Improving Vitamin D testing and supplementation in children with newly-diagnosed cancer: A Quality Improvement Initiative at Rady Children’s Hospital San Diego
Ksenya Shliakhtsitsava,Erin Stucky Fisher,Erin Trovillion,Kelly Bush,Dennis Kuo,Ron Newfield,Courtney Thornburg,William Roberts,Paula Aristizabal
Unfortunately, they aim for only >30 ng
More vitamin D is needed for treatment than prevention
- Cancer patients need more vitamin D, even those who are supplementing – observational study June 2021
- Vitamin D prevents and treats cancer in many ways – May 2021
- 8 ways that Cancer might be prevented by Vitamin D - June 2019
- Vitamin D Reduces Cancer Risk - Why Scientists Accept It but Physicians Do Not - Feb 2019 Dr. Grant
Study ignored the importance of activation of the Vitamin D Receptor for Cancers
The risk of 44 diseases at least double with poor Vitamin D Receptor as of Oct 2019
Vitamin D Receptor activation can be increased by any of: Resveratrol, Omega-3, Magnesium, Zinc, Quercetin, non-daily Vit D, Curcumin, intense exercise, Ginger, Essential oils, etc Note: The founder of VitaminDWiki uses 10 of the 13 known VDR activators
They wait months for the Vitamin D levels to respond
Loading doses could achieve the same levels within a week
Note: Loading doses have been used on over 1 million childen during the past 70 years
Would have been much better if they had increased Vitamin D levels before the surgery
- Improve your health BEFORE surgery (prehabilitation) helps your recovery - 2018
- Children stayed in ICU 3.5 days longer if low vitamin D – Dec 2015
Even better - Have high vitamin D levels and not get Cancer in the first place
- Cancer in children 6X more likely if very low vitamin D – Oct 2011
- Children with Cancer were 6X more likely to have less than 10ng of vitamin D – Feb 2011
- Chart of Vitamin D levels vs disease - Grassroots Health June 2013
Items in both categories Cancer and Infant-Child :
- Childhood Cancers - Vitamin D can help - many studies
- Poor prognosis of solid childhood cancers 14.7 X more likely with a poor Vitamin D Receptor – July 2022
- Newly diagnosed Children with Cancer have low vitamin D, especially if black - May 2022
- Cancer of the eye in children: most of the risk factors are associated with low vitamin D – July 2021
- Children's Cancer hospital now testing vitamin D frequently and supplementing weekly – July 2021
- Consensus recommends at least 20 ng of Vitamin D for childhood cancer (not nearly enough) – June 2021
- Cancer during childhood - many studies
- Childhood Cancer survivors – only 1 in 25 had consumed Vitamin D RDA – Oct 2019
- Children with cancer were deficient in Vitamin D, Vitamin C, and Zinc – July 2019
- Childhood cancer survivors have increased chronic health problems as adults – Sept 2017
- Children with Cancer were 3X more likely to be vitamin D deficient – July 2013
- Vitamin D levels very low for some childhood cancers, then got lower – Sept 2012
I will not be surprised if in the future they stop pushing Vitamin D
They are given too little vitamin D, too late to make much of a difference
Download the PDF from VitaminDWiki
Note:Most are weekly supplementations
Amazingly, they do not increase dose size with age: An 18 year-old needs much more than a 2 year-old
Increased testing
Increased supplementation
Background: Vitamin D deficiency and insufficiency have been associated with poorer health outcomes. Children with cancer are at high risk for Vitamin D deficiency and insufficiency. At our institution, we identified high variability in Vitamin D testing and supplementation in this population. Of those tested, 65% were Vitamin D deficient/insufficient. We conducted a quality improvement (QI) initiative with aim to improve Vitamin D testing and supplementation among children aged 2-18 years old with newly-diagnosed cancer to ≥ 80% over 6 months.
Methods: An inter-professional team reviewed baseline data, then developed and implemented interventions using Plan-Do-Study-Act (PDSA) cycles. Barriers were identified using QI tools, including lack of automated triggers for testing and inconsistent supplementation criteria and follow-up testing post-supplementation. Interventions included an institutional Vitamin D guideline, clinical decision-making tree for Vitamin D deficiency, insufficiency and sufficiency, electronic medical record triggers, and automated testing options.
Results: Pre-intervention: N=26 patients, four (15%) had baseline Vitamin D testing; two (8%) received appropriate supplementation. Post-intervention: N=33 patients; 32 (97%) had baseline Vitamin D testing; 33 (100%) received appropriate supplementation and completed follow-up testing timely (6-8 weeks post-supplementation). Change was sustained over 24 months.
Conclusions: We achieved and sustained our aim for Vitamin D testing and supplementation in children with newly-diagnosed cancer through inter-professional collaboration of hematology/oncology, endocrinology, hospital medicine, pharmacy, nursing, and information technology. Future PDSA cycles will address patient compliance with Vitamin D supplementation and impact on patients’ Vitamin D levels.