- This topic has 25 replies, 10 voices, and was last updated 2 years, 1 month ago by
.
-
Posts
-
Happy November!
This month’s journal club will be lead by Jeff Shawver from AJCRU.
We will be discussing use of High-Dose Vitamin C in cancer treatment. I found these article very interesting. I look forward to our conversations on them.
Intravenous Vitamin C for Cancer Therapy – Identifying the Current Gaps in Our Knowledge
Intravenous High-Dose Vitamin C in Cancer Therapy1. What was the knowledge gained from the article?
In recent journal clubs we have talked about alternatives to medications. Patient have brought up the topic of high dose vitamin C on numerous occasions across various disease processes. I choose these articles because I was curious what the hoopla was behind patients bringing these claims up during a med onc clinic visit. Firstly, the Frontier article has lots of data and research studies mentioned and can be a lot to get through but the information is very valuable upon further digging into it (especially the graphs and images).
The biggest discovery from vitamin C was curing scurvy. The articles mention that vitamin C has anti-oxidant properties (which physicians believe to be the reason for avoiding concurrent high dose vitamin C infusions). Linus Pauling is credited with the claim that megadoses of vitamin C (above 1 g) was optimal. All subsequent studies stemmed from his work. As mentioned in the article, “Ewan Cameron, a Scottish surgeon, hypothesized that ascorbate could suppress cancer development by inhibiting hyaluronidase, which otherwise weakens the extracellular matrix and enables cancer to metastasize.” I found it interesting that all research stems from the finding by Pauling and that there are no truly good trials. The 3 challenges brought up in the cancer.gov article elaborate further as to why no good trials have been completed. All big pharma companies obviously want more money (who doesn’t?) and aren’t going to fund a treatment that could potentially be cheap and offer more months for patients alive with less symptoms.
I found that both articles talk about patient receiving chemotherapy have lower levels of serum vitamin C. The studies go on to talk about if oral or IV is better for vitamin C- that is because of the half life and it being only 2 hours before the kidneys helped to clear the excess. I found it incredibly interesting (in animal studies) that numerous disease processes and chemotherapeutic agents have reported less toxicities with concurrent vitamin C infusions.2. Will the research/information in this article change or influence your practice? If so how?
These articles probably won’t change how I practice because there aren’t
articles or data backing up the use of high dose Vitamin C (especially since it is considered an alternative therapy.) The variables that I could potentially change would be advocating for multiple myeloma patients to receive vitamin C if they are getting arsenic. The Frontier article as mentioned previously is very data heavy but it covers everything imaginable with why we should be advocating for vitamin C.3. What other questions does the article raise about current practice?
This article makes me wonder why we aren’t advocating for more vitamin C
infusions to be added to relieve toxicities or symptoms? The articles mentioned that vitamin C improved the quality of life so why wouldn’t we want to do that for our patients? Is there a way we could do a study in the future where it would improve the results and give more accurate data to implement into our practice?4. Do you agree/disagree with the conclusions of the author, why?
I 100% agree with these articles… I think we should implement vitamin C in our
Care and include in our regimens for treatment (if the drug is not an oxidative drug where the anti-oxidative effects could be neutralized.) Upon first looking into these articles I was trying to determine the hoopla from patients and what they have heard about high dose vitamin C. After reading them and digging into the research more it sounds the vitamin c doesn’t remove or cure the cancer as some patients have thought but rather helped with toxicity/ symptom management.Hopefully if nothing else these articles may offer a way to help alleviate toxicities for our patients in the future and could even offer affordable breakthroughs for our patients. I know oftentimes cost is a determining factor if a patient will pick up medications and vitamin C is incredible cheap and readily available.
1. What was the knowledge gained from the article?
I had never heard about IV vitamin C infusion, so everything in the articles was new to me. I know ATRA is high-dose vitamin A and is given with arsenic in APL treatment, but have never heard of vitamin C. If human trials have not shown adverse effects of IVC, and it has shown to decrease side-effects and symptoms as well as demonstrates anti-tumor properties, why aren’t we giving it more? Because of a few inconclusive studies conducted in the 1970’s? That seems kind of lame. It sIVC sounds very promising.2. Will the research/information in this article change or influence your practice? If so how?
