March 2008: Dietary Supplement Use in Individuals Living with Cancer and Other Chronic Conditions

Article Summary:

Cancer survivors are increasingly turning to complementary and alternative medicine (CAM) to help manage secondary health effects, which range from pain and nausea to lymphedema, peripheral neuropathy, heart disease, and osteoporosis. Dietary supplement use is widespread in the United States and is among the more popular CAM modalities. There is growing evidence suggesting dietary supplements are efficacious in chronic disease prevention. However, evidence to date for supplement use as effective treatment for chronic conditions is limited, and there are well-documented herb-drug interactions that are of concern to clinicians and relevant cancer survivors, many of whom have other coexisting chronic conditions and are likely to be taking multiple medications.

Only one epidemiologic cohort and one nationally representative survey sample have examined supplement use among cancer survivors compared with cancer free individuals. These studies concluded no difference in supplement use between cancer survivors and cancer-free individuals. It is unclear whether prevalence of supplement use differs among those with and without a history of cancer. Furthermore, little is known about correlates of supplement use in population-based samples of cancer survivors and whether predictors of supplement use differ among those with and without a history of cancer.

This population-based study was conducted with participants reporting a cancer diagnosis or newly reported diagnosis on a 2003 survey. Respondents were asked about use of a multivitamin and 27 other specific dietary supplements, listed individually, during the past 12 months. The sample of this study included 1,844 cancer survivors and 7,343 cancer-free individuals. Results discovered that the prevalence of supplement use increased significantly with number of noncancer chronic conditions. However, the prevalence remained relatively stable when the number of chronic conditions exceeded two. In general, adults who reported a history of cancer, a noncancer chronic condition, or both had a higher prevalence of supplement use than those reporting no illness. Cancer status was only significantly associated with single vitamin use, whereas living with a noncancer chronic condition was significantly associated with the use of all types of dietary supplements, except for multivitamins. With the exception of the use of herbs and, among cancer-free individuals, the use of natural products, women used supplements significantly more than men. Use of all types of supplements, except herbs, gradually increased with advancing age, whereas use of other natural products increased more markedly with age. Whites were more likely than Asian or Pacific Islanders to use vitamins, minerals, or other natural products but were significantly less likely to use herbs. There was an inverse relation between perceived health status and supplement use. This association was particularly strong for use of vitamins or minerals among cancer survivors, with those reporting their health to be anything less than excellent nearly three to four times more likely to use vitamins and minerals.

The findings of this study suggest that a history of cancer was significantly associated with increased use of vitamins, but not with minerals, herbs, and other natural products. Even though cancer status does not appear to have an independent effect on use of minerals, herbs, and other natural products, cancer survivors are taking more supplements.

The additional article discusses the use of herbs with cancer treatment. It discusses commonly use herbs and their effects specifically with cancer treatment.

JADA Continuing Education Article:
Farmer-Miller, M., Bellizzi, K., Sufian, M., Ambs, A., Goldstein, M., Ballard-Barbash, R. (2008). Dietary Supplement Use in Individuals Living with Cancer and Other Chronic Conditions: A Population-Base Study. Journal of American Dietetic Association, 108 (3), 483-494.

Additional Article:
Mathieu, J. (2005). Herbs and Cancer Treatment. Journal of American Dietetic Association, 105(1), 22-24.