Abstract
The purpose of this study is to explore 25-hydroxyvitamin D (25-OHD) levels in patients with cancer in the palliative phase in relation to season, sex, age, tumor type, colectomy, and survival. To this end, we performed a post-hoc analysis of ‘Palliative-D’, a randomized placebo-controlled, double-blind trial investigating the effect of daily supplementation with 4000 IU of vitamin D for 12 weeks on pain in patients in palliative cancer care. In the screening cohort (n = 530), 10% of patients had 25-OHD levels < 25 nmol/L, 50% < 50, and 84% < 75 nmol/L. Baseline 25-OHD did not differ between seasons or tumor type and was not correlated with survival time. In vitamin D deficient patients supplemented with vitamin D (n = 67), 86% reached sufficient levels, i.e., >50 nmol/L, after 12 weeks. An increase in 25-OHD was larger in supplemented women than in men (53 vs. 37 nmol/L, p = 0.02) and was not affected by season. In the placebo-group (n = 83), decreased levels of 25-OHD levels were noted during the study period for patients recruited during the last quarter of the year. In conclusion, cancer patients in palliative phase have adequate increase in 25-OHD after vitamin D supplementation regardless of season, age, tumor type, or colectomy.
Highlights
Vitamin D is a hormone mainly synthesized in the skin in the presence of sunlight, with 7-deoxycholesterol as a substrate [1]
Placebo-controlled, double-blind trial ‘Palliative-D’, we investigated the effect of 12 weeks of supplementation with 4000 IU vitamin D3 to patients with advanced or metastatic cancer and 25-hydroxyvitamin D (25-OHD) ≤ 50 nmol/L on pain, infections, fatigue, and quality of life (QoL) [20,47]
25-OHD levels ranged from 8–50 nmol/L
Summary
Vitamin D is a hormone mainly synthesized in the skin in the presence of sunlight, with 7-deoxycholesterol as a substrate [1]. Vitamin D is activated in two hydroxylation steps into the active form, 1,25-dihydroxyvitamin D [1]. The active form of vitamin D is the only known ligand to the vitamin D receptor (VDR), a nuclear receptor present in many different cell types [3]. 25-OHD levels below 25 nmol/L constitute severe deficiency and between 25 and 50 nmol/L deficiency [7]. Levels above 50 nmol/L are considered to ensure skeletal health, while 75 nmol/L may be needed for optimal functioning of the immune system [7]. Cross sectional data on 25-OHD levels and mortality do suggest a U-shaped relationship, where levels above 125 nmol/L are not necessarily beneficial for the individual [8]
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