Low vitamin D levels are associated with higher opioid dose in palliative cancer patients--results from an observational study in Sweden

Peter Bergman, Susanne Sperneder, Jonas Höijer, Jenny Bergqvist, Linda Björkhem-Bergman, Peter Bergman, Susanne Sperneder, Jonas Höijer, Jenny Bergqvist, Linda Björkhem-Bergman

Abstract

Background: Vitamin D deficiency is common among palliative cancer patients and has been connected to an increased risk for pain, depressions and infections. Therefore we wanted to test the hypothesis that low 25-hydroxyvitamin D (25OHD) levels are associated with higher opioid dose, higher infectious burden and impaired quality of life in palliative cancer patients. The secondary aim was to investigate the association between 25OHD-levels and survival time.

Method: In this prospective, observational study in palliative cancer-patients (n = 100) we performed univariate and multiple linear regression analysis to assess the association of 25OHD levels with opioid dose, infectious burden (antibiotic consumption), quality of life (Edmonton Symptom Assessment Scale, ESAS) and survival time, controlling for potential confounding factors.

Results: The median 25OHD level was 40 nmol/L (range 8-154 nmol/L). There was a significant association between 25OHD levels and opioid dose, beta coefficient -0.67; p=0.02; i.e. a low 25OHD level was associated with a higher opioid dose. This association remained significant after adjustment for stage of the cancer disease in a multivariate analysis, beta coefficient -0.66; p = 0.04. There was no association between 25OHD levels and antibiotic use or quality of life. Univariate cox regression analysis showed a weak correlation between survival time and 25OHD levels (p<0.05). However, decreased albumin levels and increased CRP levels were superior markers to predict survival time; p<0.001 for both analyses.

Conclusion: Low 25OHD-levels are associated with increased opioid consumption in palliative cancer patients. Future interventional studies are needed to investigate if pain can be reduced by vitamin D supplementation in these patients. In addition, this study confirms previous findings that low albumin and increased CRP levels are useful markers for survival time in palliative cancer patients.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Linear regression analysis of 25-hydroxyvitamin…
Fig 1. Linear regression analysis of 25-hydroxyvitamin D levels (25OHD) and different parameters.
The 25OHD levels in 100 palliative cancer patients showed a significant correlation with opioid dose, expressed as fentanyl μg/hour, but not with infectious burden expressed, as percentage antibiotic consumption per day for 3 months, or self-assessed quality of life expressed as ESAS (numeric scale 1–10 were 10 is worst possible quality of life) or survival time (n = 71).
Fig 2. Cox regression analysis of survival…
Fig 2. Cox regression analysis of survival time and different biochemical parameters.
Survival times in 71 palliative cancer patients were significantly associated with albumin and CRP levels but not with 25-hydroxyvitamin D levels (25OHD). Cox regression showed hazard ratio (HR) 0.87 (95% CI and 0.84–0.92; p

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