Dietary Supplement Use Among Adult Cancer Survivors in the United States

Background Many cancer patients initiated supplement use after cancer diagnosis and yet the effect of supplement use on survival has not been established. The trend of and factors associated with dietary supplement use in cancer survivors warrant further investigation. Methods We examined the trend of dietary supplemental use in 1,902 adult cancer survivors who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2012, and compared the frequency of supplement use in cancer survivors to that of 3,804 individuals with no history of cancer who were matched to the cancer survivors by age, sex, and race/ethnicity. The use of any supplements and individual supplements in the past 30 days was assessed based on self‐report. We further evaluated factors associated with supplement use in cancer survivors. Results Adult cancer survivors reported a significantly higher frequency of using any supplements (58% vs. 54%, p=0.0009) and individual supplements such as folic acid (26% vs. 23%, p=0.01), vitamin D (21% vs. 17%, p=0.0002), vitamin C (19% vs. 16%, p=0.01), and magnesium (12% vs. 10%, p=0.03) than non‐cancer individuals. Cancer survivors also reported an increasing trend of using vitamin D (11% in 1999–2000 vs. 41% in 2011–2012, p for trend<0.0001) and fish oil (1% in 1999–2000 vs. 15% in 2011–2012, p for trend<0.0001) but a decreasing trend of using calcium (18% in 1999–2000 vs. 10% in 2011–2012, p for trend=0.002). Compared to survivors who reported no supplement use, those who reported any supplement use were older (60 vs. 56 years of age, p<0.0001) and more likely to be non‐Hispanic Whites (86% vs. 76%, p<0.0001), college graduates (62% vs. 46%, p<0.0001), nonsmokers (42% vs. 38%, p<0.0001), and moderate alcohol drinkers defined as <=1 drink/d for women and <=2 drinks/d for men (41% vs. 31%, p=0.004), having a diagnosis of breast cancer (22% vs.14%, p=0.004), and being diagnosed with cancer at an older (49 vs. 45 years of age, p<0.0001). Gender, weight status, and years since diagnosis were not associated with supplement use in cancer survivors. Conclusions In a national sample of US adults, cancer survivors reported a higher frequency of supplement use than non‐cancer individuals. Supplement use in cancer survivors has been increasing for vitamin D and fish oil but decreasing for calcium. Support or Funding Information NIH/NCI 1R03CA199516 1 Supplement Use in Adult Cancer Survivors and Individuals without Cancer in NHANES 1999–2012Supplement Use Cancer Survivors (n=1,902) Individuals without Cancer (n=3,804) P valueN (%) N (%)Any supplement use 1 1,111 (58.4) 2046 (53.8) 0.0009Multivitamin and mineral (MVM) supplement use 2Multivitamin with mineral 182 (9.6) 336 (8.8) 0.36 Multivitamin without mineral 75 (3.9) 111(2.9) 0.04Single supplement use 444 (23.3) 877 (23.1) 0.81VitaminsFolic Acid 492 (25.9) 862 (22.7) 0.01 Vitamin D 393 (20.7) 631 (16.6) 0.0002 Vitamin C 362 (19.0) 622 (16.4) 0.01 Vitamin E 331 (17.4) 609 (16.0) 0.18 Vitamin B12 212 (11.2} 385 (10.1) 0.23 Vitamin B6 181 (9.5) 327 (8.6) 0.25 Vitamin A 177 (9.3) 364 (9.6) 0.75 Vitamin B3 161 (8.5) 303 (8.0) 0.52 Vitamin K 54 (2.8) 118 (3.1) 0.58MineralsCalcium 274 (14.4) 551 (14.5) 0.94 Magnesium 225 (11.8) 377 (9.9) 0.03 Zinc 153 (8.0) 311 (8.2) 0.86 Iron 130 (6.8) 242 (6.4) 0.49 Selenium 118 (6.2) 214 (5.6) 0.38 Potassium 114 (6.0) 212 (5.6) 0.52 Copper 93 (4.9) 201 (5.3) 0.53 Phosphorus 56 (2.9) 109 (2.9) 0.87OthersFish Oil 116 (6.1) 218 (5.7) 0.58 Glucosamine 43 (2.3) 88 (2.3) 0.90 Garlic 40 (2.1) 82 (2.2) 0.90 Fiber 27 (1.4) 60 (1.6) 0.65 Glutamine 4 (0.2) 7 (0.2) 0.83 Echinacea 8 (0.4) 22 (0.6) 0.441 Any supplement use was defined as the use of the selected vitamins, minerals, non‐vitamin non‐mineral supplements. 