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Natural Chemotherapy Support Part Two

November 28, 2012 Written by JP       [Font too small?]

When considering an integrative approach to cancer treatment, oncologists and patients must take into account potential interactions between chemotherapy and dietary supplements. Unlike “mind-body” practices, supplements can directly affect how medications are processed by the body. In some instances, they potentiate the activity of a drug. Other times, they speed the clearance of a given medication, thereby making it less effective. And, finally, there are certain circumstances in which supplements may actually work alongside chemotherapy in such a way as to diminish side effects and improve treatment outcomes.

Many conventional physicians are familiar and reasonably comfortable recommending the use of fish oil. Among the many reasons is that there is a growing number of FDA approved, prescription only fish oils available. In the oncological field, a cancer specialist may prescribe concentrated, purified fish oil because it: a) improves antioxidant status, immune function and lowers systemic inflammation; b) preserves overall body weight and muscle mass during chemotherapy; c) reduces the risk of chemotherapy-induced, peripheral neuropathy or nerve damage to the hands and feet; d) benefits various “quality of life” measurements, including cognitive functioning, global health status and physical performance. The dosage of fish oil used in the above referenced studies generally ranges from about 2 to 4 grams daily. However, there is still no consensus as to the exact composition of omega-3 fatty acids (DHA, EPA, etc.) that is best suited for chemotherapeutic support. The actual dosages used in each of the trials can be found by clicking on the reference links provided below.

Other than the previously mentioned research, there aren’t many controlled trials that have examined the effects of dietary supplements used in conjunction with chemotherapy. The most intriguing and recent exceptions to this rule reveal that the use of two herbs: Aswagandha (Withania somnifera) and Cat’s Claw (Uncaria tomentosa) and a nutraceutical known as IP6 (inositol hexaphosphate) are capable of minimizing chemotherapeutic side effects and improving treatment markers and outcomes. Specifically, Aswagandha, an herb widely utilized in Ayurvedic medicine, decreased fatigue and contributed to a higher survival rate in patients with stage II and III breast cancer. Adding 300 mg/day of a cat’s claw extract to standard care protected against DNA damage and immune dysfunction (neutropenia) often caused by chemotherapy. In addition, a combination of IP6 and inositol (a non-essential nutrient) reduces the risk of cancer treatment side effects, including cytopenia (a drop in immune cells or leukocytes) and platelets, while at the same time bolstering “functional status” and quality of life. To be sure, the three studies documented here should be viewed as preliminary. Nonetheless, they may very well offer hope and expanded treatment options for those considering an integrative path to cancer recovery.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 – Efficacy Evaluation of an Oral Powder Supplement Enriched w/ EPA (link)

Study 2 - Fish Oil Supplement Alters Markers of Inflammatory and Nutritional (link)

Study 3 - Fish Oil Supplementation Improves Neutrophil Function During Cancer(link)

Study 4 - Effect of N-3 Fatty Acids on Patients with Advanced Lung Cancer (link)

Study 5 - Nutritional Intervention w/ Fish Oil Provides a Benefit Over Standard (link)

Study 6 - Omega-3 Fatty Acids are Protective Against Paclitaxel-Induced (link)

Study 7 - Oral Nutritional Supplements Containing N-3 Polyunsaturated Fatty (link)

Study 8 - Effect of Withania Somnifera (Ashwagandha) on the Development (link)

Study 9 - Uncaria Tomentosa – Adjuvant Treatment for Breast Cancer: Clinical (link)

Study 10 - Efficacy of IP6 + Inositol in the Treatment of Breast Cancer Patients (link)

Cat’s Claw Extract May Protect Against Some Chemotherapy Side Effects

Source: Evid Based Complement Alternat Med. 2012;2012:676984. (link)

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11 Comments & Updates to “Natural Chemotherapy Support Part Two”

  1. JP Says:

    Update of Cat’s Claw:

    http://online.liebertpub.com/doi/abs/10.1089/acm.2014.0127

    Uncaria tomentosa (Cat’s Claw) Improves Quality of Life in Patients with Advanced Solid Tumors

    Objective: Cat’s claw (Uncaria tomentosa) is a native Amazon plant that exhibits anti-inflammatory and antitumor properties. We wanted to assess its activity for symptom management of terminal cancer patients.

