Recently, doctors at the University of Miami published their research on the absolute significance of stress management for breast cancer patients.
Stress among postsurgical breast cancer patients can affect biological processes that regulate the endocrine and immune systems and these influences can have long-term effects on disease outcomes.
Chronically elevated cortisol (stress hormone) suppress the naturally occurring anti-inflammatories in the body (glucocorticoid receptors), as a result pro-inflammatory signals are released into the blood by small proteins – cytokines.
Cytokines and their inflammatory messages can congregate near tumor cells.
These cytokines may contribute to disease progression by promoting metastasis.
Therefore stress-associated neuroendocrine changes may contribute to disease course in post-surgical breast cancer patients and increase risk or breast cancer recurrence and mortality.1
Earlier research from a combined Chinese and American team explored the positive aspects of stress management in breast cancer patients shedding another view on how stress management may prevent recurrence of breast cancer.
The researchers noted that after treatment completion, breast cancer survivors frequently experience residual symptoms of pain, fatigue, high levels of psychological stress, anxiety, depression, fear of recurrence, and metastasis.
“Post-treatment stress, in particular, can adversely affect health-related quality of life, which, in turn, induces onset or recurrence of chronic diseases. Effective interventions that target these psychological symptoms and their physiological consequences are needed”
One of the worst periods of stress, the researchers wrote, was when women completed main treatments (such as chemotherapy and radiotherapy) and they progress to and have to face the stage of “watchful waiting”, a stressful period when the physician seems to be “doing nothing”.
Therefore, survivors continue to report remaining physical symptoms of pain, fatigue, and sleep dysfunction, high levels of psychological stress, anxiety, depression, fear of recurrence and metastasis, and impaired quality of life. This the researchers report may even contribute to the recurrence or progression of the disease.2
In agreement with the research presented is a recent study shows that providing women with skills to manage stress early in their breast cancer treatment can improve their mood and quality of life many years later. Published online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings suggest that women given the opportunity to learn stress management techniques during treatment may benefit well into survivorship.
In this study patients who learned relaxation techniques and new coping skills in a supportive group over 10 weeks experienced improved quality of life and less depressive symptoms during the first year of treatment.
In their latest report, the researchers found that the women who received the stress management intervention had persistently less depressive symptoms and better quality of life up to 15 years later.
The researchers found found that breast cancer survivors’ health improved after they learned Mindfulness-Based Stress Reduction (MBSR), a type of mindfulness training that incorporates meditation, yoga and physical awareness.
Your partner makes a difference
In other research, doctors found that having good partner support may play a key role in a young woman’s adjustment to a serious stressor such as breast cancer. In addition, younger age increases vulnerability to anxiety as does struggling with finances.
Because supportive efforts of a partner have potential to protect against the impact of stress, interventions to enhance partner support and reduce anxiety might be beneficial to address challenges experienced as a couple in this setting.
1 Amiel CR, Fisher HM, Carver CS, Antoni MH. The importance of stress management among postresection breast cancer patients. Future Oncol. 2016 Dec;12(24):2771-2774. Epub 2016 Oct 19.
2 Huang J, Shi L. The effectiveness of mindfulness-based stress reduction (MBSR) for survivors of breast cancer: study protocol for a randomized controlled trial. Trials. 2016;17:209. doi:10.1186/s13063-016-1335-z. 51316
Japanese researchers have published new findings on obesity, the gut micro-environment, inflammation and colon cancer prevention:
Chronic inflammation in colonic mucosa and obesity, and its related metabolic abnormalities, are considered to increase the risk of colorectal cancer.
Treatments targeting these factors might be a promising strategy to prevent the development of colorectal cancer. Among a number of functional foods, various phytochemicals, including tea catechins, which have anti-inflammatory and anti-obesity properties, and medicinal agents that ameliorate metabolic disorders, might also be beneficial in the prevention of colorectal cancer.1
The link between inflammation and colon cancer risk is also highlighted in new and alarming findings from Georgia State University:
“The increased risks conferred by inflammatory bowel disease (IBD) to the development of colorectal cancer gave rise to the term “colitis-associated cancer” and the concept that inflammation promotes colon tumorigenesis.
A condition more common than IBD is low-grade inflammation, which correlates with altered gut microbiota composition and metabolic syndrome, both present in many cases of colorectal cancer.
Recent findings suggest that low-grade inflammation in the intestine is promoted by consumption of dietary emulsifiers, a ubiquitous component of processed foods, which alter the composition of gut microbiota.
