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

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 [10-12]. 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 [12-15]. 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 [13]. 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 [14]. 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 [15]. 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 [14-18]. This stress is combated by the intrinsic antioxidants of the body including vitamin C [14]. It is seen that patients with cancer have low levels of vitamin C in their bodies [19]. 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) [20,21]. 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 [14,22,23]. 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 [13-15].

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.

Human Ethics

Animal Ethics

References