Cancer-related fatigue or cachexia is a persistent, distressing condition that is seen in many cancer patients and survivors even years after treatment. Different studies show that right nutritional interventions including use of zinc supplements, Vitamin C, omega-3 fatty acids, guarana extracts, tualang honey or processed honey and royal jelly may contribute significantly in reducing fatigue or cachexia in specific cancer types and treatments. Vitamin D deficiency in cancer patients reporting fatigue also suggest that Vitamin D supplementation may help in reducing cachexia.
Persistent fatigue or extreme weakness that is often observed in cancer patients is referred to as ‘Cancer-Related Fatigue’ or ‘Cachexia’. It is different from the normal weakness that usually goes off after taking proper food and rest. Cachexia or fatigue may be caused by the cancer disease or the side effects of the therapies used for the treatment of cancer. The physical, emotional and cognitive weakness observed in patients due to cancer or cancer treatments or both are distressing and often interferes with the patients’ normal functioning.
Cancer-related fatigue or cachexia has always been a problem seen in most of the cancer patients during and after the cancer treatment ending up in severe weight loss. The extent of fatigue and the symptoms associated with cancer-related fatigue may vary based on different factors including:
- type of cancer
- cancer treatment
- nutrition and diet
- pre-treatment health of the patient
Taking the right foods and supplements as part of the cancer nutrition is hence important to tackle cachexia. In this blog, we will provide examples of different studies conducted by researchers across the world to evaluate the impact of nutritional intervention including different dietary supplements/foods for reducing fatigue or cachexia in cancer patients.
A clinical study conducted by the researchers in Brazil assessed data from 24 patients on chemotherapy for colorectal adenocarcinoma in a tertiary care public hospital, to evaluate the effects of oral zinc supplementation on cancer related fatigue or cachexia. The patients received oral zinc capsules 35mg twice daily for 16 weeks immediately post the surgery until the fourth chemotherapy cycle. (Sofia Miranda de Figueiredo Ribeiro et al, Einstein (Sao Paulo)., Jan-Mar 2017)
The study found that patients who didn’t receive zinc capsules reported worsening of quality of life and increased fatigue between the first and fourth cycles of chemotherapy. However, those cancer patients who were administered with Zinc capsules did not report any quality of life or fatigue issues. Based on the study, the researchers concluded that zinc supplementation may be beneficial in preventing fatigue or cachexia and maintaining the quality of life of patients with colorectal cancer on chemotherapy.
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Vitamin C use for Brain Cancer Treatment Associated Fatigue
In a clinical study published in 2019, the researchers evaluated the safety and impact of using ascorbate (Vitamin C) infusion along with standard of care treatments in brain cancer/glioblastoma patients. The study analyzed data from 11 brain cancer patients and also assessed treatment side-effects of fatigue, nausea and hematological adverse events associated with standard of care treatment. (Allen BG et al, Clin Cancer Res., 2019)
The researchers found that high dose intravenous Vitamin C/ascorbate infusions improved the overall survival of glioblastoma patients from 12.7 months to 23 months and also reduced the severe side-effects of fatigue, nausea and hematological adverse events associated with the brain cancer treatments. The only negative effects associated with Vitamin C infusion that the patients experienced were dry mouth and chills.
Impact of Vitamin C on Quality of Life of Cancer Patients
In a multi-center observational study, the researchers evaluated the effects of high dose intravenous Vitamin C infusion on the quality of life of cancer patients. For this study, the researchers examined data of newly diagnosed cancer patients who received high dose intravenous Vitamin C as an adjuvant therapy. Data from 60 cancer patients were obtained from the participating institutions in Japan between June and December 2010. The assessment on quality of life was carried out using questionnaire-based data obtained before, and at 2 and 4 weeks post high dose intravenous Vitamin C therapy.
The study showed that a high dose intravenous Vitamin C administration may significantly improve the global health and quality of life of the cancer patients. The study also found improvement in physical, emotional, cognitive, and social functioning at 4 weeks of Vitamin C administration. The results showed significant reduction in symptoms including fatigue, pain, insomnia and constipation. (Hidenori Takahashi et al, Personalized Medicine Universe, 2012).
