Deutsche Zeitschrift für Onkologie 2022; 54(02): 52-59
DOI: 10.1055/a-1824-8549
Forschung

Ausgewählte Mikronährstoffe in der onkologischen Intervention – ein Update

Selected Micronutrients in Oncological Intervention – an Update
Uwe Gröber
1   Akademie für Mikronährstoffmedizin, Essen
2   Prävention und Integrative Onkologie (PRIO) eine Arbeitsgruppe der Deutschen Krebsgesellschaft (DKG)
,
Peter Holzhauer
1   Akademie für Mikronährstoffmedizin, Essen
2   Prävention und Integrative Onkologie (PRIO) eine Arbeitsgruppe der Deutschen Krebsgesellschaft (DKG)
3   Onkologisches Kompetenzzentrum, Bad Trissl
,
Klaus Kisters
1   Akademie für Mikronährstoffmedizin, Essen
4   Medizinische Klinik I, St. Anna Hospital, Herne
› Author Affiliations

Zusammenfassung

Je nach Tumorentität und Geschlecht supplementieren bis zu 90% der Krebspatienten antioxidative und immunrelevante Mikronährstoffe, häufig ohne das Wissen des behandelnden Arztes. Die Gründe für die Inanspruchnahme komplementärmedizinischer Therapien sind vielfältig, sie sind meist in einem patienteneignen, salutogenetisch orientierten Konzept zu Gesundung, Heilung und Bewältigung der Krebserkrankung sowie zur onkologischen Therapie zu finden. Aus Sicht der Patientinnen sind Aspekte mit hoher Priorität die Wahrung der Autonomie, die Verwirklichung einer Selbstbeteiligung und die Optimierung der Resilienz in einer kritischen, oft bedrohlichen Lebensphase, die es zu bewältigten gilt. Komplementäre Maßnahmen werden sowohl in der Akuttherapie als auch in der Nachsorge eingesetzt. Die Sicherheit und Kompatibilität der vielfältigen komplementären Maßnahmen mit der konventionellen Tumortherapie sind von größter Bedeutung. Onkologisch tätige Ärzte sollten daher über die aktuelle Bedeutung von Vitamin D, Selen, Omega-3-Fettsäuren und anderen (Mikro)nährstoffen sowie potenziellen Interaktionen mit der Krebstherapie informiert sein.

Abstract

Depending on the tumor entity and gender, up to 90% of cancer patients supplement with antioxidant and immune-relevant micronutrients, often without knowledge of the attending physician. There are many reasons for taking advantage of complementary medical therapies, they can usually be found in a patient-specific, salutogenetic-oriented concept for recovery, healing and overcoming the cancer as well as for oncological therapy. From the patient’s point of view, aspects with high priority are the preservation of autonomy, the realization of a personal contribution and the optimization of resilience in a critical, often threatening phase of life that has to be mastered. Complementary measures are used both in acute therapy and in aftercare. The safety and compatibility of the various complementary measures with conventional tumor therapy are of the utmost importance. Oncological doctors should therefore be informed about the current importance of vitamin D, selenium, omega-3 fatty acids and other (micro)nutrients as well as potential interactions with cancer therapy.



