Cancer patients who want to take unproven supplements

One of the most important things we do as physicians is to empower our patients with the knowledge we have so that they can make informed decisions about their care.

In oncology, patients also benefit from educating themselves about ways they can try to take some control of their disease process, for example, exercising. I often give patients pamphlets from national organizations such as the National Cancer Institute or Leukemia and Lymphoma Society to save time in the office.

Nevertheless, when I discuss a new cancer diagnosis, there is so much to review and always too little time. While every patient is unique and comes with individual concerns, I still need to convey a common set of talking points so that we are all on the same page about the process, including informed consent for treatment. I pause for questions, continue, pause, and repeat until the patient or accompanying member of their support system have no more questions.

Usually, it is at this point I am ready to wrap up the visit with my contact information should questions arise at home, when I am asked about one of three things:

1.”Is there anything I should modify in my diet?”
2. “Can you fill out a form for work or my insurance?”
3. “Is it OK if I take [insert supplement here]?”

While I work with dietitians and nurses who can help answer these questions, it is that last question that is always a provocative one.

I am familiar with the usual arguments of why medical oncology is seemingly antithetical to naturopathic or alternative treatments.

For example, one might argue that I am trained narrowly in western medicine (so evidence-based treatment is a bad thing?), that I know nothing about natural remedies (ironically, many traditional chemotherapies are derived from plants), and that I do not treat patients holistically (then why do I work with nutritionists, social workers, navigators, palliative care, etc?).

While some of these critiques are loosely valid — after all, in medical school I did not learn much about unregulated supplements — I believe I have the higher ground since I have the evidence and ability to assess the literature to see if quality evidence even exists.

Many times patients will have been told by another “practitioner” about the potent anti-cancer effects of a supplement, often based on, at best, in vitro data. However, if you give enough of almost any compound to a cancer cell in a petri dish, the cells will eventually die, yet this is a far cry from a clinical trial. Show me the phase 3 efficacy and safety data for your supplement of choice, and I will gladly consider recommending it (ginseng root is an example). A patient recently asked me about the role of IV ozone (offered by a podiatrist no less), and it was easy to find an absence of substantive evidence of its benefit (in addition to searching PubMed and Quakwatch).

So then the question becomes, how do you convince patients that certain supplements or alternatives are unproven, or proven to be useless or even harmful, without alienating them from seeking evidence-based anti-cancer treatment?

I think being non-judgmental and explaining things rationally from a scientific standpoint may ease tensions on both sides of the table. However, it is still upsetting to me that I have to disavow my patients of false beliefs derived from charlatans looking to take advantage of them at a very vulnerable time under the guise of cancer cures. Cancer is a nefarious adversary that in many cases, can be suppressed but not cured even with the most effective targeted therapies. I try to be empathetic and think about what I would do if I were diagnosed with life-curtailing cancer and had limited health literacy, perhaps I would be drawn more toward the person touting a cure from a supplement than the physician being concrete about the prognosis and limits of evidence-based treatment.

Marc Braunstein is a hematology-oncology physician and can be reached on Twitter @docbraunstein.

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