Dietary Supplement Use Among Patients With Hepatocellular Carcinoma

Abstract

Background. More than 50% of US adults, and an even larger proportion of cancer patients, use dietary supplements. Since many supplements require hepatic metabolism, they may be particularly likely to cause toxicities in patients with hepatocellular carcinoma (HCC). However, little is known about supplement use in patients with HCC. Methods. From 2008 to 2012, we gave newly diagnosed HCC patients at our institution a standardized questionnaire about dietary supplement use, demographic factors, and clinical characteristics. We then followed patients for four years or until time to death to examine the relationship with supplement use. Results. Of 146 patients, 71% had used vitamins and 45% herbal supplements. Most commonly used supplements were antioxidants (51%), multivitamins (46%), vitamin D (25%), and milk thistle (23%). People in mid-higher income brackets were more likely to use herbal supplements (19% of those earning <$30 000, 50% of those earning $30 000-60 000, and 34% of those earning >$60 000 used supplements). Hepatitis C (HCV) patients were more likely to use milk thistle than those without HCV (30% vs 13%, P = .03), and patients with hepatitis B (HBV) were more likely than non-HBV patients to use vitamin C (32% vs 14%, P = .01). Supplement use was not associated with overall survival. Conclusions. Like cancer patients in other studies, the majority of our HCC patients used dietary supplements. Supplement use was not associated with overall survival but should be studied in larger patient samples.

Poor chemical and microbiological quality of the commercial milk thistle-based dietary supplements may account for their reported unsatisfactory and non-reproducible clinical outcomes

“…Nevertheless, a large proportion of liver disease (27 to 43%) or cancer patients (26 to 87%) use this hepatoprotective herbal-based dietary supplements hoping to improve their health and quality of life 14–17 . However, although these preparations have been popularized as effective cancer preventive agents, considering the lack of clear evidence of efficacy as well as food safety 18 , a more cautious approach by consumers would be appropriate.…”

“…For example, the study of Lee et al . focused on measuring the prevalence of dietary supplement use by patients suffering from hepatocellular carcinoma revealed that patients who used milk thistle had marginally poorer survival than non-users did 14 .…”

Complex Evaluation of Antioxidant Capacity of Milk Thistle Dietary Supplements

“…However, it should be noted that although most experimental reports and some clinical data suggest that it does play a beneficial role [8,9,10], the clinical importance of silymarin is negligible [5,7,11,12]. Moreover, the results of clinical studies conducted to date are often rather controversial and non-reproducible [7,11,13]. This is probably related to the ambiguously defined chemical composition of the silymarin complex [14] and possible contaminants [15].…”

Comparison of the nutritional habits, food frequency, use of nutritional supplements and affecting factors in cancer patients before and after diagnosis

“…En yaygın kullanılan besin takviyeleri; %51.0 oranında antioksidanlar, %46.0 multivitaminler, %25.0 D vitamini ve %23.0 deve dikeni olarak raporlanmıştır. 25 Pouchieu ve arkadaşlarının 22 yaptığı çalışmaya göre ise hastaların %28.0'i tanı ile birlikte besin takviyesi kullanımına başladıkları /bıraktıkları ya da kullandıkları besin takviyesini değiştirdikleri ve genel olarak B6 vitamini, C vitamini, magnezyum takviyelerini kullandıkları saptanmıştır. Mevcut çalışmada hastaların; %69.8'i tanı öncesi ve sonrasında vitamin/ besin takviyesi kullanmadığını, %24.1'i tanı sonrası başladığını, %4.3'ü tanıdan önce de sonra da kullandığını ve %1.7'si tanıdan önce kullandığını, tanı sonrası bıraktığını beyan etmiştir.…”