Background: Supplement use is common amongst cancer patients: 64-81% of cancer survivors reported use of vitamin or mineral supplements with 14-32% indicating initiation of the supplement after their cancer diagnosis (1). There is a growing subset of cancer patients who take supplements to manage cancer-related and treatment-related symptoms, such as pain, fatigue, nausea, and cognitive impairments (2). Clinicians caring for patients with advanced cancer should be familiar with common supplements used for cancer-related symptoms, as well as their risks, adverse effects, and level of evidence to support their use. With the myriad supplements available it is impossible for this Fast Fact to address them all. These initial selections are commonly seen in our practice and each one’s use is supported by at least one randomized clinical trial. This Fast Fact will discuss the usage and precautions of seven supplements commonly used for symptom management amongst cancer patients.  

General precautions: Experts suggest caution when using dietary supplements during chemotherapy. For example, antioxidant use has been statistically associated with an increased hazard of cancer recurrence and to a lesser extent death (3). The U.S. Food and Drug Administration (FDA) does not regulate supplements, leading to contamination risks and a lack of standardization (4). The American Cancer Society recommends caution with any supplement other than a multivitamin during chemotherapy citing concerns of side effects, interactions with radiation/chemotherapy, and lack of regulation (3,5)  

*Curcumin is the bioactive component in turmeric. AIAAs: Aromatase inhibitor associated arthralgias
**Cost estimates one month supply and obtained from Amazon and ConsumerLab. 

Additional pearls:  

• Prior to starting any supplement before, during, or after anti-neoplastic treatment, the supplement should be reviewed by the multidisciplinary oncology team particularly medical oncology and the clinical pharmacist to ensure no interactions with treatment. 
• Patients should choose supplement brands that have been verified by a reputable third party such as U.S. Pharmacopeia (USP) or ConsumerLab (CL).  
• Supplements are not intended to replace a comprehensive assessment of disease- or treatment-related symptoms and consideration of other pharmacological treatment options. 
• Patients often do not spontaneously tell their clinicians about their supplements so active inquiry is required, such as asking, “Can you tell me what pills or supplements you take? Anything that you take a couple times a week is important for me to know about.”  

References  

1. Velicer CM, Ulrich CM. Vitamin and Mineral Supplement Use Among US Adults After Cancer Diagnosis: A Systematic Review. JCO. 2008 Feb;26(4):665–73.
2. Du M, Luo H, Blumberg JB, et al. Dietary Supplement Use among Adult Cancer Survivors in the United States. J Nutr. 2020 Jun 1;150(6):1499–508.
3. Ambrosone CB, Zirpoli GR, Hutson AD, et al. Dietary Supplement Use During Chemotherapy and Survival Outcomes of Patients With Breast Cancer Enrolled in a Cooperative Group Clinical Trial (SWOG S0221). JCO. 2020 Mar 10;38(8):804–14.
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Authors’ Affiliations: Cedars-Sinai Medical Center, Los Angeles, CA (PC, LA, AA); Memorial Sloan Kettering Cancer Center, New York, NY (YH, JG)
Version History: first electronically published in April 2024; originally edited by Lara India MD
Conflicts of Interest: None to report