    Methods: This prospective phase II study assessed the effects of a 100-mg dose of a dry extract of U. tomentosa three times per day in patients with advanced solid tumors who had no further therapeutic options and a life expectancy of at least 2 months. The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30) and Functional Assessment of Chronic Illness Therapy – Fatigue questionnaires were used to assess the participants’ quality of life, the Hospital Anxiety and Depression Scale questionnaire was used to assess anxiety and depression, and the Pittsburgh Sleep Quality Index was used to assess sleep quality. In addition, several biochemical and inflammatory parameters were analyzed.

    Results: Fifty-one volunteers were recruited. Their median age was 64 (range, 33–85) years, and 47% of patients were female. More than 65% of patients had scores on the Karnofsky Performance Scale of 80% or less. Treatment improved the patients’ overall quality of life (p=0.0411) and social functioning (p=0.0341), as assessed by the EORTC QLQ C-30, and reduced fatigue (p=0.0496) according to the Chalder Fatigue Questionnaire. None of the biochemical or inflammatory parameters assessed (interleukin-1 and -6, C-reactive protein, tumor necrosis factor-α, erythrocyte sedimentation rate, and α-1-acid glycoprotein) changed significantly. No tumor response was detected according to the Response Evaluation Criteria In Solid Tumors; however, the disease stabilized for more than 8 months in four participants. The medication was well tolerated by most patients.

    Conclusion: Use of cat’s claw might be beneficial in patients with advanced cancer by improving their quality of life and reducing fatigue. The mechanism of action does not seem to be related to the anti-inflammatory properties of this plant.

    Be well!

    JP

  2. JP Says:

    Update 04/17/15:

    http://ict.sagepub.com/content/early/2015/04/13/1534735415580676.abstract

    Integr Cancer Ther April 14, 2015

    High-Dose Asian Ginseng (Panax Ginseng) for Cancer-Related Fatigue
    A Preliminary Report

    Introduction and Objective. Cancer-related fatigue (CRF) is the most common and severe symptom in patients with cancer. The number and efficacy of available treatments for CRF are limited. The objective of this preliminary study was to assess the safety of high-dose Panax ginseng (PG) for CRF. Methods. In this prospective, open-label study, 30 patients with CRF (≥4/10) received high-dose PG at 800 mg orally daily for 29 days. Frequency and type of side effects were determined by the National Cancer Institute’s Common Terminology Criteria for Adverse Events, version 4.0. Scores on the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F) scale, Edmonton Symptom Assessment System (ESAS), and Hospital Anxiety and Depression Scale (HADS) were assessed at baseline, day 15, and day 29. Global Symptom Evaluation (GSE) was assessed at day 29. Results. Of the 30 patients enrolled, 24 (80%) were evaluable. The median age was 58 years; 50% were females, and 84% were white. No severe (≥grade 3) adverse events related to the study drug were reported. Of the 24 evaluable patients, 21 (87%) had an improved (by ≥3 points) FACIT-F score by day 15. The mean ESAS score (standard deviation) for well-being improved from 4.67 (2.04) to 3.50 (2.34) (P = .01374), and mean score for appetite improved from 4.29 (2.79) to 2.96 (2.46) (P = .0097). GSE score of PG for fatigue was ≥3 in 15/24 patients (63%) with median improvement of 5. Conclusion. PG is safe and improves CRF fatigue as well as overall quality of life, appetite, and sleep at night. Randomized controlled trials of PG for CRF are justified.

    Be well!

    JP

  3. JP Says:

    Update 06/10/15:

    http://www.complementarytherapiesinmedicine.com/article/S0965-2299%2815%2900054-0/abstract

    Complement Ther Med. 2015 Jun;23(3):396-404.

