Supplements / Vitamins Are they helpful? May 8, 2019 Chat

We were pleased to have Stacy Kennedy MPH,RD (@stacykennedyrd) join us for this informative chat on vitamins and supplements.  You may find a complete transcript here and analytics here.

Definitions: 

Vitamins - a nutrient that the body needs in small amounts to function and stay healthy. 

Supplement - a substance taken to remedy the deficiencies in a person's diet. 

Here are a few sample responses to our questions:

T1: Can vitamins be helpful to a woman diagnosed with a cancer at each point in her cancer experience - before, during and after treatment? Are there vitamin studies related to gynecologic cancers specifically?

• vitamins, from foods, are important for women diagnosed with cancer at each point in her experience
• Amounts & levels needed from food, and in some cases supplements, vary by individual based on many factors
• connecting to a nutrition expert in oncology is helpful and looking for reliable resources, like danafarber.org/nutrition
• a plant-based well balanced diet, maintaining a healthy weight and regular exercise are shown to be helpful for many gyn cancers
• ndividualize your vitamin and supplement use while being treated for cancer. What's right for one person may not be right for another.

T2: Are there vitamins and supplements a gynecologic cancer patient should avoid during treatment - surgery/chemo/radiation/immunotherapy? What about concerns that some vitamins and supplements help cancer grow?

• yes, there are supplements to avoid during specific treatments. for example, high dose antioxidant supplements during radiation therapy
• For surgery, many supplements can have blood thinning effects and should be avoided before and after for a period of time. Your MD can advise.
• Just like with what TO take, what not to take is very individualized. Get help from your cancer pharmacy, gyn/onc, primary doc, nutritionists and/or others to be sure everything that you are taking works with your treatment.
• It’s also important to avoid high dose antioxidant vitamins such as vitamin A C and E during chemo such as platinum.
• talking to a pharmacist can insure your medications are not conflicting with your treatments.
• also individualize what foods you eat. certain fruit like grapefruit can interfere with the metabolism of some drugs. ask!

T3: Which supplements are most helpful for cancer patients and are shown to boost the immune system? Where can reliable information about supplements be found?

• Sloan Kettering has a great app for reliable info ( About Herbs App- https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/integrative-medicine/herbs/about-herbs)
• Not exactly a supplement but 30 minutes of moderate exercise 5 days a week is helpful for cancer patients even during treatment
• for supporting the immune system, ask your doctor to test your vitamin d and see if it's low and needs a supplement. There are foods that can support immunity, look for easy ways to boost fruits & veggies, like smoothies.

T4: Studies have show than Vitamin D is beneficial for colon cancer patients. Is there potential to benefit gynecologic cancer patients as well?

•  “People with high levels of vitamin D in their bloodstream have a lower overall risk of developing colorectal cancer,” https://www.dana-farber.org/newsroom/news-releases/2015/vitamin-d-protects-against-colorectal-cancer-by-boosting-the-immune-system/
• Here's an article from @CancerNetwrk with an interview about Vitamin D  https://www.cancernetwork.com/article/does-vitamin-d-have-role-cancer-prevention
• this @CancerCenter article - "Cancer patients who get the recommended dose of vitamin D during treatment lower their risk of osteoporosis and bone fractures, especially if their treatment regimen includes certain therapies," https://www.cancercenter.com/community/blog/2018/07/vitamin-d-an-important-but-elusive-nutrient

T5: Are there foods patients can eat to get the vitamins they need in place of pills? What are some resources to learn more about nutrition after a cancer diagnosis?

• @theNCI Nutrition In Cancer Care PDQ-Patient Version can be a good place to start https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-pdq
• This @StanfordHealth website even include recipes https://stanfordhealthcare.org/medical-clinics/cancer-nutrition-services/during-cancer-treatment/nutrition-during-chemo.html
• There are some good books about eating while on cancer. One is called Kicking Cancer in the Kitchen. @DanaFarber also has a recipie app. The @savor_health blog is another resource.

Additional resources shared during the chat may be found below.

