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27 september 2021: Bron:  2021 May; 13(5): e14867. Published online 2021 May 6

Intraveneus vitamine C voor patiënten met borstkanker stadium II en III naast de behandelingen die de patiënten ondergaan vermindert duidelijk op 4 weken meting de bijwerkingen zoals misselijkheid, verlies van eetlust, tumorpijn, vermoeidheid en slapeloosheid. Dit blijkt uit een gerandomiseerde studie bij totaal 350 patiënten die in twee groepen gerandomiseerd werden ingedeeld in een verhouding van 1:1. (N = 172 en N = 171) 
De studiegroep kreeg gedurende vier weken 25 gram C intraveneus per week met een snelheid van 15 gram per uur naast hun huidige standaardbehandeling, en de controlegroep kreeg een placebo (normale zoutoplossing met label verwijderd) naast hun huidige standaard behandeling. Waarvan respectievelijk 131 vs 127 patiënten een chemokuur kregen. 51 versus 48 patiënten radiotherapie en 32 versus 36 patiënten hormoontherapie.

De gemiddelde leeftijd van de deelnemers aan het onderzoek en de controlegroep was respectievelijk 57 (± 9 jaar) en 58 (± 9 jaar). Beide groepen waren ook vergelijkbaar qua stadium van kanker en behandeling. (Table1) (zie hier wat stadia betekenen)

De resultaten tonen aan dat toediening van 25 gram IVC per week de gemiddelde VAS-scores voor alle symptomen verbeterde 28 dagen na de start van vitamine C. Er werd echter met name een significante verbetering gezien in symptomen / bijwerkingen die betrekking hebben op het maagdarmkanaal, zoals misselijkheid en eetlust, systemische en neurale symptomen zoals tumorpijn, vermoeidheid en slapeloosheid. De patiënten in de behandelingsgroep rapporteerden geen nieuwe of andere bijwerkingen na het starten van intraveneus vitamine C.

Hier twee grafieken, (Table1) gaat over de deelnemende patiënten en welke behandeling zij kregen.
 (Table2) daaronder laat de resultaten zien na 28 dagen. 

Table 1

A comparative analysis of both groups based on cancer staging and treatment
Characteristics Study Group (n = 172) Control Group (n = 171) p-Value
Mean age (years) 57 ± 9 58 ± 9 0.3
Union for International Cancer Control (UICC) stages
IIa 98 (56.98%) 91 (53.22%)   0.87
IIb 35 (20.35%) 40 (23.29%)
IIIb 27 (15.70%) 29 (19.96%)
IIIb 12 (6.98%) 11 (6.43%)
Treatment
Chemotherapy 131 (76.16%) 127 (74.27%) 0.68
Radiotherapy 51 (29.65%) 48 (28.07%) 0.74
Hormone therapy 32 (18.60%) 36 (21.05%) 0.56

In patients who had received IVC, there was a significant decrease in mean severity score after 28 days for the following symptoms: nausea (2.65 ± 0.62 vs. 2.59 ± 0.68; p-value: 0.0003), loss of appetite (2.26 ± 0.51 vs. 2.11 ± 0.52; p-value: 0.007), tumor pain (2.22 ± 0.45 vs. 1.99 ± 0.40, p-value: <0.0001*), fatigue (3.11 ± 0.32 vs. 2.87 ± 0.29; p-value: <0.0001*), and insomnia (2.59 ± 0.35 vs. 2.32 ± 0.36, p-value: <0.0001). There was no difference in mean severity score of any symptom in the placebo group (Table2).

