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Multivitamin use and all-cause and cause-specific mortality in cancer survivors

British Journal of Cancer volume 130, pages 82–87 (2024)Cite this article

Subjects

Abstract

Background

Despite no sufficient evidence on benefits and harms of multivitamin use, cancer survivors use multivitamins as a self-care strategy to improve or maintain health. We examined if multivitamin use was associated with mortality in cancer survivors.

Methods

15,936 male and 7026 female cancer survivors in the NIH-AARP Diet and Health Study were included in the analysis. Types and frequency of multivitamin use at on average 4.6 years after cancer diagnosis were assessed. Multivariable-adjusted relative risks (RR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression models.

Results

Multivitamin use was not associated with lower all-cause mortality risk in all female (RR = 0.94, 95% CI:0.87–1.01 daily vs. no use) or male cancer survivors (RR = 0.96, 95% CI:0.91–1.00); however, a modest inverse association for CVD mortality was observed in female survivors of reproductive cancers (RR = 0.75, 95% CI:0.61–0.92) and male survivors of non-reproductive cancers (RR = 0.81, 95% CI:0.70–0.94). Multivitamin use was also associated with a lower risk of cancer-specific mortality in survivors of skin (RR = 0.65, 95% CI:0.48–0.88) and breast (RR = 0.79, 95% CI:0.65–0.95) cancer.

Discussion

Multivitamin use may provide a modest survival benefit to some cancer survivors. Cancer care providers should talk with cancer survivors about potential benefits and harms of multivitamin use.

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Fig. 1: Multivariable-adjusteda relative risks and 95% confidence intervals of mortality for daily use of multivitamin vs. no use in survivors of specific cancer.

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Data availability

Data can be obtained on request. Requests should be directed to the NIH-AARP Diet and Health Study (https://dietandhealth.cancer.gov/), which has a protocol for approving data requests.

References

  1. American Cancer Society. Cancer Treatment & Survivorship Facts & Figures 2019-2021. Atlanta: American Cancer Society, 2019.

  2. NCI. Statistics, Graphs and Definitions, https://cancercontrol.cancer.gov/ocs/statistics/index.html Accessed August, 2023.

  3. Du M, Luo H, Blumberg JB, Rogers G, Chen F, Ruan M, et al. Dietary Supplement Use among Adult Cancer Survivors in the United States. J Nutr. 2020;150:1499–508.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mishra S, Stierman B, Gahche JJ, Potischman N. Dietary Supplement Use Among Adults: United States, 2017-2018. NCHS data brief. 2021;399:1–8.

  5. Luo Q, Asher GN. Use of Dietary Supplements at a Comprehensive Cancer Center. J Altern Complement Med. 2018;24:981–7.

    Article  PubMed  Google Scholar 

  6. Tank M, Franz K, Cereda E, Norman K. Dietary supplement use in ambulatory cancer patients: a survey on prevalence, motivation and attitudes. J Cancer Res Clin Oncol. 2021;147:1917–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Conway RE, Rigler FV, Croker HA, Lally PJ, Beeken RJ, Fisher A. Dietary supplement use by individuals living with and beyond breast, prostate, and colorectal cancer: a cross-sectional survey. Cancer. 2022;128:1331–8.

