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Non-herbal nutritional supplements for symptom relief in adjuvant breast cancer: creating a doctor–patient dialogue
  1. Noah Samuels1,
  2. Elad Schiff2,3 and
  3. Eran Ben-Arye4,5
  1. 1Tal Center for Integrative Medicine, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
  2. 2Department of Internal Medicine, Bnai-Zion Hospital, Haifa, Israel
  3. 3Department for Complementary/Integrative Medicine, Law and Ethics, The International Center for Health, Haifa University, Israel
  4. 4Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel
  5. 5Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and Clalit Health Services, Haifa and Western Galilee District, Israel
  1. Correspondence to Dr Noah Samuels, Tal Center for Integrative Medicine, Institute of Oncology, Sheba Medical Center, Tel Hashomer 52621, Israel; noah.samuels{at}


Patients with breast cancer frequently turn to complementary medical therapies, including non-herbal nutritional supplements (NHNS). Many of these products have been shown to potentially reduce the incidence and severity of adjuvant treatment-related symptoms. We searched the literature for potential benefits of NHNS products, addressing issues related to their safety. An evidence-based approach for promoting a dialogue between physicians and their patients interested in NHNS for adjuvant treatment-related toxicities is presented. Taxane agents, such as paclitaxel (Taxol) are frequently complicated by peripheral sensory neuropathy. Findings from several studies suggest that supplementation with vitamin E, glutamine (GLN) and acetyl-L-carnithine may reduce the incidence and severity of paclitaxel-induced neuropathy. GLN 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. An open and non-judgmental dialogue on NHNS use between physicians and patients with breast cancer is needed. This, while respecting patients’ needs and, at the same time, addressing issues of efficacy and safety. These goals can be reached through the referral of patients to an integrative medicine consultant.

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