Cancer Decisions - Free Newsletter

ANTIOXIDANTS AND CANCER TREATMENT - TWO NEW REPORTS

There are few issues in cancer therapy so surrounded by confusion as the question of whether or not cancer patients should continue to take antioxidant supplements during radiation treatment.

Prompted by the many questions I receive from clients on this topic, I am now offering two investigative reports on the subject. The first of these - Do Antioxidants Interfere With Radiation Treatment for Cancer? - is designed to help patients make sense of the conflicting information they are likely to encounter on this issue. This 26 page report contains up-to-the-minute information concerning the controversial question of whether antioxidants can safely be taken during radiation treatment, and includes new research data that more clearly identifies which patients are most likely to be affected by potential interactions.

Because the question of antioxidant use is an area of such vital importance to cancer patients, we are also offering this new report packaged with our earlier report on the use of antioxidants during cancer therapy. This combined report, 83 pages in length, offers an exhaustive discussion of the topic, covering the use of supplemental antioxidants during both chemotherapy and radiation.

For further details and information on purchasing either the single or the combined report please scroll down to the end of the newsletter.

NEW STUDY CLARIFIES ROLE OF ANTIOXIDANTS DURING RADIATION TREATMENT

An important paper on the interaction of antioxidants and radiation therapy was recently published in the International Journal of Cancer. Interestingly, despite the significance of its findings, this study has received virtually zero attention from the scientific community or the media.

As background, in April 2005, Isabelle Bairati, MD, PhD, and her colleagues at the Hôtel-Dieu de Québec Research Centre and the Université Laval completed a ten-year study on the interaction of antioxidants and radiation therapy. This was hailed as the first placebo-controlled, double-blind, randomized trial assessing the effect of supplementation with antioxidant vitamins during radiation therapy. The study concluded that supplements of synthetic beta-carotene (30 mg per day) or alpha tocopherol (400 IU per day) had a harmful effect on cancer patients. In particular, the authors claimed that the cancer recurrence rate was 40 percent higher among patients who had been randomly assigned to the supplementation arm of the trial. They therefore called on patients and physicians to exert caution in using antioxidants until new evidence could be provided by future trials.

Kedar Prasad, PhD, and other proponents of the concurrent use of antioxidants during cancer treatment criticized the Bairati paper. They were disappointed that Bairati and colleagues had used ordinary alpha tocopherol as their choice of vitamin E when Prasad's previous work had shown that it was not just alpha tocopherol but alpha tocopherol succinate that had the anticancer efficacy. They also felt that natural forms of the vitamin were more effective than synthetic, drug store-type vitamins. But, by and large, the medical world accepted the Bairati trial as definitive proof that antioxidants interfered with radiation therapy. Word spread like wildfire in oncology circles, confirming a long-held belief that antioxidants interfered with standard cancer treatments such as radiation and chemotherapy. The take away message, as stated in a Université Laval press release, was that "Supplements May Speed Up Development of Cancer." Advocates of complementary and alternative medicine (CAM) were confounded by this large and impressive study.

But now the other shoe has dropped.

In December 2007, Dr. Bairati and her Québec colleagues published a major modification of their previous conclusions. Further analysis revealed, they said, that the danger of synthetic antioxidants was limited to one particular sub-population: cigarette smokers - specifically, those who continued to smoke during radiation treatment. The authors analyzed the outcome in 540 patients who had been given radiation for head and neck cancers. During the follow-up period, 119 patients had a recurrence of their disease and 179 died. Smokers were the group with the worst prognosis. However, astonishingly, smoking in the period leading up to or following radiation therapy did not modify the effects of the two supplements. It was only smoking during the course of radiation therapy that led to a statistically significant increase in the risk of a recurrence. It was a large enough increase to skew the statistics for the group as a whole, leading to the erroneous conclusion that antioxidants interfered with radiotherapy in the general patient population.

Statistically, increased risk is generally expressed as a "hazard ratio" (abbreviated HR). In this study, current smokers had an HR of 2.41 for recurrence, in other words more than double the chance of a recurrence compared to the rest of the patient population. The HR for death from any cause was a similar 2.26. But the hazard ratio for dying of their initial head and neck cancer was a whopping 3.38 in patients who got radiation, smoked and also received a single synthetic antioxidant.

"These results could best be explained by the hypothesis that the combined exposures reduced the efficacy of radiation therapy," Bairati and her colleagues now say. "Particular attention should be devoted to prevent patients from both smoking and taking antioxidant supplements during radiation therapy" (Meyer 2007).