Note that there will be no #gyncsm chat in June.  Mark your calendar for our next chat on Wed July 10th at 9pmET. 

Thanks to everyone who has been tweeting using the #gyncsm hashtag.

See you in July!

Dee
#gyncsm Co-founder


RESOURCES

Dana Farber Nutritional Services - https://www.dana-farber.org/for-patients-and-families/care-and-treatment/support-services-and-amenities/nutrition-services/
What Are the Best Vitamins for Cancer Patients - https://blog.dana-farber.org/insight/2011/12/what-are-the-best-vitamins-for-cancer-patients/

Mobile Nutrition and Recipe App  https://www.cancernutrition.org/mobile-nutrition-and-recipe-app/

Conquer Magazine - What Should People With Cancer Eat https://conquer-magazine.com/issues/2019/vol-5-no-2-april-2019/948-what-should-people-with-cancer-eat

ChemoCare - Vitamins and Cancer ... http://chemocare.com/chemotherapy/health-wellness/vitamins-and-cancer.aspx

ASCO Post - Avoiding Antioxidant-Drug Interactions During Cancer Treatment - https://www.ascopost.com/issues/july-25-2014/avoiding-antioxidant-drug-interactions-during-cancer-treatment/

Cancerdotnet - Myths about Cancer and Food Explained  https://www.cancer.net/blog/2016-06/5-myths-about-cancer-and-food-explained-dietitians

American Institute for Cancer Research http://www.aicr.org/patients-survivors/healthy-or-harmful/supplements.html

American Cancer Society - Dietary Supplements - What is Safe? http://www.aicr.org/patients-survivors/healthy-or-harmful/supplements.html

NIH Dietary Supplements https://ods.od.nih.gov/

"What is OK During Treatment" August 8, 2018 Chat

Tonight we had the chance to learn "What is OK during treatment?". We covered what is OK in terms of exercise, food, sexual intimacy and vitamins. We also allowed our participants to ask their own "Is it OK to..." question at the end of the chat. It was a pleasure for us to have Sangeeta Agarawal RN, Ms, CAS (@sanHelpsy), founder of Helpsy join us as a guest for this evening's chat and provide valuable information on a number of topics. 

You may find our transcript here and analytics here. 

We are happy to share a few highlights from tonight's chat below. Resources may be found at the bottom of this post. 


T1: Is it OK to… take supplements and vitamins during chemotherapy? How about during radiation therapy?

• It is important to let your MD know any vitamins/supplements you are taking to ensure that they will not counteract your chemo

• For example, antioxidants can counteract the effect of chemotherapy by clearing out the free radicals that damage the cancer

• We recommend a simple multivitamin during treatment for cancer

• You can find more information about herb supplements on NCCIH's HerbList App and Memorial Sloan Kettering's About Herbs app

• Avoid taking high doses of antioxidant supplements during chemotherapy and radiation treatments as they may interfere with treatment

T2: Is it OK to… exercise during treatment? Are there specific exercises that are good to do after abdominal surgery?

• We absolutely encourage exercise during treatment for cancer - it can help reduce stress and manage symptoms such as fatigue

• Start with light exercises - slow with yoga, walking or stretching, work your way up to cycling, swimming, aerobic exercise once you feel ready. Talk to your oncologist and care team to design the right fitness routine for you

• After abdominal surgery, it's important to avoid anything that strains your core/abdomen, stick w walking & low impact exercise

• Supervised resistance training is good during and after treatment as it helps maintain muscle and bone mass

• Try exercises like finger rolls, finger taps to help with neuropathy in your hands and fingers; exercises like calf raises, ankle circles, standing heel to toe for neuropathy in feet

• There are even tutorials for seated yoga - you can get in your movement in many different ways.

• Maintain a diary to record exercise sessions. Plan exercise for good and bad days, days when you experience intense symptoms

• And exercise (appropriate for your current level of health) is excellent for your mental health, too

• Exercise reduces fatigue at 40-50%, provides muscle strength, flexibility & general conditioning, control weight. Avoid swimming if on R/T chlorine irritate radiated skin as per reading

T3: Is it OK to… eat raw fruits and vegetables during treatment?

