Vitamin D and patients with palliative cancer

Abstract

Vitamin D is a hormone that is synthesised in the skin in the presence of sunlight. Sufficient vitamin D levels are important-not only for a healthy skeleton-but also for a healthy immune system. Many patients with cancer have insufficient vitamin D levels, and low vitamin D levels are associated with increased 'all-cause mortality' and especially mortality due to cancer. Low vitamin D levels have also been associated with increased risk of infections, increased pain, depressive disorders and impaired quality of life. We review the role of vitamin D in the immune system, in relation to cancer disease, pain and depression. We have recently performed an observational study in 100 patients with palliative cancer in Sweden. The main result was that low vitamin D levels were associated with higher opioid dose, that is, more pain. We also describe a case report where vitamin D supplementation resulted in radically decreased opioid dose, less pain and better well-being. Vitamin D supplementation is not connected with any adverse side effects and is easy to administrate. Thus, we hypothesise that vitamin D-supplementation to patients with palliative cancer might be beneficial and could improve their well-being, decrease pain and reduce susceptibility to infections. However, more clinical studies in this field are needed before firm conclusions can be drawn.

Antibiotic Treatment in End-of-Life Cancer Patients—A Retrospective Observational Study at a Palliative Care Center in Sweden

“…Vitamin D status is important for host immunity against various infections [ 16 , 17 , 18 ] and has also been suggested to play a role in the quality of life of palliative cancer patients [ 15 , 19 ]. Thus, we evaluated whether the vitamin D status of the patients was related to antibiotic-use or with response to treatment.…”

Vitamin D in Pain Management

“…In vitro studies have shown that vitamin D inhibits the synthesis of Prostaglandin E2 (PGE2) [ 3 ]. Both observational and interventional studies suggest a role for vitamin D in pain intensity and in management of pain in varying clinical settings [ 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. Despite these data, three meta-analyses of randomized and placebo-controlled trials (RCTs) could not establish a correlation between vitamin D supplementation and pain reduction [ 8 , 11 , 12 ].…”

Collaborative Care to Relieve Psychological Distress in Patients with Medically Inoperable Lung Cancer: Design and Rationale for a Clinical Trial

“…There are several welldocumented risk factors for psychological distress, including younger age, a history of psychiatric illness, poor social support, advanced cancer, functional impairment, and uncontrolled pain [4]. Additionally, biological factors, such as activation of the hypothalamic–pituitary–adrenal axis or low vitamin D levels, are associated with psychological distress [5,6], and genetic components, such as the serotonin transporter (5-HTT) and brainderived neurotrophic factor (BDNF) genes, are responsible for vulnerability to depression in cancer patients [7].…”