Antioxidant Effects – Dietary and Topical Use During Treatment
By Morag Currin
There are always questions about the safety of antioxidants during chemotherapy or radiation therapy. This is not a simple one to answer. Health care professionals have been trying to definitively answer this question for many years, but it remains very controversial. From a safety perspective, most healthcare professionals will recommend that patients avoid taking (nutritional dietary) antioxidant supplements during treatment due to the concern that they might reduce their efficacy.
Healthcare professionals primarily focus on dietary (foods, teas, and supplements) while the esthetician focuses mostly on the topical application of products with ingredients that have antioxidant benefits. There are of course estheticians trained in nutrition as well.
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Healthcare professionals also have a stronger focus on what they are trained to do specifically – in the case of surgical, radiation, or medical oncologists – they will focus on removing, killing, or controlling cancer in their area of specialty. Some healthcare teams have a dermatologist on board to help with dermatological conditions arising from treatment.
For estheticians certified in Oncology Aesthetics – our focus is primarily skincare. What is important here is that the healthcare team gives the final decision on any nutritional or dietary input (internally) especially if the client is undergoing chemotherapy and for survivors on a multitude of medications.
Where there is a large gap in the care of cancer survivors is skin, hair, and nail care, as this is not a primary focus for the healthcare team. This is where estheticians can stand up and contribute their expertise. Certified estheticians, after their training, should have a better understanding of the mechanism of action of chemotherapy and other drugs, plus radiation therapy to the skin, hair, and nails. The area not addressed is the integrity of the skin barrier, its function, and how it is affected by cancer treatment. How does the esthetician work with this impaired skin barrier from a topical (and if certified in nutrition) perspective?
Radiation therapy and a number of chemotherapy drugs kill cancer by producing molecules called free radicals, which damage DNA through a process called oxidation. Normal, healthy cells can repair most, if not all, of this DNA damage within hours. Cancer cells, on the other hand, typically have defective DNA damage repair mechanisms, so they accumulate excessive amounts of DNA damage that cause cell death through a process called apoptosis – a type of cell suicide.
Antioxidants are compounds that protect against oxidation and can inactivate free radicals therefore they can reduce or eliminate the DNA-damaging effects of the free radicals.
The concern, in theory, is that antioxidants could therefore protect malignant cells from cancer treatments that rely on oxidative DNA damage.
We know that various compounds that possess antioxidant properties may exert either anticancer or cancer-protective properties, as well as normal tissue protective properties, depending on their dose, timing and route of administration, the use of other concurrent therapies and lifestyle factors.
Furthermore, a compound may function as an antioxidant within one dose range (such as oral/low-dose vitamin C), but as a pro-oxidant (such as intravenous/high-dose vitamin C) at another (such as vitamin C).
Pro-oxidants are chemicals that induce oxidative stress, through the formation of ROS or by inhibiting the antioxidant system. Recently, pro-oxidant cancer therapy that can selectively kill cancer cells by the generation of cytotoxic oxidative stress in cancer cells has emerged as an effective strategy for cancer-specific treatments. (1&2) Because cancer cells are more sensitive than normal cells to the oxidative stress, the increased ROS by PL can selectively kill cancer cells (3&4).
There is data that does not seem to indicate a decrease in anticancer effectiveness of chemotherapy nor radiation therapy. However, not all data support the safety of antioxidant supplementation during cancer treatment that relies upon the production of free radicals. For example, one study found that smokers who supplemented with alpha-tocopherol (vitamin E) and beta-carotene during their head and neck radiation therapy had increased recurrence and mortality compared to those who did not supplement.
No differences were found in the non-smokers, however, there may be a reduction in the capability of built-in, protective, anticancer mechanisms (i.e., apoptosis) in cancer cells, to die when supplemental antioxidants are taken.
Amifostine, WR-2721 or Ethyol, is a potent antioxidant drug which was approved in the US for use during radiation therapy and chemotherapy to protect sensitive tissues from the damaging effects of treatment. Amifostine appears to have no effect in reducing the efficacy of radiation therapy or chemotherapy when administered during treatment.