• Try to include colorful fruits and vegetables, at least 2.5 cups every day, be sure to wash them thoroughly

• Include citrus fruits like grapefruits and oranges and deep yellow and dark green vegetables

• very imp to wash them thoroughly before eating. Check any warnings about breakout of disease

• Vegetable sprouts such as mung bean, alfalfa, broccoli and radish should not be eaten raw, only consume pasteurized juices

• Do not consume from outside - fresh salsa or salad dressings found in refrigerated sections of the grocery store; shelf-stable salsa and dressings are okay

• This literature review found no need for a neutropenic diet: https://t.co/FBixFWj5Nt

• In case of loss of appetite or desire to eat, talk to your health care team about nutrition consult so they can suggest recommendations to help improve taste and appetite

• No need to avoid raw food completely! Avoid outside raw food. Avoid raw sushi

• I also tell patients that beware of coffee and soda. You don't get proper hydration from those products.

T3 cont'd - What about soy and soy products?

• Soy products contain phytoestrogens and not estrogen, soy contains essential amino acids, magnesium, potassium, fiber, and other vitamins. Try picking organic sources of soy

• Soy dietary supplements may not be a healthy choice, consult your physician 

• No harm in eating soy. Just ensure your body can digest it. Eat organic soy products.

T4: Is it OK to… have sexual relations while in treatment?

• No reason to avoid sexual relations, it is not sexually transmitted or contagious and won't cause the cancer to return

• You can absolutely have sex during treatment - there is no risk as long as you have the energy for it!

• If you are in the mood or have energy for it! Go for it! Sex releases happy chemicals and builds closer bond with partner. 

• Fatigue, pain, and discomfort after surgery could interfere with sexual relations, use vaginal lubricants to alleviate the pain

• Radiation may cause vaginal swelling and bladder inflammation, sexual relations may be comfortable after a short healing period of about 2-4 weeks 

• Cuddling, kissing and other forms of intimacy feel good too! :)

• It's very important to bring up this topic and discuss any questions. Many times providers and patients both avoid it, but it's an important part of our life that needs discussion and clarity 

T5: We’ll now open the floor to allow our participants to ask other “Is it OK to...” questions. What haven't covered? 

Question: How about getting your flu shot? I think it is ok with chemo and radiation but they aren't sure about getting it with immunotherapy and other new kinds of treatment....

• Usually it's given, but based on some treatments like immunotherapy - it may be held for a bit. Important to check with oncologist 

Question: Is it ok to be around kids or adults ( shingles ) who have had vaccines?

• Most are safe, but when WBC is very low, better to avoid contact during days of nadir/lowest white blood cell count

Question: For nutrition and exercise... any different recommendations for immunotherapy vs. more standard treatments? Or is there not much studies on that yet?

• so far, our recommendations for nutrition and exercise don't change for immunotherapy - we are still learning though

Thank you everyone who took part in our discussion. Remember if you are a patient or caregiver you may continue this discussion on the Smart Patients Platform ( https://www.smartpatients.com/gyncsm ). 

We hope you will join us for the next #gyncsm chat: Wednesday, September 12, 2018 where in addition to chatting about on We need support - Where do we find it?.  We will also be celebrating the #gyncsm Community's 5th Anniversary. 

See you in September. 

Dee
#gyncsm co-founder


RESOURCES

Taking vitamins/supplements:

https://blog.dana-farber.org/insight/2014/02/should-i-take-vitamins-and-supplements-during-cancer-treatment/

Supplement Showdown : A Look at Vitamins and the Fight Against Cancer
https://www.curetoday.com/articles/supplement-showdown-a-look-at-vitamins-and-the-fight-against-cancer-

Dietary Supplements During Cancer Treatment: Yes or No?
https://health.usnews.com/health-news/patient-advice/articles/2015/07/01/dietary-supplements-during-cancer-treatment-yes-or-no

ACS @AmericanCancer website
https://www.cancer.org/treatment/treatments-and-side-effects/complementary-and-alternative-medicine/dietary-supplements.htm