2 Multivitamin/mineral (MVM) supplemental use was defined as containing 3 or more vitamins with or without minerals. B‐complex vitamin is considered as a multivitamin supplement.2 Factors Associated with Supplemental Use in Adult Cancer Survivors 1Characteristics Survivors who reported supplemental use (N=1,111) Survivors who did not report supplemental use (N=791) P value OR (95% CI)Age , years, mean (SEM) 59.8 (0.5) 55.6 (0.6) <.000lGender , N (%) Men 450 (34.9) 348 (37.0) 0.50 1.0 (ref.) Women 661 (65.1) 443 (63.0) 1.1 (0.8–1.4)Race/ethnicity, N (%) Non‐Hispanic White 747 (86.4) 410 (76.1) < 0001 1.0 (ref.) Non‐Hispanic Black 179 (6.0) 209 (12.2) 0.4 (0.3–0.6) Other 185 (7.6) 172 (11.7) 0.6 (0.4–0.8)Education, N (%) Grades 0–12 242 (14.3) 289 (25.1) <.000l 1.0 (ref.) Some post high school 265 (23.3) 206 (29.2) 1.4 (1.0–1.9) College graduate 602 (62.4) 296 (45.7) 2.4 (1.8–3.2)Smoking, N (%) Nonsmokers 481 (42.2) 308 (38.0) <.0001 1.0 (ref.) Former smokers 472 (42.7) 272 (31.9) 1.2 (0.9–1.6) Current smokers 157 (15.1) 210 (30.1) 0.5 (0.3–0.6)Alcohol , drink/week, N (%) Nondrinkers 414 (33.3) 345 (40.6) 0.004 1.0 (ref.) Moderate drinkers 421 (41.4) 215 (30.8) 1.6 (1.2–2.2) Heavy Drinkers 219 (25.4) 164 (28.6) 1.1 (0.8–1.5)Body mass index (BMI) , kg/m 2 , mean (SEM) 28.9 (0.2) 29.4 (0.3) 0.13Weight status, N (%) Normal weight (BMI=18.5–24.9) 308 (31.1) 186 (28.1) 0.60 1.0 (ref.) Overweight (BMI=25–29.9) 374 (31.8) 276 (33.2) 0.9 (0.6–1.2) Obese (BMI≥30) 429 (37.1) 329 (38.7) 0.9 (0.6–1.2)Primary diagnosis, N (%) Breast cancer 233 (22.0) 114 (14.3) 0.004 1.7 (1.2–2.4) Prostate cancer 184 (11.6) 162 (12.9) 0.45 0.9 (0.7–1.2) Colon cancer 94 (6.7) 77 (7.5) 0.54 0.9 (0.6–1.3) Lung cancer 33 (3.0) 20 (2.4) 0.40 1.3 (0.7–2.1) Other 500 (50.0) 381 (57.0) 0.02 0.8 (0.6–0.9) Multiple 67 (6.7) 37 (5.8) 0.60 1.2 (0.7–2.1)Age at diagnosis, years, mean (SEM) 49.0 (0.6) 44.6 (0.7) <.0001Time from diagnosis , years, mean (SEM) 10.8 (0.5) 11.0 (0.4) 0.76Time from diagnosis, N (%) >10 453 (42.0) 324 (43.0) 0.98 1.0 (ref) 5–9 279 (24.4) 196 (24.4) 1.1 (0.6–1.9) 1–4 331 (28.6) 230 (27.9) 1.1 (0.8–1.4) <1 48 (5.0) 41 (4.7) 1.0 (0.8–1.3)1 Frequencies, odds ratio, and 95% confidence intervals presented were weighted.3 Trend of Supplemental Use in Adult Cancer Survivors and Individuals without Cancer 1Supplement Use Cancer Survivors (n=1,902) p trend Individuals Without Cancer (n=3,804) p trend99–00 01–02 03–04 05–06 07–08 09–10 11–12 99–00 01–02 03–04 05–06 07–08 09–10 11–12Any supplement use 2 125 (62.1) 133 (62.9) 156 (64.2) 131 (63.3) 192 (60.0) 197 (62.6) 177 (67.3) 0.95 239 (55.0) 286 (56.9) 313 (61.0) 260 (59.8) 352 (59.1) 332 (54.7) 264 (57.2) 0.44Folic Acid 39 (20.7) 69 (31.5) 78 (33.0) 66 (31.3) 95 (30.4) 75 (27.9) 70 (24.5) 0.26 85 (19.3) 124 (23.9) 129 (25.3) 130 (28.2) 155 (26.7) 139 (24.6) 100 (22.0) 0.49Vitamin D 21 (11.3) 30 (15.3) 44 (18.7) 38 (19.9) 68 (21.7) 96 (33.7) 96 (41.3) <.0001 38 (10.2) 53 (11.1) 78 (15.8) 71 (16.1) 125 (21.8) 134 (24.9) 132 (27.4) <.0001Vitamin C 45 (22.2) 43 (26.3) 68 (29.9) 43 (21.8) 59 (18.0) 58 (19.3) 46 (16.5) 0.08 71 (17.4) 103 (22.1) 92 (16.9) 86 (20.6) 105 (19.0) 85 (15.9) 80 (19.0) 0.48Calcium 34 (17.6) 41 (22.4) 46 (20.3) 37 (19.1) 40 (12.6) 43 (14.5) 33 (10.3) 0.002 65 (16.4) 79 (15.5) 86 (16.3) 89 (21.2) 87 (15.0) 70 (12.8) 75 (17.9) 0.02Magnesium 28 (14.0) 23 (12.1) 36 (13.1) 26 (13.9) 36 (12.0) 41 (14.0) 35 (16.5) 0.89 45 (13.3) 55 (10.2) 50 (9.8) 53 (13.7) 67 (11.4) 59 (10.7) 48 (14.1) 0.45Zinc 13 (6.5) 15 (7.9) 18 (7.0) 23 (12.7) 28 (7.8) 30 (11.8) 26 (11.8) 0.34 25 (6.6) 54 (10.6) 42 (7.9) 48 (9.8) 57 (9.9) 42 (8.0) 43 (10.8) 0.54Fish Oil 1 (0.7) 4 (1.6) 6 (2.8) 13 (7.6) 26 (6.6) 32 (8.8) 34 (15.8) <.0001 3 (1.4) 10 (2.7) 19 (4.3) 59 (9.7) 66 (13.1) 66 (13.1) 44 (6.6) <.00011 Frequencies presented were weighted frequencies. 2 Any supplement use was defined as the use of the selected vitamins, minerals, non‐vitamin non‐mineral supplements.