{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T13:17:39Z","timestamp":1788355059306,"version":"build-2803163510"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Dietary supplement use is highly prevalent among adults and particularly common among individuals with cancer. Despite this prevalence, oncology providers have ambivalence about endorsing dietary supplements due to important questions regarding safety, interactions, and quality assurance. In the United States and globally, the dietary supplement market has expanded substantially under a regulatory framework established by the Dietary Supplement Health and Education Act (DSHEA), yet the absence of premarket approval contributes to uncertainty and unfamiliarity among oncology providers. Constraints on treatment claims indirectly discourage large-scale clinical research, resulting in an evidence base that is dominated by epidemiologic studies, biomarker investigations, animal models, and trials conducted largely outside the conventional drug development paradigm. Within this context, integrative oncology has focused on selected agents with emerging data, including vitamin D, medicinal mushrooms, milk thistle, and melatonin. These supplements represent the most common categories and are among the most frequently used by individuals diagnosed with cancer. Collectively, these data indicate that selected dietary supplements may contribute to cancer prevention, treatment response, survival, and supportive care outcomes when integrated thoughtfully with standard therapies. This integration must be guided by rigorous quality assurance, individualized risk-benefit assessment, and ongoing research to clarify optimal adjunctive use.<\/jats:p>","DOI":"10.3389\/fonc.2026.1866767","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:32:51Z","timestamp":1788352371000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Dietary supplements in integrative oncology"],"prefix":"10.3389","volume":"16","author":[{"given":"Lise","family":"Alschuler","sequence":"first","affiliation":[{"name":"Sonoran University of Health Sciences","place":["Tempe, AZ, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djab048","article-title":"Addressing complementary and alternative medicine use among individuals with cancer: An integrative review and clinical practice guideline","volume":"114","author":"Balneaves","year":"2022","journal-title":"J Natl Cancer Inst"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1080\/10408398.2026.2624474","article-title":"A comparative analysis of regulatory frameworks and their market impacts on health functional foods: perspectives from South Korea, Canada, the United States, and China","volume":"66","author":"Min","year":"2026","journal-title":"Crit Rev Food Sci Nutr"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.25822","article-title":"Estimated exposure to 6 potentially hepatotoxic botanicals in US adults","volume":"7","author":"Likhitsup","year":"2024","journal-title":"JAMA Netw Open"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/nxy082","article-title":"The dietary supplement label database: Recent developments and applications","volume":"148","author":"Dwyer","year":"2018","journal-title":"J Nutr"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s00394-025-03825-4","article-title":"Trends in dietary supplement use among U.S. adults between 2011 and 2023","volume":"64","author":"Zhao","year":"2025","journal-title":"Eur J Nutr"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1080\/01635581.2020.1820050","article-title":"Dietary supplements use among adults with cancer in the United States: A population-based study","volume":"73","author":"Abdel-Rahman","year":"2021","journal-title":"Nutr Cancer"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1089\/acm.2008.0290","article-title":"Herbal and dietary supplement disclosure to health care providers by individuals with chronic conditions","volume":"14","author":"Mehta","year":"2008","journal-title":"J Altern Complement Med"},{"key":"B8","article-title":"103rd United States Congress.","volume-title":"Dietary Supplement Health and Education Act of 1994, Pub. L. No. 103-417, 108 Stat. 4325 (codified at 21 U.S.C. \u00a7321(ff))","year":"1994"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.26040","article-title":"Analysis of select dietary supplement products marketed to support or boost the immune system","volume":"5","author":"Crawford","year":"2022","journal-title":"JAMA Netw Open"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.25822","article-title":"Estimated exposure to 6 potentially hepatotoxic botanicals in US adults","volume":"7","author":"Likhitsup","year":"2024","journal-title":"JAMA Netw Open"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfca.2021.104058","article-title":"Modernization of the National Institutes of Health Dietary Supplement Label Database","volume":"102","author":"Saldanha","year":"2021","journal-title":"J Food Compost Anal"},{"key":"B12","volume-title":"Dietary Supplement and Nonprescription Drug Consumer Protection Act, Pub. L. No. 109-462, 120 Stat. 3469 (codified at 21 U.S.C. \u00a7379aa-1)","year":"2006"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1021\/acs.jnatprod.5c00456","article-title":"Dietary supplement adulteration: Laboratory approaches to risk mitigation","volume":"88","author":"Ma","year":"2025","journal-title":"J Nat Prod"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1080\/10408398.2018.1524364","article-title":"Current regulatory guidelines and resources to support research of dietary supplements in the United States","volume":"60","author":"Bailey","year":"2020","journal-title":"Crit Rev Food Sci Nutr"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1007\/s00403-024-03538-4","article-title":"Over-the-counter dermatology supplements- a practical guide to authenticity labels and reputable