Our findings support the concept that perturbations in host-microbiota interactions that cause low-grade gut inflammation can promote colon carcinogenesis. 2
Simply chronic inflammation of the bowel leads to an altered gut microbiota and to colon cancer.
We have written on many of these factors. Please see our articles on:
The Georgia research is among the newest studies on the inflammation cancer connection. Other medical universities have recently issued similar and equally troubling findings.
New research from doctors at the UCLA School of Medicine and School of Public Health discusses the role of chronic inflammation in cancers associated with the bowel, colon and intestines.
Chronic inflammation is strongly associated with approximately one-fifth of all human cancers. Arising from combinations of factors such as environmental exposures, diet, genes, infections, or from dysfunctions of the immune response, chronic inflammation begins as an attempt of the body to remove injurious stimuli; however, over time, this results in continuous tissue destruction and promotion and maintenance of carcinogenesis – the formation of cancer.
Intestinal inflammation can be widely grouped into inflammatory bowel diseases (ulcerative colitis and Crohn’s disease) and celiac disease.
Long-standing intestinal inflammation is associated with colorectal cancer and small-bowel adenocarcinoma, as well as extraintestinal manifestations, including lymphomas and autoimmune diseases.carcinogenesis.3
Doctors at the University of South Carolina suggest that when the symbiotic interactions – the regulation and balance between resident micro-organisms and the digestive tract is disturbed by environmental changes (e.g., infection, diet and/or lifestyle) this can disturb this symbiotic relationship and promote inflammatory bowel diseases and cancer.4
Diet is perhaps the biggest factor that can exert the greatest influence on colorectal cancer risk from inflammation
New research suggests the following for colorectal cancer risk reduction
Supplementation of American ginseng as a botanical-based colon cancer chemoprevention.5
Avoid a carbohydrate-rich diet that results in high blood glucose and insulin which raises risks of colorectal cancer.6
Abdominal fat accumulation is associated with colorectal cancer in postmenopausal women.7
Fish oils inhibit progression of colon cancer.8
Lifestyle concordant with Nutrition and Physical Activity Cancer Prevention Guidelines were associated with lower risk of total, breast, and colorectal cancers and lower cancer-specific mortality in postmenopausal women.9
The Nutrition and Physical Activity Cancer Prevention Guidelines recommendations include:
Be as lean as possible throughout life without being underweight.
Avoid excess weight gain at all ages. For those who are overweight or obese, losing even a small amount of weight has health benefits and is a good place to start.
Get regular physical activity and limit intake of high-calorie foods and drinks as keys to help maintain a healthy weight.
Researchers from the German Institute of Human Nutrition Potsdam-Rehbruecke quantified the impact of combined multiple healthy lifestyle behaviors on the risk of developing colorectal cancer.
The healthy lifestyle index was composed by the following lifestyle factors:
a healthy weight;
low abdominal fat;
participating in regular physical activity;
not smoking and limiting alcohol;
and a diet high in fruits, vegetables, fish, yogurt, nuts and seeds, and foods rich in fiber, and low amounts of red and processed meat.
The researchers found that the more healthy lifestyle factors the subjects adopted, the lower their risk of bowel cancer. Compared to people who had followed up to one healthy lifestyle behavior, those who practiced a combination of two, three, four and all the five healthy behaviors had a 13%, 21%, 34% and 37% lower risk of developing bowel cancer, respectively.10
Colorectal cancer prevention diet
In recent published research gathered from a 15 year study, scientists followed patients at higher risk for recurrent cancers of the large bowel. What they were looking for was the preventive potential of vitamins (A, C and E) and selenium supplementation.
Here is what the scientists did: A total of 411 patients were randomized to receive either an active compound (200 μg selenium, 30 mg zinc, 2 mg vitamin A, 180 mg vitamin C, 30 mg vitamin E) or a placebo daily for 5 years. Of them, 330 had follow-up colonoscopy (164 in the intervention and 166 in the placebo group).
After an average follow-up of 4 years, 100 patients had recurrence: 38 in the intervention and 62 in the placebo arm. The 15-year cumulative incidence of recurrence was 48.3 % in the intervention and 64.5 % in the placebo arm.
A 39 % reduction of the risk of recurrence was observed in the intervention compared to the placebo group.
