Vitamin D supplementation to palliative cancer patients shows positive effects on pain and infections-Results from a matched case-control study

Maria Helde-Frankling, Jonas Höijer, Jenny Bergqvist, Linda Björkhem-Bergman, Maria Helde-Frankling, Jonas Höijer, Jenny Bergqvist, Linda Björkhem-Bergman

Abstract

Background: We previously showed an association between low vitamin D levels and high opioid doses to alleviate pain in palliative cancer patients. The aim of this case-controlled study was to investigate if vitamin D supplementation could improve pain management, quality of life (QoL) and decrease infections in palliative cancer patients.

Methods: Thirty-nine palliative cancer patients with levels of 25-hydroxyvitamin D < 75 nmol/L were supplemented with vitamin D 4000 IE/day, and were compared to 39 untreated, matched "control"-patients from a previous study at the same ward. Opioid doses, antibiotic consumption and QoL-scores measured with the Edmonton Symptom Assessment Scale (ESAS) were monitored. The primary endpoint was the change from baseline after 1 and 3 months compared between the groups using linear regression with adjustment for a potential cofounding factor.

Results: After 1 month the vitamin D treated group had a significantly decreased fentanyl dose compared to the untreated group with a difference of 46 μg/h; 95% CI 24-78, which increased further at 3 months to 91 μg/h; 95% CI 56-140 μg/h. The ESAS QoL-score improved in the Vitamin D group the first month; -1.4; 95% CI -2.6 - (-0.21). The vitamin D-treated group had significantly lower consumption of antibiotics after 3 months compared to the untreated group, the difference was -26%; 95%CI -0.41%-(-0.12%). Vitamin D was well tolerated by all patients and no adverse events were reported.

Conclusion: Vitamin D supplementation to palliative cancer patients is safe and improvement in pain management is noted as early as 1 month after treatment. Decreased infections are noted 3 months after vitamin D treatment. The results from this pilot-study have been used for the power-calculation of a future randomized, placebo-controlled, double-blind study called "Palliative-D" that will start in Nov 2017 and will include 254 palliative cancer patients.

Conflict of interest statement

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

Figures

Fig 1. Flowchart of patients included in…
Fig 1. Flowchart of patients included in the vitamin D intervention study.
Fig 2. Differences in opioid dose (μg…
Fig 2. Differences in opioid dose (μg fentanyl/h) (A), Quality of Life (according to ESAS-assessment) (B) and antibiotic consumption (% of days with antibiotic the month before) (C) between 39 vitamin D treated palliative cancer patients and 39 matched controls.
Points show mean values and bars show 95%CI. There was a significant difference in fentanyl dose between the groups as soon as 1 month after treatment and in antibiotic consumptions after 3 months.
Fig 3. 25-hydroxyvitamin D (25-OHD) levels in…
Fig 3. 25-hydroxyvitamin D (25-OHD) levels in the vitamin D (n = 39 and n = 23) and control group (n = 39).
There was a significant increase of 25-OHD levels in the vitamin D group compared to baseline; statistical analysis was performed by using a paired t-test (p

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Source: PubMed

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