Fish oil in the cancer care setting
June 10, 2016
- Is fish oil safe and effective to use concurrently with cancer treatment?
- Can fish oil decrease side effects of common chemotherapies?
Fish oil contains several powerful omega-3 (n-3, ω-3) polyunsaturated fatty acids (PUFAs) that act to modulate the inflammatory cascade, most notably eicosapentaenoic acid (EPA 20:5 n-3) and docosahexaenoic acid (DHA 22:6 n-3).
Many human trials have shown the efficacy of fish oil concurrent with standard-of-care treatment for a variety of malignancies, without increasing unwanted side effects, and in many instances decreasing side effects. Recently, concern has developed over one mouse model study that found lowered response to cisplatin, attributable to 16:4 n-3, a fatty acid found in some fish.1 However, a human trial of fish oil concurrent with cisplatin did not show any lessening of cisplatin’s clinical effect.2
Increases efficacy of chemotherapy:
Improves surgical outcomes:
- An RCT (n=46) of patients with advanced NSCLC showed increased response rate to carboplatin with venorelbine or gemcitabine when given fish oil concurrently (p=0.008), leading to a 55% increase in 1-year survival.3
- An RCT (n=30) of individuals undergoing chemotherapy for colorectal cancer found significantly increased time to disease progression in individuals supplementing with 2g per day of fish oil concurrent with standard-of-care chemotherapy [time to tumor progression 593 days (±211.5)] vs. control [330 days (± 135.1)].4
- A phase II trial (n=25) of women with metastatic breast cancer who were treated with an anthracycline and also supplemented with DHA found that those with an inherent ability to incorporate DHA into plasma phospholipids nearly doubled their overall survival (34 months vs. 18 months) when compared with those who were less effective at incorporating DHA (p=0.02).5
- Women with greater levels of ω-3 polyunsaturated fatty acid (PUFA) in breast adipose tissue have a significantly greater response rate to chemotherapy for breast cancer (p=0.03).6
Decreases cancer cachexia and weight loss:
- An RCT of people undergoing gastrectomy for gastric carcinoma (n=60) found the incidence of postoperative infection to be significantly less with preoperative supplementation with ω-3 PUFAs and arginine (p <0.05).7
- An RCT (n=44) found that liver and pancreatic function (as measured by AST, ALT, bilirubin, and LDH levels in blood) is improved with postoperative fish oil supplementation in individuals undergoing surgery for gastrointestinal or pancreatic cancers (p<0.05).8
Decreases cancer treatment side effects:
- Multiple RCTs of patients with NSCLC treated with first-line chemotherapy and fish oil showed less weight loss, and in some instances weight gain, as well as maintenance of more skeletal muscle mass than controls.9,10,11
- An RCT of patients with colorectal cancer (n=23) found that patients were able to maintain weight during chemotherapy when supplemented with fish oil (p=0.01).12
- An RCT of children with leukemia (n=51) showed increased appetite (p<0.05) and upper arm muscle circumference (p<0.001) with supplemental fish oil.13
May improve efficacy of radiotherapy:
- An RCT of women on paclitaxel for breast cancer found 70% lowered risk of peripheral neuropathy with concurrent fish oil supplementation (p=0.029).14
- Fish oil supplementation improved neutrophil counts (p<0.05) as well as increased phagocytosis • (p<0.001) in an RCT of individuals undergoing treatment with 5-FU (n=38).15
- An RCT (n=40) showed increased overall quality of life as measured by physical function (p<0.01), cognitive function (p<0.01) and social function (p=0.04) when patients were supplemented with fish oil while going through standard-of-care treatment for stage III NSCLC.16
- 4g of combined DHA/EPA daily over three months were found to decrease bone resorption (p<0.05) in an RCT of women taking aromatase inhibitors for breast cancer (n=38).17
- Several in vitro studies have demonstrated enhanced cytotoxicity of radiation therapy when cancer cells are exposed to EPA and DHA by enhancing lipid peroxidation and subsequent apoptosis.18,19
- Patients with advanced inoperable NSCLC undergoing chemotherapy had significantly lower levels of CRP (p<0.05) and IL-6 (p<0.05) than controls in an RCT of 850mg of daily EPA/DHA (n=33).20
- An RCT of patients undergoing surgical resection of gastric tumors found lower inflammatory markers, IL-6 and TNF-α (p<0.05) in individuals supplemented with fish oil perioperatively at 0.2 g/kg body weight daily.21
- Diets high in omega-3 fatty acids have been shown to decrease the risk of developing gastrointestinal,22 breast23 and pancreatic24 cancers.
Fish oil is safe to use concurrently with surgery, chemotherapy and radiation. In addition, fish oil supplementation may help increase efficacy of certain chemotherapies and radiation, decrease potential side effects and increase overall quality of life.
It is safe and effective to use 3g or more combined DHA/EPA in patients with cancer during active treatment under the guidance of a trained integrative medicine professional.
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- Daenen LGM, Cirkel GA, Houthuijzen JM, et al. Increased plasma levels of chemoresistance-inducing fatty acid 16:4(n-3) after consumption of fish and fish oil. JAMA Oncol. 2015 Jun;1(3):350-8.
- Finocchiaro C, Segre O, Fadda M, et al. Effect of n-3 fatty acids on patients with advanced lung cancer: a double-blind, placebo-controlled study. Br J Nutr. 2012 Jul;108(2):327-33.
- Murphy RA, Mourtzakis M, Chu Q, Baracos VE, Reiman T, Mazurak VC. Supplementation with fish oil increases first-line chemotherapy efficacy in patients with advanced nonsmall cell lung cancer. Cancer. 2011;117(16):3774-80.