“This study showed study showed a statistically significant effect of antioxidant supplementation on adenoma recurrence.11
There have been numerous studies recently examining anti-oxidants in the fight against cancer. “At present, single natural chemicals are investigated in clinical trials to evaluate their potential chemopreventive activity on different types of cancer. For instance, lycopene and genistein are investigated for the prevention of prostate cancer, resveratrol and curcumin particularly for colon cancer, while green tea preferentially for solid tumors, lung and esophageal cancers. The inclusion of Quercetin in this group will likely expand the possibility to fight against (cancers).”12
In our cancer strategies we utilize antioxidants, intravenous vitamin C, dietary changes, nutritional supplementation, hyperbaric oxygen and detoxification, and have received national recognition for our pioneering work in improving the quality of life for our patients living with cancer.
Our approach is one that utilizes holistic methods of healing, close monitoring of your body’s cancer-fighting natural killer (NK) cells, and analysis of your individual cancerous-cell cycle (meaning the number of cancer cells that are either actively dividing or are about to do so).
1 Yamauchi R, Inoue R, Chiba D, Yamamoto Y, Harada Y, Takahashi I, Nakaji S, Ishibashi Y. Association of clinical and radiographic signs of femoroacetabular impingement in the general population. J Orthop Sci. 2017 Jan;22(1):94-98. doi: 10.1016/j.jos.2016.09.014.
2 Viennois E, Merlin D, Gewirtz AT, Chassaing B. Dietary Emulsifier-Induced Low-Grade Inflammation Promotes Colon Carcinogenesis. Cancer Res. 2017 Jan 1;77(1):27-40. doi: 10.1158/0008-5472.CAN-16-1359. Epub 2016 Nov 7.
3 Westbrook AM, Szakmary A, Schiestl RH. Mouse models of intestinal inflammation and cancer. Arch Toxicol. 2016 Sep;90(9):2109-30. doi: 10.1007/s00204-016-1747-2. Epub 2016 Jun 16.
4. Deng FE. et al. Association between diet-related inflammation, all-cause, all-cancer, and cardiovascular disease mortality, with special focus on prediabetics: findings from NHANES III. Eur J Nutr. 2016 Jan 29. [Epub ahead of print]
5 Yu C et al. American ginseng attenuates azoxymethane/dextran sodium sulfate-induced colon carcinogenesis in mice. J Ginseng Res. 2015 Jan;39(1):14-21. doi: 10.1016/j.jgr.2014.07.001. Epub 2014 Jul 18.
6. Sieri S et al. Dietary glycemic index and glycemic load and risk of colorectal cancer: results from the EPIC-Italy study.Int J Cancer. 2014 Nov 18. doi: 10.1002/ijc.29341. [Epub ahead of print]
7 Lee JY et al Visceral fat accumulation is associated with colorectal cancer in postmenopausal women. PLoS One. 2014 Nov 17;9(11):e110587. doi: 10.1371/journal.pone.0110587. eCollection 2014.
9 Chlebowski RT, Martinez ME, Stefanick ML, Rohan TE, Manson JE, Tindle HA, Ockene J, Vitolins MZ, Wactawski-Wende J, Sarto GE, Lane DS, Neuhouser ML. Nutrition and Physical Activity Cancer Prevention Guidelines, Cancer Risk, and Mortality in the Women’s Health Initiative. Cancer Prev Res (Phila). 2014 Jan;7(1):42-53. doi: 10.1158/1940-6207.CAPR-13-0258.
11. Bonelli L, Puntoni M, Gatteschi B, et al. Antioxidant supplement and long-term reduction of recurrent adenomas of the large bowel. A double-blind randomized trial. J Gastroenterol. 2012 Oct 13. [Epub ahead of print]
12. Gibellini L, Pinti M, Nasi M, Montagna JP, De Biasi S, Roat E, Bertoncelli L, Cooper EL, Cossarizza A. Quercetin and Cancer Chemoprevention. Quercetin and Cancer Chemoprevention.
Often a patient will come into our office after chemotherapy treatments. One of the first things they will say is “I wish they told me about these side effects so I could be prepared.” One side effect is chemo brain. This is a “brain fog sensation,” a loss of memory and cognitive function. Most research reports that these are temporary conditions caused by chemotherapy treatments and that symptoms should be treated with various methods including memory and brain exercises when needed. Included are certain medications included Alzheimer medications and those for attention-deficit disorder. However, new research is suggesting doctors look at inflammation for possible answers.