I’m not sure if I will recommend vitamin C supplementation to patients for several reasons: the Carr and Cook (2018) article focused on IVC, not PO, and even pointed out that, in the Mayo Clinic study in the 1970’s that seemed to debunk the positive effects of vitamin C, patients were only given PO vitamin C, not IV. Cantley & Yun (2020) also mention PO vitamin C intake is tightly controlled by our bodies. Lastly, I do not know what dosing or timing would be recommended. But I certainly think more trials and studies should be conducted.3. What other questions does the article raise about current practice?
Why aren’t we studying this more, or even giving patients vitamin C? Cantley and Yun (2020) list 3 reasons why vitamin C isn’t being studied more. I believe the primary reason is vitamin C is not patentable. It is unfortunate that so much of the research today is conducted by pharmaceutical companies looking for more ways to make money. There must be public institutions that offer research grants that an aspiring researcher could use to study vitamin C further? How about something like the nation’s largest grass-roots biking fundraiser for cancer named Pelotonia? I know the Pelotonia Institute for Immuno-Oncology is focused on immunotherapy, but with the promise of vitamin C, I think they could make an exception?4. Do you agree/disagree with the conclusions of the author, why?
“In our view, the implementation of this treatment paradigm could provide benefit to many cancer patients.” (Cantley & Yun, 2020) Yes, I agree 100%.Carr, A. C., & Cook, J. (2018, August 23). Intravenous vitamin C for cancer therapy – identifying the current gaps in our knowledge. Frontiers in Physiology. Retrieved October 31, 2022, from https://www.frontiersin.org/articles/10.3389/fphys.2018.01182/full
Cantley, L., & Yun, J. (2020, July 24). Intravenous high-dose vitamin C in cancer therapy. National Cancer Institute. Retrieved November 2, 2022, from https://www.cancer.gov/research/key-initiatives/ras/ras-central/blog/2020/yun-cantley-vitamin-c
Jeff these articles are really interesting. Thank you for picking them and leading the discussion. It does seem that IVC has many benefits and should be studied closer. It could potentially really help our patients deal with side effects and toxicities of treatment! I Have heard of these types of alternative therapies. I have had patients that have forgone standard therapy and opted for alternative cancer treatments such as IVC. I am remembering one patient who went to a center in Mexico and received IVC and other therapies such as hyperthermia treatments. Sadly these alternative therapies alone did not do much to help her, as she came back with worsening disease progression and ended up on a clinical trial.
Greg, I agree completely that the reason no one is researching IVC is because there is no profit to be made. It is so sad and actually disgusting to me. Something that actually has the potential to help our patients may never be researched because of money. Sounds like “nursing” needs to head this up, but wait that would take money! What a great idea using money from Peletonia or other fundraising outlets to fund IVC research!
1)What was the knowledge gained from the article?
I found it interesting that the article, Intravenous Vitamin C for Cancer Therapy-Identifying the Current Gaps in Our Knowledge, states-the vitamin c status of oncology patients is often not assessed in clinical trials or in clinical practice. Many studies have consistently shown that patients with cancer have lower mean plasma vitamin C status that healthy controls, and a large proportion of them present with hypovitaminosis and outright deficiency. Also, that severity of oncologic disease appears to impact vitamin C status. Certain chemotherapy regimens and medications, such as Cisplatin, can contribute to vitamin C depletion. The benefits IVC could have for our chemotherapy and radiation patients is very surprising as well as exciting. I also learned that IVC is contraindicated in patients with renal dysfunction, which makes me think about a lot of Multiple Myeloma patients, and of course Renal Cell Carcinoma patients, so it does appear that there would have to be some sort of clearance for patients to receive IVC.
2)Will the research/information in this article change or influence your practice? If so how?
I don’t think it will necessarily change my practice, because I can’t just give IVC to my patients! I don’t know if we even have it available at the James? The article has given me a lot to think about. In the past, when my patients have told me they have taken homeopathic treatment for their cancer, such as IVC, instead of conventional treatment, I thought they were, for lack of a better word, “crazy”. After reading the articles I can see that their could be benefits to taking IVC in addition to conventional cancer treatment.
