The presence and/or treatment of Neuroendocrine Cancer can disrupt normal digestive function – this can impact on our ability to absorb nutrients, including vitamins and minerals, from the food we eat.
Malnutrition has been reported in up to 40% of patients with a digestive tract based primary (e.g. small bowel, stomach and / or pancreas) – this can negatively impact on quality of life, treatment options and overall survival.
Pancreatic Enzyme Insufficiency (PEI) has also been reported – more commonly in those with digestive tract based primaries – but is also seen in others, e.g. Lung, who are receiving somatostatin analogues. PEI is one of a number of factors that may affect vitamin and mineral absorption.
There are deficiencies in fat-soluble vitamins that can occur either as a direct consequence of tumour presence and/or cancer treatment(s) – for example – Vitamin D deficiency (defined as 25 OH vitamin D levels ≤ 20 ng/mL) is described in between 46% and 81% of all patients with Neuroendocrine Cancer.
Recent review articles have discussed the nutritional impacts of Neuroendocrine Cancer, have identified the potential risks of risk of niacin and fat-soluble vitamin deficiency in some patients and there is increasing agreement, within the Neuroendocrine Cancer community, that the inclusion of an expert dietitian, as a core member of the specialist multidisciplinary team, is to be encouraged if not mandated.
So vitamin supplement or not?
In the absence of any symptoms and/or identified deficiency, we would encourage those with Neuroendocrine Cancer to follow the healthy dietary guidelines as recommended for the general population – the Eatwell Guide. Most people do not need to take vitamin supplements and can get all the vitamins and minerals they need by following this guide.
We would strongly recommend that an assessment of your nutritional requirements is undertaken, and discussed with your specialist team (and/or dietitian, if available), before making adjustments to your diet or adding in vitamin and/or mineral supplements.
NHS and the BDA (Association of UK Dietitians) on Supplements:
UK Food Standards Agency advice and regulatory information on Supplements
- Randomised trial evidence does not support use of vitamin, mineral, and fish oil supplements to reduce the risk of non-communicable diseases – such as cancer or diabetes.
- There is no reliable evidence that dietary or nutritional supplements can prevent, cure or control the growth of cancer. Check with your specialist before you take any supplements to make sure they won’t interfere with any cancer treatment you are having.
- Use of supplements may have health benefits for population subgroups, such as people with inadequate nutrient intake from foods but may also increase the risk of excess intake – which could lead to toxicity.
- All supplements should be discussed with your team and it is not advisable to take high doses of any single or multi ingredient vitamins and minerals unless requested by your team to either prevent or treat a deficiency.
- Further research is needed to assess the long term effects of supplements on the health of the general population and in individuals with specific nutritional needs.
Further information on Neuroendocrine Cancer is available on our website www.neuroendocrinecancer.org.uk