Micronutrients as Supportive Care for Gastrointestinal Cancer Patients; Benefits and Concerns

  • Yoo-Sun Kim (Department of Nutritional Science and Food Management, Ewha Womans University) ;
  • Yuri Kim (Department of Nutritional Science and Food Management, Ewha Womans University)
  • Received : 2013.09.04
  • Accepted : 2013.10.24
  • Published : 2013.11.30

Abstract

Cancer is the first leading cause of death in Korea and the second leading cause of death in the USA. There is extensive research into prevention of cancer and the support of oncology patients with diet or dietary supplements. In vitro and in vivo animal studies have indicated that antioxidants, including beta-carotene, alpha-tocopherol, and ascorbic acid, can yield anti-cancer effects in addition to providing protection against oxidative damage. Although many observational studies have shown that consuming fruits and vegetables can reduce the risk of some cancers, the results of several large-scale human intervention trials testing the benefits of a single or combined higher-dose of individual micronutrients have been inconsistent. Cancer can cause profound metabolic and physiological changes which may affect patients' nutrient requirements. Although the optimal route of nutrient delivery is through diet, cancer patients often suffer symptoms that disrupt their food intake, including anorexia, premature satiety, altered taste and smell, and changes in bowel mobility. In particular, micronutrient deficits can slow postoperative healing, contribute to depression symptoms, and decrease immune competence. Cancer patients are generally motivated to take dietary supplements to improve responses to treatment and quality of life. The Physician's Health Study II (PHS II) randomized controlled trial reported recently that daily multivitamin supplementation significantly, albeit modestly, reduced the risk of total cancer. Although evidence of multivitamin use benefits is limited in cancer patients, taking dietary supplements with constituents in the range of the recommended daily allowance according to the Dietary Reference Intake (DRI) recommendation is generally considered to be safe.

Keywords

References

  1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA: a cancer journal for clinicians. 2010;60(5):277-300.
  2. Song YM, Sung J, Ha M. Obesity and risk of cancer in post-menopausal Korean women. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2008;10;26(20):3395-402.
  3. Thun MJ, DeLancey JO, Center MM, Jemal A, Ward EM. The global burden of cancer: priorities for prevention. Carcinogenesis 2010;31(1):100-110.
  4. Mayne ST. Beta-carotene, carotenoids, and disease prevention in humans. FASEB journal: official publication of the Federation of American Societies for Experimental Biology 1996;10(7):690-701.
  5. Yuan JM, Ross RK, Chu XD, Gao YT, Yu MG Prediagnostic levels of serum beta-cryptoxanthin and retinol predict smoking-related lung cancer risk in Shanghai, China. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2001;10(7):767-773.
  6. Meyer F, Galan P, Douville P, Bairati I, Kegle P, Bertrais S, et al. Antioxidant vitamin and mineral supplementation and prostate cancer prevention in the SU.VI.MAX trial. International Journal of Cancer Journal International du Cancer 2005;116(2):182-186.
  7. Michaud DS, Pietinen P, Taylor PR, Virtanen M, Virtamo J, Albanes D. Intakes of fruits and vegetables, carotenoids and vitamins A, E, C in relation to the risk of bladder cancer in the ATBC cohort study. British Journal of Cancer 2002;87(9):960-965.
  8. Hoque A, Albanes D, Lippman SM, Spitz MR, Taylor PR, Klein EA, et al. Molecular epidemiologic studies within the Selenium and Vitamin E Cancer Prevention Trial (SELECT). Cancer causes & control: CCC. 2001; 12(7):627-633.
  9. Li JY, Taylor PR, Li B, Dawsey S, Wang GQ, Ershow AG, et al. Nutrition intervention trials in Linxian, China: multiple vitamin/mineral supplementation, cancer incidence, and disease-specific mortality among adults with esophageal dysplasia. Journal of the National Cancer Institute 1993;85(18):1492-1498.
  10. Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer Journal for Clinicians 2012;62(4):243-274.
  11. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA. Cancer Journal for Clinicians. 2012;62(1):10-29.
  12. Bryan J, Calvaresi E. Associations between dietary intake of folate and vitamins B-12 and B-6 and self-reported cognitive function and psychological well-being in Australian men and women in midlife. The Journal of Nutrition, Health & Aging 2004;8(4):226-232.
  13. Strohle A, Hahn A. [Vitamin C and immune function]. Medizinische Monatsschrift fur Pharmazeuten 2009;32(2):49-54;quiz 5-6.
  14. Gogos CA, Ginopoulos P, Salsa B, Apostolidou E, Zoumbos NC, Kalfarentzos F. Dietary omega-3 polyunsaturated fatty acids plus vitamin E restore immunodeficiency and prolong survival for severely ill patients with generalized malignancy: a randomized control trial. Cancer 1998;82(2):395-402.
