Omega-3 Fatty Acids
Author
Nancy Hepp, MS, BCCT Project Manager
Read more Ms. Hepp is a science researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. View profile.
Reviewer
Laura Pole, RN, MSN, OCNS, BCCT Senior Researcher
Read more Ms. Pole is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation and education services for more than 30 years. View profile.
Last updated November 3, 2020.
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Also known by these names
- O3FAs
- ω-3 fatty acids
- n-3 fatty acids
- omega 3s
- Individual O3FAs:
- Docosahexaenoic acid (DHA)
- Eicosapentaenoic acid (EPA)
- Alpha-linolenic acid (ALA)
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Key Points
- Before using this therapy, consult your oncology team about interactions with other treatments and therapies. Also make sure this therapy is safe for use with any other medical conditions you may have.
- Omega-3 fatty acids are found naturally in many fish and a few seeds and walnuts.
- Omega-3s are widely available as supplements.
- BCCT is interested in omega-3s because evidence shows benefits in several types of cancer treatment, and preliminary evidence shows omega-3s may reduce risks of breast and colon cancer.
- While omega-3s are generally considered safe, a few cautions and interactions are noted.
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Omega-3 fatty acids are a type of polyunsaturated fatty acid (PUFA) found naturally in these foods and supplements:
Expand list
- Fish and fish oil: anchovies, bluefish, herring, mackerel, salmon (wild has more omega-3s than farmed), sardines, sturgeon, lake trout and tuna
- Krill oil
- Cod liver oil
- Flaxseed oil
- Linseed oil
- Walnuts
- Chia seeds
The three main omega-3 fatty acids are docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and alpha-linolenic acid (ALA). DHA and EPA generally show greater benefits in cancer, but are found only in animal sources. ALA from plant sources is converted to DHA and EPA in our bodies, but with a low conversion efficiency. ALA is not recommended as your sole source of omega-3s.
Clinical Practice Guidelines
2013 evidence-based clinical practice guidelines from the American College of Chest Physicians recommended oral nutritional supplementation with omega-3 fatty acids to improve the nutritional status for lung cancer patients with sarcopenia (loss of muscle tissue).
Treating the Cancer
Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action
Clinical Evidence
Breast Cancer
- Improved outcomes with DHA added to chemotherapy in a small trial of metastatic breast cancer patients
Colorectal Cancer
- A diet rich in omega-3 fatty acids is associated with higher survival with colorectal cancer
- Reduced length of hospital stay, but no reduction in noninfectious complications or mortality when taken before surgery in a nutritional supplement also including arginine and nucleotides
- No decrease in tumor size or improvement in patient survival times in a 2015 review
- Reduced number and size of rectal adenomas
- Eicosapentaenoic acid (EPA) effects:
- Improved overall survival in patients undergoing liver resection surgery for colorectal cancer liver metastases
- Reduced the extent of blood vessel networks consistent with reduced creation of new blood vessels to supply tumors (angiogenesis) with EPA use
- Compared with a placebo, eicosapentaenoic acid (EPA) either with or without aspirin did not reduce the proportion of patients with at least one colorectal adenoma in patients with sporadic colorectal neoplasia.
Prostate Cancer
A group of men with prostate cancer combining omega 3 supplements with a low-fat (15 percent of calories from fat) diet for four to six weeks before prostatectomy was compared to a control group consuming the standard American diet with 40 percent of calories from fat and no fish oil supplementation. At prostatectomy, the group supplement had smaller prostates (both benign and malignant components), lower proliferation index, and plasma that inhibited growth of prostate cancer cells in vitro more than the plasma from the control patients. Other effects in prostate cancer:
- Decreased prostate cancer proliferation and decreased prostate tissue omega-6:omega-3 ratios, but no change in serum insulin-like growth factor I (IGF-1) in a small study of men undergoing radical prostatectomy
Conflicting interactions with chemotherapy have been reported:
- No adverse side effects and possible improved anthracycline-based chemotherapy outcome were found in a small uncontrolled trial of group patients with rapidly progressing visceral metastases.
