Palliative cancer benefit of 4,000 IU of Vitamin D – less opioids, infection, and CRP

Vitamin D supplementation to palliative cancer patients shows positive effects on pain and infections—Results from a matched case-control study - 2017

PLOS x, August 31, 2017 https://doi.org/10.1371/journal.pone.0184208

Maria Helde-Frankling, Jonas Höijer, Jenny Bergqvist, Linda Björkhem-Bergman

"Palliative care (pronounced pal-lee-uh-tiv) is specialized medical care for people with serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family." "Both palliative care and hospice care provide comfort. But palliative care can begin at diagnosis, and at the same time as treatment. Hospice care begins after treatment of the disease is stopped and when it is clear that the person is not going to survive the illness " * Opiate addiction 2.4 X more likely if vitamin D deficient before surgery – June 2020 * Reduced palliative cancer pain after Vitamin D supplementation – April 2016 * Less fatigue if more vitamin D (90 percent of palliative cancer were deficient) – Aug 2015 * Hypothesis: Drug addiction in humans can be prevented and treated by vitamin D -May 2014 * including reduced opiate usage - as was found in the study on this page * Off Topic: 4X increase in Americans taking morphine-type drugs in last decade (consider Vitamin D instead) – Aug 2014 * Mistreated – book by Dr. Robert Pearl - May 2017 * "Opiate use is now the most common cause of death from injury in the US." * Vitamin D and Opioids both reduce Magnesium, which results in constipation – Sept 2016 * Opioid use in palliative cancer patients far less if high level of vitamin D – May 2015 * * Overview Pain and Vitamin D * Chronic Pain reported 38 percent less often if supplemented with Vitamin D – meta-analysis Sept 2016 * Fibromyalgia treated with Vitamin D (50,000 IU weekly for 3 months) – 2016, 2017, 2018, 2019 * Off topic: Cannabis and disease studies at GreenMedInfo – Dec 2015 * CBD is great for pain relief - including pain with pallative cancer

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Decreased use of Opiates

Decreased use of antibiotics

Increased Vitamin D levels

Background

We previously showed an association between low vitamin D levels and high opioid doses to alleviate pain in palliative cancer patients. The aim of this case-controlled study was to investigate if vitamin D supplementation could improve pain management, quality of life (QoL) and decrease infections in palliative cancer patients.

Methods

Thirty-nine palliative cancer patients with levels of 25-hydroxyvitamin D < 75 nmol/L were supplemented with vitamin D 4000 IE/day , and were compared to 39 untreated, matched “control”-patients from a previous study at the same ward. Opioid doses, antibiotic consumption and QoL-scores measured with the Edmonton Symptom Assessment Scale (ESAS) were monitored. The primary endpoint was the change from baseline after 1 and 3 months compared between the groups using linear regression with adjustment for a potential cofounding factor.

Results

After 1 month the vitamin D treated group had a significantly decreased fentanyl dose compared to the untreated group with a difference of 46 μg/h; 95% CI 24–78, which increased further at 3 months to 91 μg/h; 95% CI 56–140 μg/h. The ESAS QoL-score improved in the Vitamin D group the first month; -1.4; 95% CI -2.6 - (-0.21). The vitamin D-treated group had significantly lower consumption of antibiotics after 3 months compared to the untreated group, the difference was -26%; 95%CI -0.41%–(-0.12%). Vitamin D was well tolerated by all patients and no adverse events were reported.

Conclusion

Vitamin D supplementation to palliative cancer patients is safe and improvement in pain management is noted as early as 1 month after treatment. Decreased infections are noted 3 months after vitamin D treatment. The results from this pilot-study have been used for the power-calculation of a future randomized, placebo-controlled, double-blind study called “Palliative-D” that will start in Nov 2017 and will include 254 palliative cancer patients.

Opiod dose reduced somewhat in pallitive cancer when add 4,000 IU Vitamin D for 12 weeks – RCT July 2021

Palliative-D’—Vitamin D Supplementation to Palliative Cancer Patients: A Double Blind, Randomized Placebo-Controlled Multicenter Trial

Cancers 2021, 13(15), 3707; https://doi.org/10.3390/cancers13153707

by Maria Helde Frankling 1,2OrcID,Caritha Klasson 1,2,3OrcID,Carina Sandberg 3,Marie Nordström 3,Anna Warnqvist 4,Jenny Bergqvist 5,6,Peter Bergman 7,8OrcID andLinda Björkhem-Bergman 1,2,3,*OrcID

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Simple Summary

In this study, the effect of vitamin D supplementation on pain, infections, fatigue and quality of life in patients with advanced cancer with verified vitamin D deficiency was studied. To this end, a randomized controlled trial, ‘Palliative-D’, was conducted, comparing the effect of 4000 IU vitamin D3/day for 12 weeks to placebo in cancer patients admitted to palliative care. Pain was assessed as change in opioid dose and infections measured as days on antibiotics. Vitamin D-supplemented patients increased their opioid doses at a significantly slower rate than patients receiving placebo, i.e., 0.56 µg less fentanyl/h per week with vitamin D treatment. Vitamin D reduced self-assessed fatigue but did not affect antibiotic use or self-assessed Quality of life. The treatment was safe and well-tolerated. In conclusion, correction of vitamin D deficiency may have positive effects on pain and fatigue in palliative cancer patients.

Abstract

The aim of the ‘Palliative-D’ study was to test the hypothesis that correction of vitamin D deficiency reduces opioid use in cancer patients admitted to palliative care. A multicenter randomized, placebo-controlled, double-blind trial in three home-based palliative care facilities in Sweden was performed. Patients with advanced cancer and 25-hydroxyvitamin D < 50 nmol/L were randomized to vitamin D3 4000 IU/day or placebo for 12 weeks. The primary endpoint was the difference of long-acting opioid use (fentanyl ug/h) between the groups during 12 weeks, based on four time points. Secondary outcomes included changes in antibiotic use, fatigue and Quality of Life (QoL). A total of 244 patients were randomized, and 150 patients completed the 12 weeks. The major reason for drop-out was death due to cancer. The vitamin D-group had a significantly smaller increase of opioid doses compared to the placebo-group; beta coefficient −0.56 (p = 0.03), i.e., 0.56 µg less fentanyl/h per week with vitamin D treatment. Vitamin D-reduced fatigue assessed with ESAS was −1.1 points after 12 weeks (p < 0.01). Antibiotic use or QoL did not differ significantly between the groups. The treatment was safe and well-tolerated.

In conclusion, correction of vitamin D deficiency may have positive effects on opioid use and fatigue in palliative cancer patients, but only in those with a survival time more than 12 weeks