It’s Only Natural

Session: Catching Up to Speed on the Role of Nutritional Supplements in the Management of Gynecologic Cancer Patients

Speaker: Judith Ann Smith, PharmD, Associate Professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at UTHealth McGovern Medical School and Director of the Women’s Health Integrative Medicine Research Program

Caution is key when guiding patients to nutritional and herbal supplements to ease surgical menopause symptoms

“A large area of treatment for our patient population is surgical menopause or treatment-related menopause from radiation. And many of our patients want a natural way to do this—without using hormone replacements, like estrogen replacement,” explained Judith Ann Smith, PharmD, Associate Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences at UTHealth McGovern Medical School and Director of the Women’s Health Integrative Medicine Research Program.

That’s how Dr. Smith launched her discussion about nutritional supplements and how they can ease symptoms associated with surgical menopause. The topic was a sub-section of her larger SGO 2021 session, Catching Up to Speed on the Role of Nutritional Supplements in the Management of Gynecologic Cancer Patients.

What’s the Big Deal?

Understanding which nutritional supplements can support—or harm— gynecologic oncology patients is essential for two reasons.

To begin with, Dr. Smith said, the use of nutritional supplements, or complementary and alternative medication (CAM) therapies has significantly increased over the past couple decades. “Up to 60 percent of patients now take some kind of nutritional supplement to complement their health and wellness.”

Secondly, “herbal and mineral supplements are really medications,” Dr. Smith emphasized. And certain supplements interact negatively with certain medications, she added. A few detrimental interactions involve decreased mechanism of action, interference with metabolism, prevention of drug breakdown, obstruction of renal or hepatic clearance, and drug accumulation.

Because of these interactions, it’s imperative that there be a discussion about all supplements a patient is taking, which Dr. Smith feels can take some digging. “I don’t think patients are hiding their supplement use. It’s just that many of our patients don’t identify supplements as medication. You buy supplements over the counter,” Dr. Smith said. “So when we’re triaging patients and discussing medications, we need to specifically ask about what nutritional supplements they take.”

Specific questions, Dr. Smith added, may need to begin with a brief definition of what falls under complementary and alternative medication. “We need to explain that CAM includes the consumption of any kind of herbs, homeopathic phytochemicals, or mega-vitamins to promote wellbeing. And by mega-vitamin I mean equal or greater to 10 times the daily recommended allowance. That’s an important distinction since it’s the higher quantities than can cause concern.”

If a patient still can’t quite understand the importance of discussing supplements with their gynecologic oncologist, then Dr. Smith suggests explaining that many supplements as well as common chemotherapy agents come from plants. For example, paclitaxel is derived from the bark of the Pacific yew tree.

It’s a Sign

“In the gynecologic oncology arena, we see many patients go through surgical menopause and even if the patient is already postmenopausal, removal of the ovaries may cause a resurgence of menopausal symptoms,” Dr. Smith said. Regardless of why a patient is experiencing menopausal symptoms, it still comes down to the same goals—managing hot flashes, maybe improving the libido, and possibly resolving signs of depression, dry skin, and weight gain.

Hormone replacement therapy may be one way to go, although some patients are not a good candidate for estrogen replacement. There are also patients who simply want to follow the CAM therapy path.

Omega 3 supplements are on that natural path, and Dr. Smith shared that the polyunsaturated fatty acid may help decrease silent inflammation, which can help improve weight loss and weight management, especially in the cancer recovery period. In addition, data suggests that omega 3 helps with the management of hot flashes.

Phytoestrogens, plant-based compounds that mimic estrogen in the body, make up another group of natural products used in the management of menopausal symptoms. This category traditionally includes 18 different plant-derived compounds in 11 different families. “They are all proposed to be structurally similar to endogenous estrogens,” Dr. Smith said. “And some have both estrogenic and anti-estrogenic activity, depending on the dose you’re taking.”

The majority of phytoestrogens are shown to be safe, Dr. Smith said, adding that it’s product efficacy that prompts the most questions. “There is often a gap in the literature as to whether or not this group demonstrates true efficacy—and when efficacy is demonstrated the data is often animal derived.”

Dr. Smith concluded her session with a few “reliable resources” to help gynecologic oncologists evaluate the safety and efficacy of supplements for their patients. These, she added, are worth bookmarking:

Dr. Smith’s discussion included a slide with several phytoestrogens listed along with conformation concerning data reporting preclinical and clinical efficacy as well as safety.