  15. Biondo PD, Brindley DN, Sawyer MB, Field CJ. The potential for treatment with dietary long-chain polyunsaturated n-3 fatty adds during chemotherapy. The Journal of Nutritional Biochemistry 2008;19(12):787-796.
  16. Mantovani G, Maccio A, Madeddu C, Mura L, Gramignano G, Lusso MR, et al. The impact of different antioxidant agents alone or in combination on reactive oxygen species, antioxidant enzymes and cytokines in a series of advanced cancer patients at different sites: correlation with disease progression. Free Radical Research 2003;37(2):213-223.
  17. Block KI, Koch AC, Mead MN, Tothy PK, Newman RA, Gyllenhaal C Impact of antioxidant supplementation on chemotherapeutic toxicity: a systematic review of the evidence from randomized controlled trials. International Journal of Cancer Journal International du Vancer 2008;123(6):1227-1239.
  18. Mayne ST, Handelman GJ, Beecher G. Beta-Carotene and lung cancer promotion in heavy smokers-a plausible relation-ship? Journal of the National Cancer Institute 1996;88(21):1513-1515.
  19. Li K, Kaaks R, Linseisen J, Rohrmann S. Vitamin/mineral supplementation and cancer, cardiovascular, and all-cause mortality in a German prospective cohort (EPIC-Heidelberg). European Journal of Nutrition 2012;51(4):407-413.
  20. Park SY, Murphy SP, Wilkens LR, Henderson BE, Kolonel LN. Multivitamin use and the risk of mortality and cancer incidence: the multiethnic cohort study. American Journal of Epidemiology 2011;173(8):906-914.
  21. Larsson SC, Akesson A, Bergkvist L, Wolk A. Multivitamin use and breast cancer incidence in a prospective cohort of Swedish women. The American Journal of Clinical Nutrition 2010;91(5):1268-1272.
  22. Neuhouser ML, Wassertheil-Smoller S, Thomson C, Aragaki A, Anderson GL, Manson JE, et al. Multivitamin use and risk of cancer and cardiovascular disease in the Women's Health Initiative cohorts. Archives of Internal Medicine 2009;169(3):294-304.
  23. Knight JA, Lesosky M, Barnett H, Raboud JM, Vieth R. Vitamin D and reduced risk of breast cancer: a population-based case-control study. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2007; 16(3):422-429.
  24. Coulter ID, Hardy ML, Morton SC, Hilton LG, Tu W, Valentine D, et al. Antioxidants vitamin C and vitamin e for the prevention and treatment of cancer. Journal of General Internal Medicine 2006;21(7):735-744.
  25. Kirsh VA, Hayes RB, Mayne ST, Chatterjee N, Subar AF, Dixon LB, et al. Supplemental and dietary vitamin E, beta-carotene, and vitamin C intakes and prostate cancer risk. Journal of the National Cancer Institute 2006;98(4) :245-254.
  26. Albanes D, Heinonen OP, Taylor PR, Virtamo J, Edwards BK, Rautalahti M, et al. Alpha-Tocopherol and beta-carotene supplements and lung cancer incidence in the alpha-tocopherol, beta-carotene cancer prevention study: effects of base-line characteristics and study compliance. Journal of the National Cancer Institute 1996;88(21):1560-1570.
  27. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. The New England Journal of Medicine 1994;330(15):1029-1035.
  28. Omenn GS, Goodman GE, Thornquist MD, Balmes J, Cullen MR, Glass A, et al. Risk factors for lung cancer and for intervention effects in CARET, the Beta-Carotene and Retinol Efficacy Trial. Journal of the National Cancer Institute 1996;88(21):1550-1559.
  29. Liu S, Lee I-M, Ajani U, Cole SR, Buring JE, Manson JE. Intake of vegetables rich in carotenoids and risk of coronary heart disease in men: The Physicians' Health Study. International Journal of Epidemiology 2001;30(l): 130-135.
  30. Blot WJ, Li JY, Taylor PR, Guo W, Dawsey S, Wang GQ, et al. Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population. Journal of the National Cancer Institute 1993;85(18):1483-1492.
  31. Hercberg S, Galan P, Preziosi P, Bertrais S, Mennen L, Malvy D, et al. The SU. VI. MAX Study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Archives of Internal Medicine. 2004; 164(21):2335.
  32. Hercberg S, Kesse-Guyot E, Druesne-Pecollo N, Touvier M, Favier A, Latino-Martel P, et al. Incidence of cancers, ischemic cardiovascular diseases and mortality during 5-year follow-up after stopping antioxidant vitamins and minerals supplements: A postintervention follow-up in the SU. VI. MAX Study. International Journal of Cancer. 2010; 127(8): 1875-1881.
