Dietary Supplement Use Among Adult Cancer Survivors in the United States
Authors: Du Mengxi , Zhang Fang Fang 
Published: November 2023

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

Supplement Use in Adult Cancer Survivors and Individuals without Cancer in NHANES 1999–2012

Supplement Use
Cancer Survivors (n=1,902)
Individuals without Cancer (n=3,804)
P value

N (%)
N (%)

Any supplement use1
1,111 (58.4)
2046 (53.8)
0.0009

Multivitamin and mineral (MVM) supplement use2

Multivitamin with mineral
182 (9.6)
336 (8.8)
0.36

Multivitamin without mineral
75 (3.9)
111(2.9)
0.04

Single supplement use
444 (23.3)
877 (23.1)
0.81

Vitamins

Folic 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)
0.58

Minerals

Calcium
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)
0.87

Others

Fish 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)
0.44

Any supplement use was defined as the use of the selected vitamins, minerals, non‐vitamin non‐mineral supplements.

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.

Factors Associated with Supplemental Use in Adult Cancer Survivors1

Characteristics
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)
<.000l

Gender, 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/m2, mean (SEM)
28.9 (0.2)
29.4 (0.3)
0.13

Weight 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)
<.0001

Time from diagnosis, years, mean (SEM)
10.8 (0.5)
11.0 (0.4)
0.76

Time 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)

Frequencies, odds ratio, and 95% confidence intervals presented were weighted.

Trend of Supplemental Use in Adult Cancer Survivors and Individuals without Cancer1

Supplement Use
Cancer Survivors (n=1,902)
p trend
Individuals Without Cancer (n=3,804)
p trend

99–00
01–02
03–04
05–06
07–08
09–10
11–12

99–00
01–02
03–04
05–06
07–08
09–10
11–12

Any supplement use2
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)
0.44

Folic 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)
0.49

Vitamin 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)
<.0001

Vitamin 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)
0.48

Calcium
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)
0.02

Magnesium
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)
0.45

Zinc
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)
0.54

Fish 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)
<.0001

Frequencies presented were weighted frequencies.

Any supplement use was defined as the use of the selected vitamins, minerals, non‐vitamin non‐mineral supplements.