- Camargo CQ, Mocellin MC, Pastore S, et al. Fish oil supplementation during chemotherapy increases posterior time to tumor progression in colorectal cancer. Nutr Cancer. 2015 Dec 23:1-7 [Epub ahead of print].
- Bougnoux P, Hajjaji N, Ferrasson MN, et al. Improving outcome of chemotherapy of metastatic breast cancer by docosahexaenoic acid: a phase II trial. Br J Cancer. 2009;101:1978-1985.
- Bougnoux P, Germain E, Chajes V, Hubert B, Lhuillery C, Le Floch O, Body G, Calais G. Cytotoxic drugs efficacy correlates with adipose tissue docosahexaenoic acid level in locally advanced breast carcinoma. British Journal of Cancer. 1999;79(11/12):1765-69.
- Yoshika O, Okano K, Izuishi K, Usuki H, Wakabayashi H, Suzuki Y. Attenuation of the systemic inflammatory response and infectious complications after gastrectomy with preoperative oral arginine and ω-3 fatty acids supplemented immunonutrition. World J Surg. 2009;33:1815-21.
- Heller AR, Rossel T, Gottschlich B, Tiebel O, Menschikowski M, Litz RJ, Zimmerman T, Koch T. Omega-3 fatty acids improve liver and pancrease function in postoperative cancer patients. Int J Cancer. 2004;111:611-16.
- Murphy RA, Mourtzakis M, Chu Q, Baracos VE, Reiman T, Mazurak VC. Nutritional intervention with fish oil provides a benefit over standard of care for weight and skeletal muscle mass in patients with nonsmall cell lung cancer receiving chemotherapy. Cancer. 2011;117(8):1775-82.
- Van der Meij BS, Langius J, Smit EF, Spreeuwenberg MD, et al. Oral nutritional supplements containing (n-3) polyunsaturated fatty acids affect the nutritional status of patients with stage III non-small cell lunch cancer during multimodality treatment. Journal of Nutrition. 2010;140(10):1774-80.
- Sanchez-Lara K, Turcott J, Juarez-Hernandez E, et al. Effects of an oral nutritional supplement containing eicosapentaenoic acid on nutritional and clinical outcomes in patients with advanced non-small cell lung cancer: randomized trial. Clinical Nutrition. 2014;33:1017-1023.
- Silva J, Trindade E, Fabre M, Menegotto V, Gevaerd S, Buss Z, Frode T. Fish oil supplement alters markers of inflammatory and nutritional status in colorectal cancer patients. Nutrition and Cancer. 2012;64(2):267-73.
- Zaid ZA, Shahar S, Jamal ARA, Mohd Yusef NA. Fish oil supplementation is beneficial on caloric intake, appetite and mid upper arm muscle circumference in children with leukemia. Asia Pac J Clin Nutr. 2012;21(4):502-510.
- Ghoreishi Z, Esfahani A, Djazayeri A, Djalali M, et al. Omega-3 fatty acids are protective against paclitaxel-induced peripheral neuropathy: a randomized double-blind placebo controlled study. BMC Cancer. 2012;12:355.
- Bonatto S, Oliveira H, Nunes E, et al. Fish oil supplementation improves neutrophil function during cancer chemotherapy. Lipids. 2012;47:383-89.
- van der Meij BS, Langius JAE, Spreeuwenberg MD, Slootmaker SM, Paul MA, Smit EF, van Leeuwen PAM. Oral nutritional supplements containing n-3 polyunsaturated fatty acids affect quality of life and functional status in lung cancer patients during multimodality treatment: an RCT. European Journal of Clinical Nutrition. 2012;66:399-404.
- Hutchins-Wiese H, Picho K, Watkins BA, Li Y, Tannenbaum S, Claffey K, Kenny AM. High-dose eicosapentaenoic acid and docosahexaenoic acid supplementation reduces bone resportion in postmenopausal breast cancer survivors on aromatase inhibitors: a pilot study. Nutrition and Cancer. 2014;55(1):68-76.
- Cai F, Sorg O, Granci V, et al. Interaction of ω-3 polyunsaturated fatty acids with radiation therapy in two difference colorectal cancer cell lines. Clinical Nutrition. 2014;33:164-70.
- Manda K, Kriesen S, Hildebrandt G, Rietkau R, Klautke G. Omega-3 fatty acid supplementation in cancer therapy: does eicosapentanoic acid influence the radiosensitivity of tumor cells? Strahlentherapie und Onkologie. 2011;2:127-34.
- Finocchiaro C, Segre O, Fadda M, Monge T, Scigliano M, Schena M, Tinivella M, Tiozzo E, Catalano MG, Pugliese M, Fortunati N, Aragno M, Muzio G, Maggiora M, Oraldi M, Canuto RA. Effect of n-3 fatty acids on patients with advanced lung cancer: a double-blind, placebo-controlled study. Br J Nutr. 2012;108:327-33.
- Wei Z, Wang W, Chen J, Yang D, Yan R, Cai Q. A prospective, randomized, controlled study of ω-3 fish oil fat emusion-based parenteral nutrition for patients following surgical resection of gastric tumors. Nutrition Journal. 2014;13:25.
- Park J, Kwon S, Han Y, Hahm K, Kim E. Omega-3 polyunsaturated fatty acids as potential chemopreventive agent for gastrointestinal cancer. Journal of Cancer Prevention. 2013;18(3):201-8.
- Liu J, Ma, D. The role of n-3 polyunsaturated fatty acids in the prevention and treatment of breast cancer. Nutrients. 2014;6:5184-5223.
- Strouch MJ, Ding Y, Salabat MR, Melstrom LG, et al. A high omega-3 fatty acid diet mitigates murine pancreatic precancer development. J Surg Res. 2011;165(1):75-81.