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As more cancer patients explore complementary therapies, oncologists are seeking evidence-based guidance on teh role of dietary supplements. A session at the Society for Integrative Oncology (SIO) 2025 Annual Meeting,led by Dr. Channing Paller of Johns Hopkins University, offered a pragmatic approach to optimizing patient outcomes through informed supplement use and integrative care.
The increasing prevalence of supplement use among cancer patients presents a challenge for clinicians, who must balance patient well-being with the potential for harm. “Patients are increasingly turning to supplements to manage treatment side effects and improve their overall quality of life,” a senior oncology official stated, “but the safety and efficacy of many remain unclear.” Dr.Paller’s presentation aimed to bridge this gap, providing practical steps for safe and effective integration of supplements into cancer care.
Identifying and Addressing Common Deficiencies
Dr. Paller emphasized that addressing true nutritional deficiencies should be a priority. Vitamin D emerged as the supplement with the strongest supporting evidence. Over 50% of newly diagnosed cancer patients are found to have a chronic deficiency,which can lead to complications like low calcium,muscle weakness,and increased fracture risk,notably in older adults.The National comprehensive Cancer Network (NCCN) guidelines recommend screening and supplementation – alongside calcium – for at-risk patients,especially those undergoing androgen or estrogen deprivation therapy or living with bone metastases. Maintaining serum 25-hydroxyvitamin D levels between 30-50 ng/mL is advised, with vitamin D proving more effective than D and optimal absorption achieved when taken with dietary fat.
Similarly, vitamin B12 deficiency affects up to 48% of cancer patients, particularly those with gastrointestinal issues, older individuals, or those taking proton pump inhibitors. Symptoms can be subtle, including anemia, neuropathy, and fatigue. Treatment options range from oral to intramuscular forms, depending on the severity of malabsorption. Folate deficiency, while less common, can result from poor diet, alcohol use, chemotherapy, or oral contraceptives, manifesting as mega
Curcumin, derived from turmeric, has demonstrated anti-inflammatory and antioxidant properties. However, its poor bioavailability necessitates formulations containing piperine (black pepper extract) to enhance absorption. some formulations of curcumin have been linked to liver toxicity, particularly those containing black pepper.
Green tea extract (EGCG) also shows promise, with studies suggesting a 44% lower breast cancer recurrence rate among women consuming 3-5 cups daily. However, excessive intake (≥800 mg/day) can elevate liver enzymes and reduce the effectiveness of drugs like bortezomib.
Omega-3 fatty acids (EPA and DHA), derived from fish oil, play a role in inflammation control and metabolic health. While insufficient evidence exists to recommend them universally, the ESPEN Clinical Nutrition Guidelines suggest considering supplementation for weight-losing or malnourished patients undergoing chemotherapy to maintain lean body mass and appetite. High-dose fish oil’s antiplatelet properties necessitate caution in patients using anticoagulants or at risk of bleeding.
The Power of Exercise
Beyond supplements, Dr. Paller underscored the critical role of exercise in cancer survivorship. A randomized controlled trial demonstrated that structured exercise substantially improved disease-free survival in patients with stage I-II colon cancer compared to health education alone.recommendations from the American Society of Clinical Oncology (ASCO) and the SIO include at least 150 minutes of moderate or 75 minutes of vigorous exercise per week, combined with 2-3 strength training sessions.
A Call for balance and Collaboration
Dr. Paller concluded by urging clinicians to prioritize a balanced, evidence-based approach. Routine screening and correction of true deficiencies – such as vitamin D, B12, and folate – are essential. However, she cautioned against over-supplementation, emphasizing the potential for liver toxicity, drug interactions, and reduced treatment efficacy. A collaborative approach, focused on patient education and individualized care, is paramount in navigating the complex landscape of supplements and cancer survivorship. .
