Are you navigating the complex world of cancer treatment and wondering about dietary supplements? You're not alone. Many patients seek ways to support their well-being alongside conventional care. At the Society for Integrative Oncology (SIO) 2025 Annual Meeting, Dr. Channing Paller from Johns Hopkins University delivered a crucial session shedding light on this very topic. Her insights offer a roadmap for oncologists and patients alike, helping to bridge the gap between conventional and integrative approaches. But what are the key takeaways? Let's dive in!
The Growing Need for Clarity
As more individuals embrace supplements, the need for clear, evidence-based guidance becomes paramount. Dr. Paller's presentation, inspired by the questions patients frequently ask, offered a comprehensive review of vitamins, minerals, and lifestyle interventions. The goal? To empower clinicians with the knowledge to provide safe and effective recommendations.
Vitamin D: The Cornerstone of Nutritional Support
Dr. Paller began by highlighting vitamin D, emphasizing its robust body of evidence. Did you know that over 50% of newly diagnosed cancer patients are deficient in vitamin D? This deficiency can lead to significant health issues, including low calcium levels, muscle weakness, and an increased risk of falls, particularly in older adults.
According to the NCCN guidelines, screening and supplementation with vitamin D and calcium are recommended for at-risk patients, especially those undergoing androgen or estrogen deprivation therapy or dealing with bone metastases. The recommendation is to maintain serum 25-hydroxyvitamin D levels between 30–50 ng/mL. Dr. Paller also pointed out that vitamin D₃ is more effective than D₂ and should be taken with a meal containing fat for optimal absorption.
Vitamin B12 and Folate: Addressing Common Deficiencies
Moving on to other crucial nutrients, vitamin B12 deficiency affects up to 48% of cancer patients, especially those with gastrointestinal issues, older adults, or those taking proton pump inhibitors. Symptoms can be subtle, such as anemia, neuropathy, or fatigue. Replacement options include oral, sublingual, or intramuscular forms, depending on how well the body is absorbing the vitamin.
Folate deficiency, though less common, can result from poor diet, alcohol use, chemotherapy, or oral contraceptives. Dr. Paller noted that early warning signs include megaloblastic anemia and mucosal ulcerations. She recommended 1 mg of folic acid daily for correction and maintenance.
Vitamin C: A Closer Look at the Data
Vitamin C's role in cancer therapy is intriguing. At low doses, it functions as an antioxidant, but at high intravenous concentrations, it may act as a pro-oxidant.
- A 2024 Phase II trial in metastatic pancreatic cancer showed promising results when high-dose intravenous vitamin C (HDIVC) was combined with standard chemotherapy. It improved progression-free survival (6.2 vs. 3.9 months) and overall survival (16 vs. 8.3 months) compared to standard care, without added toxicity.
- However, a separate trial in metastatic castration-resistant prostate cancer (mCRPC) found no significant benefit when HDIVC was added to docetaxel. This highlights the need for careful patient selection in future studies.
Trace Elements: The Importance of Balance
Zinc deficiency can manifest as impaired taste, dermatitis, and reduced immunity. Mild deficiencies can be corrected with a supplement of 2–3 times the RDA (11 mg for men, 8 mg for women). But here's where it gets controversial: chronic intake exceeding 75 mg/day over long periods may increase the risk of aggressive prostate cancer, according to the Health Professionals Follow-Up Study.
Similarly, selenium, essential in small doses (55 µg/day), may raise the risk of both prostate cancer and diabetes when consumed in excess, especially in men with specific genetic variants. Dr. Paller emphasized that “moderation is essential” and supplementation should only address true deficiencies.
Curcumin and Green Tea: Promising, But Not Without Risks
Curcumin, the active compound in turmeric, offers anti-inflammatory and potential anticancer benefits. The FDA generally recognizes it as safe, even at doses of 4,000–8,000 mg/day. However, Dr. Paller cautioned that curcumin can interact with certain chemotherapies and has been linked to liver toxicity in some formulations.
Green tea extract (EGCG) also shows chemopreventive potential. Data from two Japanese studies revealed that women who consumed 3–5 cups of green tea daily had a 44% lower breast cancer recurrence rate. But excessive intake (≥800 mg/day) has been linked to elevated liver enzymes and reduced efficacy of drugs like bortezomib.
Omega-3 Fatty Acids: Supporting Treatment
Fish-derived omega-3 fatty acids (EPA and DHA) play a crucial role in inflammation control and metabolic health. While not recommended for all patients, the ESPEN Clinical Nutrition Guidelines suggest considering omega-3 supplementation for weight-losing or malnourished patients undergoing chemotherapy.
Dr. Paller also noted that high-dose fish oil has antiplatelet properties, which warrants caution in patients using anticoagulants or at risk for bleeding.
Exercise: A Powerful Ally in Survivorship
Shifting from supplements to lifestyle, Dr. Paller underscored the power of physical activity. A randomized controlled trial in patients with stage I–II colon cancer showed that structured exercise significantly improved disease-free survival compared to health education alone. The ASCO and SIO recommend at least 150 minutes of moderate or 75 minutes of vigorous exercise per week, plus 2–3 strength sessions targeting major muscle groups.
Conclusion: A Balanced Approach
Dr. Paller's key message was clear: focus on balance and evidence. True deficiencies should be addressed, but over-supplementation can be harmful. Clinicians and patients need to work together, prioritizing safety and informed decision-making.
What are your thoughts? Do you agree with the emphasis on moderation? Have you had personal experiences with supplements during cancer treatment? Share your insights in the comments below – let's start a conversation!