Publication History

Article published online:
29 June 2022

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  • Literatur

  • 1 Global Burden of Disease 2019 Cancer Collaboration. Kocarnik JM, Compton K, Dean FE. et al. Cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life years for 29 cancer groups from 2010 to 2019: A systematic analysis for the Global Burden of Disease Study 2019. JAMA Oncol 2022; 8: 420-444 DOI: 10.1001/jamaoncol.2021.6987.
  • 2 Stoffel EM, Murphy CC. Epidemiology and mechanisms of the increasing incidence of colon and rectal cancers in young adults. Gastoenterology 2020; 158: 431-353
  • 3 Kabirib N, Khodayari-Zarnag R, Khoshbaten M. et al. Gastrointestinal cancer prevention policies: A qualitative systematic review and meta-synthesis. Int J Prev Med 2022; 13: 8
  • 4 Gröber U, Holzhauer P, Kisters K. et al. Micronutrients in oncological intervention. Nutrients 2016; 8 pii: E163 DOI: 10.3390/nu8030163.
  • 5 Wode K, Henriksson R, Sharp L. et al. Cancer patients’ use of complementary and alternative medicine in Sweden: a cross-sectional study. BMC Complement Altern Med 2019; 19: 62
  • 6 Shaver AL, Tufuor T, Nie J. et al. Cost-effectiveness of nutrient supplementation in cancer survivors. Cancers (Basel) 2021; 13: 6276
  • 7 Holzhauer P, Gröber U, Aivazova-Fuchs V, Friese K. Sinnvolle komplementär-medizinische Maßnahmen in der gynäkologischen Onkologie. Der Gynäkologe 2016; 49: 805-817
  • 8 Mukherjee MS, Sukumaran S, Delaney CL. et al. Validation of a short food frequency questionnaire to measure dietary intake of a selection of micronutrients in oncology patients undergoing systemic therapy. Nutrients 2021; 13: 4557
  • 9 Alam W, Ullah H, Santarcangelo C. et al. Micronutrient food supplements in patients with gastro-intestinal and hepatic cancers. Int J Mol Sci 2021; 22: 8014
  • 10 Newell M, Mazurak V, Postovit LM. et al. N-3 Long-Chain Polyunsaturated Fatty Acids, Eicosapentaenoic and Docosahexaenoic Acid, and the Role of Supplementation during Cancer Treatment: A Scoping Review of Current Clinical Evidence. Cancers 2021; 13: 1206
  • 11 Niedermaier T, Gredner T, Kuznia S. et al. Vitamin D supplementation to the older adult population in Germany has the cost-saving potential of preventing almost 30,000 cancer deaths per year. Mol Oncol 2021; 15: 1986-1994
  • 12 Zhang Y, Fang F, Tang J. et al. Association between vitamin D supplementation and mortality: systematic review and meta-analysis. BMJ 2019; 366: l4673
  • 13 Demircan K, Bengtsson Y, Sun Q. et al. Serum selenium, selenoprotein P and glutathione peroxidase 3 as predictors of mortality and recurrence following breast cancer diagnosis: A multicentre cohort study. Redox Biol 2021; 47: 102145
  • 14 Tong H, Isenring E, Yates P. The prevalence of nutrition impact symptoms and their relationship to quality of life and clinical outcomes in medical oncology patients. Support Care Cancer 2009; 17: 83-90
  • 15 Bozzetti F. SCRINIO Working Group. Screening the nutritional status in oncology: a preliminary report on 1,000 outpatients. Support Care Cancer 2009; 17: 279-284
  • 16 Khorasanchi A, Nemani S, Pandey S. et al. Managing nutrition impact symptoms in cancer cachexia: A case series and mini review. Front Nutr 2022; 9: 831934
  • 17 Nakajima N. Differential diagnosis of cachexia and refractory cachexia and the impact of appropriate nutritional intervention for cachexia on survival in terminal cancer patients. Nutrients 2021; 13: 915
  • 18 Ströhle A, Zänker K, Hahn A. Nutrition in oncology: the case of micronutrients (review). Oncol Rep 2010; 24: 815-828
  • 19 Rock CL, Doyle C, Demark-Wahnefried W. et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 2012; 62: 243-274
  • 20 Liu J, Bi K, Yang R. et al. Role of DNA damage and repair in radiation cancer therapy: a current update and a look to the future. Int J Radiat Biol 2020; 96: 1329-1338
  • 21 Arends J, Bachmann P, Baracos V. et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr 2017; 36: 11-48
  • 22 Gröber U, Kisters K, Adamietz IA. Vitamin D in oncology: Update 2015. Med Monatsschr Pharm 2015; 38: 512-516
  • 23 Churilla TM, Brereton HD, Klem M, Peters CA. Vitamin D deficiency is widespread in cancer patients and correlates with advanced stage disease: a community oncology experience. Nutr Cancer 2012; 64: 521-525
  • 24 Kim WW, Chung SH, Ban EJ. et al. Is preoperative vitamin D deficiency a risk factor for postoperative symptomatic hypocalcemia in thyroid cancer patients undergoing total thyroidectomy plus central compartment neck dissection?. Thyroid 2015; 25: 911-918
  • 25 Haykal T, Samji V, Zayed Y. et al. The role of vitamin D supplementation for primary prevention of cancer: meta-analysis of randomized controlled trials. J Community Hosp Intern Med Perspect 2019; 9: 480-488
  • 26 Keum N, Lee DH, Greenwood DC. et al. Vitamin D supplementation and total cancer incidence and mortality: a meta-analysis of randomized controlled trials. Ann Oncol 2019; 30: 733-743