    Effects of inhaled ginger aromatherapy on chemotherapy-induced nausea and vomiting and health-related quality of life in women with breast cancer.

    OBJECTIVE: To assess the efficacy of inhaled ginger aromatherapy on nausea, vomiting and health-related quality of life (HRQoL) in chemotherapy breast cancer patients.

    DESIGN: Single-blind, controlled, randomized cross-over study. Patients received 5-day aromatherapy treatment using either ginger essential oil or fragrance-matched artificial placebo (ginger fragrance oil) which was instilled in a necklace in an order dictated by the treatment group sequence.

    SETTING: Two oncology clinics in the East Coast of Peninsular Malaysia.

    MAIN OUTCOME MEASURES: VAS nausea score, frequency of vomiting and HRQoL profile (EORTC QLQ-C30 scores).

    RESULTS: Sixty female patients completed the study (age=47.3±9.26 years; Malay=98.3%; on highly emetogenic chemotherapy=86.7%). The VAS nausea score was significantly lower after ginger essential oil inhalation compared to placebo during acute phase (P=0.040) but not sustained for overall treatment effect (treatment effect: F=1.82, P=0.183; time effect: F=43.98, P<0.001; treatment×time effect: F=2.04; P=0.102). Similarly, there was no significant effect of aromatherapy on vomiting [F(1, 58)=0.29, P=0.594]. However, a statistically significant change from baseline for global health status (P<0.001) was detected after ginger essential oil inhalation. A clinically relevant 10 points improvement on role functioning (P=0.002) and appetite loss (P<0.001) were also documented while patients were on ginger essential oil.

    CONCLUSION: At present time, the evidence derived from this study is not sufficiently convincing that inhaled ginger aromatherapy is an effective complementary therapy for CINV. The findings for HRQoL were however encouraging with significant improvement in several domains.

    Be well!

    JP

  4. JP Says:

    Updated 12/26/15:

    http://www.ncbi.nlm.nih.gov/pubmed/26700096?dopt=Abstract

    Nutr Cancer. 2015 Dec 23:1-7.

    Fish oil supplementation during chemotherapy increases posterior time to tumor progression in colorectal cancer.

    The authors evaluated clinical outcomes during and after chemotherapy in colorectal cancer patients supplemented with fish oil during the first 9 wk of treatment. Thirty individuals never submitted to chemotherapy were randomized into supplemented group (SG), which received 2 g/day of fish oil (0.6 g/day of EPA and DHA) for 9 wk or control group (CG), which received neither fish oil nor placebo. Outcomes assessed were number of chemotherapy cycles administered; days undergoing chemotherapy; number of delays and interruptions in the administration of chemotherapy; number of hospitalizations during chemotherapy; tumor progression; values of carcinoembryonic antigen (CEA); days until events (death and progression); and 3 yr survival. Time to tumor progression was significantly longer in SG [S593 days (±211.5)] vs. CG [330 days (± 135.1); P = 0.04], other outcomes did not differ between groups. Subjects with advanced cancer who received fish oil presented longer time to tumor progression and lower CEA values after chemotherapy; however these differences were not statistically significant. Supplementation with 2 g/day of fish oil for the first 9 wk of chemotherapy may contribute to delay in tumor progression in colorectal patients, possibly by enhancing the antineoplastic action of the chemotherapeutic drug.

    Be well!

    JP

  5. JP Says:

    Updated 06/26/16:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918070/

    Biomark Res. 2016 Jun 23;4:13.

    The effect of n-3 polyunsaturated fatty acids on incidence and severity of oxaliplatin induced peripheral neuropathy: a randomized controlled trial.

    BACKGROUND: Oxaliplatin induced peripheral neurotoxicity (OXIPN) is the major dose-limiting and long-lasting side effect of oxaliplatin. N-3 PUFAs have neuroprotective property via their effects on voltage-gated ion channels and by reducing the production of proinflammatory cytokines that causes neuropathy. This study was a randomized double blind placebo controlled trial to find the possible advantages of n-3 PUFAs for preventing and reducing the severity of OXIPN in patients with colon cancer.

