Importance of Choosing the Right Multivitamin During Treatment


The use of supplements in cancer patients has been studied at length. Over the past several years there has been an increase in the use of non-prescribed supplements in this population, regardless of cancer type or geographic location of the patients. The rationale behind its use has been mostly in an effort to try to improve prognosis and counteract the side effects of various cancer therapies.

Medically speaking the reason behind some of the healthcare practitioners to recommend the use of multivitamins on cancer patients is the lack of a normal nutrition, either secondary to nausea, taste alterations or other symptoms.  As we evolve on our treatment strategies in an effort to control cancer we understand more the need to supplement certain vitamins and minerals like B12 and folate in patients being treated with medications such as premetrexed.

Since most vitamins, minerals and botanicals don’t require prescription patients have the feeling that they are safe. However, most patients don’t realize that some of the supplements can be detrimental to their care. Two examples are the SELECT and the CARET studies. In the SELECT study we randomized patients to receive vitamin D, selenium or the combination of both in an effort to prevent prostate cancer; however, the results showed an increase in the incidence of the disease. In the CARET study vitamin A was used in smokers finding an increased incidence of cancer as well. The medical explanation of these findings could be the presence of high doses of antioxidants in the supplements that end up protecting the cancer cells or even protecting the premalignant cell in an at risk population. If indeed antioxidants could be good as antiaging strategies, when cells start to develop mutations and they are protected from undergoing apoptosis (cell death), they continue to mutate and develop into malignant cells.

Could this be a fact in all antioxidants? It does not appear to be case.  Some of the more natural strategies that have been found to be safe is the use of beta-carotene at lower doses. Even though it didn’t show to be a good preventive strategy it is at least safe on patients already diagnosed with a malignancy. Moreover, they (antioxidants) remain important in many nutritional pathways and important to be at good levels during all stages of life.

The other interesting feature of a well-developed nutritional supplement is to look for common symptoms that patients might have and to try to counteract them with a more natural supplement rather than with another medication that might cause other side effects. In my clinical practice the most common complaints of patients and families is the extreme fatigue that accompanies the cancer therapies. Many botanicals have been studied in this setting especially the adaptogenics. Adaptogenics are substances that help regulate the level of “energy” as it is perceived by the patient and ashwaganda is likely the most important of this group. Other substances such as turmeric might enhance the anti-inflammatory effect that will allow for a better activity of the commonly known cancer therapies.

I usually recommend to my patients that when selecting a supplement, they need to follow some simple rules of looking for one that was design for their specific condition, with reputable ingredients free of contamination, and with all the ingredients being listed in their “true” content and no proprietary blends that might not be delivering the doses needed. They should be produced in a facility that follows good manufacturing practices with the appropriate certifications. Not all supplements are created equal and multivitamins that are not designed with a specific condition in mind could be harmful if taken by populations at risk.

Written by Dr. Mike Cusnir

For additional reading about the importance of choosing multivitamins, visit



Heine-Bröring RC, Winkels RM, Renkema JM, Kragt L, van Orten-Luiten AC, Tigchelaar EF, Chan DS, Norat T, Kampman E.Dietary supplement use and colorectal cancer risk: a systematic review and meta-analyses of prospective cohort studies. Int J Cancer. 2015 May 15;136(10):2388-401. doi: 10.1002/ijc.29277. Epub 2014 Nov 11

Mueller CM, Mai PL, Bucher J, Peters JA, Loud JT, Greene MH. Complementary and alternative medicine use among women at increased genetic risk of breast and ovarian cancer. BMC Complement Altern Med. 2008 Apr 30;8:17. doi: 10.1186/1472-6882-8-17. PubMed PMID: 18447953; PubMed Central PMCID: PMC2391138.

Greenlee H, Sardo Molmenti CL, Falci L, Ulmer R, Deming-Halverson S, DeRoo LA, Sandler DP. High use of complementary and alternative medicine among a large cohort of women with a family history of breast cancer: the Sister Study. Breast Cancer Res Treat. 2016 Apr;156(3):527-38. doi: 10.1007/s10549-016-3740-0. Epub 2016 Mar 26. PubMed PMID: 27017506.

Scagliotti GV, Shin DM, Kindler HL, Vasconcelles MJ, Keppler U, Manegold C, Burris H, Gatzemeier U, Blatter J, Symanowski JT, Rusthoven JJ. Phase II study of pemetrexed with and without folic acid and vitamin B12 as front-line therapy in malignant pleural mesothelioma. J Clin Oncol. 2003 Apr 15;21(8):1556-61. PubMed PMID: 12697881.

Klein EA, Thompson IM Jr, Tangen CM, Crowley JJ, Lucia MS, Goodman PJ, Minasian LM, Ford LG, Parnes HL, Gaziano JM, Karp DD, Lieber MM, Walther PJ, Klotz L, Parsons JK, Chin JL, Darke AK, Lippman SM, Goodman GE, Meyskens FL Jr, Baker LH. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2011 Oct 12;306(14):1549-56. doi: 10.1001/jama.2011.1437. PubMed PMID: 21990298; PubMed Central PMCID: PMC4169010.

Omenn GS, Goodman G, Thornquist M, Grizzle J, Rosenstock L, Barnhart S, Balmes J, Cherniack MG, Cullen MR, Glass A, et al.The beta-carotene and retinol efficacy trial (CARET) for chemoprevention of lung cancer in high risk populations: smokers and asbestos-exposed workers. Cancer Res. 1994 Apr 1;54(7 Suppl):2038s-2043s. PubMed PMID: 8137335.

Druesne-Pecollo N, Latino-Martel P, Norat T, Barrandon E, Bertrais S, Galan P, Hercberg S. Beta-carotene supplementation and cancer risk: a systematic review and metaanalysis of randomized controlled trials. Int J Cancer. 2010 Jul 1;127(1):172-84. doi: 10.1002/ijc.25008. Review. PubMed PMID: 19876916.

Biswal BM, Sulaiman SA, Ismail HC, Zakaria H, Musa KI. Effect of Withania somnifera (Ashwagandha) on the development of chemotherapy-induced fatigue and quality of life in breast cancer patients. Integr Cancer Ther. 2013 Jul;12(4):312-22. doi: 10.1177/1534735412464551. Epub 2012 Nov 9. PubMed PMID: 23142798.


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