- Rise in plasma levels after supplementation in healthy volunteers to levels capable of causing chemoresistance to cisplatin in mice; use is not recommended on the days surrounding chemotherapy.
Lab and Animal Evidence
Read more
Omega-3 fatty acids promote the death of of human cancer cells and increase their sensitivity to conventional anticancer therapies without affecting normal cells.
Omega-3s promoted cell death and reduced proliferation in preclinical studies of breast cancer.
Omega-3 supplements have shown some effects in ovarian cancer cells:
- Induced apoptosis (programmed cell death) with docosahexaenoic acid (DHA) in some ovarian cancer cells
- Inhibited ovarian cancer cell growth with eicosopentaneoic acid (EPA)
- DHA may be more effective than EPA in growth suppression.
Dietary fat composition—especially the ratio of omega-3 to omega-6 polyunsaturated fatty acids—regulates tumor growth and the frequency and sites of metastasis that together impact overall survival in mice.
Managing Side Effects and Promoting Wellness
Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being
Results related to patient body weight and composition:
- Omega-3 fatty acid (EPA and DHA) capsules or supplements with EPA have been associated with weight stabilization, gain in lean body mass, and improvement in quality of life markers in patients losing weight as a result of advanced pancreatic and head and neck cancers.
- Promoted weight maintenance or gain during cancer treatment, and improved scores of physical function and global health status
- Maintained body weight during chemotherapy
- The weight of patients with gastrointestinal cancer (anal, colorectal, esophageal, stomach) increased significantly with EPA supplementation. EPA and DHA ameliorated muscle loss and myosteatosis (the presence of intermuscular and intramuscular adipose tissue) in clinical studies.
- In patients with colorectal cancer, EPA supplements increased weight and improved scores of health-related quality of life, with a trend toward fewer interruptions of chemotherapy treatment in a small study; EPA also increased mean weight and energy levels in an uncontrolled trial of colorectal cancer patients undergoing chemotherapy with folinic acid, 5-fluorouracil, irinotecan (FOLFIRI)
- A small study involving cancer patients receiving chemotherapy after surgical tumor (mainly gastrointestinal) removal found that fish oil supplementation reduced weight loss and improved the function of blood neutrophils.
- Omega-3 supplements improved outcomes, especially body composition, in patients undergoing chemotherapy and/or radiotherapy.
- EPA reduced deterioration of nutritional status resulting from antineoplastic therapies (therapies to block the formation of neoplasms) by improving calorie and protein intake
High-dose EPA inhibited bone resorption in breast cancer survivors taking aromatase inhibitors.
Omega-3s reduced paclitaxel-induced peripheral neuropathy in a small clinical study of breast cancer patients. One review found reduced incidence of peripheral neuropathy, but another review found insufficient evidence yet exists to recommend use for treating or preventing chemotherapy-induced peripheral neuropathy (CIPN).
Reduced postoperative infectious complications and hospital stay after colorectal cancer surgery in one study but no improvement in infectious or non-infectious postoperative complications in another
Dietary omega-3 fatty acids combined with guarana extract and a diet rich in whole foods, fruits and vegetables can treat cancer-related fatigue in patients with breast cancer.
Nutritional supplementation with omega-3 fatty acids, arginine and nucleotides resulted in a marked improvement of immune functions in cancer patients undergoing surgery and a reduction in infectious complications, hospital stay and co-morbidities.
Combination therapies:
- Medroxyprogesterone or megestrol acetate, eicosapentaenoic acid (EPA), L-carnitine and thalidomide
- Increased lean-body mass, decreased resting energy expenditure, improved fatigue and appetite, improved performance status in patients with cachexia (weakness and wasting)
- Omega-3 fatty acid and microbial cell preparation
Reducing Risk
Reducing the risk of developing cancer or the risk of recurrence
Clinical Evidence
Substantial data support the importance of omega-3 fatty acids for colorectal cancer prevention. A decreased risk of colon cancer with fish oil supplements, primarily in men, was found in one study; an increased risk was found with individuals with high genetic risk. Eicosapentaenoic acid (EPA) alone reduced the number and size of polyps in patients with familial adenomatous polyposis. Eicosapentaenoic acid (EPA) alone, either with or without aspirin, did not reduce the proportion of patients with sporadic colorectal neoplasia who had at least one colorectal adenoma, but did reduce the number of adenomas.