Table 2

Analysis of change in severity of symptoms after IVC treatment using VAS score

IVC, intravenous vitamin C; VAS, visual analog scale

*: Significant

Symptoms Study Group Control Group
Day 0 Mean VAS Score Day 28 Mean VAS Score p-Value Day 0 Mean VAS Score Day 28 Mean VAS Score p-Value
Diarrhea 2.65 ± 0.62 2.59 ± 0.68 0.39 2.51 ± 0.55 2.58 ± 0.50 0.2
Nausea 3.01 ± 0.62 2.78 ± 0.54 0.0003* 2.98 ± 0.55 2.92 ± 0.52 0.3
Loss of appetite 2.26 ± 0.51 2.11 ± 0.52 0.007* 2.41 ± 0.62 2.47 ± 0.54 0.34
Vomiting 2.87 ± 0.56 2.77 ± 0.50 0.08 2.81 ± 0.41 2.86 ± 0.34 0.22
Tumor pain 2.22 ± 0.45 1.99 ± 0.40 <0.0001* 2.31 ± 0.47 2.40 ± 0.46 0.07
Fatigue 3.11 ± 0.32 2.87 ± 0.29 <0.0001* 3.08 ± 0.40 3.09 ± 0.44 0.82
Insomnia 2.59 ± 0.35 2.32 ± 0.36 <0.0001* 2.62 ± 0.42 2.59 ± 0.44 0.51

De onderzoekers ontdekten dus dat vitamine C een gunstige rol speelt bij het verlichten van symptomen die optreden als bijwerkingen van standaard adjuvante therapie of door de kanker zelf. De resultaten tonen aan dat toediening van 25 gram IVC per week de gemiddelde VAS-scores voor alle symptomen verbeterde 28 dagen na de start van vitamine C.

Het volledige studieverslag is gratis in te zien. Klik daarvoor op de titel van het abstract:

 2021 May; 13(5): e14867.
Published online 2021 May 6. doi: 10.7759/cureus.14867
PMCID: PMC8177022
PMID: 34113504

Impact of Intravenous Vitamin C Administration in Reducing Severity of Symptoms in Breast Cancer Patients During Treatment

Monitoring Editor: Alexander Muacevic and John R Adler

Abstract

Introduction

Alternative medicine during treatment is often used to make the quality of life (QoL) better. Women with early-stage breast cancer, particularly the ones who possess lower QoL, are more prone to opt for complementary medicine. This study aims to explore the effects exerted by intravenous vitamin C (IVC) on symptoms and adverse events associated with breast cancer treatment.

Methods

This single-center, parallel-group, single-blind interventional study was conducted in the oncology ward of a tertiary care hospital in Pakistan. For this study, after informed consent was taken, breast cancer patients with Union for International Cancer Control stages IIA to IIIb were included in the study. Three hundred and fifty (n = 350) patients were randomized into two groups at a ratio of 1:1. Study group was randomized to receive 25 grams per week of IVC at a rate of 15 grams per hour for four weeks in addition to their current standard treatment, and the control group received placebo (normal saline drip with label removed) in addition to their current standard treatment.

Results

In patients who had received IVC, there was a significant decrease in the mean severity score after 28 days for the following symptoms: nausea (2.65 ± 0.62 vs. 2.59 ± 0.68; p-value: 0.0003), loss of appetite (2.26 ± 0.51 vs. 2.11 ± 0.52; p-value: 0.007), tumor pain (2.22 ± 0.45 vs. 1.99 ± 0.40, p-value: <0.0001), fatigue (3.11 ± 0.32 vs. 2.87 ± 0.29; p-value: <0.0001), and insomnia (2.59 ± 0.35 vs. 2.32 ± 0.36, p-value: <0.0001).

Conclusion

Our study showed improvement in the mean severity score of nausea, fatigue, tumor pain, loss of appetite, and fatigue. More studies are also needed to assess the long-term effects of IVC in the cancer management. This shall help incorporate the use of IVC in standard practice to make the journey of cancer management comfortable for the patients.

Discussion

Although the role of vitamin C and other antioxidants as a complementary treatment in cancer management has been of keen interest for scientists, limited literature exists on its practical use and clinical effects in humans, particularly in those with breast cancer [-]. Our study aimed to fill this gap in knowledge and tried to add to the scarce evidence pool by exploring the role of IVC in improving QoL in patients with breast cancer. We found that vitamin C plays a beneficial role in alleviating symptoms arising either as side effects of standard adjuvant therapy or by cancer itself. In our sample, most patients belonged to UICC stage IIa for breast cancer with almost 75% of patients undergoing chemotherapy. The randomization led to no significant difference in baseline characteristics of patients receiving IVC and those in the control group. Results show that per-week administration of 25 grams of IVC improved mean VAS scores for all the symptoms at 28 days post vitamin C initiation. However, significant improvement was notably seen in symptoms pertaining to the gastrointestinal tract, such as nausea and appetite, systemic and neural symptoms like tumor pain, fatigue, and insomnia. The patients in the treatment group reported no new side effects after initiation of IVC.