Vitamin C administration in Breast Cancer Patients
In a multicentre cohort study in Germany, data from 125 Stage IIa and IIIb breast cancer patients were evaluated to study the impact of Vitamin C administration on quality of life of breast cancer patients. Out of these, 53 patients were administered with intravenous vitamin C along with their standard cancer therapy for at least 4 weeks and 72 patients were not given Vitamin C with their cancer therapy. (Claudia Vollbracht et al, In Vivo., Nov-Dec 2011)
The study found that compared to the patients who didn’t receive Vitamin C, there were significant reduction of complaints induced by the disease and chemotherapy/radiotherapy including fatigue/cachexia, nausea, loss of appetite, depression, sleep disorders, dizziness and haemorrhagic diathesis in those patients who received the intravenous Vitamin C.
Findings in Cancer Patients based on the European Palliative Care Research Centre Cachexia Project
A systematic review was done by the researchers of University Hospital of Bonn in Germany, University of Diponegoro/Kariadi Hospital in Indonesia and Norwegian University of Science and Technology in Norway, to evaluate the impact of vitamins, minerals, proteins, and other supplements on cachexia in cancer. A systematic literature research on CENTRAL, MEDLINE, PsycINFO, ClinicalTrials.gov and a selection of cancer journals until 15 April 2016 yielded 4214 publications, out of which 21 were included in the study. (Mochamat et al, J Cachexia Sarcopenia Muscle., 2017)
The study found that vitamin C supplementation led to an improvement of various quality of life aspects in a sample with a variety of cancer diagnoses.
Impact of β-hydroxy-β-methylbutyrate (HMB), Arginine and Glutamine combination on Lean Body Mass in Advanced Solid Tumour Patients
In the same study mentioned above which was under the European Palliative Care Research Centre Cachexia Project, the researchers also found that a combination therapy of β-hydroxy-β-methylbutyrate (HMB), arginine, and glutamine showed an increase in lean body mass after 4 weeks in a study of advanced solid tumour patients. However, they also found that this same combination had no benefit on lean body mass in a large sample of advanced lung and other cancer patients after 8 weeks.(Mochamat et al, J Cachexia Sarcopenia Muscle., 2017)
European Palliative Care Research Centre Cachexia Project
The European Palliative Care Research Centre Cachexia Project also found that vitamin D supplementation has the potential to improve muscle weakness in patients with prostate cancer. (Mochamat et al, J Cachexia Sarcopenia Muscle., 2017)
Additionally, the same study also found that L-carnitine may lead to an increase in body mass and an increase in the overall survival in advanced pancreatic cancer patients.
Different studies have been carried out to understand the relationship between Vitamin D deficiency and fatigue or cachexia in cancer patients.
In a study published in 2015, the researchers of Spain evaluated the association of Vitamin D deficiency with quality of life issues, fatigue / cachexia and physical functioning in locally advanced or metastatic or inoperable solid cancer patients under palliative care. Among 30 patients with advanced solid cancer who were under palliative care, 90% had Vitamin D deficiency. The analysis of the results of this study found that Vitamin D deficiency may be associated with increased cancer related fatigue/cachexia, suggesting that vitamin D supplementation may decrease the incidence of fatigue and improve physical and functional well-being of advanced solid cancer patients. (Montserrat Martínez-Alonso et al, Palliat Med., 2016)
However, as this is suggested only based on the link between Vitamin D deficiency and cancer related fatigue / cachexia, confirmation of this interpretation in a controlled study is required.
Omega-3 Fatty Acid Supplementation in Patients with Bile Duct or Pancreatic Cancer Undergoing Chemotherapy
In a study conducted by the researchers of the Jikei University School of Medicine, Tokyo in Japan, an enteral (intake of food via the gastrointestinal (GI) tract) nutrient formulated with omega-3 fatty acids, was given to 27 pancreatic and bile duct cancer patients. Information on the skeletal muscle mass and blood test were obtained before giving the omega-3-fatty acid supplement to the patients and at 4 and 8 weeks after they started taking the supplements. (Kyohei Abe et al, Anticancer Res., 2018)
The study found that in all 27 patients, the skeletal muscle mass was significantly increased at both 4 and 8 weeks after the initiation of omega-3-fatty acids as compared to the skeletal muscle mass before administration of omega-3-fatty acids. The findings of the study suggested that omega-3 fatty acid supplementation in patients with unresectable pancreatic and bile duct cancer may be beneficial in improving cancer cachexia.
n-3-fatty acid use in Pancreatic Cancer Patients for Cachexia
Another clinical trial was done by the researchers in Germany to compare low dose marine phospholipids and fish oil formulations, which had the same amount and composition of n-3 fatty acid, on weight and appetite stabilization, quality of life and plasma fatty acid-profiles in patients suffering from pancreatic cancer. The study included 60 pancreatic cancer patients who were either administered with fish oil or marine phospholipids. (Kristin Werner et al, Lipids Health Dis. 2017)
The study found that the intervention with low dose n-3-fatty acids, either as fish oil or MPL supplementation, resulted in promising weight and appetite stabilization in pancreatic cancer patients. Study also found that marine phospholipids capsules were slightly better tolerated with fewer side effects, when compared to fish oil supplementation.