Higher omega-6 to omega-3 ratios are associated with higher risk of breast cancer, while higher consumption of dietary marine omega-3 polyunsaturated fatty acids is associated with a lower risk of breast cancer. Higher levels from combined diet and supplements are associated with reduced risks of breast cancer. No impact of supplements on breast cancer recurrence and improved overall mortality in patients were found with early stage breast cancer, but marine omega-3s from food were associated with reduced risk of additional breast cancer events and all-cause mortality.
Higher levels from combined diet and supplements are associated with reduced risks of breast cancer. No impact of supplements was found on breast cancer recurrence and improved overall mortality in patients with early stage breast cancer, but marine omega-3s (DHA and EPA) from food were associated with reduced risk of additional breast cancer events and all-cause mortality.
Data on omega-3 fatty acid supplementation for prostate cancer prevention are inconclusive. A 2017 review of the literature showed no clear relationship between fish-derived omega-3 fatty acids and risk of prostate cancer, but a separate review found that consumption of omega-3 long-chain polyunsaturated fatty acids (LCPUFAs) and "an omega-6/omega-3 ratio of 2-4:1 are associated with a reduced risk of breast, prostate, colon and renal cancers."
Lab and Animal Evidence
Read more
A 2018 review drew these conclusions:
- Fish oil rich in DHA has induced suppression of human breast carcinoma in a nude mice model.
- EPA and DHA is cytotoxic to cervical cancer cells.
- The addition of a fish emulsion induced apoptosis and arrested cell proliferation in human colon cancer cells.
Optimizing Your Terrain
Creating an environment within your body that does not support cancer development, growth or spread
- Reduced inflammation, or improved anti-inflammatory markers
- including when accompanying anticancer treatment and in patients undergoing radical colorectal cancer resection
Cautions
A few cautions are noted. Please see the Memorial Sloan Kettering Cancer Center’s About Herbs website for information.
- High blood concentrations of omega-3s are associated with increased risk of prostate cancer (see the Foundation for Alternative and Integrative Medicine for an analysis of the study that found this).
- Increased resistance to chemotherapy is a concern; a type of omega-3 fatty acid, 16:4(n-3), can reduce the activity of the chemotherapy drug cisplatin. Use is not recommended on the days surrounding chemotherapy.
- 2018 review conclusions:
- Four grams of supplementation may impair clotting; patients may want to eliminate omega-3 supplements before and immediately after surgery.
- A few adverse reactions and interactions with prescription and other drugs have been observed.
Dosing
BCCT does not recommend therapies or doses, but only provides information for patients and providers to consider as part of a complete treatment plan. Patients should discuss therapies with their physicians, as contraindications, interactions and side effects must be evaluated. Levels of active ingredients of natural products can vary widely between and even within products. See Quality and Sources of Herbs, Supplements and Other Natural Products.
Dosage recommendations are available from these sources:
Integrative Programs, Protocols and Medical Systems
Non-cancer Uses of Omega-3 Fatty Acids
BCCT has not reviewed the effectiveness of this therapy for non-cancer uses.
- Depression
- High cholesterol
- Cardiovascular risk factors, including elevated triglyceride levels
- Stroke
- Rheumatoid arthritis
- NSAID-associated gastroduodenal damage
- Sunburn and sensitivity to ultraviolet radiation
- Cystic fibrosis
- Systemic lupus erythematosus (SLE)
- Type 1 diabetes
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Note: BCCT has not conducted an independent review of research of Omega-3 fatty acids. This summary draws from the Memorial Sloan Kettering Cancer Center’s About Herbs and other sources as noted.
