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Low 25-hydroxyvitamin D levels in people with a solid tumor cancer diagnosis: the tip of the iceberg?

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Abstract

Purpose

Low serum 25-hydroxyvitamin D [25(OH)D] levels have been linked to both cancer incidence and poor prognosis. The frequency of 25(OH)D tests and clinical factors associated with low levels in cancer patients are unknown.

Patients and methods

Electronic medical records from 2006 to 2007 of 39,252 adult solid tumor patients were reviewed. Data included demographics, cancer sites (primary and metastatic), and first serum 25(OH)D level during the study period. Laboratory data, comorbidities, selected medications, and anticancer treatment within the prior 2 months were recorded. Data were compared between (1) those tested and not tested and (2) 25(OH)D levels ≤10 ng/ml (deficient), 11–30 ng/ml (insufficient), and ≥31 ng/ml (sufficient). Stepwise logistic regression identified independent predictors of low serum 25(OH)D levels.

Results

The cohort was 86 % Caucasian and 48 % female with a mean age of 63 ± 14 years (mean ± SD). The most prevalent cancer was breast (19 %). In total, 2,098 (5 %) had a 25(OH)D test. Of those tested, 133 (6 %) had levels ≤10 ng/ml and 1,311 (62 %) 11–30 ng/ml. Tests were more frequent in females and in those with breast, skin, and thyroid cancers (P < 0.001). Low 25(OH)D levels were associated (in univariable analyses) with male gender, non-Caucasian race, gastrointestinal tumor primary sites, metastatic disease, benign liver disease, low serum albumin, and elevated liver enzymes. Significant factors in multivariable models for 25(OH)D levels ≤10 and ≤30 ng/ml included non-Caucasian race, primary cancer site, and test calendar month. Vitamin D supplements and recent antineoplastic medication were associated with sufficient levels.

Conclusions

Low (deficient or insufficient) 25(OH)D serum levels were highly prevalent in people with solid tumors. Vitamin D tests were infrequent and paradoxically less often done in high-risk groups. Tests were more frequent in females and in those with breast, skin, and thyroid cancers. Further research should examine role of routine 25(OH)D tests, the clinical consequences of low levels, and therapeutic supplementation in people with cancer.

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Conflict of interest

The listed authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honorarium, royalties, deferred payments, consultancies, any other direct compensation or own any equity interest, stocks, stock options from a financially interested company) or non-financial interest (personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript. We have full control of all primary data and we agree to allow the journal to review the data upon request.

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Author notes

  1. Declan Walsh

    Present address: Faculty of Health Sciences, Trinity College Dublin and University College Dublin, First Floor, Old Chemistry Building Extension Trinity College, Dublin 2, Ireland

Authors and Affiliations

  1. The Harry R. Horvitz Center for Palliative Medicine, Cleveland, OH, USA

    Katherine Hauser, Declan Walsh & Shiva Shrotriya

  2. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, OH, USA

    Matthew Karafa

  3. Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA

    Katherine Hauser, Declan Walsh & Shiva Shrotriya

  4. The Harry R. Horvitz Center for Palliative Medicine, Section of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue, M77, Cleveland, OH, 44195, USA

    Declan Walsh

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  1. Katherine Hauser
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Corresponding author

Correspondence to Declan Walsh.

Additional information

The Harry R. Horvitz Center for Palliative Medicine is a World Health Organization Demonstration Project in Palliative Medicine and an ESMO Designated Center of Integrated Oncology and Palliative Care.

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Hauser, K., Walsh, D., Shrotriya, S. et al. Low 25-hydroxyvitamin D levels in people with a solid tumor cancer diagnosis: the tip of the iceberg?. Support Care Cancer 22, 1931–1939 (2014). https://doi.org/10.1007/s00520-014-2154-y

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  • DOI: https://doi.org/10.1007/s00520-014-2154-y

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