Vitamin D status in breast cancer cases following chemotherapy: A pre and post observational study in a tertiary hospital in Yogyakarta, Indonesia

Abstract

Objectives To observe pre- and post-treatment vitamin D level and its association with treatment and concomitant factors in breast cancer patients treated with chemotherapy. Methods We performed a pre-post observational analysis that nested in an ongoing prospective cohort study of breast cancer patients at Dr. Sardjito General Hospital, Yogyakarta, Indonesia. 136 subjects were recruited from the main study. Information on subjects’ socio-demographic characteristics clinical status, and tumour profile was assessed at baseline. Number of chemotherapy cycles and chemotherapy-induced nausea vomiting (CINV) were also recorded. Vitamin D concentration was measured using ELISA methods at baseline and post-treatment. Vitamin D level of <20 ng/ml and <12 ng/ml were defined as deficiency and severe deficiency. Correlation between socio-demographic and clinical profile with baseline vitamin D was tested using Spearman correlation. Paired t-test was used to evaluate changes in post-treatment vitamin D concentration. The odds ratio for a subject to experience post-treatment vitamin D decrease was assessed based on number of chemotherapy cycles and CINV severity. Results The mean vitamin D level before chemotherapy was very low (8.80±3.64 ng/ml) in the whole panel. Higher AST level were associated with lower vitamin D level at baseline (r = -0.188, p = 0.028). Severe deficiency was found in 82.4% subjects at baseline and the rate increased to 89.0% after chemotherapy. Eighty-five cases showed a decrease level whereas 51 showed a slight improvement. Overall, a significant decrease of the vitamin D level was observed after chemotherapy (median change 3.13±4.03 ng/ml, p <0.001). Subjects who received >6 cycles of chemotherapy were less likely to experience a decreased level of post-treatment vitamin D (OR = 0.436, 95% CI = 0.196–0.968, p = 0.039). Conclusions Indonesian breast cancer patients showed pre-existing severe vitamin D deficiency and deterioration of vitamin D after chemotherapy. Future research is needed to explore its implication towards patients’ survival in the local setting. Evidence-based approach also needs to be taken to address this modifiable condition, including increasing awareness of the importance of maintaining vitamin D sufficiency both in patients and the general population.

The correlation between serum 25-hydroxy-vitamin D levels and anti-SARS-CoV-2 S-RBD IgG and neutralizing antibody levels among cancer patients receiving COVID-19 vaccines

“…The daily vitamin D 3 was more efficacious than weekly and monthly administrations ( 59 ). These finding was consistent with the Endocrine Society that the vitamin D could only perform its function when serum 25(OH)D levels reached 30 ng/mL (75 nmol/L) or higher ( 36 , 38 ). Vitamin D has major effects on both the innate and adaptive immune systems through its biological activities ( 12 , 27 ).…”

“…Another study by Chillon et al found that 25(OH)D levels did not correlate with anti-SARS-CoV-2 IgG levels in healthy subjects with deficient vitamin D status [median 25(OH)D levels less than 30 ng/mL (75 nmol/L)] during four sequential measurements ( 66 ). However, vitamin D could only perform its function when blood 25(OH)D serum levels exceeded 30 ng/mL (75 nmol/L) ( 36 , 38 ). In our study, the median 25(OH)D level was 36.36 ng/mL (90 nmol/L), indicating that the subjects had sufficient vitamin D status ( Table 2 ).…”

“…The recommended daily dose of vitamin D 3 among cancer patients has not been established ( 88 ). The Endocrine Society’s Clinical Practice Guideline recommends 1,500–2,000 IU per day for all healthy adults to keep 25(OH)D levels above the optimal level of 30 ng/mL ( 38 , 88 – 90 ). The 2011 US Institute of Medicine suggested a dose of 600 IU per day for adults aged up to 70 years and 800 IU per day for older adults.…”

“…The tolerable upper limit is 4,000 IU per day. Beyond this dose, the risk of toxic effects is increased ( 38 , 91 ). Hence, further studies to determine an optimal daily dose for vitamin D 3 are crucial to enhance the efficacy COVID-19 vaccine and prevent toxicity from excessive doses.…”

The Effect of Vit-D Supplementation on the Side Effect of BioNTech, Pfizer Vaccination and Immunoglobulin G Response Against SARS-CoV-2 in the Individuals Tested Positive for COVID-19: A Randomized Control Trial

“…In consistent with our study, Chel et al [ 32 ], evaluated the vitamin D status of oral Vit-D3 doses of 600 IU/day, 4,200 IU/week, and 18,000 IU/month, which shows that daily consumption of vitamin D has more impact than weekly or monthly consumption [ 32 ]. Their findings were consistent with the Endocrine Society’s conclusion that serum vitamin D levels of 30 ng/mL (75 nmol/L) or higher can boost the immune system [ 33 ]. Vit-D3 has important effects on both the innate and adaptive immune systems belong its biological functions [ 34 ].…”