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- Linus Pauling Institute. Essential Fatty Acids. Oregon State University. Viewed May 14, 2019.
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- Bougnoux P, Hajjaji N et al. Improving outcome of chemotherapy of metastatic breast cancer by docosahexaenoic acid: a phase II trial. British Journal of Cancer. 2009 Dec 15;101(12):1978-85.
- Daenen LG, Cirkel GA et al. Increased plasma levels of chemoresistance-inducing fatty acid 16:4(n-3) after consumption of fish and fish oil. JAMA Oncology. 2015 Jun;1(3):350-8.
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- Silva Jde A, Trindade EB et al. Fish oil supplement alters markers of inflammatory and nutritional status in colorectal cancer patients. Nutrition and Cancer. 2012;64(2):267-73.
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- Ewaschuk JB, Almasud A, Mazurak VC. Role of n-3 fatty acids in muscle loss and myosteatosis. Applied Physiology, Nutrition, and Metabolism. 2014 Jun;39(6):654-62.
- Trabal J, Leyes P, Forga M, Maurel J. Potential usefulness of an EPA-enriched nutritional supplement on chemotherapy tolerability in cancer patients without overt malnutrition. Nutricion Hospitalaria. 2010 Sep-Oct;25(5):736-40.
- Read JA, Beale PJ et al. Nutrition intervention using an eicosapentaenoic acid (EPA)-containing supplement in patients with advanced colorectal cancer. Effects on nutritional and inflammatory status: a phase II trial. Supportive Care in Cancer. 2007 Mar;15(3):301-7.
- Bonatto SJ, Oliveira HH et al. Fish oil supplementation improves neutrophil function during cancer chemotherapy. Lipids. 2012 Apr;47(4):383-9.
- de Aguiar Pastore Silva J, Emilia de Souza Fabre M, Waitzberg DL. Omega-3 supplements for patients in chemotherapy and/or radiotherapy: a systematic review. Clinical Nutrition. 2015 Jun;34(3):359-66.
- Pappalardo G, Almeida A, Ravasco P. Eicosapentaenoic acid in cancer improves body composition and modulates metabolism. Nutrition. 2015 Apr;31(4):549-55.
- Hutchins-Wiese HL, Picho K et al. High-dose eicosapentaenoic acid and docosahexaenoic acid supplementation reduces bone resorption in postmenopausal breast cancer survivors on aromatase inhibitors: a pilot study.
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- Ghoreishi Z, Esfahani A et al. Omega-3 fatty acids are protective against paclitaxel-induced peripheral neuropathy: a randomized double-blind placebo controlled trial. BMC Cancer. 2012 Aug 15;12:355.
- de Aguiar Pastore Silva J, de Souza Fabre ME, Waitzberg DL. Omega-3 supplements for patients in chemotherapy and/or radiotherapy: a systematic review. Clinical Nutrition. 2015 Jun;34(3):359-66.
- Schloss JM, Colosimo M, Airey C, Masci PP, Linnane AW, Vitetta L. Nutraceuticals and chemotherapy induced peripheral neuropathy (CIPN): a systematic review [published correction appears in Clinical Nutrition. 2015 Feb;34(1):167]. Clinical Nutrition. 2013;32(6):888–893.
- Xie H, Chang YN. Omega-3 polyunsaturated fatty acids in the prevention of postoperative complications in colorectal cancer: a meta-analysis. OncoTargets and Therapy. 2016 Dec 9;9:7435-7443.
- Sorensen LS, Thorlacius-Ussing O et al. Randomized clinical trial of perioperative omega-3 fatty acid supplements in elective colorectal cancer surgery. British Journal of Surgery. 2014 Jan;101(2):33-42.
- Pereira PTVT, Reis AD et al. Dietary supplements and fatigue in patients with breast cancer: a systematic review. Breast Cancer Research and Treatment. 2018 Oct;171(3):515-526.