sources","volume":"317","author":"Mokhtari","year":"2024","journal-title":"Arch Dermatol Res"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0199265","article-title":"Breast cancer risk markedly lower with serum 25-hydroxyvitamin D concentrations \u226560 vs <20 ng\/ml (150 vs 50 nmol\/L): Pooled analysis of two randomized trials and a prospective cohort","volume":"13","author":"McDonnell","year":"2018","journal-title":"PLoS One"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1177\/1534735417712007","article-title":"Circulating vitamin D and overall survival in breast cancer patients: A dose-response meta-analysis of cohort studies","volume":"17","author":"Hu","year":"2018","journal-title":"Integr Cancer Ther"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2014.175","article-title":"Vitamin D intake, blood 25(OH)D levels, and breast cancer risk or mortality: a meta-analysis","volume":"110","author":"Kim","year":"2014","journal-title":"Br J Cancer"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djn152","article-title":"Serum vitamin D concentration and prostate cancer risk: a nested case-control study","volume":"100","author":"Ahn","year":"2008","journal-title":"J Natl Cancer Inst"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1158\/0008-5472.CAN-03-3456","article-title":"Reduced 1alpha-hydroxylase activity in human prostate cancer cells correlates with decreased susceptibility to 25-hydroxyvitamin D3-induced growth inhibition","volume":"61","author":"Hsu","year":"2001","journal-title":"Cancer Res"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1023\/a:1008835903714","article-title":"Dietary influences of 1,25(OH)2 vitamin D in relation to prostate cancer: a hypothesis","volume":"9","author":"Giovannucci","year":"1998","journal-title":"Cancer Causes Control"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-14-0115","article-title":"Plasma vitamin D and prostate cancer risk: results from the Selenium and Vitamin E Cancer Prevention Trial","volume":"23","author":"Kristal","year":"2014","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.07.5358","article-title":"Circulating 25-hydroxyvitamin D levels predict survival in early-stage non-small-cell lung cancer patients","volume":"25","author":"Zhou","year":"2007","journal-title":"J Clin Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3390\/nu16030391","article-title":"Vitamin D supplementation: A review of the evidence arguing for a daily dose of 2000 International Units (50 \u00b5g) of vitamin D for adults in the general population","volume":"16","author":"Pludowski","year":"2024","journal-title":"Nutrients"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1007\/s00253-023-12656-4","article-title":"Mushroom \u03b2-glucans: application and innovation for food industry and immunotherapy","volume":"107","author":"Timm","year":"2023","journal-title":"Appl Microbiol Biotechnol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.foodchem.2010.12.149","article-title":"A new colorimetric method to quantify \u03b2-1,3-1,6-glucans in comparison with total \u03b2-1,3-glucans in edible mushrooms","volume":"127","author":"Nitschke","year":"2011","journal-title":"Food Chem"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.foodchem.2021.129116","article-title":"Systematic assessment of oat \u03b2-glucan catabolism during in vitro digestion and fermentation","volume":"348","author":"Bai","year":"2021","journal-title":"Food Chem"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.seminoncol.2025.152398","article-title":"The effects of microbiota-derived short-chain fatty acids on T lymphocytes: From autoimmune diseases to cancer","volume":"52","author":"Saadh","year":"2025","journal-title":"Semin Oncol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.carbpol.2024.122586","article-title":"Insights into oral lentinan immunomodulation: Dectin-1-mediated lymphatic transport from Peyer's patch M cells to mononuclear phagocytes","volume":"346","author":"Wang","year":"2024","journal-title":"Carbohydr Polym"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2018.00673","article-title":"The complexity of fungal \u03b2-glucan in health and disease: Effects on the mononuclear phagocyte system","volume":"9","author":"Camilli","year":"2018","journal-title":"Front Immunol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/567427","article-title":"Oral administration of MBG to modulate immune responses and suppress OVA-sensitized allergy in a murine model","volume":"2014","author":"Wu","year":"2014","journal-title":"Evid Based Complement Alternat Med"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.173.2.797","article-title":"Mechanism by which orally administered beta-1,3-glucans enhance the tumoricidal activity of antitumor monoclonal antibodies in murine tumor models","volume":"173","author":"Hong","year":"2004","journal-title":"J Immunol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V82.12.3695.3695","article-title":"Cross-linking of the beta-glucan receptor on human monocytes results in interleukin-1 receptor antagonist but not interleukin-1 production","volume":"82","author":"Poutsiaka","year":"1993","journal-title":"Blood"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007731.pub3","article-title":"Ganoderma lucidum (Reishi mushroom) for cancer treatment","volume":"4","author":"Jin","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012053.pub2","article-title":"Coriolus (Trametes) versicolor mushroom to reduce adverse effects from chemotherapy or radiotherapy in people with colorectal cancer","volume":"11","author":"Pilkington","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.2174\/187221312798889310","article-title":"Efficacy of Yun Zhi (Coriolus versicolor) on survival in cancer patients: systematic review and meta-analysis","volume":"6","author":"Eliza","year":"2012","journal-title":"Recent Pat Inflamm Allergy Drug