Exercise:

http://ovarian.org/component/content/article/33-latest-nocc-updates/362-tips-for-exercising-during-and-after-cancer-treatment

https://www.roswellpark.org/media/news/exercise-may-reduce-risk-cervical-cancer

http://exerciseismedicine.com.au/wp-content/uploads/2016/11/2014-Gynaecological-Cancer-FULL.pdf

pelvic exercises via @PelvicGuru1
 https://pelvicguru.com/2013/12/28/what-is-pelvic-physical-therapy-and-why-doesnt-everyone-know-about-it/

Eating raw fruits and vegetables:

https://www.cancer.org/content/dam/cancer-org/cancer-control/en/booklets-flyers/life-style-changes-that-make-a-difference.pdf

http://www.aicr.org/new-american-plate/cancer-preventive-diet-model-plate.html

https://medlineplus.gov/ency/patientinstructions/000061.htm

Savor Health blog
http://savorhealth.com/blog/

Health Care System Eliminates Neutropenic Diet in Patients with Cancer with no Rise in Infection
https://www.curetoday.com/articles/health-system-eliminates-neutropenic-diet-in-patients-with-cancer-with-no-rise-in-infections

Eating soy: 

https://www.oncologynutrition.org/erfc/hot-topics/soy-and-hormone-related-cancers/

Tamar Rothenberg, RDN Is Soy Helpful or Harmful for Cancer Patients
https://www.tamarrothenbergrd.com/single-post/2018/01/10/Is-soy-helpful-or-harmful-for-cancer-survivors

@fredhutch Soy Is it Safe for Cancer Survivors
https://www.fredhutch.org/en/treatment/survivorship/survival-strategies/soy-safe-for-cancer-survivors.html

Having sexual relations during treatment:

https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/sexuality-for-women-with-cancer/problems.html

https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/sexuality-for-women-with-cancer/faqs.html

Guide to Sexuality During & After Cancer Treatment
https://www.oncolink.org/support/sexuality-fertility/sexuality/women-s-guide-to-sexuality-during-after-cancer-treatment

Foundation For Womens Cancer
http://www.foundationforwomenscancer.org/wp-content/uploads/Sexuality-Brochure_Final.pdf

Mindy Schiffman, PhD. Sexuality and Intimacy after Cancer in this video
https://t.co/8bw9Lr79Zc

Be around children who are recently vaccinated: 

https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/infections/vaccination-during-cancer-treatment.html

Eating cake and sugary foods:

https://www.oncologynutrition.org/erfc/healthy-nutrition-now/sugar-and-cancer/

Miscellaneous:
The Chemotherapy Survival Guide Authors Judith McKay, RN, OCN and Tamera Schachen, RN, OCN, MSN

August 8, 2018 What is OK during Treatment?

Over the past few years #gyncsm has heard questions from women about what they should or should not do during treatment. Such as, is it OK to...

• exercise? 
• eat raw fruits and vegetables? 
• have sexual relations during treatment? 
• take vitamins? 
• eat soy or not? 
• take supplements during chemotherapy? 
• be around children who have recently been vaccinated? 
• eat cake and other sugary food?

Even as treatments options are expanding for women diagnosed with a gynecologic cancer - from chemotherapy and radiation therapy to targeted therapies and immunotherapies - women still are looking for guidance in these areas.

Join us as this month as we welcome Sangeeta Agarawal RN, Ms, CAS (@sanHelpsy), founder of Helpsy "an integrative medicine platform for improving symptoms and health outcomes", as our guest. Sangeeta has long been involved with the Stanford MedicineX conferences and her mission is to empower people with the best quality of life by bringing together the best of eastern and western medicine and disseminating it using the power of technology. Sangeeta hosted a panel discussion in 2016 with the Oncology Nursing Society: Complementary & Alternative Medicine – A 360-degree View.

During the chat we'll be sharing information such as this National Comprehensive Cancer Network article on Exercise During Cancer Treatment and Memorial Sloan Kettering Cancer Center's article on Eating Well During and After Your Treatment.