In a study in the medical journal Cancer, changes in cognitive functioning over time were compared in:
(1) breast cancer survivors treated with chemotherapy plus radiotherapy,
(2) breast cancer survivors treated with radiotherapy only, and
(3) women with no history of cancer.
The researchers noted cognitive problems for up to three years post chemo. What they also found in test subjects was that not only did chemotherapy lead to what is commonly referred to as “Chemo Brain,” but radiotherapy did as well. 1
Somehow radiotherapy was causing brain problems and adding to speculation that inflammation plays a role in brain fog.
It also may explain why “chemo brain” patients do not respond as well as hoped for to WEB-based outpatient cognitive training, the aforementioned brain exercises and training.2 The cognitive training does not address the inflammation issue.
In a new study, doctors are exploring the hypothesis that inflammation opens a door for chemotherapy associated neurotoxicity and cognitive dysfunction.
The focus is on cytokines – a small protein that communicates with cells to get them to the site of injury, infection, and inflammation. The thinking is that cytokines are somehow opening a doorway in “blood-brain barrier” the blood filtering mechanism that carries blood to the brain while blocking many harmful substances. It is through this doorway that “unfiltered” chemicals are getting through.
In research from the International Journal of Cancer, doctors looked at neurotoxicity a common side effect of chemotherapy treatment.
Clinical studies suggest that the most frequent neurotoxic adverse events affect memory and learning, attention, concentration, processing speeds and executive function.
Emerging preclinical research points toward direct cellular toxicity and induction of neuroinflammation as key drivers of neurotoxicity and subsequent cognitive impairment. (The research suggests that the chemicals used in chemotherapy are somehow bypassing the blood – brain barrier., as we mentioned above.)
Emerging data now show detectable levels of some chemotherapeutic agents within the central nervous system, indicating potential disruption of blood brain barrier integrity.
Blood brain barrier disruption is a key aspect of many neurocognitive disorders, particularly those characterized by a proinflammatory state.3
In new research from the spring of 2017, researchers in Czech Republic reported that cognitive impairment (impairment of memory, attention, or concentration) is documented in 17-75% of patients with various malignancies treated with chemotherapeutic agents that worsen quality of life.
Changes occur mainly in the ability to learn and remember, in the speed of reactions, and in attention and executive functions.
Although Chemo-related cognitive impairment’s complexities are not yet fully understood, the involvement of neurotoxicity, such as that induced by treatment, anemia, higher levels of oxidative stress and inflammatory responses, genetic factors, and reduced brain connectivity should be discussed.4
At the Magaziner Center for Wellness we see a lot of patients post-treatment. These include cancer patients already undergoing conventional treatment by an oncologist or radiotherapist who wish to give themselves the added benefits of nutritional and immune-function support. These patients have reported reduced side effects and better therapeutic results while on our program.
“Brain fog,” or “Chermo brain,” can be helped with a customized program of various methods that we offer here.
1. Cognitive functioning after cancer treatment: A three-year longitudinal comparison of breast cancer survivors treated with chemotherapy or radiation and non-cancer controls.” Phillips KM, Jim HS, Small BJ, et al. CANCER; Published Online: December 12, 2011.
2 Damholdt M, Mehlsen M, O’Toole M, Andreasen R, Pedersen A, Zachariae R. Web‐based cognitive training for breast cancer survivors with cognitive complaints—a randomized controlled trial. Psycho-Oncology. 2016;25(11):1293-1300. doi:10.1002/pon.4058.
3. Wardill HR, Mander KA, Van Sebille YZ, Gibson RJ, Logan RM, Bowen JM, Sonis ST. Cytokine-mediated blood brain barrier disruption as a conduit for cancer/chemotherapy-associated neurotoxicity and cognitive dysfunction. Int J Cancer. 2016
4. Chemotherapy-related Cognitive Impairment in Patients with Hodgkin Lymphoma – Pathophysiology and Risk Factors. Klin Onkol. 2017 Spring;30(2):93-99. doi: 10.14735/amko201793.
There are many studies that link eating certain foods with lowering the risk of recurrence in cancer survivors and improving quality of life during conventional treatments. Here are more recent findings:
Doctors in the United Kingdom’s University Hospitals Bristol Education Centre write: “A growing body of observational evidence suggests that nutritional and physical activity interventions are associated with beneficial outcomes for men with prostate cancer, including brisk walking, lycopene intake, increased fruit and vegetable intake and reduced dairy consumption.” 1
Doctor’s at Germany’s Leopoldina Hospital Schweinfurt suggest that low-carb – high protein diets administered as supportive measures during radiotherapy are safe and might be helpful in preservation of muscle mass.2
Patients with advanced cancer can benefit from a rehabilitation program combining exercise, nutritional counselling and symptom control, according to an evidence review in CMAJ (Canadian Medical Association Journal). Palliative care programs should be expanded to include these elements and should be available to patients from diagnosis.3
There are many lifestyle changes to consider after a diagnosis of cancer: How you eat is one of them.