  33. Plopper CG, Hill LH, Mariassy AT. Ultrastructure of the non-ciliated bronchiolar epithelial (Clara) cell of mammalian lung. III. A study of man with comparison of 15 mammalian species. Experimental Lung Research 1980;1(2):171-180.
  34. Wang XD, Liu C, Bronson RT, Smith DE, Krinsky NI, Russell M. Retinoid signaling and activator protein-1 expression in ferrets given beta-carotene supplements and exposed to tobacco smoke. Journal of the National Cancer Institute 1999;91(1):60-66.
  35. Wang XD, Tang GW, Fox JG, Krinsky NI, Russell RM. Enzymatic conversion of beta-carotene into beta-apo-carotenals and retinoids by human, monkey, ferret, and rat tissues. Archives of Biochemistry and Biophysics. 19915;285(1):8-16.
  36. Wang XD, Russell RM, Marini RP, Tang G, Dolnikowski GG, Fox JG, et al. Intestinal perfusion of beta-carotene in the ferret raises retinoic acid level in portal blood. Biochimica et biophysica acta. 1993;1167(2):159-164.
  37. Wang XD, Krinsky NI, Marini RP, Tang G, Yu J, Hurley R, et al. Intestinal uptake and lymphatic absorption of beta-carotene in ferrets: a model for human beta-carotene metabolism. The American Journal of Physiology 1992;263(4 Pt 1):G480-486.
  38. Gugger ET, Bierer TL, Henze TM, White WS, Erdman JW, Jr. Beta-carotene uptake and tissue distribution in ferrets (Mustela putorius furo). The Journal of Nutrition 1992;122(1):115-119.
  39. Liu C, Lian F, Smith DE, Russell RM, Wang XD. Lycopene supplementation inhibits lung squamous metaplasia and induces apoptosis via up-regulating insulin-like growth factor-binding protein 3 in cigarette smoke-exposed ferrets. Cancer Research 2003;63(12):3138-3144.
  40. Ribaya-Mercado JD, Fox JG, Rosenblad WD, Blanco MC, Russell RM. Beta-carotene, retinol and retinyl ester concentrations in serum and selected tissues of ferrets fed beta-carotene. The Journal of Nutrition 1992;122(9):1898-903.
  41. Ribaya-Mercado JD, Holmgren SC, Fox JG, Russell RM. Dietary beta-carotene absorption and metabolism in ferrets and rats. The Journal of Nutrition 1989; 119(4):665-668.
  42. Van Riel D, Munster VJ, de Wit E, Rimmelzwaan GF, Fouchier RA, Osterhaus AD, et al. Human and avian influenza viruses target different cells in the lower respiratory tract of humans and other mammals. The American Journal of Pathology 2007;171(4):1215-1223.
  43. Liu C, Wang X-D, Bronson RT, Smith DE, Krinsky NI, Russell RM. Effects of physiological versus pharmacological p-carotene supplementation on cell proliferation and histopathological changes in the lungs of cigarette smoke-exposed ferrets. Carcinogenesis. 2000;21(12):2245-2253.
  44. Palozza P, Serini S, Di Nicuolo F, Boninsegna A, Torsello A, Mariano N, et al. β-Carotene exacerbates DNA oxidative damage and modifies p53-related pathways of cell proliferation and apoptosis in cultured cells exposed to tobacco smoke condensate. Carcinogenesis 2004;25(8):1315-1325.
  45. Liu C, Wang XD, Mucci L, Gaziano JM, Zhang SM. Modulation of lung molecular biomarkers by β-carotene in the Physicians' Health Study. Cancer 2009;115(5):1049-1058.
  46. Kim Y, Chongviriyaphan N, Liu C, Russell RM, Wang X-D. Combined antioxidant (β-carotene, a-tocopherol and ascorbic acid) supplementation increases the levels of lung retinoic acid and inhibits the activation of mitogen-activated protein kinase in the ferret lung cancer model. Carcinogenesis 2006;27(7):1410-1419.
  47. Kim Y, Chongviriyaphan N, Liu C, Russell RM, Wang X-D. Combined a-tocopherol and ascorbic acid protects against smoke-induced lung squamous metaplasia in ferrets. Lung Cancer 2012;75(1):15-23.
  48. Marin Caro MM, Laviano A, Pichard C. Nutritional intervention and quality of life in adult oncology patients. Clinical Nutrition 2007;26(3):289-301.
  49. Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. European journal of oncology nursing: the official journal of European Oncology Nursing Society 2005;9 Suppl 2:S51-63.
  50. Strohle A, Zanker K, Hahn A. Nutrition in oncology: the case of micronutrients (review). Oncology Reports 2010;24(4):815-828.
  51. Davies M. Nutritional screening and assessment in cancer-associated malnutrition. European journal of oncology nursing: the Official Journal of European Oncology Nursing Society 2005;9 Suppl 2:S64-73.
