Dietary Supplement Use During Chemotherapy and Survival Outcomes of Patients | Hacker News Reader

Dietary Supplement Use During Chemotherapy and Survival Outcomes of Patients

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67 pointsDanBC42 comments

Don't have access to the full paper, but it seems like this study was based on asking patients whether they were taking supplements, as opposed to administering placebo/supplements and measuring the outcome. I would imagine that the worse your cancer is, the more likely you are to try things like supplements and whatnot. Did they manage to control for this?

> "...were queried on their use of supplements at registration and during treatment..."

My concern as well. Self-reported is a red flag. Not necessarily fatal but it obviously has an unpredictable affect on the data collected.

I suspect that if you're the type to take a bunch of individual vitamin supplements then you know exactly what you're taking and how much, much more so than if you're taking a multivitamin every morning washed down with your coffee. There's also no reason to be lying about that to your doctor.

Lying? No. Memory issues? Could be. Giving answers that you think are expected? Yup. Highly possible.

Someone or sonehow these humans were questioned. There are a number of reasons why that might not be accurate.

Most oncology pts have so many meds they barely remember which ones they're taking when. Generally a spouse, family member or other caretaker organizes the med schedule and keeps track.

Working in the industry, the supplements we get the most questions about and that come up as conmeds for the main treatment is turmeric and biotin. The turmeric is getting popular as an antiinflamatory and biotin has good word of mouth to help prevent hair loss.

Biotin can really throw off lab values and for our infusion treatment patients we need to constantly monitor their labs, so that is really important to ensure they're not taking. Turmeric has some interactions as well, but not as severe as biotin.

The issue isn't that the patient is lying or doesn't know; the issue is that the patient is taking supplements or not for a reason that is itself correlated with the other side of our analysis: someone who is taking vitamins might be more desperate, or might have more money (and so be living in very different conditions or have less stress), or might be more likely to be doing other random "maybe this will help?" things that are also random effects you aren't asking about, or might be better at doing anything at all on a routine (including other medical steps), or might be more able to get up and walk/drive to take/buy vitamins, or might be experiencing a different level of digestive effects from their chemotherapy. The reason why we use controlled randomized trials is because they just fully solve this correlation analysis issue.

It's a reasonable concern, but all studies are flawed in some way. From the perspective of clinical practice, this is how most clinics assess supplement use - by asking the patient. In the absence of any better data (and it surely could be better) it at least offers some guidance when patients ask if they should or shouldn't take supplements during chemotherapy. I would tell them that there's limited evidence, but it points towards avoiding supplements.

All studies are flawedin some way? That's a reasonable theory. But self-reported data is a clasic red flag. That doesn't mean we dismiss the study. But we should be highly supect until it's duplicted.

I propose that for most people "I'm on chemotherapy" triggers the feeling that their cancer is pretty bad.

My impression is that lumped as a (extremely broad and diverse) whole that OTC supplements, when studied rigorously in humans in vivo, have generally not been found to be terribly effective for most maladies. Many have been often found to have poor quality control, often adulterated with other substances, provided in poorly bioavailable forms, or sometimes not actually containing the substance they claim to contain.

As a whole they generally get a bad rap in medical school and among physicians.

So I wonder if this study reflects a tendency of some patients to disregard or be less adherent to the treatment plan recommended by their oncologists, who seem unlikely to recommend dietary supplements that lack large supporting RTCs.

Or perhaps, as mentioned, if they didn't properly control for severity of disease, it is not uncommon for a provider to give a "sure, why not" when a patient with severe / terminal disease is interested in an unconventional but low cost and likely low harm intervention.

Well, antioxidants prevent damage to cells, so while that's normally helpful, it directly works against things like Chemotherapy which are actively trying to kill cells.

If I understand correctly, it looks like this is just evidence corroborating the existing stance?

The problem with antioxidant supplements is that they don't necessarily work well with metabolism.

After the antioxidant hype and supplement boom yielded no health benefits, there have been multiple large studies showing no effect or negative effects. They can remove benefits from physical exercise and increase cancer risk. Vitamin C can remove benefits from exercise.

Overall the risks and benefits are small, but basically they are all useless. If studies show benefits, it can be because some of the subjects suffered from deficiency. You should take them only to treat vitamin deficiency or increased need. Taking more and more of the good stuff is not automatically better.

While all that may or may not be true, that is irrelevant to this study.

That’s exactly it.

There was another paper that showed dosing with supplements prevented improved fitness as well.

Oxygen radicals do cause damage in the body, but they are also important signals and invoked in programmed cell death.

Yes, but many of the nutrients in this study such as iron aren't anti-oxidants, but simply useful for cells, cancerous or otherwise. Usual health advice must often be inverted for cancer patients.

And the concept of "anti-oxidant" in general can be misleading with respect to the mechanism of action. It isn't simply the anti-oxidant effects of polyphenols that are responsible for the reported benefits.