New research is suggesting the obvious to cancer survival patients – diet and lifestyle changes after the diagnosis of cancer may affect prognosis.
Researchers noted that several studies have shown that:
a sedentary lifestyle,
high serum levels of insulin,
and inflammation, after the diagnosis of cancer are associated with an increased incidence of recurrences.
Diet changes after cancer diagnosis eat more cruciferous vegetables
As we have noted here at the Magaziner Center, and in the cited research in the medical journal Cancer Treatment and Research, in the clinical management of cancer, little attention is presently paid to improving lifestyle and controlling body weight.4
Recently a study by Vanderbilt-Ingram Cancer Center and Shanghai Center for Disease Control and Prevention investigators reveals that breast cancer survivors who eat more cruciferous vegetables may have improved survival. Besides the antioxidant factors, cruciferous vegetables are a low caloric food.
The study found survival rates were significantly influenced by vegetable consumption. As women ate more of these vegetables, their risk of death or cancer recurrence decreased. 5
Some cruciferous vegetables commonly found at the market are:
The complexities of cancer are apparent from the incredible amount of literature that the medical community produces every year. Cancer is complex, it is not a single disease but an evolving mutation of genes that follow their own rules in the body. It is important that different cancer studies reflect different cancers and different cancers are indeed different from each other.
6. Madhwa Raj et al. Simultaneous Inhibition of Cell – Cycle, Proliferation, Survival, Metastatic Pathways and Induction of Apoptosis in Breast Cancer Cells by a Phytochemical Super – Cocktail: Genes That Underpin Its Mode of Action. Journal of Cancer, November 2013
Radiotherapy for breast cancer may expose the heart and vessels to late radiation-induced complications. Although recent technical progress in radiation therapy has been associated with drastic reduction in cardiovascular mortality, the prolonged life expectancy of patients with cancer requires cardiovascular evaluation for many years. This study data shows local arterial stiffening because of radiation that can be involved in increased cardiovascular risk in breast cancer-treated patients.1
The problem is breathing – when a breast cancer patients receives radiation therapy, the tumor moves as the patient breathes. The radiation beam must be made wider to make sure the tumor is always in the “line of fire.” This can damage the heart. Doctors are trying and reporting on various risk reduction methods for patient breathing techniques during radiation therapy.2
Doctors say that among men treated for prostate cancer, those who received radiation therapy were more likely to develop bladder or rectal cancer.
University of Michigan Comprehensive Cancer Center researchers looked at the number of secondary cancers that developed 10 or more years after men were diagnosed with prostate cancer. As a whole, men diagnosed with prostate cancer were at a lower risk of developing a second cancer. But when researchers looked at patients who received external beam radiation therapy, they found these patients were estimated to be 70 percent more likely to be diagnosed with a rectal cancer and 40 percent more likely for bladder cancer than the general public.3
Researchers reporting in the Journal of Clinical Oncology say that elderly, early-stage breast cancer patients, maybe getting radiation treatment that offers no extra benefit and may put them at risk for greater side-effects.4
Radiation therapy used to treat uterine cancer may increase a patient’s risk of developing bladder cancer
In other research, doctors found that radiation therapy used to treat uterine cancer may increase a patient’s risk of developing bladder cancer. The findings indicate the importance of monitoring patients for potential signs of bladder cancer to ensure early diagnosis and treatment.
In the United States, uterine cancer is the fourth most common cancer in women. In addition to surgery, 38 percent of patients undergo pelvic radiation therapy to decrease uterine cancer recurrence. Studies have found that women treated with radiation therapy for uterine cancer, like men who received radiation therapy for prostate cancer, have an increased risk of developing bladder cancer later in life.5
Do you have questions about radiation therapy and cancer?