  • 27 Zhang Y, Fang F, Tang J. et al. Association between vitamin D supplementation and mortality: systematic review and meta-analysis. BMJ 2019; 366: l4673
  • 28 Niedermaier T, Gredner T, Kuznia S. et al. Vitamin D supplementation to the older adult population in Germany has the cost-saving potential of preventing almost 30.000 cancer deaths per year. Mol Oncol 2021; 15: 1986-1994
  • 29 Gröber U, Kisters K. Influence of drugs on vitamin D and calcium metabolism. Dermatoendocrinol 2012; 4: 158-166
  • 30 Gröber U. Common drugs as vitamin D disruptors. J Transl Sci 2020; 6: 2-4 DOI: 10.15761/JTS.1000378.
  • 31 Bittenbring JT, Neumann F, Altmann B. et al. Vitamin D deficiency impairs rituximab-mediated cellular cytotoxicity (RMCC) and outcome of patients with diffuse large B-cell lymphoma treated with but not without rituximab. J Clin Oncol 2014; 32: 3242-3248
  • 32 Zeichner SB, Koru-Sengui T, Shah N. Improved clinical outcomes associated with vitamin D supplementation during adjuvant chemotherapy in patients with HER2+nonmetastatic breast cancer. Clin Breast Cancer 2015; 15: e1-e11
  • 33 Hohaus S, Tisi MC, Bellesi S. Vitamin D deficiency and supplementation in patients with aggressive B-cell lymphomas treated with immunochemotherapy. Cancer Med 2018; 7: 270-281
  • 34 Mortara L, Gariboldi MB, Bosi A. Vitamin D deficiency has a negative impact on cetuximab-mediated cellular cytotoxicity against human colon carcinoma cells. Target Oncol 2018; 13: 657-665
  • 35 Zheng JS, Hu XJ, Zhao YM. et al. Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort studies. BMJ 2013; 346: f3706
  • 36 Yang B, Ren XL, Fu YQ. et al. Ratio of n-3/n-6 PUFAs and risk of breast cancer: a meta-analysis of 274135 adult females from 11 independent prospective studies. BMC Cancer 2014; 14: 105
  • 37 Liu J, Ma DW. The role of n-3 polyunsaturated fatty acids in the prevention and treatment of breast cancer. Nutrients 2014; 6: 5184-5223
  • 38 Newell M, Mazurak V, Postovit LM. et al. N-3 long-chain polyunsaturated fatty acids, eicosapentaenoic and docosahexaenoic acid, and the role of supplementation during cancer treatment: A scoping review of current clinical evidence. Cancers 2021; 13: 1206
  • 39 Lee KH, Seong HJ, Kim G. Consumption of fish and ω-3 fatty acids and cancer risk: An umbrella review of meta-analyses of observational studies. Adv Nutr 2020; 11: 1134-1149
  • 40 Zhang X, Chen H, Liu Y. et al. Prevention of oxaliplatin-related neurotoxicity by ω-3 PUFAs: A double-blind randomized study of patients receiving oxaliplatin combined with capecitabine for colon cancer. Medicine (Baltimore) 2020; 99: e23564
  • 41 Ghoreishi Z, Esfahani A, Diazaveri A. et al. Omega-3 fatty acids are protective against paclitaxel-induced peripheral neuropathy: a randomized double-blind placebo controlled trial. BMC Cancer 2012; 12: 355
  • 42 Shen S, Unger JM, Crew KD. et al. Omega-3 fatty acid use for obese breast cancer patients with aromatase inhibitor-related arthralgia (SWOG S0927). Breast Cancer Res Treat 2018; 172: 603-610 DOI: 10.1007/s10549-018-4946-0.
  • 43 Rayman M. Selenium and human health. Lancet 2012; 379: 1256-1268
  • 44 Wallenberg M, Misra S, Wasik AM, Marzano C, Björnstedt M, Gandin V, Fernandes AP. Selenium induces a multi-targeted cell death process in addition to ROS formation. J Cell Mol Med 2014; 18: 671-684
  • 45 Wallenberg M, Misra S, Björnstedt M. Selenium cytotoxicity in cancer. Basic Clin Pharmacol Toxicol 2014; 114: 377-386
  • 46 Demircan K, Bengtsson Y, Sun Q. et al. Serum selenium, selenoprotein P and glutathione peroxidase 3 as predictors of mortality and recurrence following breast cancer diagnosis: A multicentre cohort study. Redox Biol 2021; 47: 102145
  • 47 Puspitasari IM, Abdulah R, Yamazaki C. et al. Updates on clinical studies of selenium supplementation in radiotherapy. Radiat Oncol 2014; 9: 125 DOI: 10.1186/1748-717X-9-125.
  • 48 Holzhauer P. Kann durch die prophylaktische Gabe von Natriumselenit die Inzidenz und der Schweregrad der durch Vinorelbin induzierten lokalen Phlebitis beeinflusst werden?. Deutsche Zeitschrift für Onkologie 2002; 34: 14-16 DOI: 10.1055/s-2002-31511.
  • 49 Ma C, Hoffmann PR. Selenoproteins as regulators of T cell proliferation, differentiation, and metabolism. Semin Cell Dev Biol 2021; 115: 54-61 DOI: 10.1016/j.semcdb.2020.11.006.
  • 50 Gustafsson L. Enhancement of anti-tumor effects of checkpoint inhibitors by selenium in melanoma [Abstract]. 2010 Mar 7. Lund University
  • 51 Roy M. et al. Supplementation with selenium and human immune cell functions. I. Effect on lymphocyte proliferation and interleukin 2 receptor expression. Biol Trace Elem Res 1994; 41: 103-114 DOI: 10.1007/BF02917221.
  • 52 Kim SJ, Choi MC, Park JM, Chung AS. Antitumor effects of selenium. Int J Mol Sci 2021; 22: 11844 DOI: 10.3390/ijms222111844.
  • 53 Clark LC, Combs GF, Turnbull BW. et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial. Nutritional Prevention of Cancer Study Group. JAMA 1996; 276: 1957-1963 Erratum in: JAMA 1997; 277: 1520