We investigated the prevalence and associated factors of vitamin D deficiency among Hong Kong advanced cancer patients receiving palliative care.
This was a prospective cross-sectional study performed in Caritas Medical Centre. Consecutive Chinese advanced cancer patients receiving palliative care service were enrolled. Demographic data, functional status, symptom burden were assessed by Palliative Performance Scale (PPS), Charlson Comorbidity Index (CCI), Edmonton Symptom Assessment System (ESAS) and Hospital Anxiety and Depression Scale (HADS). Complete blood count, liver/renal function and vitamin D level were checked. Patients with vit D deficiency were given vitamin D supplement and followed up for 90 days. The results of first 50 patients were analysed.
The mean age was 70.2 years [SD 13.1], with 68% were male. Most common primary sites were colorectal (18%) and lung (12%), while 86% patients had metastatic disease. Mean age-adjusted CCI was 9 [SD 2.0]. Deficiency occured in 35 (70%) patients. It was associated with “use of nifedipine” (p = 0.041), “not taking vitamin Dâ³ (p = 0.027) in last 3 months and “microbial infection in last year” (p = 0.043). The deficiency group had a higher HADS-depression score than the sufficient group (8.4 [SD5.3] vs. 7.1 [SD3.7], p = 0.048). Presence of moderate or severe deficiency was associated with use of proton pump inhibitor in past 3 months (p = 0.002), and higher HADS-depression score (9.9 [SD5.7] vs. 7 0 [SD4.0], p = 0.040). No association was found between vitamin D level and demographics, CCI, PPS, ESAS, HADS-anxiety score and blood tests. At 90 days, mortality was significantly higher in moderate or severe deficiency group as compared with patients with normal or mild vitamin D deficiency (66.7% vs 29.1%, p = 0.008).
|Deficiency Category||Level||Number of Subject (Percentage)||90-day mortality (Percentage)|
|Sufficient||50nmol/L or more||15 (30%)||5 (33.33%)|
|Mild||30-49 nmol/L||17 (34%)||4 (23.53%)|
|Moderate||12.5-29 nmol/L||13 (26%)||7 (53.85%)|
|Severe||less than 12.5nmol/L||5 (10%)||5 (100%)|
Vitamin D deficiency was common in Hong Kong Chinese cancer patients receiving palliative care. Moderate or severe vitamin D deficiency was associated with higher HADS-depression score and 90-day mortality.
Clinical trial identification
The study was approved by the Research Ethics Committee of Kowloon West Cluster, Hospital Authority. The study was funded by Young Investigator Research Grant of Hong Kong College of Physician
All authors have declared no conflicts of interest.