    METHODS: Eligible patients with colon cancer randomly allocated to take n-3 PUFAs pearls, 640 mg t.i.d during chemotherapy with oxaliplatin and one month after the cessation of the treatment or placebo. All patients were evaluated for incidence and severity of OXIPN based on “reduced Total Neuropathy Score” in which clinical and electrophysiological assessments were included.

    RESULTS: Seventeen patients (47 %) of the n-3 PUFA supplemented group (n = 36) did not develop PN while it was 11 %(4 patients) in the placebo group (n = 35). There was a significant difference in PN incidence (OR = 0.14, .95 % CI = (0.04 to 0.49), p = 0.002). The difference of OXIPN severity was significant between the two study groups (B = -1.61, 0.95 % CI = (-2.59 to -0.62), p = 0.001).

    CONCLUSIONS: N-3 PUFAs may have neuroprotective effect for reducing the incidence and severity of OXIPN. Finding an effective prophylactic or symptomatic therapy for OXIPN would significantly improve the patients’ quality of life.

    Be well!

    JP

  6. JP Says:

    Updated 06/26/16:

    http://www.ncbi.nlm.nih.gov/pubmed/27340931

    Nutr Cancer. 2016 Jun 24:1-8.

    Fish Oil Supplementation Enhances Pulmonary Strength and Endurance in Women Undergoing Chemotherapy.

    We investigated the effect of fish oil (FO) supplementation, at 4 g/day, on the respiratory performance and blood lipid profile of 32 patients with breast cancer at the beginning of chemotherapy. They were randomized into two groups: control (C) and FO supplemented (S). Both groups underwent three respiratory evaluations and blood harvest (before chemotherapy-Day 0, and 30 and 60 days after supplementation). The S group showed a significant increase in the maximal inspiratory and expiratory pressure (P ≤ 0.05 vs. Day 0) and in the maximum voluntary ventilation (P ≤ 0.05). In the treadmill 6-min-walk test, the S group had a significant increase in the walked distance (P ≤ 0.05). Blood lactate concentration was significantly lower in the S group after 60 days, at rest, when compared to C (P ≤ 0.05). Plasma high-density lipoprotein (HDL) cholesterol concentration remained the same after 60 days of supplementation, while in the C group, it decreased significantly (P ≤ 0.05 Day 0 vs. Day 60). Triacylglycerol (TAG) plasma concentration in the S group was lower when compared to the C group (P ≤ 0.05 Day 60S vs. Day 60). Supplementation with FO caused improvement in the respiratory muscle strength and endurance, ameliorated functional performance, and kept TAG, HDL cholesterol, and lactate plasma concentration at normal levels.

    Be well!

    JP

  7. JP Says:

    Updated 08/16/16:

    http://www.ncbi.nlm.nih.gov/pubmed/27515877

    Complement Ther Med. 2016 Aug;27:58-64.

    Sage tea-thyme-peppermint hydrosol oral rinse reduces chemotherapy-induced oral mucositis: A randomized controlled pilot study.

    OBJECTIVE: This pilot study aimed to investigate the preventive effect of sage tea-thyme-peppermint hydrosol oral rinse used in conjunction with basic oral care on chemotherapy-induced oral mucositis.

    DESIGN: An open-label randomized controlled study.

    SETTING: Two oncology hospitals in Ankara, Turkey.

    INTERVENTIONS: Patients receiving 5-fluorouracil-based chemotherapy regimens were divided into the intervention group (N=30) and control group (N=30). Basic oral care was prescribed to the control group, while the intervention group was prescribed sage tea-thyme-peppermint hydrosol in addition to basic oral care. All patients were called to assess their compliance with the study instructions on day 5 and 14.

    MAIN OUTCOME MEASURES: Oral mucositis was evaluated using an inspection method or by assessing oral cavity photos based on the World Health Organization oral toxicity scale on day 5 and 14.