  52. Seike J, Tangoku A, Yuasa Y, Okitsu H, Kawakami Y, Sumitomo M. The effect of nutritional support on the immune function in the acute postoperative period after esophageal cancer surgery: total parenteral nutrition versus enteral nutrition. The journal of medical investigation: JMI 2011;58(1-2):75-80.
  53. Dodson S, Baracos VE, Jatoi A, Evans WJ, Celia D, Dalton JT, et al. Muscle wasting in cancer cachexia: clinical implications, diagnosis, and emerging treatment strategies. Annual Review of Medicine 2011;62:265-279.
  54. Huhmann MB, Cunningham RS. Importance of nutritional screening in treatment of cancer-related weight loss. The Lancet Oncology. 2005;6(5):334-343.
  55. Radimer K, Bindewald B, Hughes J, Ervin B, Swanson C, Picciano MF. Dietary supplement use by US adults: data from the National Health and Nutrition Examination Survey, 1999-2000. American Journal of Epidemiology 2004;160(4):339-349.
  56. Strohle A, Zanker K, Hahn A. Nutrition in oncology: The case of micronutrients (Review). Oncology Reports 2010;24(4):815-828.
  57. Argiles J. Cancer-associated malnutrition. European Journal of Oncology Nursing 2005;9:S39-S50.
  58. Laviano A, Meguid MM. Nutritional issues in cancer management. Nutrition. 1996;12(5):358-71.
  59. Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. European Journal of Oncology Nursing 2005;9:S51-S63.
  60. Kamphuis MH, Geerlings MI, Grobbee DE, Kromhout D. Dietary intake of B (6-9-12) vitamins, serum homocysteine levels and their association with depressive symptoms: the Zutphen Elderly Study. European Journal of Clinical Nutrition 2008;62(8):939-945.
  61. Elango N, Samuel S, Chinnakkannu P. Enzymatic and non-enzymatic antioxidant status in stage (III) human oral squamous cell carcinoma and treated with radical radio therapy: influence of selenium supplementation. Clinica chimica Acta; International Journal of Clinical Chemistry. 2006v;373(1-2):92-98.
  62. Federico A, Iodice P, Federico P, Del Rio A, Mellone MC, Catalano G, et al. Effects of selenium and zinc supplementation on nutritional status in patients with cancer of digestive tract. European Journal of Clinical Nutrition 2001;55(4):293-297.
  63. Black R. Micronutrient deficiency: an underlying cause of morbidity and mortality. Bulletin of the World Health Organization. 2003;81(2):79.
  64. Tisdale MJ. Cachexia in cancer patients. Nature Reviews Cancer 2002;2(11):862-871.
  65. Centers for Disease C, Prevention. Cancer survivors-United States, 2007. MMWR Morbidity and mortality weekly report. 2011;60(9):269-272.
  66. Visser M, Smets E. Fatigue, depression and quality of life in cancer patients: how are they related? Supportive Care in Cancer 1998;6(2):101-108.
  67. Bozzetti F, Gavazzi C, Miceli R, Rossi N, Mariani L, Cozzaglio L, et al. Perioperative total parenteral nutrition in malnourished, gastrointestinal cancer patients: a randomized, clinical trial. Journal of Parenteral and Enteral Nutrition 2000;24(1):7-14.
  68. Sesso HD, Christen WG, Bubes V, Smith JP, MacFadyen J, Schvartz M, et al. Multivitamins in the Prevention of Cardio-vascular Disease in MenThe Physicians' Health Study II Randomized Controlled TrialMultivitamins in Prevention of CVD in Men. JAMA: the journal of the American Medical Association 2012;308(17):1751-1760.
  69. Greenwald P, Anderson D, Nelson SA, Taylor PR. Clinical trials of vitamin and mineral supplements for cancer prevention. The American Journal of Clinical Nutrition. 2007;85(1):314S-317S.
  70. Grodstein F, Kang JH, Glynn RJ, Cook NR, Gaziano JM. A randomized trial of beta carotene supplementation and cognitive function in men: the Physicians5 Health Study II. Archives of Internal Medicine 2007;167(20):2184.
  71. Molassiotis A, Fernadez-Ortega P, Pud D, Ozden G, Scott JA, Panteli V, et al. Use of complementary and alternative medicine in cancer patients: a European survey. Annals of Oncology 2005;16(4):655-663.
  72. Lippert MC, McClain R, Boyd JC, Theodorescu D. Alternative medicine use in patients with localized prostate carcinoma treated with curative intent. Cancer 1999;86(12):2642-2648.
  73. Evans P, Halliwell B. Micronutrients: oxidant/antioxidant status. British Journal of Nutrition 2001;85(S2):S67-S74.