Chemotherapy and Natural Interventions

Assessment and Plan: Chemotherapy and Natural Interventions

• In general, cancer patients on or between chemotherapy regimens should adhere to all healthful dietary and exercise habits as previous to chemotherapy, but follow the special guidelines as recommended by the oncologist.

• Cancer patients suffering from chemotherapy related fatigue may benefit from levocarnitine (L-carnitine) supplementation, but an improvement was not seen in all trials. The subjects in research that showed benefit in fatigue used a dose of 4-6 grams per day divided into 3 doses taken for 1-4 weeks while on chemotherapy (1,2,3).

• L-carnitine should not be taken without approval from a physician overseeing care. Adverse effects include halitosis (7), diarrhea, and rash which have been reported with higher doses. L-acetylcarnitine has been reported to induce seizures (9) and at the same time prevented seizures by lowering ammonia levels and reducing neurotoxicity (8). L-carnitine levels may be depleted by some anti-convulsants and cause an increase ammonia blood levels sometimes resulting in encephalopathy (11). Supplementation by L-carnitine is able reduce this elevated ammonia level (10). It may also make hypothyroidism worse by reducing the absorption of thyroid hormone.

• The most common dose of melatonin used was an oral dose of 20 mg once daily taken at night. Compared to standard treatment alone, melatonin improved the rate of complete or partial remission in cancer patients with solid tumors undergoing chemotherapy or radiation therapy (4). Melatonin improved the survival rate at one year, and it lowered the risk of low platelet count, neuropathy, and fatigue (4,6). Supplementation with melatonin reduced the relative risk of death at one year without adverse effects (5). Melatonin lowered the rate of chemotherapy related fatigue, oral toxicity, cardiac adverse effects and neurotoxic complications (6).