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How To Communicate to Patients About the Pitfalls


Most cancers dietitian Lisa Cianciotta generally finds herself sitting across from a client who abruptly fishes a bottle of antioxidant health supplements from their bag and suggests, “My friend instructed me this functions actually effectively,” or “I go through on the world wide web that this is meant to be actually good for cancer.” 

Though using an antioxidant tablet appears harmless, Cianciotta, a clinical dietitian who operates with cancer sufferers at NewYork-Presbyterian Medical center in New York City, is familiar with well that this well-liked nutritional health supplement can interfere with a patient’s radiation or chemotherapy.

But quite a few clients with cancer think these about-the-counter natural vitamins, minerals, or natural therapies will help them, and most use at minimum a person dietary dietary supplement along with their most cancers cure.

And that leaves Cianciotta with a fragile dialogue in advance of her. 

Drug-health supplement interactions are complex, often different by complement, cancer, and treatment method sort, and can do more damage than very good. Preferred nutritional health supplements may, for instance, cancel the outcomes of a cancer treatment method, earning it a lot less successful, or enhance severe side outcomes, these kinds of as liver toxicity. But in other scenarios, supplementation, such as vitamin D for patients who absence the vitamin, may possibly be effective, Cianciotta says. 

These drug-health supplement interactions can be hard to pinpoint, supplied that far more than two-thirds of doctors don’t know their sufferers are utilizing nutritional supplements.

This is what individuals want to know about the likely risks of supplement use throughout treatment, and how oncologists can address this thorny, typically badly understood topic with sufferers.

The Complex Drug-Dietary supplement Landscape

The record of nutritional supplements and how they can interact with unique treatment options and cancer styles is lengthy and nuanced. 

But specific nutritional supplements seem to affect cancer treatment plans regardless of other items and must be prevented. Any health supplement that strongly alters the body’s stages of the protein cytochromes P450 is a person illustration. This team of enzymes plays a key purpose in metabolizing medications, which include chemotherapy and immunotherapy brokers. 

Certain dietary supplements — most notably St. John’s wort extract — could minimize or increase the activity of cytochrome P450, which can then  affect the concentrations of anticancer medication in the blood, claims William Figg, PharmD, an affiliate director of the Middle for Cancer Study at the Countrywide Cancer Institute in Bethesda, MD. Reports exhibit, for instance, that this widespread organic nutritional supplement can boost the activity of cytochrome P450, ensuing in decrease stages of most cancers prescription drugs.

Exterior of drug metabolic process, individuals with hormone-related cancers, this kind of as breast and prostate cancers, really should steer obvious of dietary health supplements that can alter concentrations of testosterone or estrogen, Figg says. The evergreen shrub ashwagandha, for case in point, is promoted to reduce stress and tiredness, but can also maximize testosterone amounts — a prospective dilemma for people with prostate cancer acquiring androgen deprivation treatment, which lowers testosterone concentrations. 

Many oncologists counsel people towards using antioxidant-primarily based dietary supplements — significantly turmeric and environmentally friendly tea extract — while they have radiation therapy and specified chemotherapies. These therapies operate by generating an abundance of really reactive molecules referred to as totally free radicals in tumor cells, which boost stress inside of these cells, finally killing them off. Antioxidants, in concept, can neutralize this influence, says Skyler Johnson, MD, a radiation oncologist at the Huntsman Cancer Institute at the University of Utah, Salt Lake Metropolis. Some scientific tests recommend that antioxidant supplements might lessen the outcomes of radiation and chemotherapy, despite the fact that the proof is blended.

Some nutritional health supplements, together with significant-dose eco-friendly tea extract and vitamin A, can result in kidney or liver toxicity, and “several most cancers individuals presently have compromised kidney or liver functionality,” states Jun J. Mao, MD, main of integrative medicine at Memorial Sloan Kettering Most cancers Middle in New York Metropolis. Even herbs that do not interfere with how effectively a cancer drug functions, these types of as stevia, can raise treatment-relevant aspect results, such as nausea and vomiting. 

