Ideally you will work with a registered dietitian to meet your needs through proper food choices. However, the following may predispose you to needing additional supplementation:

If you have had loss of appetite, taste, or smell, or have had surgery to the head and neck area resulting in difficulty with swallowing, you may not be able to meet all of your needs.

If you're female, postmenopausal, and not on hormone replacement therapy or tamoxifin, you may need to supplement with calcium and Vitamin D to protect against osteoporosis.

If you have Cancer of the digestive tract, such as intestinal, pancreatic, liver, and gallbladder cancer, you may have impaired digestion and absorption of nutrients.

If you eat fewer than 1,000 calories per day or your diet is limited because of food intolerances.

If you follow a special diet that eliminates certain food groups, or if you eat a vegetarian diet that omits all animal products, you may need additional Vitamin B-12 or calcium.

If you have been told that you have poor wound healing due to nutrient deficiencies, you may need additional supplementation.

If you are over 50 years of age, your nutritional requirements increase in certain areas that may not be met if you have loss of appetite or eliminate food groups. For example your need for Vitamin B12 increases.

How to Choose a Multi-Vitamin: Reading the Label

Check the Daily Value. The Daily Value (DV) is a government standard that specifies the minimum daily requirements that helps prevent a deficiency disease for healthy people. The DV is based on intake of at least 2,000 calories per day. In general, females have this caloric requirement or less per day, and males have greater caloric needs.

Check the serving size. Look for how many tablets are needed to provide the stated nutrients. You may need to swallow up to six tablets a day to get the amounts listed on the label.

Skip the iron in a multi-vitamin. For cancer patients, it is advisable to ask your medical team about whether or not you should take iron in a multi-vitamin. Usually unless you have iron-deficient anemia are at risk of anemia, or have had recent surgery, you may not desire to take extra iron. Iron supplements can also cause constipation and you will need to increase your fiber and fluid intake.

Don't pay more for "timed-release" ones. This has no meaning for a multi-vitamin. To improve absorbability, take your supplement with food. Chelate (key-late) minerals may be better absorbed because they are protected from substances in foods that can bind with it. For example, the phytic acid in grains or the oxalates in spinach can bind with minerals like calcium, lessening the absorption. Chelated minerals may be twice the cost or more. Evaluate the price of the chelated mineral to determine if it is worth the additional cost.

Many practitioners recommend stopping any high dose supplements during a window of time while receiving chemotherapy or radiation therapy. If you choose to take vitamins/minerals while on chemotherapy or receiving radiation therapy, don't exceed certain dosages. For example:

No more than 500 mg Vitamin C
100 iu of Vitamin E while on anticoagulant therapy or no more than 800 iu of Vitamin E generally,
No more than 200 mcg. of selenium.
Discuss with your medical team any specific vitamin or mineral interactions with your particular chemotherapy.

Always read the labels and avoid added agents like coloring (such as Yellow #5), and additional fillers.

Read specialized formulas (those for women, men, seniors, etc.) carefully. Claims aren't regulated, each formula company decides on what each group needs. For example, most women's formulas have additional calcium but may lack the DV for Vitamin D, which is a helper for calcium absorption and utilization. Senior formulas may not contain the appropriate amount of DV for Vitamin B-12 (25 mcg.)

Look for the expiration date!
It is advisable to take the vitamin with food to assist with absorption. MVI's as a rule, work better when taken with food.

Avoid megadoses -- especially with the fat-soluble vitamins, as vitamin A,D, E, the minerals iron and selenium,copper, and zinc, or when taking any supplements long-term. The fat-soluble vitamins can be stored in your liver, putting extra demands on this organ which already is working overtime when your receiving chemotherapy.

Look for:

100% of the Daily Value for Vitamins B1 (thiamin), B2 (riboflavin), niacin, Vitamin B6, B 12, C, D, E, folic acid. If you do intend on having additional supplementation of the antioxidants such as Vitamin C or E it may be advantageous to take these separately . Most of the multi-vitamins do not provide adequate supplemental amounts of these. However, note that too much Vitamin C may cause diarrhea, gas or stomach upset. It has been documented in levels greater than 1,000 mg. It may be advisable to take smaller dosages more often.

beta-carotene and Vitamin A, both of which act as strong antioxidants, are in most multi-vitamin supplements. Beta-carotene is converted to Vitamin A, but will not cause Vitamin A toxicity.

Minimize or avoid iron, unless your medical team recommends additional amounts

Phosphorus -- We easily get enough from our diets, too much can prevent calcium absorption. Look for minimal amounts of this mineral.

Substances such as iodine, manganese, molybdenum, chloride, and boron -- there is no evidence that we need supplements of these.

Look for "USP" on a label. This specifies that the supplements meet the standards of the U.S. Pharmacopoeia. The have gone through a testing for dissolvability that mimics what happens in your body.

Determine what is the best form for you to take. Supplements are available in liquid form or chewable form to ease any problems with swallowing.
Treat nausea prior to taking MVI. Remember to take the MVI with meals rather than on an empty stomach

MVI come in many forms. If you have problems with swallowing there are also other forms that are easier to swallow as liquid forms or chewable forms. Liquid forms usually may not meet the DV for minerals as these may not stay in solution.

Remember: A good multi-vitamin is just that. It is not a substitute for eating well.

Special Considerations

Chemotherapy Agents
Use of certain chemotherapy medications may require additional supplementation. Be sure to ask your medical team before supplementing.

Those people receiving cisplatin may require additional magnesium and potassium. Good food sources of magnesium include whole grains, nuts, legumes, dark green leafy vegetables and meat. Potassium food sources include bananas, oranges, potatoes, and apricots. Usually your MVI will not contain potassium.

Look for 100% of Daily Value or more for magnesium. You may need additional supplementation in addition to the amount in your MVI. Your medical team will determine this based on your blood levels.

Chronic Illness
Chronic illness can lead to poor eating habits or deplete your nutrient stores. Extra-strength formulas may be important if you have a long-term digestive problem or have liver or gallbladder problems. Be sure to consult with your medical team on your individual needs before taking supplements.

Reliance on Fast Foods or Processed Foods
These food groups contain an unusually high amount of sodium and possibly phosphorous. Be sure be look for lower amounts of phosphorous in your multi-vitamin. Too much phosphorous will interfere with calcium absorption.

Daily Values
Daily values reflect the recommended levels of intake for most vitamins and minerals and you will see these on a MVI label. If you take MVI and other supplements, keep the levels within the safe upper limits.

Source: UCSF Cancer Research Center (cc.ucsf.edu)