Dr. Brian Lawenda and colleagues published a review on this topic in 2008 and the findings and conclusions have not changed until today. Few animal and cell studies have shown a reduced efficacy of radiation therapy and chemotherapy; however, no human studies have reported reduced efficacy of either chemotherapy or radiation therapy when administered at the same time as antioxidants (exception: smokers who took vitamin E and beta-carotene during head and neck cancer radiation therapy).
Numerous studies have reported reduced side effects and improved treatment tolerance when chemotherapy or radiation therapy is administered along with antioxidants in humans.
Depending on a range of factors (i.e., the patient’s condition, cancer, stage, type of treatments they received or are receiving, their interest level in using antioxidants, etc.).
The following excerpt is provided by Dr. Brian Lawenda and this information can be found on his website.
Dr. Lawenda usually counsels his patients on taking either a more-cautious or a less-cautious approach.
Avoid high-dose antioxidants during chemotherapy and radiation therapy.
Consuming antioxidants through food and beverages (i.e., fruits, vegetables, teas, etc.) or low-dose supplements (not to exceed the recommended daily allowance, RDA) is not likely to offer any significant protection to tumors.
Antioxidants supplements for which there are no established RDA’s (i.e., EGCG, curcumin), should either be consumed in moderation only in their whole plant forms (i.e., green tea instead of EGCG, turmeric instead of curcumin) or avoided.
While it may be safe to resume higher-dose antioxidants after the completion of chemotherapy or radiation therapy, these may reduce the effectiveness of natural, mechanisms the cancer cells employ to activate cell death pathways (i.e., apoptosis) leading to enhanced cancer cell survival. Furthermore, there are established concerns from some studies that suggest high-dose antioxidant supplements may increase the risk of certain cancers (i.e., beta-carotene supplements increased the risk of lung cancer in smokers) and other untoward effects (i.e., vitamin E supplements increased the risks of hemorrhagic/bleeding stroke and prostate cancer) REF.
Less Cautious Approach
Consider taking various antioxidant supplements (along with fruits and vegetables) to improve treatment tolerance and quality of life. The selection of these antioxidants should be informed by the scientific evidence in the published literature.
Work with a provider who is highly knowledgeable in the safety of these supplements and their potential interactions with conventional treatments (i.e., prescribed, and over-the-counter drugs, botanicals, chemotherapy agents, surgery, radiation therapy, etc.)
Consider targeted intake (preferably through foods) of antioxidant micronutrient deficiencies, as identified on micronutrient lab testing.”
Any cancer survivors conversing with estheticians should be advised to discuss the intake of supplements and diet with their oncology health care team.
Here are a few known antioxidants used in skincare that are also used in the world of cancer.
Epigallocatechin gallate (EGCG) is a catechin and an abundant polyphenol in green tea. The active constituents of green tea include the polyphenol epigallocatechin-3-gallate (EGCG), caffeine, and theanine.
EGCG, applied topically, has been reported to help relieve radiation-induced dermatitis in breast cancer patients (5&6).
A more specific herbal supplement-drug interaction is that of green tea extract (EGCG) and Velcade (bortezomib), a chemotherapeutic agent used to treat multiple myeloma, a type of blood cancer.
EGCG has been shown to reduce the anti-tumor effects of bortezomib (7).
EGCG in skin care as shown in studies conducted at the University of Manchester demonstrated that EGCG can significantly reduce skin scarring and can even shrink keloid scars by up to 40% (8).
The active substance in turmeric is curcumin. Curcumin is a powerful antioxidant that can also help to reduce swelling and pain. The active constituents are turmerone oil and water-soluble curcuminoids, among which curcumin has been the focus of research over the past few years.
A topical turmeric-based cream has been found to reduce radiotherapy-induced dermatitis in patients with head and neck cancer (9). Topical application of either curcumin or turmeric has been found useful for controlling signs and symptoms of oral mucositis (10).