An additional prospective issue with nutritional supplements: It truly is nearly not possible to know just what is actually in them. For occasion, just past year, the Food and drug administration sent practically 50 warning letters to providers advertising dietary dietary supplements. The challenge is that federal restrictions governing manufacturing are fewer demanding for supplements than for medicines. As a end result, some supplements include substances not shown on the label. 

One historic example was the dietary supplement Personal computer-SPES, a combine of eight herbs, marketed to males with prostate cancer. The supplement was recalled in 2002 immediately after sure batches had been uncovered to consist of traces of prescription drugs, such as diethylstilbestrol, ethinyl estradiol, warfarin, and alprazolam.

To even more complicate issues, some nutritional health supplements can be beneficial. Most people with most cancers “are malnourished and lacking out on nutrients they could be receiving from food,” claims Cianciotta.

Individuals are tested routinely for vitamin deficiencies and obtain supplements as necessary, she states. Vitamin D and folic acid are two of the most frequent deficiencies in this patient population. Vitamin D supplementation can enhance outcomes in patients who have acquired a stem cell transplant by aiding engraftment and rebuilding the immune system, whilst folic acid supplementation can aid to raise very low red blood cell counts and hemoglobin stages. 

Even though she almost never sees vitamin toxicity, Cianciotta stresses that much more is not always improved and nutritional supplement use, even when it seems risk-free or warranted owing to a deficiency, ought to be taken beneath supervision, and monitored thoroughly by the patient’s treatment team. 

Bringing Complement Use Into the Light

Far too generally, suppliers are unaware of a patient’s complement use. 

A core purpose: Dietary supplements are usually touted as normal, which a lot of people equate with protection, says Samantha Heller, a senior medical nutritionist at New York College Langone Health and fitness in New York Town. 

That means sufferers may not know a complement can act like a drug and interfere with their most cancers remedy, and so may perhaps not see the value of telling their health care provider.

Continue to, the assure of herbs, vitamins, and minerals can be alluring, and there are quite a few explanations people come to a decision to partake. A single important enchantment: Dietary health supplements can aid some individuals sense empowered.

“Most cancers is a sickness that will take absent a large amount of regulate from the specific. Taking health supplements or herbs is a way to regain some feeling of control,” claims Mao. 

The phenomenon can also be cultural, he says. Some folks expand up taking herbs and nutritional supplements to remain balanced or combat well being woes.

Strain or guidance from loved ones or pals who may perhaps feel they are serving to a beloved a person with their dietary suggestions could enjoy a role as well. Friends and family “can’t prescribe chemo, but they can buy herbs and health supplements,” Mao says. 

Patients searching for greater command more than their overall health or who experience large levels of stress and anxiety might be extra most likely to get strategies from mates and family members or far more possible to consider bogus or deceptive claims about the efficacy or security of dietary supplements, describes  medical oncologist William Dahut, MD, chief scientific officer for the American Most cancers Culture. 

Furthermore, social media usually amplifies and normalizes this misinformation, notes Johnson. In a 2021 analyze published in the Journal of the Countrywide Most cancers Institute, he and colleagues located that one-third of the most well known posts on cancer remedy posted to social media in 2018 and 2019 contained fake, inaccurate, or deceptive information that was usually harmful. 

Some of the untrue statements centered on unproven, most likely unsafe natural solutions, according to Johnson. These provided “lung most cancers can be treated with hashish oil” and “golden-berries remedy and reduce most cancers.” 

Specified exaggerated promises of “cures,” some individuals may perhaps preserve their dietary supplement use below the radar out of anxiety they will be judged or criticized. 

“Clinicians ought to stay away from making sufferers come to feel judged or telling individuals not to go on-line to do their own study,” Johnson states.                         

Guiding individuals, as an alternative, to exact resources of on the web facts may well be a person way to aid clients really feel empowered, he states. Cancer.gov and the Memorial Sloan Kettering Most cancers Center’s About Herbs databases provide available and precise details on dietary dietary supplements and cancer treatment for both of those overall health care industry experts and patients, he notes. 