We look forward to seeing you on Wednesday, August 8, 2018 at 9pmET (8pmCT, 6pmPT).

Dee
#gycnsm Co-Founder

November 11th : Nutrition and Exercise Chat

This month we had Brooke McMillan from LIVESTRONG (@LIVESTRONG) as well as William Greider (@DanaFarber), Stacy Kennedy (@stacykennedyrd) and Nancy Campbell (@exercise_cancer) from Dana Farber Cancer Center as our guests for this fact-filled and fast-paced discussion of Nutrition and Exercise. This chat's analytics were the best of any chat of 2015 with 88 participants, 823 tweets and over 18,000,000 impressions!

Topic questions and a very small sample of the responses are found below. You can also view a chat recap by @LIVESTRONG here. For additional information on recommended exercises, diet, foods to eat and foods to avoid we recommend reading the complete transcript - available here.

T1: What role does exercise play during treatment? How does it affect quality of life / outcomes? Did you exercise during treatment?

A1: It give us physical strength & successes which can elevate mood, increase mental strength and positivity. #gyncsm

— Dana-Farber (@DanaFarber) November 12, 2015

A1. A number of studies show a positive correlation btwn exercise & mood improvement & recurrence risk reduction. #gyncsm

— Nancy Campbell (@exercise_cancer) November 12, 2015

T2: Many gyn cancer patients undergo abdominal surgery. What exercises are recommended in recovery? long term?

A2: Good to create a rehab care plan with your care team. Here's a good place to start: https://t.co/tjpOnVDgVc #gyncsm

— LIVESTRONG (@livestrong) November 12, 2015

T2: During immediate post op time, light exercise is great--just shy away from heavy lifting while you heal! #gyncsm

— Elizabeth Dickson (@edicksonMD) November 12, 2015

T3: What are some resources for patients and survivors about exercise? What programs/exercises have helped you most?

A3: We offer a free program at 450+ @YMCA's across the US to anyone post-treatment: LIVESTRONG at the YMCA https://t.co/okhxE7OqIe. #gyncsm

— LIVESTRONG (@livestrong) November 12, 2015

A3: @ACSM has a Certified Cancer Exercise Trainer certification: https://t.co/qr44wEcOVk #gyncsm

— Dana-Farber (@DanaFarber) November 12, 2015

T4: We periodically hear news about sugar and cancer...  Does sugar feed cancer? Should we avoid all sugar? Why do we need sugar?

A4: #gyncsm Reducing processed refined #sugars and frequent consumption is best recommendation Keep some #fruit! #nutrition

— Stacy Kennedy MPH RD (@stacykennedyrd) November 12, 2015

A4: Eating #Plantbased diet with protein and #hydration plus #exercise all help blood sugar control #gyncsm

— Stacy Kennedy MPH RD (@stacykennedyrd) November 12, 2015

T5: Are there specific foods GYN cancer patients should avoid? What's being discovered re: nutrition and gyn cancers? 

A5: For GYN cancers there are specific nutrition recommendations depending on the type of cancer & current tx or related symptoms. #gyncsm

— Dana-Farber (@DanaFarber) November 12, 2015

A5: Obesity raises risk for endometrial cancer significantly. Manage your weight through healthy eating/exercise to reduce risk. #gyncsm

— Rick Boulay,MD (@journeycancer) November 12, 2015

T6: For cancer survivors, is nutrition more about finding balance or it is more about cutting certain things altogether? Tips?

A6: Nutrition & healthy eating are absolutely about finding balance & eating patterns that can be replicated everyday. #gyncsm

— Dana-Farber (@DanaFarber) November 12, 2015

A6: Think about it this way - you finally have a good reason to try a whole host of new and exciting foods. Explore new things. #gyncsm

— LIVESTRONG (@livestrong) November 12, 2015

Please scroll down for Resources shared during the chat. And remember that you may continue our conversation about nutrition and exercise on Smart Patients (https://www.smartpatients.com/gyncsm).

