Vitamin A, vitamin C, vitamin D, aspirin and fish oil may one day play important roles in the treatment and prevention of different cancers. But at the moment, researchers say it is too early to know how valuable these seemingly benign additions to traditional chemotherapy and radiation will turn out to be in the ongoing search for more efficient and less costly ways of extending the lives of cancer patients.

Research that may lead to more definitive answers on the utility of over-the-counter supplements and medicines in the war on cancer is taking place at Thomas Jefferson University and Fox Chase Cancer Center.

Pancreatic cancer patients enrolled in a study at Jefferson are receiving intravenous infusions of vitamin C to determine if the vitamin can increase the effectiveness of chemotherapy. The amount of vitamin C they are receiving is 10 times the amount people could take by mouth, according to medical oncologist Edith Mitchell, who is involved in the ?G?-backed study. Found naturally in citrus fruits and available as a supplement, large amounts of vitamin C taken orally can cause stomach discomfort and absorption problems. Intravenous delivery that goes directly into the bloodstream eliminates those problems, Mitchell said.

Although the first phase of the study was just completed, it is too early to share specific results. "I can say they are encouraging," said Dr. Daniel A. Monti, director of the Jefferson-Myrna Brind Center of Integrative Medicine. A separate clinical trial for vitamin C and colorectal cancer is planned.

Monti said there is a hunger for information about vitamin C. He often receives phone calls from oncologists whose patients are interested in learning more about vitamin C therapy "It's because it's out there that it is being investigated, and because it's a vitamin it is perceived as healthful. People are often feeling worn out by other cancer processes or feeling they want to take a more natural approach to their cancer care," Monti said. "But the caveat here is that we treat the vitamin C like an actual drug and we are giving it at a pharmaceutical dose that has to be infused into the bloodstream under medical supervision. Of course, the positive side is that it isn't toxic. There are little to no side effects of doing it and we are studying it to see if it actually does help with different types of cancer because alternative medicine doctors have been giving it for years."

Meanwhile, Dr. Jose Russo, director of the Breast Cancer Research Laboratory Center at Fox Chase Cancer Center, has been studying whether fish oil can enhance the effectiveness of tamoxifen therapy in rats with breast tumors. Women with breast cancer are often prescribed tamoxifen because it reduces the sometimes harmful breakdown of the naturally occurring female hormone estrogen. Over time, estrogen exposure can be a risk factor for cancer.

Some of the rats in Russo's study were fed a diet that included fish oil while others consumed a corn oil-based diet. Some received tamoxifen with the diet. Russo found that the rats given tamoxifen plus fish oil had less aggressive tumors. He said "it is tremendously important" that women may be able to boost the effectiveness of their tamoxifen therapy by taking fish oil. "It's the kind of thing that is keeping us excited." Russo said. Russo is working on another animal study to determine if omega-3 fatty acids such as fish oil can prevent breast cancer in animals.

Also under study at Fox Chase is whether taking aspirin can prevent the reoccurrence of prostate cancer in men whose cancer had been treated with radiation. Radiation oncologist Mark K. Buyyounouski headed the team that examined data Fox Chase has been keeping for patients who received radiation between 1989 and 2006. The data contained information on the medications men with prostate cancer were taking before and after they were treated. Buyyounouski's team concluded that men who had reported taking aspirin appeared to reduce their risk of having their prostate cancer return.

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Still, he said, many questions need to be answered. They include: how much aspirin do men need to take and how often do they need to take it; how does aspirin prevent reoccurrence; and what are the risks involved in taking aspirin. "We do know there can be considerable bleeding risks even with a baby as; pirin in some patients," Buyyounouski said "So it's a little premature to tell patients with prostate cancer who are getting radiation to go out and starting taking a baby aspirin. But if they are already taking aspirin because it was recommended to them by their cardiologist for their heart health, then they may be getting double duty out of it."

Buyyounouski added that he hopes the Fox Chase study will inspire other research institutions to commit their time and resources to trying to confirm his findings. After all, companies that produce inexpensive overthe-counter products such as aspirin are unlikely to invest millions of dollars to test their effectiveness as a cancer treatment.

Ironically, before health care reform, patients with tax-advantaged flexible spending accounts through their employers used to be able to purchase and deduct over-the-counter products that were not covered by their health insurance. They now need a doctor's prescription to do so. Dr. Richard Stefanacci, associate professor of health policy at the Mayes College of Healthcare Business and Policy at the University of Sciences in Philadelphia, said some people won't bother to take the deduction because of the extra work - although it is likely that most doctors would be willing to write such prescriptions if asked.

What You Can Do

As researchers continue to study what works and what doesn't, there are some vitamins and supplements that might be worth taking now.

For example, calcium has been shown to decrease the number of colon polyps in patients, said Dr. Edith Mitchell, who specializes in gastrointestinal cancers. Mitchell said it doesn't matter whether you take a supplement or get calcium from your diet by drinking milk or eating yogurt. The caveat: Nobody can tell you how much calcium you need to take. Still, Mitchell said, "I don't think people need to take massive doses or drink a gallon of milk a day [to get the benefit]."

Women concerned about breast health might want to take the supplement Peak for Her, which contains a substance found in cruciferous vegetables like broccoli, kale and Brussels sprouts. Dr. Daniel A. Monti, who directs the Jefferson-Myma Brind Center of Integrative Medicine, recommends the supplement because it contains diindolylmethane (DIM), which helps estrogen harmlessly break down. He also recommends that women have a simple blood test to determine if their vitamin D levels are in a healthy range. People make vitamin D by spending time in the sun without wearing sunblock, something fewer people do today. Low levels of the vitamin have been found in some people with cancer.

Monti said another wise move may be bumping up your consumption of vitamin A (beta carotene) by taking a multivitamin or increasing your intake of carrots, sweet potatoes, leafy greens and other similar vegetables.

Author affiliation:

Gail Snyder is a Chalfont-based freelance writer and frequent contributor to Special Sections.