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J Clin Oncol. 2019 Dec 19:JCO1901203. doi: 10.1200/JCO.19.01203. [Epub ahead of print]

Dietary Supplement Use During Chemotherapy and Survival Outcomes of Patients With Breast Cancer Enrolled in a Cooperative Group Clinical Trial (SWOG S0221).

Author information

1
Roswell Park Comprehensive Cancer Center, Buffalo, NY.
2
Boston University, Boston, MA.
3
Fred Hutchinson Cancer Research Center, Seattle, WA.
4
The Ohio State University, Columbus, OH.
5
Columbia University, New York, NY.
6
Cleveland Clinic, Cleveland, OH.
7
Baystate Medical Center, Springfield, MA.
8
Georgetown University, Washington, DC.
9
Mayo Clinic, Rochester, MN.
10
Allan Blair Cancer Centre, Regina, Saskatchewan, Canada.
11
The University of Texas MD Anderson Cancer Center, Houston, TX.
12
Seattle Cancer Care Alliance, Seattle, WA.
13
Loyola University Chicago Stritch School of Medicine, Chicago, IL.

Abstract

PURPOSE:

Despite reported widespread use of dietary supplements during cancer treatment, few empirical data with regard to their safety or efficacy exist. Because of concerns that some supplements, particularly antioxidants, could reduce the cytotoxicity of chemotherapy, we conducted a prospective study ancillary to a therapeutic trial to evaluate associations between supplement use and breast cancer outcomes.

METHODS:

Patients with breast cancer randomly assigned to an intergroup metronomic trial of cyclophosphamide, doxorubicin, and paclitaxel were queried on their use of supplements at registration and during treatment (n =1,134). Cox proportional hazards regression adjusting for clinical and lifestyle variables was used. Recurrence and survival were indexed at 6 months after enrollment using a landmark approach.

RESULTS:

There were indications that use of any antioxidant supplement (vitamins A, C, and E; carotenoids; coenzyme Q10) both before and during treatment was associated with an increased hazard of recurrence (adjusted hazard ratio [adjHR], 1.41; 95% CI, 0.98 to 2.04; P = .06) and, to a lesser extent, death (adjHR, 1.40; 95% CI, 0.90 to 2.18; P = .14). Relationships with individual antioxidants were weaker perhaps because of small numbers. For nonantioxidants, vitamin B12 use both before and during chemotherapy was significantly associated with poorer disease-free survival (adjHR, 1.83; 95% CI, 1.15 to 2.92; P < .01) and overall survival (adjHR, 2.04; 95% CI, 1.22 to 3.40; P < .01). Use of iron during chemotherapy was significantly associated with recurrence (adjHR, 1.79; 95% CI, 1.20 to 2.67; P < .01) as was use both before and during treatment (adjHR, 1.91; 95% CI, 0.98 to 3.70; P = .06). Results were similar for overall survival. Multivitamin use was not associated with survival outcomes.

CONCLUSION:

Associations between survival outcomes and use of antioxidant and other dietary supplements both before and during chemotherapy are consistent with recommendations for caution among patients when considering the use of supplements, other than a multivitamin, during chemotherapy.

PMID:
31855498
DOI:
10.1200/JCO.19.01203

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