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Vitamin D supplementation may increase quality of life in palliative care patients

Posted on: September 22, 2017   by  Riley Peterson & John Cannell, MD.

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Researchers from a recent matched case-control study published in PLOS One discovered that vitamin D supplementation improved symptoms of pain and decreased infection risk in palliative care patients.

Palliative care refers to the care given to individuals affected by very serious and often life-threatening diseases. Due to the patient’s condition, this type of care is meant to relieve pain and stress that may result from their condition, and to increase the individual’s overall quality of life. Palliative care may be an option for individuals who are suffering from cancer, Amyotrophic Lateral Sclerosis, dementia, Alzheimer’s disease, Parkinson’s disease, HIV/AIDS, COPD and more.

While patients in palliative care may experience pain or discomfort due to symptoms of their condition, they may also be more susceptible to life-endangering infection. Many pharmacological medications used to treat symptoms or infection often has adverse side effects. Therefore, palliative caretakers may face difficulties when trying to manage an individual’s disease symptoms in the most comfortable way possible.

Recent research has established a relationship between vitamin D and several components of quality of life (QOL). This may include, but is not limited to, decreased disease severity, lessened pain, reduced risk of infection and decreased depressive symptoms.

Past studies have explored the relationship between vitamin D and QOL in palliative care patients, but these studies were observational and did not include vitamin D supplementation. Therefore, researchers from this study decided to further analyze this potential relationship, utilizing vitamin D supplementation in a matched, case-control analysis.

Researchers included patients from a palliative care unit in Stockholm, Sweden from September 2015 to June 2016. A total of 26 patients were supplemented over a period of three months and were compared to 26 matched controls. Patients included in the analysis were over the age of 18, were diagnosed with an incurable form of cancer and had vitamin D levels less than 30 ng/ml (75 nmol/L). The supplement group were given 4,000 IU daily and had available vitamin D levels at baseline and after 3 months of supplementation. A group of matched patients were not supplemented with vitamin D, but also had vitamin D levels recorded.

Data was recorded on patients survival time, opioid use, rate of infection (% of days with antibiotic use in the month prior to the beginning of the study) and QOL self-assessment. QOL was measured using the Edmonton Symptom Assessment Scale (ESAS), with higher scores indicating decreased QOL.

This is what the researchers found:

  • Average opioid use in the supplement group decreased from 31 mcg/hour at baseline to 22 mcg/hour after three months (95% CI: 120 mcg/hour (-185 ±-49).
  • Average opioid use in the control group increased from 43 mcg/hour at baseline to 117 mcg/hour after three months (95% CI: 120 mcg/hour (-185 ±(-49)).
  • There was a decreased rate of infection in the vitamin D supplement group compared to the control group after one and three months (95% CI: -41%-(-12%)).

The researchers concluded:

“Vitamin D treatment in palliative cancer patients may reduce opioid doses, reduce infections  and improve QoL without causing harm to the patients.”

Though the findings of this study were significant, there are some limitations that must be addressed. First, the study population was very small. Second, the design of this study does not allow conclusions to be made regarding the causal relationship between vitamin D and QOL in palliative care patients. Matching case individuals to controls was also a limitation of this study, as it was nearly impossible to match all patients with 100% similarity.

Stronger randomized controlled trials are needed to further determine if there is a causal relationship between vitamin D and QOL in palliative care patients.

Citation

Peterson, R. Vitamin D supplementation may increase quality of life in palliative care patients. Vitamin D Council Blog and Newsletter, 2017.

Source

Helde-Frankling, M. et al. Vitamin D supplementation to palliative cancer patients shows positive effects on pain and infections-Results from a matched case-control study. PLOS One, 2017.

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