Omega-3-Fatty Acid Supplementation in Gastrointestinal and Lung Cancer Patients
In a meta-analysis done by the researchers of Portugal, they assessed the effect of n-3 polyunsaturated fatty acids on nutritional features and quality of life in cancer cachexia. They obtained clinical trial studies published between 2000 and 2015 through literature search in PubMed and B-on databases. 7 studies were used for the analysis. (Daryna Sergiyivna Lavriv et al, Clin Nutr ESPEN., 2018)
The study found that the weight of patients with gastrointestinal cancer increased significantly with the use of n-3 polyunsaturated fatty acids, however, patients with lung cancer showed no significant response.
Guarana (Paullinia cupana) Use in Patients with Advanced Cancer
Researchers from ABC Foundation Medical School in Brazil evaluated the impact of guarana extracts on decreased appetite and weight loss in advanced cancer patients. The patients were given 50 mg of the crude dry extract of guarana twice a day for 4 weeks. (Cláudia G Latorre Palma et al, J Diet Suppl., 2016)
Out of 18 patients who completed the protocol, two patients had weight gain above 5% from their baseline and six patients had at least a 3-point improvement in the visual appetite scale when administered with guarana extracts. They found that there was a significant decrease in the lack of appetite and in sleepiness for unusually longer periods.
The study observed weight stabilization and increased appetite when supplemented with guarana extracts suggesting benefits on cancer related fatigue/cachexia. The researchers recommended further studies of guarana in this cancer patient population.
In a clinical study including 40 participants, aged between 18 and 65 years, with head and neck cancer who completed chemotherapy and/or radiotherapy in Hospital USM, Kelantan Malaysia or Hospital Taiping, the researchers evaluated the impact of supplementing Tualang honey or Vitamin C on fatigue and quality of life. (Viji Ramasamy, Gulf J Oncolog., 2019)
The study found that after four and eight weeks of treatment with Tualang honey or Vitamin C, the fatigue level for the patients treated with Tualang honey was significantly better than those who were treated with Vitamin C. The researchers also found significant improvement on quality of life in patients treated with Tualang honey at week 8. However, there they didn’t find any significant difference/improvements in the white cell count and C-reactive protein level between the two groups of patients.
In a study published in 2016, researchers from different universities of medical Sciences in Iran evaluated the effectiveness of processed honey and royal jelly on the symptoms of fatigue or cachexia in cancer patients who are undergoing hormone therapy, chemotherapy, chemo-radiation or radiotherapy. The study included 52 participants from the patients who visited the oncology clinic of Shohada-e-Tajrish hospital in Tehran (Iran) between May 2013 and August 2014. The mean age of these patients were approximately 54 years. Out of these, 26 patients received processed honey and royal jelly, while the rest received pure honey, twice daily for 4 weeks. (Mohammad Esmaeil Taghavi et al, Electron Physician., 2016)
The study found that the use of processed honey and royal jelly significantly reduced fatigue or cachexia in cancer patients as compared to the use of pure honey.
Most of the studies mentioned above indicate the importance of taking the right foods and supplements for specific cancer types to reduce fatigue and cachexia in cancer patients. Taking zinc supplements, Vitamin C, omega-3 fatty acids, guarana extracts, tualang honey, processed honey and royal jelly may contribute significantly in reducing fatigue or cachexia in specific cancer types and treatments. Vitamin D deficiency in cancer patients reporting fatigue may also indicate that Vitamin D supplementation may help in reducing cachexia.
Nutritional intervention plays a major role in reducing fatigue or cachexia in cancer patients and survivors. Cancer patients should hence consult their oncologist and nutritionist to design a proper nutrition plan personalized to their cancer and treatment to improve their quality of life.
“What should I eat?” is the most frequently asked question to cancer dieticians and physicians. The right answer depends upon cancer type, underlying genomics, current treatments, any allergies, lifestyle information, and factors like BMI.
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Cancer patients often have to deal with different chemotherapy side effects which affect their quality of life and look out for alternative therapies for cancer.Taking the right nutrition and supplements based on scientific considerations (avoiding guesswork and random selection) is the best natural remedy for cancer and treatment related side-effects.