We want to thank all participants in this chat both regulars (patients/survivors/healthcare providers) and new community members.  We look forward to having you join us on December 9, 2015 at 9pmET | 8pmCT | 6pm PT for the Looking Back and Looking Forward chat.

Dee
Co-Moderator



RESOURCES:

NUTRITION

Nutrition for the Person with Cancer - ACS https://t.co/ByOEMsuWvz

@DanaFarber : FREE nutrition and cancer app:  https://t.co/37ELiVMrYe 

@DanaFarber Myths about Food and Cancer Slideshow https://t.co/ykP7n5jdbm 

@DanaFarber "Does Sugar Feed Cancer"  https://t.co/kkzzaegxp5 

AICR : http://www.aicr.org/reduce-your-cancer-risk/diet/

LiVES study: healthy lifestyle and PFS in #ovariancancer https://t.co/4kHGSaWc9R

Nutrition Recommendations During and After Treatment via @CancerDotNet https://t.co/Ngy9jhGIyB

ELLICSR cooking class : https://www.ellicsr.ca

UPenn: http://www.oncolink.org/coping/article.cfm?c=464&aid=1468&id=959

Nutrition in Gyn Cancer http://link.springer.com/article/10.1007/s13669-015-0130-2#/page-1

EXERCISE

Iram's story: https://t.co/jlFlU23n7r

@AICR infographic Making Time for Physical Activity: https://t.co/vNdlXhC42t

Rehab care plan via @livestrong https://t.co/tjpOnVDgVc

Dana Farber programs: https://t.co/WsRhJWRgIJ

US news and world report - exercise new RX for cancer pts https://t.co/KJ36gLRO6K

ACS Certified Cancer Exercise Trainer certification: https://t.co/qr44wEcOVk

ACS recommendations https://t.co/ucAjwIWChG

LIVESTRONG at the Y: https://t.co/okhxE7OqIe

@CancerSupportCm exercise classes

Exercising During Cancer Treatment--NCCN resources https://t.co/F1VkQNwycw

Physical Activity and the Cancer Patient--ACS resource https://t.co/XAIEEvLakj

Journal article : Physical activity and gynecologic cancer prevention https://t.co/Sw1N6kyPFX

Evidence based exercise program via @active_match  https://t.co/rkob5ZTpxO

GENERAL

Cancer Harbors - http://www.sunspiritwellnessservices.com/cancer-harbors/

"Heal Well Guide" https://t.co/PIFFRTGCeU

Nutrition / Exercise November 11th Chat

On Wednesday November 11, 2015 at 9pmET / 8pmCT / 6pmPT the gyn cancer community will be chatting about Nutrition and Exercise. Research has shown the value of healthy eating and movement (exercise) in the survivorship and quality of life of cancer patients.

We are pleased that Dana-Farber Cancer Institute (@DanaFarber) and LIVESTRONG (@livestrong) will be joining us.

Dana-Farber recently shared a slide show on the Myths About Food and Cancer. We invite you to take a moment and view these slides.
 (http://www.slideshare.net/DanaFarber/myths-about-food-amp-cancer )

Myths About Food and Cancer from Dana-Farber Cancer Institute

Since 2007 LIVESTRONG and the YMCA have partnered to provide a program for cancer survivors to promote physical activity after a cancer diagnosis. The 12 week program helps to improve the strength and quality of life of survivors. Learn more about their program here.

Our conversation will be guided by these topic questions: 

T1: What role does exercise play during treatment? How does it affect quality of life / outcomes? Did you exercise during treatment?

T2: Many gyn cancer patients undergo abdominal surgery. What exercises are recommended in recovery? long term?

T3: What are some resources for patients and survivors about exercise? What programs/exercises have helped you most?

T4: We periodically hear news about sugar and cancer...  Does sugar feed cancer? Should we avoid all sugar? Why do we need sugar?

T5: Are there specific foods GYN cancer patients should avoid? What's being discovered re: nutrition and gyn cancers?

T6: For cancer survivors, is nutrition more about finding balance or it is more about cutting certain things altogether? Tips?


We hope you can join us. See you on the 11th!

Dee
Co-Founder & Co-Moderator