Non-herbal nutritional supplements for symptom relief in adjuvant breast cancer: creating a doctor-patient dialogue

Patients with breast cancer frequently turn to complementary medical therapies, including non-herbal nutritional supplements (NHNS). A number of NHNS products have been shown to potentially reduce the incidence and severity of adjuvant treatment-related symptoms. We review the literature and summarise the potential beneficial effects of these products and address issues regarding the safety of this practice. We offer an evidence-based approach for advancing a dialogue between doctors and patients interested in NHNS for adjuvant treatment-related toxicities. Taxane agents such as paclitaxel are frequently complicated by peripheral sensory neuropathy. The findings from several studies suggest that supplementation with vitamin E, glutamine and acetyl-L-carnithine may reduce the incidence and severity of paclitaxel-induced neuropathy. Glutamine has also been shown to reduce the incidence and severity of chemotherapy-induced and radiation-induced oral mucositis. Selenium can reduce upper limb lymphoedema following surgery and radiation treatments, and an antioxidant supplement has exhibited a protective effect against radiation-induced dermatitis. Finally, vitamin D has been shown to be effective in reducing the incidence and severity of arthralgia resulting from treatment with the aromatase inhibitor letrozole. The use of coenzyme Q10 was not found to be of benefit for cancer-related fatigue. There is a need to develop an open and non-judgmental dialogue between doctors and their patients with breast cancer, respecting the needs of the patient while addressing issues related to the efficacy and safety of NHNS products. Referral of patients to an integrative medicine consultant may help achieve these goals.