3)What other questions does the article raise about current practice?
2 questions come to mind after reading the articles. Why aren’t we using IVC in conjunction with standard therapy to help our patients? This could be an inexpensive, simple, and positive intervention. Secondly, reading this makes me question why we aren’t looking at vitamin levels in all patients. We work in so many blood draw areas and the only vitamin level I occasionally draw is a vitamin D. Wouldn’t it benefit everyone, especially our oncology population, to get a complete overview of nutritional health prior to starting treatments? We all have seen that patients in “good health” at baseline tolerate treatment and side effects better.
Greg- your comments align with what I was thinking. Why are we letting a few inconclusive trials from the 1970’s dictate what we are able to do for treatment now- 50 years later with no new trials? Heck 50 years ago a computer was the size of a room and now our phones do everything imaginable. I would love to see more trials on high dose Vitamin C especially if it is going to help our patients feel better and tolerate treatment better.
Kasey- It is awful to see big pharma only does research for money purposes and not the betterment of patients but I completely understand the business side of it as well. I know that Vitamin D is the only vitamin level we semi regularly check but it does lead to questions why we aren’t drawing more vitamin levels. Most adults are deficient on magnesium (which I know isn’t a vitamin- but still if adults are low on vitamin level it would be an easy fix and could potentially help them feel better and even tolerate treatment better).
Kasey- you bring up a good point that we should check a patient’s overall nutritional status before we begin treatment, and even throughout treatment. During the Covid pandemic, researchers were surprised to find those with low vitamin D were more susceptible to Covid illness, though vit D supplementation did not shorten or lessen illness (sorry I don’t remember the reference for this). We might be surprised to find how our various treatments affects different vitamin levels, and by supplementing we might improve their overall health and decrease side-effects.
The articles mention that vitamin C levels are tightly controlled by our bodies, and the only way to see a peak is to give high dose IV vitamin C, but even that peak decreases quickly. I wonder if it would require daily vitamin C infusions? This might create scheduling problems with patients. Some of the patients that get bi-weekly hydration have trouble making it to appointments, although HTC patients that get daily arsenic for ages and ages seem to do fine with their schedule. Insurance reimbursement would be the problem- I doubt any insurance would want to pay for frequent infusion appointments for something that is not directly treating their illness. There are lots of ‘IV bars’ around town that offer various vitamins and supplements with IV fluid, but they are expensive! For any IV infusion other than just hydration, prices ranged from $150 to $900! I can’t see many patients paying for that.
https://rejuvenateyouohio.com/services/iv-hydration-therapy-columbus-ohio/
Greg- I don’t think there is any chance insurance would pay for multiple infusion visits. Insurance already doesn’t want to pay for things and sadly dictates what our treatments are for patients. I have heard numerous patients comment about them needing 2 or 3 infusions per week after talking to providers to make it most effective.
I think our patients would be all for checking vitamin levels especially with seasonal affective disorder and already dealing with the stressors of chemo treatment. If supplementing with an easy solution of vitamins could make them feel better I don’t know any patient who would be opposed to that!
Hello everyone, I’m Stephanie from CTU.
What was the knowledge gained from the article?
The idea of high-dose vitamin C for cancer therapy was very intriguing. Something as simple as a vitamin being able to be used as therapy or with current cancer regimens sounds theoretically promising. I was unfamiliar with high-dose vitamin C therapies but have heard patients talk of their benefits. The NIH journal by Cantley and Yun shared that studies show improved management of pain, and it protected normal tissues from toxicity caused by chemotherapy. They also shared that vitamin C showed complementary effects when used with radiation and standard chemotherapies. If that is indeed a valid finding, how wonderful. Although none of the studies were conclusive due to a lack of sample size, inconsistent treatments (oral versus IV), and outdated trials. This also has brought about some discussions on our unit, CTU, with our specialty pharmacist. There was another study that our pharmacist talked of with ICU patients and sepsis.
https://www.nejm.org/doi/full/10.1056/NEJMoa2200644What other questions does the article raise about current practice?