    RESULTS: Most of the patients in the intervention group did not develop oral mucositis on day 5. In addition, the incidence of grade 1 oral mucositis was statistically lower in the intervention group (10%) than the control group (53.3%) on day 5. By day 14, the majority of patients in both the groups had grade 0 oral mucositis.

    CONCLUSIONS: Sage tea-thyme-peppermint hydrosol oral rinse has promising results in alleviating oral mucositis. This hydrosol can be recommended for clinical use as it is well tolerated and cost-effective. However, further randomized controlled trials are needed to support the study.

    Be well!

    JP

  8. JP Says:

    Updated 02/17/17:

    https://www.dovepress.com/antioxidant-activity-of-ginger-extract-as-a-daily-supplement-in-cancer-peer-reviewed-fulltext-article-CMAR

    Cancer Manag Res. 2017 Jan 31;9:11-18.

    Antioxidant activity of ginger extract as a daily supplement in cancer patients receiving adjuvant chemotherapy: a pilot study.

    PURPOSE: The aim of this study was to examine the antioxidant activity of ginger extract oral supplement in newly diagnosed cancer patients receiving adjuvant chemotherapy compared to placebo.

    PATIENTS AND METHODS: Newly diagnosed cancer patients receiving moderate-to-high emetogenic potential adjuvant chemotherapy were randomized to receive either a ginger extract (standardized 6-gingerol 20 mg/day) or a placebo 3 days prior to chemotherapy, which they continued daily. Oxidant/antioxidant parameters, including the activities of superoxide dismutase (SOD) and catalase (CAT) and levels of glutathione peroxidase (GPx), total glutathione (GSH/GSSG), lipid peroxidation products detected as malondialdehyde (MDA) and NO2-/NO3-, were measured at baseline and at days 1, 22, 43 and 64 after undergoing chemotherapy. Two-sided statistical analysis, with P < 0.05, was used to determine statistical significance.

    RESULTS: A total of 43 patients were included in the study: 19 and 24 patients were randomly assigned to the ginger group and placebo group, respectively. Antioxidant activity parameters, including SOD, CAT, GPx and GSH/GSSG, were significantly increased at day 64 in the ginger group compared to those in the placebo group, while MDA and NO2-/NO3- levels were significantly decreased (P < 0.0001). When compared to the baseline, the activities of SOD and CAT and the levels of GPx and GSH/GSSG were significantly higher on day 64 (P = 0.01), while the blood levels of MDA and NO2-/NO3- were significantly decreased (P < 0.01).

    CONCLUSION: Daily supplement of ginger extract started 3 days prior to chemotherapy has been shown to significantly elevate antioxidant activity and reduce oxidative marker levels in patients who received moderate-to-high emetogenic potential chemotherapy compared to placebo.

    Be well!

    JP

  9. JP Says:

    Updated 03/30/17:

    http://link.springer.com/article/10.1007%2Fs12032-017-0931-4

    Med Oncol. 2017 Apr;34(4):69.

    A phase II randomized double-blind placebo-controlled study of 6-gingerol as an anti-emetic in solid tumor patients receiving moderately to highly emetogenic chemotherapy.