Curcumin in skin care is known for its anti-inflammatory and antioxidant effects, and the prevention of skin aging has been examined, especially when related to sun exposure (photoaging).
Astaxanthin has shown demonstrated a consistent ability to reduce multiple types of cancer. These findings have the potential to incite many diverse types of medical research that could affect modern-day cancer treatment (11).
Astaxanthin (ASX) is a marine-based ketocarotenoid; an accessory pigment in plants in that it has many different potential functions plus is an antioxidant that is more potent than many other antioxidants. Antioxidants have anti-inflammatory and oxidative stress-reducing properties to potentially reduce the incidence of cancer or inhibit the expansion of tumor cells.
Astaxanthin in skincare is primarily associated with photoprotective, antioxidant, and anti-inflammatory effects.
Resveratrol, a non-flavonoid polyphenol, is a phytoestrogen that possesses antioxidant, anti-inflammatory, cardioprotective, and anti-cancer properties. This non-flavonoid polyphenol occurs naturally occurs in many species of plants, including peanuts, grapes, pines, and berries, and assists in the response against pathogen infections (12).
It has been reported that resveratrol can reverse multidrug resistance in cancer cells, and, when used in combination with clinically used drugs, it can sensitize cancer cells to standard chemotherapeutic agents.
Resveratrol in skincare is primarily associated with the proven ability to penetrate the skin barrier and antiaging activity. It has been shown to stimulate the proliferation of fibroblasts and contribute to the increase in the concentration of collagen III. Resveratrol also has antioxidant properties, thus can protect cells against oxidative damage associated with the effects of free radicals and UV radiation on the skin by reducing the expression of AP-1 and NF-kB factors and it slows down the process of photoaging of the skin.
There have been studies done where there are also benefits to these ingredients in preventing cancer. However, a good guide for the herb-drug interactions can be found here.
- Trachootham D., Alexandre J., Huang P. Targeting cancer cells by ROS-mediated mechanisms: A radical therapeutic approach? Nat. Rev. Drug Discov. 2009;8:579–591. doi: 10.1038/nrd2803.
- Schumacker P.T. Reactive oxygen species in cancer cells: Live by the sword, die by the sword. Cancer Cell. 2006;10:175–176. doi: 10.1016/j.ccr.2006.08.015.
- Liu J., Wang Z. Increased oxidative stress as a selective anticancer therapy. Oxid. Med. Cell Longev. 2015;2015:294303. doi: 10.1155/2015/294303.
- Zhu W, Jia L, Chen G, et al. Epigallocatechin-3-gallate ameliorates radiation-induced acute skin damage in breast cancer patients undergoing adjuvant radiotherapy. Oncotarget. 2016 Jul 26;7(30):48607-48613.
- Zhao H, Zhu W, Jia L, et al. Phase I study of topical epigallocatechin-3-gallate (EGCG) in patients with breast cancer receiving adjuvant radiotherapy. Br J Radiol. 2016;89(1058):20150665.
- Eunji Kim,1,† Kyeonghwan Hwang,2,† Jongsung Lee,1,† Sang Yun Han,1 Eun-Mi Kim,2 Junseong Park,2,* and Jae Youl Cho1,
- Palatty PL, Azmidah A, Rao S, et al. Topical application of a sandal wood oil and turmeric based cream prevents radiodermatitis in head and neck cancer patients undergoing external beam radiotherapy: a pilot study. Br J Radiol. 2014 Jun;87(1038):20130490.
- Normando AGC, de Menêses AG, de Toledo IP, et al. Effects of turmeric and curcumin on oral mucositis: A systematic review. Phytother Res. 2019 Mar 6. doi: 10.1002/ptr.6326.
- Cucciolla V., Borriello A., Oliva A., Galletti P., Zappia V., Della Ragione F. Resveratrol: From basic science to the clinic. Cell Cycle. 2007;6:2495–2510. doi: 10.4161/cc.6.20.4815.