Support Care Cancer DOI 10.1007/s00520-014-2218-z
ORIGINAL ARTICLE
Vitamin D deficiency in patients with malignancy in Brisbane Adam Morton & Janet Hardy & Anthony Morton & Angela Tapuni & Helen Anderson & Ngaire Kingi & Catherine Shannon
Received: 25 November 2013 / Accepted: 12 March 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Purpose This study aims to investigate the prevalence and factors predictive of vitamin D deficiency in patients with malignancy in Brisbane, Australia (latitude 27° S). Methods This is a prospective cross-sectional study measuring serum levels of 25-hydroxyvitamin D (25-OHD) in 100 subjects with non-haematological cancer at least 18 years of age not taking vitamin D supplements attending a day oncology unit and oncology/palliative care inpatient ward in Brisbane, Australia. Results Thirty-seven per cent of outpatient and 49 % of inpatient subjects respectively were vitamin D deficient. Functional status was predictive of low vitamin D levels. Conclusion There was a high prevalence of vitamin D deficiency in patients with cancer in Brisbane, Australia. Keywords Vitamin D . Oncology . Palliative Care . Functional Status
Introduction Several studies have shown vitamin D deficiency to be highly prevalent in subjects with cancer [1–10]. Individuals with cancer may be at increased risk of vitamin D deficiency as a result of reduced sunlight exposure, reduced oral intake, A. Morton (*) : J. Hardy : A. Tapuni : H. Anderson : N. Kingi : C. Shannon Mater Health Services, Raymond Tce, South Brisbane QLD 4101, Australia e-mail: [email protected] A. Morton QLD University of Technology, George St, Brisbane QLD 4000, Australia
increasing age and medication including glucocorticoids and anticonvulsants. Vitamin D deficiency may be associated with symptoms of bone pain, muscle weakness and fatigue in noncancer patients. These symptoms are commonly present in individuals with advanced cancer. We sought to examine the prevalence of vitamin D deficiency in 100 individuals with non-haematological malignancy attending a day oncology unit or admitted to a palliative care/oncology ward within a tertiary cancer centre in Brisbane, Australia, across four seasons, and to examine demographic and clinical characteristics predictive of vitamin D deficiency.
Methods We performed a prospective study of 100 subjects measuring serum 25-hydroxyvitamin D (25-OHD) levels on a single blood test and collecting demographic and clinical characteristics including age, sex, diagnosis, presence of bone metastases, treatment with bisphosphonates and season at time of blood collection. Pain (specifically bone and muscle pain) was assessed using a modified Brief Pain Inventory (BPI). Functional status was assessed using the Australia-modified Karnofsky Performance Status (AKPS) and Eastern Cooperative Oncology Group (ECOG) status. Serum 25OHD was measured using tandem mass spectrometry. The functional sensitivity of the vitamin D assay used is 2 nmol/L, with an intra-assay coefficient of variability of 5 % at three different concentrations. External quality assurance is via enrolment in the Royal College of Pathologists of Australia, Vitamin D External Quality Assessment Scheme (DEQAS) and National Institute of Standards and Technology Vitamin D programs. Vitamin D deficiency was defined as a level less than 50 nmol/L. Ethics approval was obtained from the Mater Health Services Human Research Ethics and Governance.
Support Care Cancer Table 2 Vitamin D levels by diagnosis primary malignancy
Statistical analysis The analysis employed both the proportions of patients with 25-OHD levels below 50 nmol/L and the measured vitamin D levels. The analysis was performed using R (R Core Team (2012), R: A language and environment for statistical computing, R Foundation for Statistical Computing, Vienna, Austria, ISBN 3-900051-07-0, URL http://www.R-project.org/). The former (proportions of patients with vitamin D deficiency) were analysed using tabulations, the Fisher exact tests and a trend test for proportions. For the latter (vitamin D levels), we employed boxplots and histograms, Shapiro’s test for normality, t tests, Kruskal-Wallis tests, linear models and Kendall’s rank correlation test.