Discov"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1002\/ptr.3207","article-title":"Milk thistle in liver diseases: past, present, future","volume":"24","author":"Abenavoli","year":"2010","journal-title":"Phytother Res"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.3390\/antiox4010204","article-title":"Silymarin as a natural antioxidant: An overview of the current evidence and perspectives","volume":"4","author":"Surai","year":"2015","journal-title":"Antioxidants (Basel)"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.3390\/antiox13010098","article-title":"Silymarin and inflammation: Food for thoughts","volume":"13","author":"Surai","year":"2024","journal-title":"Antioxidants (Basel)"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24723","article-title":"A randomized, controlled, double-blind, pilot study of milk thistle for the treatment of hepatotoxicity in childhood acute lymphoblastic leukemia (ALL)","volume":"116","author":"Ladas","year":"2010","journal-title":"Cancer"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1177\/10781552211006182","article-title":"Oral silymarin formulation efficacy in management of AC-T protocol induced hepatotoxicity in breast cancer patients: A randomized, triple blind, placebo-controlled clinical trial","volume":"28","author":"Moezian","year":"2022","journal-title":"J Oncol Pharm Pract"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.3727\/096504021X16218531628569","article-title":"A pilot study of silymarin as supplementation to reduce toxicities in metastatic colorectal cancer patients treated with first-line FOLFIRI plus bevacizumab","volume":"28","author":"Chang","year":"2021","journal-title":"Oncol Res"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1002\/ptr.5704","article-title":"Effect of oral silymarin administration on prevention of radiotherapy induced mucositis: A randomized, double-blinded, placebo-controlled clinical trial","volume":"30","author":"Elyasi","year":"2016","journal-title":"Phytother Res"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1002\/ptr.5857","article-title":"Topical silymarin administration for prevention of capecitabine-induced hand-foot syndrome: A randomized, double-blinded, placebo-controlled clinical trial","volume":"31","author":"Elyasi","year":"2017","journal-title":"Phytother Res"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.3390\/molecules27165327","article-title":"Mechanistic insights into the pharmacological significance of silymarin","volume":"27","author":"Wadhwa","year":"2022","journal-title":"Molecules"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v17.i18.2288","article-title":"Silybin and the liver: from basic research to clinical practice","volume":"17","author":"Loguercio","year":"2011","journal-title":"World J Gastroenterol"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-009-0624-9","article-title":"Effect of silymarin on the pharmacokinetics of losartan and its active metabolite E-3174 in healthy Chinese volunteers","volume":"65","author":"Han","year":"2009","journal-title":"Eur J Clin Pharmacol"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1111\/jpi.12162","article-title":"Melatonin: a well-documented antioxidant with conditional pro-oxidant actions","volume":"57","author":"Zhang","year":"2014","journal-title":"J Pineal Res"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1007\/s00280-012-1828-8","article-title":"The efficacy and safety of melatonin in concurrent chemotherapy or radiotherapy for solid tumors: A meta-analysis of randomized controlled trials","volume":"69","author":"Wang","year":"2012","journal-title":"Cancer Chemother Pharmacol"},{"key":"B50","article-title":"Biomodulation of cancer chemotherapy for metastatic colorectal cancer: A randomized study of weekly low-dose irinotecan alone versus irinotecan plus the oncostatic pineal hormone melatonin in metastatic colorectal cancer patients progressing on 5-fluorouracil-containing combinations","volume":"23","author":"Cerea","year":"2003","journal-title":"Anticancer Res"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-079x.2003.00032.x","article-title":"Five years survival in metastatic non-small cell lung cancer patients treated with chemotherapy alone or chemotherapy and melatonin: a randomized trial","volume":"35","author":"Lissoni","year":"2003","journal-title":"J Pineal Res"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-015-1873-4","article-title":"Clinical pharmacokinetics of melatonin: a systematic review","volume":"71","author":"Harps\u00f8e","year":"2015","journal-title":"Eur J Clin Pharmacol"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctim.2018.11.003","article-title":"Adverse events associated with oral administration of melatonin: A critical systematic review of clinical evidence","volume":"42","author":"Foley","year":"2019","journal-title":"Complement Ther Med"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1111\/jpi.12782","article-title":"Safety of higher doses of melatonin in adults: A systematic review and meta-analysis","volume":"72","author":"Menczel Schrire","year":"2022","journal-title":"J Pineal Res"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-079X.2006.00407.x","article-title":"One molecule, many derivatives: A never-ending interaction of melatonin with reactive oxygen and nitrogen species?","volume":"42","author":"Tan","year":"2006","journal-title":"J Pineal Res"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1866767\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:32:52Z","timestamp":1788352372000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1866767\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,2]]},"references-count":55,"alternative-id":["10.3389\/fonc.2026.1866767"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1866767","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,2]]},"article-number":"1866767"}}