According to the National Cancer Institute, 85 percent of head and neck cancers are linked to tobacco use. (Alcohol use further exacerbates this trend.) This has been widely known for years, and so it is shocking that there are still people so hopelessly addicted to tobacco that they not only continue to smoke after they've been diagnosed with head and neck cancer but continue to smoke right through their radiation therapy. It was in this subset of particularly unhealthy individuals that antioxidants were associated with an increased risk of disease progression. As Bairati and colleagues suggest, such individuals should definitely not compound their problems by then taking a synthetic antioxidant.

But the more important lesson for patients and practitioners is that antioxidants do NOT generally interfere with the effects of radiation therapy, as was previously suggested. They do NOT increase the risk of a recurrence, of death from head and neck cancer, or of overall mortality in the average patient. In this updated study, the harmful effect of synthetic antioxidants was entirely limited to those relatively few tobacco-addicted patients who continued to smoke during their radiation therapy. Thus, the major premise underpinning oncologists' condemnation of antioxidants during radiation therapy has crumbled, although few seem to have noticed so far.

ANTIOXIDANTS AND CANCER TREATMENT - A CHOICE OF REPORTS

In late 2005 the peer-reviewed journal CA (the American Cancer Society's journal for clinicians working in the field of cancer) published a paper strongly recommending against the use of antioxidants during cancer treatment. In response to this paper we published a detailed report titled Should Patients Undergoing Chemotherapy and Radiotherapy Be Prescribed Antioxidants? This report analyzes the specific arguments raised by D'Andrea and others against the use of antioxidants during cancer therapy and finds that there is scant evidence to support the widespread practice of forbidding antioxidants during cancer treatment.

Because this is a topic of such immediate importance to cancer patients, we are now offering this report packaged with our newly published Do Antioxidants Interfere With Radiation Treatment for Cancer? The combined report, totaling 83 pages, gives an extensive overview of the entire subject, including a detailed, point-by-point rebuttal of the specific arguments put forward against the use of antioxidants during cancer therapy.

Do Antioxidants Interfere With Radiation Treatment for Cancer? received enthusiastic reviews from several prominent clinicians and researchers:

"An excellent article that clearly brings into perspective the issues raised."
-Kenneth A. Conklin, MD, PhD, University of California, Los Angeles

"Excellent and timely."
-Jeanne Drisko, MD, University of Kansas Medical Center

"Superb, very thorough, should convince anyone except those whose minds are closed."
-Abram Hoffer, MD, PhD, FRCP (C)

"A comprehensive rebuttal that is also an excellent review of this complex topic."
-Leanna Standish, ND, PhD, Bastyr University, Seattle

You can purchase the combined report - Do Antioxidants Interfere With Radiation Treatment for Cancer? plus Should Patients Undergoing Radiation and Chemotherapy Take Antioxidants? by clicking here:

To purchase the single report Do Antioxidants Interfere With Radiation Treatment for Cancer? please click here.

MOSS REPORTS

We have Moss Reports on more than 200 different cancer diagnoses. You can see the full list of reports, view a table of contents and read a sample excerpt from one of the reports at our Web site, www.cancerdecisions.com.

PHONE CONSULTATIONS - FINDING DIRECTION AND REGAINING A SENSE OF CONTROL

A phone consultation can be enormously helpful in drawing up an effective treatment strategy and getting one's options clearly prioritized, as these comments from recent phone consultation clients illustrate:

“The phone consultation was very enlightening. Dr. Moss has a compassionate way of communicating a message of hope and explaining various avenues of inquiry that are easy to understand. He projects a feeling of empowerment, that to date, has been lacking in my discussions regarding my cancer” - S.M.

Clients who have purchased a Moss Report can schedule an appointment for a phone consultation by calling 1-800-980-1234 (814-238-3367 from outside the US) or by submitting a request via email to Jacquie@cancerdecisions.com.

We look forward to helping you.

--Ralph W. Moss, Ph.D.

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References:

Bairati I, Meyer F, Jobin E, et al. Antioxidant vitamins supplementation and mortality: a randomized trial in head and neck cancer patients. Int J Cancer. 2006;119:2221-4.

Bairati I, Meyer F, Gélinas M, et al. Randomized trial of antioxidant vitamins to prevent acute adverse effects of radiation therapy in head and neck cancer patients. J Clin Oncol. 2005;23:5805-5813.

Bairati I, Meyer F, Gélinas M, et al. A randomized trial of antioxidant vitamins to prevent second primary cancers in head and neck cancer patients. J Natl Cancer Inst. 2005;97:481-488.

Meyer F, Bairati I, Fortin A, et al. Interaction between antioxidant vitamin supplementation and cigarette smoking during radiation therapy in relation to long-term effects on recurrence and mortality: A randomized trial among head and neck cancer patients. Int J Cancer. 2007 Dec 4;122(7):1679-168.

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IMPORTANT DISCLAIMER

The news and other items in this newsletter are intended for informational purposes only. Nothing in this newsletter is intended to be a substitute for professional medical advice.