    Article  CAS  PubMed  Google Scholar 

  8. Kwan ML, Greenlee H, Lee VS, Castillo A, Gunderson EP, Habel LA, et al. Multivitamin use and breast cancer outcomes in women with early-stage breast cancer: the Life After Cancer Epidemiology study. Breast Cancer Res Treat. 2011;130:195–205.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Poole EM, Shu X, Caan BJ, Flatt SW, Holmes MD, Lu W, et al. Postdiagnosis supplement use and breast cancer prognosis in the After Breast Cancer Pooling Project. Breast Cancer Res Treat. 2013;139:529–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Saquib J, Rock CL, Natarajan L, Saquib N, Newman VA, Patterson RE, et al. Dietary intake, supplement use, and survival among women diagnosed with early-stage breast cancer. Nutr Cancer. 2011;63:327–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Inoue-Choi M, Greenlee H, Oppeneer SJ, Robien K. The association between postdiagnosis dietary supplement use and total mortality differs by diet quality among older female cancer survivors. Cancer Epidemiol Biomarkers Prev. 2014;23:865–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Ng K, Meyerhardt JA, Chan JA, Niedzwiecki D, Hollis DR, Saltz LB, et al. Multivitamin use is not associated with cancer recurrence or survival in patients with stage III colon cancer: findings from CALGB 89803. J Clin Oncol. 2010;28:4354–63.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Koole JL, Bours MJL, Breedveld-Peters JJL, van Roekel EH, Breukink SO, Janssen-Heijnen MLG, et al. Is dietary supplement use longitudinally associated with fatigue in stage I-III colorectal cancer survivors? Clin Nutr. 2020;39:234–41.

    Article  PubMed  Google Scholar 

  14. Kanellopoulou A, Riza E, Samoli E, Benetou V. Dietary Supplement Use after Cancer Diagnosis in Relation to Total Mortality, Cancer Mortality and Recurrence: A Systematic Review and Meta-Analysis. Nutr Cancer. 2021;73:16–30.

    Article  CAS  PubMed  Google Scholar 

  15. Wassertheil-Smoller S, McGinn AP, Budrys N, Chlebowski R, Ho GY, Johnson KC, et al. Multivitamin and mineral use and breast cancer mortality in older women with invasive breast cancer in the women’s health initiative. Breast Cancer Res Treat. 2013;141:495–505.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Skeie G, Braaten T, Hjartaker A, Brustad M, Lund E. Cod liver oil, other dietary supplements and survival among cancer patients with solid tumours. Int J Cancer. 2009;125:1155–60.

    Article  CAS  PubMed  Google Scholar 

  17. Schatzkin A, Subar AF, Thompson FE, Harlan LC, Tangrea J, Hollenbeck AR, et al. Design and serendipity in establishing a large cohort with wide dietary intake distributions : the National Institutes of Health-American Association of Retired Persons Diet and Health Study. Am J Epidemiol. 2001;154:1119–25.

    Article  CAS  PubMed  Google Scholar 

  18. Ishihara J, Sobue T, Yamamoto S, Sasaki S, Akabane M, Tsugane S. Validity and reproducibility of a self-administered questionnaire to determine dietary supplement users among Japanese. Eur J Clin Nutr. 2001;55:360–5.

    Article  CAS  PubMed  Google Scholar 

  19. Messerer M, Wolk A. Sensitivity and specificity of self-reported use of dietary supplements. Eur J Clin Nutr. 2004;58:1669–71.

    Article  CAS  PubMed  Google Scholar 

  20. Satia-Abouta J, Patterson RE, King IB, Stratton KL, Shattuck AL, Kristal AR, et al. Reliability and validity of self-report of vitamin and mineral supplement use in the vitamins and lifestyle study. Am J Epidemiol. 2003;157:944–54.

    Article  PubMed  Google Scholar 

  21. Lawson KA, Wright ME, Subar A, Mouw T, Hollenbeck A, Schatzkin A, et al. Multivitamin use and risk of prostate cancer in the National Institutes of Health-AARP Diet and Health Study. J Natl Cancer Inst. 2007;99:754–64.

    Article  CAS  PubMed  Google Scholar 

  22. Stevens VL, McCullough ML, Diver WR, Rodriguez C, Jacobs EJ, Thun MJ, et al. Use of multivitamins and prostate cancer mortality in a large cohort of US men. Cancer Causes Control. 2005;16:643–50.

    Article  PubMed  Google Scholar 

  23. O’Connor EA, Evans CV, Ivlev I, Rushkin MC, Thomas RG, Martin A, et al. Vitamin and Mineral Supplements for the Primary Prevention of Cardiovascular Disease and Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. Jama. 2022;327:2334–47.

