• Eran Ben-Arye, Aaron Polliack, Elad Schiff, Tamar Tadmor, and Noah Samuels.
• Integrative Oncology Program, The Oncology Service, Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Haifa, Israel; Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Electronic address: eranben@netvision.net.il.
• J Pain Symptom Manage. 2013 Dec 1;46(6):887-96.

ContextMany cancer patients are using non-herbal nutritional supplements (NHNS), often without informing their oncologists.ObjectivesTo review the literature and summarize the beneficial effects and safety of NHNS in the prevention and reduction of treatment-related symptoms.MethodsDatabases were searched for randomized, controlled clinical trials (Jadad score ≥ 2) using AltHealthWatch, Cochrane Database of Systematic Reviews, Embase, MEDLINE, Memorial Sloan-Kettering Integrative Medicine Service Database, Natural Standard Database, and PubMed. The key words searched were the following: alternative and/or complementary medicine, nutritional and/or dietary supplements, quality of life, symptoms and/or side effects, specific toxicities (e.g., neuropathy, mucositis), and specific supplements (e.g., vitamin E, glutamine, etc.).ResultsA number of NHNS products were found to be effective. The incidence and severity of peripheral sensory neuropathy associated with taxane-agents such as paclitaxel can be reduced with vitamin E, glutamine, and acetyl-L-carnitine. Vitamin E and glutamine also have been shown to reduce oral mucositis resulting from radiation and chemotherapy, and glutamine and probiotics can reduce chemotherapy-induced diarrhea.ConclusionThere is a need to develop an open and nonjudgmental dialogue between oncologists and cancer patients, addressing the needs of the patient while dealing with issues related to the efficacy and safety of these products. Referral of patients to an integrative medicine consultant may help achieve these goals, providing both parties with the option of reaching an informed and respectful decision about treatment.Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

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