title: Survey of Policies and Guidelines on Antioxidant Use for Cancer Prevention, Treatment, and Survivorship in North American Cancer Centers: What Do Institutions Perceive as Evidence?
abstract: BACKGROUND
  Health care policies and guidelines that are clear and consistent with research evidence are important for maximizing clinical outcomes. To determine whether cancer centers in Canada and the United States had policies and/or guidelines about antioxidant use, and whether policies were aligned with the evidence base, we reviewed current research evidence in the field, and we undertook a survey of the policies and guidelines on antioxidant use at cancer institutions across North America.
  
  
  METHODS
  A survey of policies and guidelines on antioxidant use and the development and communication of the policies and guidelines was conducted by contacting cancer institutions in North America. We also conducted a Website search for each institution to explore any online resources.
  
  
  RESULTS
  Policies and guidelines on antioxidant use were collected from 78 cancer institutions. Few cancer institutions had policies (5%) but most provided guidelines (69%). Antioxidants from diet were generally encouraged at cancer institutions, consistent with the current research evidence. In contrast, specific antioxidant supplements were generally not recommended at cancer institutions. Policies and guidelines were developed using evidence-based methods (53%), by consulting another source (35%), or through discussions/conference (26%), and communicated mainly through online resources (65%) or written handouts (42%). For cancer institutions that had no policy or guideline on antioxidants, lack of information and lack of time were the most frequently cited reasons.
  
  
  CONCLUSIONS
  Policies and guidelines on antioxidants from diet were largely consistent with the research evidence. Policies and guidelines on antioxidant supplements during treatment were generally more restrictive than the research evidence might suggest, perhaps due to the specificity of results and the inability to generalize findings across antioxidants, adding to the complexity of their optimal and safe use. Improved communication of comprehensive research evidence to cancer institutions may aid in the development of more evidence-based policies and guidelines.
authors.affiliation: Tom Baker Cancer Centre-Holy Cross Site, Calgary, Alberta, Canada.
authors.forename: Gyeongyeon
authors.initials: G
authors.lastname: Hong
authors.affiliation: Tom Baker Cancer Centre-Holy Cross Site, Calgary, Alberta, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: White
authors.affiliation: Tom Baker Cancer Centre-Holy Cross Site, Calgary, Alberta, Canada.
authors.forename: Lihong
authors.initials: L
authors.lastname: Zhong
authors.affiliation: Tom Baker Cancer Centre-Holy Cross Site, Calgary, Alberta, Canada University of Calgary Department of Oncology, Cumming School of Medicine, Calgary, Alberta, Canada lcarlso@ucalgary.ca.
authors.forename: Linda E
authors.initials: LE
authors.lastname: Carlson
mesh_terms: D000975:Antioxidants / Q000008:administration & dosage*; D002170:Canada; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D003625:Data Collection; D004032:Diet; D019587:Dietary Supplements; D019317:Evidence-Based Medicine; D006801:Humans; D009369:Neoplasms / Q000517:prevention & control / Q000628:therapy*; D016134:Organizational Policy; D017410:Practice Guidelines as Topic; D015996:Survival Rate; D014481:United States
chemical_list: D000975:Antioxidants
keywords: antioxidant; cancer; diet; guideline; policy; prevention; supplement; treatment