okpala
- Faculty of Biotechnology and Food Sciences, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
- UGA Cooperative Extension, College of Agricultural and Environmental Sciences, University of Georgia Athens, Athens, GA, United States
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