4. Soulos PR, Yu JB, Roberts KB, et al. Assessing the Impact of a Cooperative Group Trial on Breast Cancer Care in the Medicare Population. Journal of Clinical Oncology 10.1200/JCO.2011.39.4890
5. Janet E. Baack Kukreja, Emil Scosyrev, Ralph A. Brasacchio, Eugene P. Toy, Edward M Messing, Guan Wu. Bladder Cancer Incidence and Mortality in Patients Treated with Radiation for Uterine Cancer. BJU International, 2013; DOI: 10.1111/bju.12543
Doctors in Spain have published a new study (March 2017) in which vitamin D’s protective role against cancer is examined.
The Spanish researchers looked at vitamin D’s influence in the early and late stages of cancer development. They found that vitamin D’s benefits were at maximum when given in early stage cancer, and much less effective if given in late stage cancer.1 This agrees with many other studies that suggests the sooner patients are supplemented with vitamin D, the more benefit they will derive. Below is some of that research.
A recent study published in the British Medical Journal found:
Many patients with cancer have insufficient vitamin D levels, and low vitamin D levels are associated with increased ‘all-cause mortality’ and especially mortality due to cancer.
Low vitamin D levels have also been associated with increased risk of infections, increased pain, depressive disorders and impaired quality of life.
Cancer patients with low vitamin D levels have been associated with higher opioid dose, that is, more pain.
The researchers also reported on a case report where vitamin D supplementation resulted in radically decreased opioid dose, less pain and better well-being.
The researchers conclude: vitamin D-supplementation to patients with palliative cancer might be beneficial and could improve their well-being, decrease pain and reduce susceptibility to infections. 2
Here is what other researchers reported: “Insufficient vitamin D plasma levels are found in 20- 60% of cancer patients at diagnosis andvitamin D deficiency is associated with higher aggressivity of tumor and shorter survival of patients.
Even in the absence of clinical studies showing benefit of supplementation on outcome, clear recommendations are currently available for treatment of vitamin D deficiency. Owing to the high prevalence of vitamin D insufficiency in cancer patients and significant risks of its further decrease after antitumor therapy, it should become standard of care to examine 25- hydroxyvitamin D serum levels and correct vitamin D insufficiency in cancer patients” 3
In recent research, doctors suggest that bowel cancer patients with high levels of vitamin D in their blood are more likely to survive the disease.
vitamin D levels in healthy adults significantly impacts genes involved with a number of biologic pathways associated with cancer.
The list of growing research in support of vitamin D for cancer prevention and positive impact on cancer continues to grow.
In a supportive study cancer patients who have higher levels of vitamin D when they are diagnosed tend to have better survival rates and remain in remission longer than patients who are vitamin D-deficient, according to a new study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM).4
Vitamin D is associated with a much better chance of cancer survival
According to research from the Dana-Farber Cancer Institute, patients with metastatic colorectal cancer who had high levels of vitamin D in their bloodstream prior to treatment with chemotherapy and targeted drugs, survived longer, on average, than patients with lower levels of the vitamin.Patients with the highest levels of vitamin D have half the risk of dying compared with those with the lowest levels, the findings reveal.
Their findings: “Vitamin D metabolites increase communication between cells by switching on a protein that blocks aggressive cell division. . . As long as vitamin D receptors are present tumor growth is prevented and kept from expanding its blood supply. Vitamin D receptors are not lost until a tumor is very advanced. This is the reason for better survival in patients whose vitamin D blood levels are high.”
1: Bandera Merchan B, Morcillo S, Martin-Nuñez G, Tinahones FJ, Macías-González M. The role of vitamin D and VDR in carcinogenesis: Through epidemiology and basic sciences. J Steroid Biochem Mol Biol. 2017 Mar;167:203-218. doi: 10.1016/j.jsbmb.2016.11.020. Review. PubMed PMID: 27913313. 2 Björkhem-Bergman L, Bergman P. Vitamin D and patients with palliative cancer. BMJ Support Palliat Care. 2016 Sep;6(3):287-91. doi: 10.1136/bmjspcare-2015-000921. Epub 2016 Apr 15. 3 C. Duggan, J. de Dieu Tapsoba, C. Mason, I. Imayama, L. Korde, C.-Y. Wang, A. McTiernan. Effect of Vitamin D3 Supplementation in Combination with Weight Loss on Inflammatory Biomarkers in Postmenopausal Women: A Randomized Controlled Trial. Cancer Prevention Research, 2015; DOI: 10.1158/1940-6207.CAPR-14-0449 4 The Impacts of Circulating 25-Hydroxyvitamin D Levels on Cancer Patient Outcomes: A Systematic Review and Meta-Analysis,”