- Soldati L, Di Renzo L et al. The influence of diet on anti-cancer immune responsiveness. Journal of Translational Medicine. 2018 Mar 20;16(1):75; Adiamah A, Skořepa P, Weimann A, Lobo DN. The impact of preoperative immune modulating nutrition on outcomes in patients undergoing surgery for gastrointestinal cancer: a systematic review and meta-analysis. Annals of Surgery. 2019 Feb 26.
- Mantovani G, Macciò A et al. Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia. Oncologist. 2010;15(2):200-11.
- Golkhalkhali B, Rajandram R et al. Strain-specific probiotic (microbial cell preparation) and omega-3 fatty acid in modulating quality of life and inflammatory markers in colorectal cancer patients: a randomized controlled trial. Asia-Pacific Journal of Clinical Oncology. 2018 Jun;14(3):179-191.
- Song M, Chan AT. Environmental factors, gut microbiota, and colorectal cancer prevention. Clinical Gastroenterology and Hepatology. 2019 Jan;17(2):275-289.
- Kantor ED, Lampe JW, Peters U, Vaughan TL, White E. Long-chain omega-3 polyunsaturated fatty acid intake and risk of colorectal cancer. Nutrition and Cancer. 2014;66(4):716-27.
- Song M, Chan AT. Environmental factors, gut microbiota, and colorectal cancer prevention. Clinical Gastroenterology and Hepatology. 2019 Jan;17(2):275-289.
- Hull MA, Sprange K et al. Eicosapentaenoic acid and aspirin, alone and in combination, for the prevention of colorectal adenomas (seAFOod Polyp Prevention trial): a multicentre, randomised, double-blind, placebo-controlled, 2 × 2 factorial trial. Lancet. 2018 Dec 15;392(10164):2583-2594.
- Serna-Thomé G, Castro-Eguiluz D et al. Use of functional foods and oral supplements as adjuvants in cancer treatment. Revista de Investigacion Clinica. 2018;70(3):136-146.
- Zheng JS, Hu XJ, Zhao YM, Yang J, Li D. Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort studies. BMJ. 2013 Jun 27;346:f3706.
- Fabian CJ, Kimler BF, Hursting SD. Omega-3 fatty acids for breast cancer prevention and survivorship. Breast Cancer Research. 2015 May 4;17:62.
- Patterson RE, Flatt SW et al. Marine fatty acid intake is associated with breast cancer prognosis. Journal of Nutrition. 2011 Feb;141(2):201-6.
- Fabian CJ, Kimler BF, Hursting SD. Omega-3 fatty acids for breast cancer prevention and survivorship. Breast Cancer Research. 2015 May 4;17:62.
- Patterson RE, Flatt SW et al. Marine fatty acid intake is associated with breast cancer prognosis. Journal of Nutrition. 2011 Feb;141(2):201-6.
- Aucoin M, Cooley K et al. Fish-derived omega-3 fatty acids and prostate cancer: a systematic review. Integrative Cancer Therapies. 2017 Mar;16(1):32-62.
- Zárate R, El Jaber-Vazdekis N, Tejera N, Pérez JA, Rodríguez C. Significance of long chain polyunsaturated fatty acids in human health. Clinical and Translational Medicine. 2017 Dec;6(1):25.
- Serna-Thomé G, Castro-Eguiluz D et al. Use of functional foods and oral supplements as adjuvants in cancer treatment. Revista de Investigacion Clinica. 2018;70(3):136-146.
- Pappalardo G, Almeida A, Ravasco P. Eicosapentaenoic acid in cancer improves body composition and modulates metabolism. Nutrition. 2015 Apr;31(4):549-55; de Aguiar Pastore Silva J, Emilia de Souza Fabre M, Waitzberg DL. Omega-3 supplements for patients in chemotherapy and/or radiotherapy: a systematic review. Clinical Nutrition. 2015 Jun;34(3):359-66.