The current study findings seem to be consistent with the results of a handful of studies published previously on the topic [-]. A study conducted in Korea in terminally ill cancer patients (including breast cancer) reported that IVC significantly improved physical, emotional, and cognitive function as well as ameliorated the symptoms of nausea, vomiting, and fatigue and improved the appetite []. Similar results were found in a German study conducted in breast cancer patients where administration of 7.5 grams of IVC in patients significantly improved nausea, loss of appetite, fatigue, dizziness, sleep disorders, depression, and hemorrhagic diathesis []. Consistent findings were also seen in a case report of a woman with recurrent breast cancer receiving once-weekly chemotherapy. It was found that twice-weekly administration of 50 grams of vitamin C dramatically decreased fatigue and insomnia while concomitantly improving cognitive functioning []. Compared to our study, none of these studies reported any side effects of the IV administration of vitamin C. Despite the difference in the doses of vitamin C in the different studies, the results remained consistently positive and endorsed the role of vitamin C administration for alleviation of symptoms in breast cancer patients. 

The role of vitamin C in reducing symptoms in cancer patients can be explained by its antioxidant properties. It is known that radiation and chemotherapy along with tumor cell metabolism increase oxidative stress in cancer patients [-]. This stress is combated by the intrinsic antioxidants of the body including vitamin C []. It is seen that patients with cancer have low levels of vitamin C in their bodies []. This is because uncontrolled oxidative stress in cancer leads to high consumption of intrinsic body reserves resulting in vitamin C depletion. If not replenished duly, this deficiency eventually leads to the unopposed production of reactive oxygen species (ROS) [,]. The gut mucosa and the neural tissues, being the most sensitive to ROS, are affected the most. This leads to mucosal irritation of the gastrointestinal tract causing symptoms of nausea, vomiting, and loss of appetite. The neural irritation may trigger mental disorders including insomnia, tumor pain, and fatigue [,,]. Thus, replenishment of the intrinsic reserve by parenteral vitamin C administration may help combat the unopposed ROS production and play a vital role in alleviating cancer symptomatology, and hence QoL in these patients, as witnessed in our current study.

Our study has a few limitations that must be highlighted. Due to lack of resources and difficulty in maintaining follow-up, our study assessed only the short-term effects of IVC on QoL in breast cancer patients. Although convenient sampling was employed for participant recruitment, patient allocation to the treatment and control groups was randomized to minimize the risk of selection bias. Most participants were elderly and belonged to the UICC stage IIa; therefore, the generalization of the current findings to all breast cancer patients must be done cautiously. Despite the limitations, our study adds to the limited literature on the role of parenteral vitamin C in breast cancer patients. As the intervention was physician-led, it dodges the concerns of patient adherence to the treatment and its confounding effect on the study outcomes. The use of 25 grams of vitamin C in the present study is unique and never been used before in the other trials hence providing evidence in support of a range of doses without the consequence of side effects [-].

Conclusions

Our study showed improvement in the mean severity score of nausea, fatigue, tumor pain, loss of appetite, and fatigue. Although our findings suggest that vitamin C can significantly improve QoL in breast cancer patients, more studies with a larger sample size and use of different vitamin C doses are needed to confidently infer the findings to all breast cancer patients and to determine the most potent dose, respectively. More studies are also needed to assess the long-term effects of vitamin C in cancer management. This shall help incorporate the use of vitamin C in standard practice to make the journey of cancer management comfortable for the patients.

Notes

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

Human Ethics

Consent was obtained or waived by all participants in this study. Jinnah Post Graduate Medical Center issued approval JPMC/2019/IRB/O-12

Animal Ethics

Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.

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