If a specific supplement is not secure during remedy, companies really should be capable to explain why, states  Cianciotta. In a latest review, 80% of well being care providers surveyed thought that interactions involving herbals and remedies could be problematic, but only 15% could explain why. 

“Remaining capable to explain why we are discouraging a specific nutritional supplement proper now tends to be a great deal far better acquired than just telling a affected individual not to consider a little something, because it is poor,” she states. 

A further vital is listening intently to individuals to realize why they might be using a individual supplement. Does the patient come to feel out of handle? Is nausea a difficulty? 

“Making it possible for clients to notify you why they are using a specific dietary supplement will typically reveal unmet requirements or psychosocial issues,” Mao states. This data can allow companies to recommend an evidence-primarily based alternate, these kinds of as mindfulness meditation or acupuncture to regulate pressure.

And if a patient has acquired a nutritional complement from properly-that means relatives and good friends?

“Simply just telling a patient that a presented dietary supplement is useless or harmful could develop relatives pressure,” suggests  Mao. 

Rather, he recommends reframing the concern. 

“We want to have a far better comprehension of how people are tolerating chemo or immunotherapy right before throwing other items on leading of it. Enable them know that now may possibly just not be the correct time to increase a dietary supplement to the combine,” Mao states. 

The bottom line: “Individuals want to play an active role in their have treatment, and we want to support them do that in a safe and sound way,” he suggests. 


Lisa Cianciotta, clinical dietitian, NewYork-Presbyterian Clinic, New York Metropolis. 

William Figg, PharmD, affiliate director, Middle for Most cancers Study, Nationwide Cancer Institute, Bethesda, MD. 

Skyler Johnson, MD, radiation oncologist, Huntsman Most cancers Institute, University of Utah, Salt Lake Metropolis. 

Jun J. Mao, MD, main of integrative drugs, Memorial Sloan Kettering Most cancers Center, New York Town.

Samantha Heller, senior clinical nutritionist, New York College Langone Overall health, New York Metropolis. 

William Dahut, MD, main scientific officer, American Cancer Culture.

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Informed Consent for Psychotherapy, Nutritional or Medical Counselling


The purpose of this form is to provide you with information about psychotherapy, nutritional counseling, and medical counseling and to obtain your consent to participate in these treatments. These services involve professional relationships between you and your therapist, nutritionist, and medical doctor to address your emotional, nutritional, and medical needs. This form is intended to give you information that will help you make an informed decision about whether or not to engage in these treatments.

Therapist Qualifications:

Your therapist is a licensed mental health professional who has completed an advanced degree in psychology or a related field and has been trained to provide psychotherapy. Your nutritionist and medical doctor are also licensed professionals with expertise in their respective fields. They are committed to providing you with the highest quality of care possible.

Goals and Objectives:

The goals of psychotherapy are to help you overcome emotional or psychological difficulties that are causing distress in your life. Nutritional counseling aims to support your dietary needs, promote healthy eating habits, and address specific nutritional concerns. Medical counseling focuses on providing you with medical guidance, treatment options, and managing your overall health.

Treatment Methods:

Your therapist will use a variety of treatment methods in psychotherapy, including talk therapy, cognitive-behavioral therapy, psychodynamic therapy, mindfulness techniques, or other approaches. Your nutritionist will provide nutritional education, create personalized meal plans, and offer guidance on making healthy food choices. Your medical doctor will assess your medical history, perform necessary examinations, refer you for lab tests and recommend appropriate medical treatments.

Risks and Benefits:

Psychotherapy, nutritional counseling, and medical counseling can be beneficial in various ways, such as improving your emotional well-being, enhancing your nutrition, and promoting better physical health. However, there are also some risks associated with these treatments. Risks may include experiencing uncomfortable emotions during therapy, potential changes in your relationships, and the possibility of addressing challenging nutritional or medical issues.


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The length and frequency of therapy sessions, nutritional counseling sessions, and medical counseling appointments will depend on your individual needs and goals. Typically, therapy and counseling sessions are scheduled weekly or biweekly and last for approximately 50 minutes. While nutritional counselling appointments last up 45 minutes and medical counseling appointments last up to 30 minutes and their frequency may vary.

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