- Sorensen LS, Thorlacius-Ussing O et al. Effects of perioperative supplementation with omega-3 fatty acids on leukotriene B₄ and leukotriene B₅ production by stimulated neutrophils in patients with colorectal cancer: a randomized, placebo-controlled intervention trial. Nutrients. 2014 Sep 29;6(10):4043-57; Silva Jde A, Trindade EB et al. Fish oil supplement alters markers of inflammatory and nutritional status in colorectal cancer patients. Nutrition and Cancer. 2012;64(2):267-73; Xie H, Chang YN. Omega-3 polyunsaturated fatty acids in the prevention of postoperative complications in colorectal cancer: a meta-analysis. OncoTargets and Therapy. 2016 Dec 9;9:7435-7443; Golkhalkhali B, Rajandram R et al. Strain-specific probiotic (microbial cell preparation) and omega-3 fatty acid in modulating quality of life and inflammatory markers in colorectal cancer patients: a randomized controlled trial. Asia-Pacific Journal of Clinical Oncology. 2018 Jun;14(3):179-191; Aucoin M, Cooley K et al. Fish-derived omega-3 fatty acids and prostate cancer: a systematic review. Integrative Cancer Therapies. 2017 Mar;16(1):32-62.
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- Daenen LG, Cirkel GA et al. Increased plasma levels of chemoresistance-inducing fatty acid 16:4(n-3) after consumption of fish and fish oil. JAMA Oncology. 2015 Jun;1(3):350-8.
- Daenen LG, Cirkel GA et al. Increased plasma levels of chemoresistance-inducing fatty acid 16:4(n-3) after consumption of fish and fish oil. JAMA Oncology. 2015 Jun;1(3):350-8.
- Abrams D. An integrative approach to prostate cancer. The Journal of Alternative and Complementary Medicine. 2018 Sep/Oct;24(9-10):872-880.
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View All References
More Information
- Memorial Sloan Kettering Cancer Center’s About Herbs website: Omega-3
- Deng G, Gubili J. Omega-3 Fatty Acids. ASCO Post. March 10, 2019.
- American Institute for Cancer Research website: more than 100 articles and scientific reports on omega-3 fatty acids and cancer
- TRC Natural Medicines website (subscription is required): in-depth information, ratings of effectiveness and safety and evaluation of specific omega-3 fatty acid products
- Consumer Labs: Product Review (subscription required): Fish Oil and Omega-3 and -7 Fatty Acids Supplement Review
- Moss Reports (purchase required): Select from the list of cancers down the left side of the page for a report describing uses of conventional, complementary, alternative and integrative therapies related to that cancer. Ralph Moss is among the most knowledgeable and balanced researchers of integrative cancer therapies. The cost of his Moss Reports is not negligible, but many patients find them of considerable value. Moss is also available for consultations.
- Harvard Health Publishing: Should you be taking an omega-3 supplement?
- Linus Pauling Institute, Oregon State University: Essential Fatty Acids
- Gurdev Parmar and Tina Kaczor: Textbook of Naturopathic Oncology
- Dawn Lemanne and Victoria Maizes: Advising Women Undergoing Treatment for Breast Cancer
- Block KI, Block PB, Gyllenhaal C: Integrative Treatment for Colorectal Cancer
- Keith Block and others: A Broad-Spectrum Integrative Design for Cancer Prevention and Therapy
- Raymond Chang, MD: Beyond the Magic Bullet: The Anti-Cancer Cocktail
- Donald I. Abrams, MD, and Andrew T. Weil, MD: Integrative Oncology, 2nd Edition
- Neil McKinney, BSc, ND: Naturopathic Oncology, 3rd Edition
- Ted Schettler, MD, MPH: The Ecology of Breast Cancer: The Promise of Prevention and the Hope for Healing
- Lise Alschuler, ND, FABNO, and Karolyn Gazella: The Definitive Guide to Cancer, 3rd Edition
- Keith I. Block, MD: Life over Cancer: The Block Center Program for Integrative Cancer Treatment
- Lorenzo Cohen and Alison Jefferies: Anticancer Living: Transform Your Life and Health with the Mix of Six
- National Cancer Institute: Office of Cancer Complementary and Alternative Medicine
- Lone Star Medical Group: Natural Alternative Treatments
- Michael Lerner: Choices In Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer
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