Results Vitamin D levels were measured in 100 participants over 15 months. Four patients found to have been taking vitamin D supplements were excluded. Patient characteristics of the remaining 96 participants are shown in Table 1. Forty three were from outpatients attending a day oncology unit, and 53 were inpatients. The most common cancer diagnoses were breast and colorectal. The majority of participants (73 (76 %)) had metastatic disease, and 30 (31 %) had bone metastases. The median average pain score was 2/10 (range 0–8). Participants generally had good performance status with a median AKPS score of 70 % (range 20–90) and ECOG score of 2 (range 0–4). Overall, the mean 25-OHD level was 54.6 nmol/L. The prevalence of vitamin D deficiency was 44 %. Thirty-seven per cent of outpatient and 49 % of inpatient subjects respectively were vitamin D deficient. Sixteen per cent of subjects Table 1 Patient characteristics (n=96)
Sex Median age (range) Primary malignancy (%) Colorectal
57 F, 39 M 61 (26–86)
Breast Ovary Lung Prostate Other ECOG score 0 1 2 3 4
19 (20) 13 (13.5) 13 (13.5) 8 (8) 22 (23)
21 (22)
5 41 37 11 2
Primary malignancy
Number
Mean 25-OHDa
25-OHD
ORIGINAL ARTICLE
Vitamin D deficiency in patients with malignancy in Brisbane Adam Morton & Janet Hardy & Anthony Morton & Angela Tapuni & Helen Anderson & Ngaire Kingi & Catherine Shannon
Received: 25 November 2013 / Accepted: 12 March 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Purpose This study aims to investigate the prevalence and factors predictive of vitamin D deficiency in patients with malignancy in Brisbane, Australia (latitude 27° S). Methods This is a prospective cross-sectional study measuring serum levels of 25-hydroxyvitamin D (25-OHD) in 100 subjects with non-haematological cancer at least 18 years of age not taking vitamin D supplements attending a day oncology unit and oncology/palliative care inpatient ward in Brisbane, Australia. Results Thirty-seven per cent of outpatient and 49 % of inpatient subjects respectively were vitamin D deficient. Functional status was predictive of low vitamin D levels. Conclusion There was a high prevalence of vitamin D deficiency in patients with cancer in Brisbane, Australia. Keywords Vitamin D . Oncology . Palliative Care . Functional Status
Introduction Several studies have shown vitamin D deficiency to be highly prevalent in subjects with cancer [1–10]. Individuals with cancer may be at increased risk of vitamin D deficiency as a result of reduced sunlight exposure, reduced oral intake, A. Morton (*) : J. Hardy : A. Tapuni : H. Anderson : N. Kingi : C. Shannon Mater Health Services, Raymond Tce, South Brisbane QLD 4101, Australia e-mail: [email protected] A. Morton QLD University of Technology, George St, Brisbane QLD 4000, Australia
increasing age and medication including glucocorticoids and anticonvulsants. Vitamin D deficiency may be associated with symptoms of bone pain, muscle weakness and fatigue in noncancer patients. These symptoms are commonly present in individuals with advanced cancer. We sought to examine the prevalence of vitamin D deficiency in 100 individuals with non-haematological malignancy attending a day oncology unit or admitted to a palliative care/oncology ward within a tertiary cancer centre in Brisbane, Australia, across four seasons, and to examine demographic and clinical characteristics predictive of vitamin D deficiency.
Methods We performed a prospective study of 100 subjects measuring serum 25-hydroxyvitamin D (25-OHD) levels on a single blood test and collecting demographic and clinical characteristics including age, sex, diagnosis, presence of bone metastases, treatment with bisphosphonates and season at time of blood collection. Pain (specifically bone and muscle pain) was assessed using a modified Brief Pain Inventory (BPI). Functional status was assessed using the Australia-modified Karnofsky Performance Status (AKPS) and Eastern Cooperative Oncology Group (ECOG) status. Serum 25OHD was measured using tandem mass spectrometry. The functional sensitivity of the vitamin D assay used is 2 nmol/L, with an intra-assay coefficient of variability of 5 % at three different concentrations. External quality assurance is via enrolment in the Royal College of Pathologists of Australia, Vitamin D External Quality Assessment Scheme (DEQAS) and National Institute of Standards and Technology Vitamin D programs. Vitamin D deficiency was defined as a level less than 50 nmol/L. Ethics approval was obtained from the Mater Health Services Human Research Ethics and Governance.
Support Care Cancer Table 2 Vitamin D levels by diagnosis primary malignancy
Statistical analysis The analysis employed both the proportions of patients with 25-OHD levels below 50 nmol/L and the measured vitamin D levels. The analysis was performed using R (R Core Team (2012), R: A language and environment for statistical computing, R Foundation for Statistical Computing, Vienna, Austria, ISBN 3-900051-07-0, URL http://www.R-project.org/). The former (proportions of patients with vitamin D deficiency) were analysed using tabulations, the Fisher exact tests and a trend test for proportions. For the latter (vitamin D levels), we employed boxplots and histograms, Shapiro’s test for normality, t tests, Kruskal-Wallis tests, linear models and Kendall’s rank correlation test.
Results Vitamin D levels were measured in 100 participants over 15 months. Four patients found to have been taking vitamin D supplements were excluded. Patient characteristics of the remaining 96 participants are shown in Table 1. Forty three were from outpatients attending a day oncology unit, and 53 were inpatients. The most common cancer diagnoses were breast and colorectal. The majority of participants (73 (76 %)) had metastatic disease, and 30 (31 %) had bone metastases. The median average pain score was 2/10 (range 0–8). Participants generally had good performance status with a median AKPS score of 70 % (range 20–90) and ECOG score of 2 (range 0–4). Overall, the mean 25-OHD level was 54.6 nmol/L. The prevalence of vitamin D deficiency was 44 %. Thirty-seven per cent of outpatient and 49 % of inpatient subjects respectively were vitamin D deficient. Sixteen per cent of subjects Table 1 Patient characteristics (n=96)
Sex Median age (range) Primary malignancy (%) Colorectal
57 F, 39 M 61 (26–86)
Breast Ovary Lung Prostate Other ECOG score 0 1 2 3 4
19 (20) 13 (13.5) 13 (13.5) 8 (8) 22 (23)
21 (22)
5 41 37 11 2
Primary malignancy
Number
Mean 25-OHDa
25-OHD