  24. Kim J, Choi J, Kwon SY, McEvoy JW, Blaha MJ, Blumenthal RS, et al. Association of multivitamin and mineral supplementation and risk of cardiovascular disease: a systematic review and meta-analysis. Circ Cardiovas Qual Outcomes. 2018;11:e004224.

    Article  Google Scholar 

  25. Zhang FF, Liu S, John EM, Must A, Demark-Wahnefried W. Diet quality of cancer survivors and noncancer individuals: Results from a national survey. Cancer. 2015;121:4212–21.

    Article  CAS  PubMed  Google Scholar 

  26. Blumberg JB, Frei BB, Fulgoni VL, Weaver CM, Zeisel SH. Impact of Frequency of Multi-Vitamin/Multi-Mineral Supplement Intake on Nutritional Adequacy and Nutrient Deficiencies in U.S. Adults. Nutrients. 2017;9:849.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Murphy SP, White KK, Park SY, Sharma S. Multivitamin-multimineral supplements’ effect on total nutrient intake. Am J Clin Nutr. 2007;85:280s–284s.

    CAS  PubMed  Google Scholar 

  28. Wallace TC, Frankenfeld CL, Frei B, Shah AV, Yu CR, van Klinken BJ, et al. Multivitamin/Multimineral Supplement Use is Associated with Increased Micronutrient Intakes and Biomarkers and Decreased Prevalence of Inadequacies and Deficiencies in Middle-Aged and Older Adults in the United States. J Nutr Gerontol Geriatr. 2019;38:307–28.

    Article  PubMed  Google Scholar 

  29. Fassier P, Egnell M, Pouchieu C, Vasson MP, Cohen P, Galan P, et al. Quantitative assessment of dietary supplement intake in 77,000 French adults: impact on nutritional intake inadequacy and excessive intake. Eur J Nutr. 2019;58:2679–92.

    Article  CAS  PubMed  Google Scholar 

  30. Strongman H, Gadd S, Matthews A, Mansfield KE, Stanway S, Lyon AR, et al. Medium and long-term risks of specific cardiovascular diseases in survivors of 20 adult cancers: a population-based cohort study using multiple linked UK electronic health records databases. Lancet. 2019;394:1041–54.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Armenian SH, Xu L, Ky B, Sun C, Farol LT, Pal SK, et al. Cardiovascular disease among survivors of adult-onset cancer: a community-based retrospective cohort study. J Clin Oncol. 2016;34:1122–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Carver JR, Shapiro CL, Ng A, Jacobs L, Schwartz C, Virgo KS, et al. American Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects. J Clin Oncol. 2007;25:3991–4008.

    Article  CAS  PubMed  Google Scholar 

  33. Narayan V, Ky B. Common cardiovascular complications of cancer therapy: epidemiology, risk prediction, and prevention. Annu Rev Med. 2018;69:97–111.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Abdel-Qadir H, Thavendiranathan P, Austin PC, Lee DS, Amir E, Tu JV, et al. The Risk of Heart Failure and Other Cardiovascular Hospitalizations After Early Stage Breast Cancer: A Matched Cohort Study. J Natl Cancer Inst. 2019;111:854–62.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Simon MS, Hastert TA, Barac A, Banack HR, Caan BJ, Chlebowski RT, et al. Cardiometabolic risk factors and survival after cancer in the Women’s Health Initiative. Cancer. 2021;127:598–608.

    Article  PubMed  Google Scholar 

  36. Nechuta S, Lu W, Chen Z, Zheng Y, Gu K, Cai H, et al. Vitamin supplement use during breast cancer treatment and survival: a prospective cohort study. Cancer Epidemiol Biomarkers Prev. 2011;20:262–71.

    Article  CAS  PubMed  Google Scholar 

  37. Greenlee H, Kwan ML, Kushi LH, Song J, Castillo A, Weltzien E, et al. Antioxidant supplement use after breast cancer diagnosis and mortality in the Life After Cancer Epidemiology (LACE) cohert. Cancer. 2012;118:2048–58.