Bad title (lumping together all supplements) when they are specifically talking about antioxidant supplements.

They also looked at vitamin B, iron, and multivitamins.

Peter Attia talks about this indirectly, where he’s been to some chemo floors and observed patients taking “healthy” drinks and supplements that are mixed as a milkshake of sugar and carbs.

Problem is a number of the cancer cells can only live on glucose. The other pathways for energy are broken/nonexistent, and so consumption of sugary drinks directly feeds fuel to these type of cells.

Strange how the field hasn’t connected the dots yet.

1. Prove the cancer cells of X type can only feed on glucose

2. If so, don’t ingest glucose.

Radical science here folks

Your comment isn't relevant to this article. The study was about vitamins and antioxidants, not carbohydrates.

I think he’s referring to the method of ingestion. A lot of supplements come in different forms, including sweetened chewables and drink mixes.

I think Otto Warburg might have beaten you to it

Do you work in oncology or medicine?

This reply was downvoted, and I am a bit surprised:

I would expect that making a strong claim of naivete of an entire field of people dedicating their life to a problem (oncology) should be at least put in context of the commentator's expertise and evidence (see the other Metformin related comment).

I hope this is seen as a constructive comment: let's not abandon the respect for expertise.

I can appreciate the inquiry, but I would expect a senior biology undergrad to be able to write a comprehensive paper on a topic like this based solely on the information that's been published.

If you post a comment like that just as a one-liner, it's much too easy to interpret it as snark or personal attack. That's destructive of good conversation on the internet. If you provide more information about your intent, as you did in your second comment, that helps to prune the response tree of defensive or aggressive replies, and we all benefit.

Do you have evidence beyond indirect second hand anecdotes that might support your hypothesis?

I think op is only partially right.

There seems to be indirect connection trough insulin and insulin like growth factors. They can play important role in oncogenesis.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3614012/

This is not new information. And it's been shown to be efficacious. The problem is patient adherence. Chemo is something that so long as the patient shows up you can administer it and they can go back home. A glucose free diet could only be adhered to on an in-patient basis. Which most patient / healthcare systems cannot afford.

There have also been studies showing efficacy of a compound which down regulates Glut1 in order to cut off glycolysis in cancer cells which rely solely on it for energy production.

>A glucose free diet could only be adhered to on an in-patient basis.

That's not true, the Keto diet is a big fad and it only works if your diet is basically glucose free.

Dieting is notoriously difficult to follow 100%. And in this case that's important. In-patient, the intake is exactly what the dietician (and indirectly the doctor) prescribes. A better outcome could be expected.

I have doubts about a couple of the assumptions implicit in this statement.

- The "Keto" diet particularly works. Last time I checked, the research suggested it worked about as well as any other elimination diet, or vanilla CR.

- The reason it works. Given that it works about as well as any other elimination diet, it's probably important for practitioners to adhere strictly, rather than continuing to consume the foods that made them fat; but successfully avoiding carbohydrate intake enough to trigger some particular level of ketosis is probably not a part of how it "works".

Neither of those assumptions were implicit in the statement. The keto diet is simply evidence that glucose elimination is possible for some people without an inpatient treatment. The context of this discussion is glucose elimination for cancer, not weight loss.

(There is a fad that people attempt to do X) + (the observable result is orthogonal to whether they successfully did X) => not very strong evidence that doing X is achievable

This study mentions antioxidants rather than glucose.

Not questioning you. But do you have a link to the cancer cell and glucose connection?

The Warburg hypothesis should be a good jumping off point: https://en.wikipedia.org/wiki/Warburg_hypothesis

It's being worked on. As with anyting in living systems, it's not simple. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197057/

The field has 100% connected the dots. And there are a lot of studies on it, but trying to cure cancer through the Warburg effect isn't quite the holy Grail they hoped.

A lot of statistical and methodological crimes being committed here.

"Patients... were queried on their use of supplements at registration and during treatment".

Hazard ratios.

The blender approach of looking at all the reported vitamins at once, and picking anything that looks significant.

People with the money to buy supplements take supplements...so this runs right into the health/wealth correlation.

There are such varied supplements out there that this title feels vague. The study focused on antioxidants.

Browse the top results of a search for “cancer supplements” and look at their ingredients. You’ll find the majority were not included in this study.

Seems just as likely that sicker patients tend to take more supplements.

I come from decades in the healthcare field (and published). Honestly? I would take with a grain of salt pretty much anything i see published these days.

A. Friend 1, follows the MDs orders to the T. Is dead in 6 months.

B. Friend B. MDs you have 6 months to live. Get your affairs in order. It's hopeless. Friend B? Fuck that, I feel great.

Friend B? Alive and running off to a yoga class. 14 years later. Healthy as can B. As he says, Chinese medicine. Just do your homework.

Food for thought ... :-)

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