Regardless of the dosage amount that is being recommended and studied how much of the vitamin C is truly being absorbed? Can a true clinical trial be established since vitamin C compound quality and administration is so difficult to control?Do you agree/disagree with the conclusions of the author, and why?
I agree that vitamin C does appear to have the potential to be beneficial to our patients, but further clinical trials are needed.Jeff, thank you for sharing these journals.
I too, found both interesting in their findings but also felt it to be very difficult to have a valid clinical trial study. I find some of our patients are doing their own therapies regardless of what the studies may show and are taking large amounts of vitamin C. They will say they whole heartedly believe it does work, even though I have stated that whatever their body doesn’t absorb will end up in the toilet 😉Greg,
I completely forgot about ATRA therapy. Thank you for sharing the information of the IV bars, I never knew such places existed and it is pretty pricey. It reminds me of concierge medicine for the wealthy.Kasey,
I agree, we don’t standardly look at the vitamin levels of our patients. It does appear that it would be truly beneficial to look at their baseline levels and supplement accordingly.What was the knowledge gained from the article?
High-dose vitamin C for cancer therapy appears more promising than I originally thought after reading these articles. It’s disheartening that more research hasn’t been pursued to find out whether or not this therapy is beneficial to cancer patients. The Mayo Clinic research seems like the picked the cheaper option. IV therapy would be more costly than oral therapy.
Stephanie I agree it would be interesting to see if Cantley and Yun were right in their findings that if you combined chemotherapy and high dose vitamin C we can improve the management of pain, and it can protect normal tissues from toxicity caused by chemotherapy. I think of my metastatic patients and how the goal I talk about so often is maintaining quality of life and for me this treatment gives me hope for my patients.Will the research/information in this article change or influence your practice? If so how?
Unfortunately, I feel more research needs to be done. I’m caught on the fact that vitamin C is not patentable, so where will the money come from for research. The stores that sell vitamins and hydration facilities should support this type of research.
These articles showed me that the United States Healthcare system is flawed and our focus isn’t always on improving the wellbeing of our patients.Do you agree/disagree with the conclusions of the author, and why?
I agree that High-Dose vitamin C could provide benefit to cancer patients. Hopefully more research is done.Kasey- I agree with you I’ve seen many patients choose alternative medicine as their primary treatment when initially diagnosed and then they come back to us with more cancer than they started with.
Is my view skewed because those that respond to the alternative treatment I never see again?Thank you Jeff for bringing these articles to the club.
What was the knowledge gained from the article?
I have never heard of IVC but if it would help our patients reduce the side effects to their treatment, I am totally for it! The articles hit on that oral Vitamin C could be less effective makes sense due to most IV medications are more powerful and absorbed better than oral (ex benadryl, K replacement). These articles remind me of a patient in HTC that I gave a copper infusion too. They were diagnosed at an outside hospital with leukemia and when we did all the vitamin labs, that I didn’t realize we did before transplant. It was found the patient DID NOT have cancer but also did not have any copper in her system. This was so interesting to me. I think CTU should do a IVC trial with some kind of nursing grant money. We do check Vit D levels on our patients, why not vitamin C? Vitamin C doesn’t interfere with the treatment the patient is getting so why not just add it to the regime? We replace magnesium & potassium levels on a daily basis. Vitamin C as an agent that reduces inflammation, lowers the loss of white blood cells, lowers ascites, toxicities in organs and issues with the heart make you wonder what exactly the pharmaceutical companies are thinking/saying when using IVC is brought up.What other questions does the article raise about current practice?
Why not test people for vitamin C levels? Why can’t big pharm be proactive and not just reactive with more and more drugs? How effective is oral vitamin C? Should it be something we add to our pt’s regimen since we can’t give them IV?Do you agree/disagree with the conclusions of the author, why?
I totally agree with less pharmaceutical intervention & more natural interventions to help our patients make it through this cancer journey. To see the side effects our treatments cause & know there are things out there that could lessen or even get rid of them yet because they don’t make us money we ignore, sickens me.
- You must be logged in to reply to this topic.