Vitamin D in palliative care : aspects on pain, infections and quality of life
Author: Helde Frankling, Maria
Date: 2020-11-26
Location: Magnus Huss Aula, Stockholms Sjukhem, Mariebergsgatan 22
Time: 09.00
Department: Inst för neurobiologi, vårdvetenskap och samhälle / Dept of Neurobiology, Care Sciences and Society
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Thesis (2.176Mb)
Abstract
The World Health Organization’s (WHO’s) definition of palliative care stresses the importance of early identification and assessment of physical symptoms in the palliative patient, to prevent and relieve suffering. The overall goal is to improve quality of life, and it is thus important that side effects of medical treatment do not outweigh beneficial effects. Vitamin D has few and mild side effects, and vitamin D treatment has well defined uses in medicine. However, the role of vitamin D supplementation to patients with advanced or metastatic cancer has rarely been studied. The papers included in this thesis aim at understanding the possible effects and optimal use of vitamin D in symptom management in palliative cancer patients, and to study effects of antibiotics in end-of-life cancer patients.
In study I, we investigated the effect of antibiotic use in patients in the last week of life. Almost 50 % in the studied cohort were treated with antibiotics during the last week in life; 37% of all patients and 50% of patients with septic symptoms experienced symptom relief.
Based on a study showing association between lower vitamin D levels and higher doses of opioids in patients with advanced cancer, we performed a pilot study to investigate effects of vitamin D in pain management, Quality of Life (QoL) and infections in patients with advanced or metastatic cancer, study II. Participants (n=39, with 25-hydroxyvitamin D < 75 nmol/L) received vitamin D 4000 IU/day for twelve weeks and were matched to untreated controls. After one month, the mean change in opioid dose was significantly lower in the vitamin D supplemented group -46 μg/h (95% CI -24-78), and difference increased over time. Differences in antibiotic use and QoL were also significant, in favor of the supplementation group.
The encouraging results from study II were used to plan study III, a multicentre, randomized, double blind placebo-controlled trial investigating the effect of vitamin D supplementation (4000 IU/day) on pain, infections, fatigue and QoL for 12 weeks. Last patient out was in June 2020, and results (submitted but not yet accepted manuscript) indicate a significant effect on opioid use and fatigue, but not on infections and QoL.
In a post-hoc analysis of a previously studied cohort of immunodeficient patients, study IV, we compared the effectiveness of vitamin D supplementation administered as oil drops versus powdered tablets in raising the individual’s vitamin D level. There was no significant difference between groups (p = 0.77). In a subgroup of patients without immunoglobulin replacement, vitamin D supplementation with oil drops (n = 34) but not with tablets (n = 60) resulted in significantly less antibiotic use (p < 0.001 and p = 0.58.
In study I, we investigated the effect of antibiotic use in patients in the last week of life. Almost 50 % in the studied cohort were treated with antibiotics during the last week in life; 37% of all patients and 50% of patients with septic symptoms experienced symptom relief.
Based on a study showing association between lower vitamin D levels and higher doses of opioids in patients with advanced cancer, we performed a pilot study to investigate effects of vitamin D in pain management, Quality of Life (QoL) and infections in patients with advanced or metastatic cancer, study II. Participants (n=39, with 25-hydroxyvitamin D < 75 nmol/L) received vitamin D 4000 IU/day for twelve weeks and were matched to untreated controls. After one month, the mean change in opioid dose was significantly lower in the vitamin D supplemented group -46 μg/h (95% CI -24-78), and difference increased over time. Differences in antibiotic use and QoL were also significant, in favor of the supplementation group.
The encouraging results from study II were used to plan study III, a multicentre, randomized, double blind placebo-controlled trial investigating the effect of vitamin D supplementation (4000 IU/day) on pain, infections, fatigue and QoL for 12 weeks. Last patient out was in June 2020, and results (submitted but not yet accepted manuscript) indicate a significant effect on opioid use and fatigue, but not on infections and QoL.
In a post-hoc analysis of a previously studied cohort of immunodeficient patients, study IV, we compared the effectiveness of vitamin D supplementation administered as oil drops versus powdered tablets in raising the individual’s vitamin D level. There was no significant difference between groups (p = 0.77). In a subgroup of patients without immunoglobulin replacement, vitamin D supplementation with oil drops (n = 34) but not with tablets (n = 60) resulted in significantly less antibiotic use (p < 0.001 and p = 0.58.
List of papers:
I. Antibiotic treatment in End-of-Life Cancer Patients – A Retrospective Observational Study at a Palliative Care Center in Stockholm. Helde-Frankling M, Bergqvist J, Bergman P, Björkhem-Bergman L. Cancers. 2016, Vol.8(9).
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II. Vitamin D supplementation to palliative cancer patients shows positive effects on pain and infections-Results from a matched case-control study. Helde-Frankling, M., Höijer, J., Bergqvist, J., & Björkhem-Bergman, L. PloS One. 2017, Vol.12(8).
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III. Vitamin D supplementation reduces opioid-use and fatigue in cancer patients admitted to palliative care - results from the Palliative-D study, a double blind, randomized placebo-controlled multi-center trial. Helde Frankling M, Klasson C, Sandberg C, Nordström M, Warnqvist A, Bergqvist J, Bergman, Björkhem-Bergman L. [Manuscript]
IV. Are Vitamin D3 Tablets and Oil Drops Equally Effective in Raising S-25-Hydroxyvitamin D Concentrations? A Post-Hoc Analysis of an Observational Study on Immunodeficient Patients. Helde Frankling M, Norlin AC, Hansen S, Wahren Borgström E, Bergman P, Björkhem-Bergman L. Nutrients. 2020 Apr 26;12(5):1230.
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I. Antibiotic treatment in End-of-Life Cancer Patients – A Retrospective Observational Study at a Palliative Care Center in Stockholm. Helde-Frankling M, Bergqvist J, Bergman P, Björkhem-Bergman L. Cancers. 2016, Vol.8(9).
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II. Vitamin D supplementation to palliative cancer patients shows positive effects on pain and infections-Results from a matched case-control study. Helde-Frankling, M., Höijer, J., Bergqvist, J., & Björkhem-Bergman, L. PloS One. 2017, Vol.12(8).
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III. Vitamin D supplementation reduces opioid-use and fatigue in cancer patients admitted to palliative care - results from the Palliative-D study, a double blind, randomized placebo-controlled multi-center trial. Helde Frankling M, Klasson C, Sandberg C, Nordström M, Warnqvist A, Bergqvist J, Bergman, Björkhem-Bergman L. [Manuscript]
IV. Are Vitamin D3 Tablets and Oil Drops Equally Effective in Raising S-25-Hydroxyvitamin D Concentrations? A Post-Hoc Analysis of an Observational Study on Immunodeficient Patients. Helde Frankling M, Norlin AC, Hansen S, Wahren Borgström E, Bergman P, Björkhem-Bergman L. Nutrients. 2020 Apr 26;12(5):1230.
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Institution: Karolinska Institutet
Supervisor: Björkhem-Bergman, Linda
Co-supervisor: Bergqvist, Jenny
Issue date: 2020-11-04
Rights:
Publication year: 2020
ISBN: 978-91-7831-845-2
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