    6-Gingerol is a natural compound extracted from ginger. Preclinical studies demonstrated that 6-gingerol has an anti-emetic activity by inhibiting neurokinin-1, serotonin, and dopamine receptors. Several clinical trials examined crude ginger powder for preventing chemotherapy-induced nausea and vomiting (CINV), but none of them was conducted with a standardized bioactive compound. Patients who received moderately to highly emetogenic adjuvant chemotherapy were randomized to receive 6-gingerol 10 mg or placebo orally twice daily for 12 weeks. Ondansetron, metoclopramide, and dexamethasone were given to all patients. The primary endpoint was complete response (CR) rate defined as no emesis or rescue treatment at any time. Eighty-eight patients were randomized to receive 6-gingerol (N = 42) or placebo (N = 46). Most patients received highly emetogenic chemotherapy (93%). Overall CR rate was significantly higher in 6-gingerol group as compared with that of the placebo (77 vs. 32%; P < 0.001). The difference in means of appetite score was significant (P = 0.001) and more noticeable over time. Mean FACT-G score indicating quality of life was significantly higher (86.21) in 6-gingerol group at 64 days as compared with that of placebo group (72.36) (P < 0.001). No toxicity related to 6-gingerol was observed. Patients treated with 6-gingerol reported significantly less grade 3 fatigue (2 vs. 20%; P = 0.020). 6-Gingerol significantly improved overall CR rate in CINV, appetite and quality of life in cancer patients receiving adjuvant chemotherapy. A phase III randomized study of 6-gingerol is warranted to confirm these results.

    Be well!

    JP

  10. JP Says:

    Updated 03/31/17:

    http://link.springer.com/article/10.1007%2Fs00381-017-3372-7

    Childs Nerv Syst. 2017 Mar 27.

    Effect of Nigella sativa seed administration on prevention of febrile neutropenia during chemotherapy among children with brain tumors.

    PURPOSE: Seeds of Nigella sativa (NS) are used to combat various disease conditions through their antibacterial effects. To evaluate the seeds’ potential, we studied their effect on the prevention of febrile neutropenia (FN) in children with brain tumors.

    METHODS: A randomized pretest-post-test control group study including 80 children (2-18 years) with brain tumors undergoing chemotherapy were equally allocated into two groups. Intervention group received 5 g of NS seeds daily throughout treatment while controls received nothing. CBC with differentials, incidence of FN, and LOS were noted on each follow-up.

    RESULTS: The majority of children 38/40 (95%), of the intervention group, took the seeds for 3-9 consecutive months. Eight out of 372 (2.2%) FN episodes were experienced by children of intervention group compared to controls 63/327 (19.3%) (p = 0.001) and a shorter LOS (median = 2.5 days) vs 5 days in the control group (p = 0.006). Children in both groups belonged to almost same geographical area with similar socio-economic background. Weights of children were almost equal at diagnosis.

    CONCLUSION: NS seeds showed a decrease in incidence of FN in children with brain tumors with shortening of subsequent LOS which may improve their outcome and thereby quality of life. Larger scale studies are needed to further evaluate the seeds’ potential.

    Be well!

    JP

  11. JP Says:

    Updated 04/30/17:

    http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1679-45082017000100024&lng=en&nrm=iso&tlng=en

    Einstein (Sao Paulo). 2017 Jan-Mar;15(1):24-28.

    Effects of zinc supplementation on fatigue and quality of life in patients with colorectal cancer.

    Objective: To investigate the effects of oral zinc supplementation on fatigue intensity and quality of life of patients during chemotherapy for colorectal cancer.

    Methods: A prospective, randomized, double-blinded, placebo-controlled study was conducted with 24 patients on chemotherapy for colorectal adenocarcinoma in a tertiary care public hospital. The study patients received zinc capsules 35mg (Zinc Group, n=10) or placebo (Placebo Group, n=14) orally, twice daily (70mg/day), for 16 weeks, from the immediate postoperative period to the fourth chemotherapy cycle. Approximately 45 days after surgical resection of the tumor, all patients received a chemotherapeutic regimen. Before each of the four cycles of chemotherapy, the Functional Assessment of Chronic Illness Therapy-Fatigue scale was completed. We used a linear mixed model for longitudinal data for statistical analysis.

    Results: The scores of quality of life and fatigue questionnaires were similar between the groups during the chemotherapy cycles. The Placebo Group presented worsening of quality of life and increased fatigue between the first and fourth cycles of chemotherapy, but there were no changes in the scores of quality of life or fatigue in the Zinc Group.

    Conclusion: Zinc supplementation prevented fatigue and maintained quality of life of patients with colorectal cancer on chemotherapy.

    Be well!

    JP

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