    Article  CAS  PubMed  Google Scholar 

  38. Zhang Y, Song M, Mucci LA, Giovannucci EL. Regular, Long-Duration Multivitamin Use and Risk of Overall and Aggressive Prostate Cancer in the Health Professionals Follow-Up Study. J Urol. 2022;208:633–40.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Gaziano JM, Sesso HD, Christen WG, Bubes V, Smith JP, MacFadyen J, et al. Multivitamins in the prevention of cancer in men: the Physicians’ Health Study II randomized controlled trial. Jama. 2012;308:1871–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Van Blarigan E, Kenfield SA, Cedars BE, Broering J, Cowan JE, Carroll P, et al. Multivitamin use and risk of prostate cancer recurrence: Data from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE). J Clin Oncol. 2018;36:70–70.

    Article  Google Scholar 

  41. National Toxicology Program Monograph: identifying research needs for assessing safe use of high intakes of folic acid. National Institutes of Health. U.S. Department of Health and Human Services. 2015. https://ntp.niehs.nih.gov/ntp/ohat/folicacid/final_monograph_508.pdf.

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Acknowledgements

Cancer incidence data from the Atlanta metropolitan area were collected by the Georgia Center for Cancer Statistics, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia. Cancer incidence data from California were collected by the California Cancer Registry, California Department of Public Health’s Cancer Surveillance and Research Branch, Sacramento, California. Cancer incidence data from the Detroit metropolitan area were collected by the Michigan Cancer Surveillance Program, Community Health Administration, Lansing, Michigan. The Florida cancer incidence data used in this report were collected by the Florida Cancer Data System (Miami, Florida) under contract with the Florida Department of Health, Tallahassee, Florida. The views expressed herein are solely those of the authors and do not necessarily reflect those of the FCDC or FDOH. Cancer incidence data from Louisiana were collected by the Louisiana Tumor Registry, Louisiana State University Health Sciences Center School of Public Health, New Orleans, Louisiana. Cancer incidence data from New Jersey were collected by the New Jersey State Cancer Registry, The Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey. Cancer incidence data from North Carolina were collected by the North Carolina Central Cancer Registry, Raleigh, North Carolina. Cancer incidence data from Pennsylvania were supplied by the Division of Health Statistics and Research, Pennsylvania Department of Health, Harrisburg, Pennsylvania. The Pennsylvania Department of Health specifically disclaims responsibility for any analyses, interpretations or conclusions. Cancer incidence data from Arizona were collected by the Arizona Cancer Registry, Division of Public Health Services, Arizona Department of Health Services, Phoenix, Arizona. Cancer incidence data from Texas were collected by the Texas Cancer Registry, Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas. Cancer incidence data from Nevada were collected by the Nevada Central Cancer Registry, Division of Public and Behavioral Health, State of Nevada Department of Health and Human Services, Carson City, Nevada.

We are indebted to the participants in the NIH-AARP Diet and Health Study for their outstanding cooperation. We also thank Sigurd Hermansen and Kerry Grace Morrissey from Westat for study outcomes ascertainment and management and Leslie Carroll at Information Management Services for data support and analysis.

Funding

The study was supported in part by the Intramural Research Program of the National Cancer Institute.

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Authors and Affiliations

  1. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Yikyung Park

  2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA

    Zeinab Farhat, Linda M. Liao, Maki Inoue-Choi & Erikka Loftfield

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Contributions

YP designed and conceptualized study. YP and LML involved in the acquisition of the data. ZF performed data analysis. YP wrote the first draft of the manuscript. All authors contributed to the interpretation of results and critically reviewed the manuscript. All authors read and approved the final manuscript.

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Correspondence to Yikyung Park.

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The study was approved by the US National Cancer Institute Special Studies Institutional Review Board. All participants gave informed consent by virtue of completing and returning the questionnaire.

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Park, Y., Farhat, Z., Liao, L.M. et al. Multivitamin use and all-cause and cause-specific mortality in cancer survivors. Br J Cancer 130, 82–87 (2024). https://doi.org/10.1038/s41416-023-02421-9

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