Vitamin D levels dropped 3 ng during cancer chemotherapy – May 2012

Variations in serum vitamin D status during cancer chemotherapy.

Journal of Clinical Oncology, 2012 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 30, No 15_suppl (May 20 Supplement), 2012: e19550
© 2012 American Society of Clinical Oncology
Bogda Koczwara, Richard John Woodman, Laisa Vicki Teleni, Michael Kimlin, Euan Thomas Walpole, Kunal Jain, Christos Stelios Karapetis, Emma-Louise Smith, Wendy Louise Davidson, Maree Ferguson, Shawgi Sukumaran, Ganessan Kichenadasse and Elizabeth Isenring
Flinders University of South Australia and Flinders Medical Centre, Bedford Park, Australia; Flinders University, Adelaide, Australia;
Princess Alexandra Hospital, Woolloongabba, Australia;
University of Queensland, Kelvin Grove, Australia;
Christian Medical College and Hospital, Ludhiana, India;
Flinders Medical Centre and Flinders University, Adelaide, Australia;
Flinders Medical Centre, Bedford Park, Australia;
Flinders Medical Centre, Adelaide, Australia;
Flinders Medical Centre, Flinders University, Adelaide, Australia;
The Univesity of Queensland, Brisbane, Australia

Background: Low serum vitamin D in cancer patients has been associated with inferior cancer outcomes and bone loss. The impact of chemotherapy on vitamin D levels is not known. We examined serum vitamin D levels during chemotherapy to identify magnitude and predictors of change.

Methods: A prospective study of chemotherapy naïve patients commencing chemotherapy in two different sun exposure areas. Vitamin D (25(OH)D) deficiency was defined as 25 nmol/L and insufficiency 26-50 nmol/L. Demographic data, nutrition, sun exposure, season and biochemical parameters were collected at baseline 6 weeks (6W) and 12 weeks (12W) since commencement of treatment. The effects were assessed using a multivariate multilevel linear regression model that also included age, gender and BMI.

Results: 82 Caucasian and 3 indigenous patients were enrolled. Median age was 57 (21-85) years. Forty-nine (58%) were female; 54 (65%) were treated with curative intent.
Tumours included

• 29 (34%) breast,1
• 2 (14%) colorectal,
• 9 (11%) lymphomas,
• 7 (8%) leukemias,
• 7 (8%) lung,
• 5 (6%) ovarian,
• 3 (4%) testis,
• 3 (4%) unknown primary and
• 10 (11%) others.

Median weight was 75 kg (50-151) and median BMI was 26.9 kg/m2 (17.7- 44.5). Seventy-six (89%) and 55 (65%) patients were receiving chemotherapy treatment at 6W and 12W respectively. Mean (±SD) serum 25(OH)D at baseline was 49.2 ± 22.3 nmol/L.
Ten (12%) patients were vitamin D deficient at baseline and a further 33 (41%) had insufficient levels.
Mean serum 25(OH)D status was higher in higher sun exposure locations (61.9±22.1 nmol/L vs 42.2±19.2 nmol/L, p<0.001), varied according to season (spring=46.9±20.3 nmol/L, summer=50.8±18.2 nmol/L, fall=76.4±25.2 nmol/L, winter=36.5±15.7 nmol/L, p<0.001) and changed with treatment period (

• baseline=49.2±22.3 nmol/L,
• 6W=40.9±19.0 nmol/L,
• 12W=45.9±19.7 nmol/L, p=0.002).

There was no association between 25(OH)D status and age, gender, BMI or nutritional status.

Conclusions: Chemotherapy is associated with a fall in serum 25(OH)D. Further research is needed to determine the underlying mechanism, the impact of low serum 25(OH)D on patient outcomes and the potential role for screening and vitamin D supplementation in this group.

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