Implementing a protocol for vitamin-D screening and replacement in cancer patients — ASN Events
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Implementing a protocol for vitamin-D screening and replacement in cancer patients (#420)

Wen Xu 1 2 , Janet Hardy 1 2 , Zarnie Lwin 3 , Natasha Woodward 1 2 , Catherine Shannon 1 2
  1. Mater Hospital, South Brisbane, QLD, Australia
  2. Mater research/University of Queensland, Brisbane, QLD, Australia
  3. Cancer Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia

AIMSs:
A recent meta-analysis showed improved outcomes for cancer patients with higher serum 25(OH)D levels1. We explored the implementation of a vitamin-D screening and replacement protocol in an oncology ambulatory-care setting.

METHODS:
Our protocol encouraged routine vitamin-D screening of all new patients presenting to oncology outpatients. Patients found to be vitamin-D deficient were to be treated with a standardised replacement protocol:
           25(OH)D levels:
                   • 25–50 nmol/L - to receive 2000IU oral cholecalciferol daily;
                   • <25 nmol/L - to receive 4000IU oral cholecalciferol daily. 

Follow up vitamin-D levels were checked at 3months to assess adequacy of replacement. We audited the first 100 new oncology outpatients at a single centre, over a 10 week period (Nov 2013-Jan 2014), post introduction of vitamin-D screening, to assess adherence to protocol.

RESULTS:
Of 100 consecutive outpatients, the median age was 63 (median ECOG 1). The majority of patients were female (79%), in keeping with the predominant cancers seen (breast 38%, gynaecological 27%). 61% of patients were treated with curative intent, with 73% of patients receiving chemotherapy. 9% of patients had bone metastases at presentation.

56/100 new patients were screened according to protocol. Of these, 14(25%) were found to be vitamin-D deficient, with 13/14 commencing 25-OHD replacement at our centre. As of July 2014, 100% (9/9) of patients who had a followup 25-OHD level checked ≥3months post commencing replacement, achieved adequate replacement.

CONCLUSIONS:
A lower rate of vitamin-D deficiency was seen (25%) in the implementation phase of our study compared to a previous pilot study2 (37%). This may reflect the relatively high performance status of the implementation cohort; with a greater proportion of patients with early-stage disease. 

Within the limited sample-size, the proposed vitamin-D replacement protocol appeared to be successful. Compliance with our vitamin-D screening protocol (56%) was sub-optimal. Better processes need to be adopted to translate research into practice.

  1. Li M, Chen P, Li J et al. J Clin Endocrinol Metab 2014;99:1-10
  2. Morton A , Hardy J , Morton A.et al. Supportive Care in Cancer, 2014 (in press)
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